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Specialised perinatal mental health services are crucial in providing the best care for women and their families. An essential guide to perinatal psychiatry, this comprehensive resource is a must-have for psychiatric trainees, consultants, and mental health teams. Written by experts in the specialty, this book fills a critical gap in the field by addressing the specific needs of women during pregnancy and the postnatal period, their infants and families. Covering topics from normal development to rare syndromes, theoretical perspectives to cutting-edge treatments, it offers a thorough overview of perinatal psychiatry, ensuring that clinicians are well-prepared to provide comprehensive care to women and families in need. Part of The College Seminars series, and directly mapped to the MRCPsych curriculum, this book is a key resource for psychiatric trainees.
Trust in biomedical research is essential, multidimensional, and shaped by individual experiences, culture, and communication. Participants’ trust relies on researchers’ commitment to ethical practices. As public trust in science declines due to misinformation and disinformation campaigns, biomedical researchers (BmRs) must ensure trust and cultivate trustworthiness. This study explores BmR’s perspectives on trust and trustworthiness.
Methods:
We employed a qualitative, phenomenological approach to explore the experiences of BmRs. Through purposive sampling via the Indiana Clinical and Translational Sciences Institute, we invited BmRs to participate in semi-structured interviews. We employed rapid qualitative analysis (RQA) to identify key themes from interviews with BmRs. This action-oriented approach enables a research team to efficiently summarize experiences and perspectives, using structured templates and matrixes for systematic analysis and interpretation.
Results:
Fourteen BmRs were interviewed. Volunteer demographics were collected for race/ethnicity, gender, faculty rank, and investigator experience level. The following domains were identified: individual trust and trustworthiness, institutional trustworthiness, and trust and equity as a crucial part of structural and social drivers of health.
Conclusion:
We recognize that BmRs are dedicated to health equity and addressing disparities. However, in addition to committing to “best practices,” BmRs should prioritize actions that foster genuine trust from the communities they serve. More development opportunities are needed for reflection of what it means to be trusted by research volunteers and communities. Furthermore, intentions alone aren’t sufficient; earned trust and trustworthiness are vital.
This article describes the publication and evaluation of a user-driven narrative module on the public-facing 3D platform Sketchfab, which comprises dozens of interlinked 3D models relating to the archaeology of the Faynan region of Southern Jordan. Models included in the project are archaeological sites, excavation units, and artifacts related to the Iron Age and Islamic period archaeology of the region. By interlinking these models according to their spatial, conceptual, and contextual relationships, this project facilitates the nonlinear exploration of archaeological data and replicates the process of archaeological knowledge generation, in which information is produced through examination of the relationship between object and its provenience. Through the inclusion of bilingual (Arabic and English) text in this project, we aim to increase the accessibility of archaeological data and interpretation to interested parties. We also invite participation in the development of multiple narratives based on user-driven, independent exploration of artifacts and context. Through free navigation within and between models, users can develop their own understanding of the archaeology of Faynan based on research-based content published in 3D. The effectiveness of the project is evaluated here through surveying Arabic-speaking Jordanians, a key group of interested parties.
Functional impairment in daily activities, such as work and socializing, is part of the diagnostic criteria for major depressive disorder and most anxiety disorders. Despite evidence that symptom severity and functional impairment are partially distinct, functional impairment is often overlooked. To assess whether functional impairment captures diagnostically relevant genetic liability beyond that of symptoms, we aimed to estimate the heritability of, and genetic correlations between, key measures of current depression symptoms, anxiety symptoms, and functional impairment.
Methods
In 17,130 individuals with lifetime depression or anxiety from the Genetic Links to Anxiety and Depression (GLAD) Study, we analyzed total scores from the Patient Health Questionnaire-9 (depression symptoms), Generalized Anxiety Disorder-7 (anxiety symptoms), and Work and Social Adjustment Scale (functional impairment). Genome-wide association analyses were performed with REGENIE. Heritability was estimated using GCTA-GREML and genetic correlations with bivariate-GREML.
Results
The phenotypic correlations were moderate across the three measures (Pearson’s r = 0.50–0.69). All three scales were found to be under low but significant genetic influence (single-nucleotide polymorphism-based heritability [h2SNP] = 0.11–0.19) with high genetic correlations between them (rg = 0.79–0.87).
Conclusions
Among individuals with lifetime depression or anxiety from the GLAD Study, the genetic variants that underlie symptom severity largely overlap with those influencing functional impairment. This suggests that self-reported functional impairment, while clinically relevant for diagnosis and treatment outcomes, does not reflect substantial additional genetic liability beyond that captured by symptom-based measures of depression or anxiety.
‘Living well’ is an important concept across national dementia strategies. Qualitative research has contributed to understanding of living well for people with dementia. Longitudinal qualitative approaches, though fewer, can explore potential changes in accounts of living well, psychological coping and adapting to dementia, and if/how people with dementia maintain continuity in their lives. This longitudinal qualitative study aims to gauge what is important for ‘living well’ with mild-to-moderate dementia and whether this changes over time in a group of older people with mild-to-moderate dementia living at home. Semi-structured, qualitative interviews with 20 people with dementia from the IDEAL cohort study were conducted in 2017 and again one year later then thematically analysed. The overarching narrative was largely that of continuity and adaptation, with incremental not disruptive change. Continuing participation and meaningful occupation were important to maintaining living well over time; individuals pursued new as well as previous interests. As a key psychological coping strategy to support continuity in their lives, individuals emphasised their capabilities to maintain activities in spite of dementia, compartmentalising areas that had become more challenging. Maintaining social networks and accommodating changes in social relationships were also central to living well, including managing the psychological impacts of changes in spousal relationships. People in the earlier stages of dementia emphasise continuity and their capabilities, reporting change over time only in certain aspects of their lives. However, small, incremental changes in their social relationships and opportunities for meaningful occupation may still afford key areas for supporting capability to ‘live well’.
Invasive plants can gain a foothold in new environments by manipulating soil conditions through allelopathy or through the disruption of associations between native plants and their mycorrhizal associates. The resulting changes in soil conditions can affect the recovery of habitats long after the invasive plant has been removed. We conducted a series of greenhouse experiments to examine the effects of soil conditioned by pale swallow-wort [Vincetoxicum rossicum (Kleopow) Barbarich; Apocynaceae], on the growth of native plants. Additionally, we tested the effects of aqueous extracts of common milkweed (Asclepias syriaca L.; Apocynaceae), a related plant with known allelopathic effects, on the regrowth of V. rossicum from transplanted root crowns. Soil from a 15-yr-old V. rossicum infestation reduced seedling emergence in A. syriaca as well as in V. rossicum itself. Conversely, the same soil had no effect on the growth of mature A. syriaca plants. Soil conditioned by V. rossicum growth in the greenhouse had no effect on the biomass and percentage cover generated by two restoration seed mixes. Soil conditioned by A. syriaca, however, yielded lower biomass and percentage cover from both seed mixes. In contrast to the allelopathic effects of A. syriaca on seedlings, aqueous extracts of A. syriaca increased aboveground plant growth in V. rossicum. Our results suggest that the effects of V. rossicum–conditioned soil on native plants are concentrated at the seedling establishment phase. Additionally, the use of diverse native seed mixes shows great potential for restoring productivity to ecosystems affected by V. rossicum.
OBJECTIVES/GOALS: The Appalachian Translational Research Network (ATRN) Newsletter provides a unique platform that facilitates communication among Appalachian-serving CTSAs/CTSIs and partnering academic and community organizations that strengthens research efforts and advances translational science across the region. METHODS/STUDY POPULATION: Published biannually, each ATRN Newsletter features content submitted by ATRN member universities and organizations. Members of the Communications Committee, who represent both CTSA- or non-CTSA- affiliated ATRN member institutions, provide as well as review and edit content for the Newsletter. Regular features include researcher and community member spotlights; funding opportunity announcements; information on upcoming seminars, trainings, and special events; and opportunities for collaborations among partnering ATRN institutions. Complementing regularly scheduled Newsletters, special editions are released as warranted, such as a special COVID-19 focused edition published in 2020. RESULTS/ANTICIPATED RESULTS: First published in 2012, the ATRN Newsletter initially represented founding ATRN institutions, the University of Kentucky and the Ohio State University CTSAs, and a readership of 50. Reflecting ATRN growth that now represents 9 academic centers including NCATS- and IDeA-funded hubs, affiliated universities and partnering organizations, readership has grown to include 500 subscribers from across the U.S. and 3 other countries. With the establishment of the official ATRN website in 2019, the ATRN Newsletter became a prominent addition, providing ATRN members’ access to both new and archived editions, thereby expanding reach and further strengthening critical communication across the Network. DISCUSSION/SIGNIFICANCE: Providing a vehicle for communication that supports ATRN collaborations and networking, the Newsletter is foundational to the success of the ATRN mission to improve health outcomes across Appalachia by fostering collaborative inter-institutional and community-academic research partnerships.
In this section, we describe psychiatric disorders in the perinatal period, with a focus on understanding the triggering of mood and psychotic disorders by childbirth (postpartum psychosis and postnatal depression). We define perinatal disorders and the perinatal period, and the issues around how these episodes of illness are dealt with in the current diagnostic classification systems – the World Health Organization’s International Classification of Diseases, 11th edition (ICD-11) and the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) [1, 2].
Childhood adversity is one of the strongest predictors of adolescent mental illness. Therefore, it is critical that the mechanisms that aid resilient functioning in individuals exposed to childhood adversity are better understood. Here, we examined whether resilient functioning was related to structural brain network topology. We quantified resilient functioning at the individual level as psychosocial functioning adjusted for the severity of childhood adversity in a large sample of adolescents (N = 2406, aged 14–24). Next, we examined nodal degree (the number of connections that brain regions have in a network) using brain-wide cortical thickness measures in a representative subset (N = 275) using a sliding window approach. We found that higher resilient functioning was associated with lower nodal degree of multiple regions including the dorsolateral prefrontal cortex, the medial prefrontal cortex, and the posterior superior temporal sulcus (z > 1.645). During adolescence, decreases in nodal degree are thought to reflect a normative developmental process that is part of the extensive remodeling of structural brain network topology. Prior findings in this sample showed that decreased nodal degree was associated with age, as such our findings of negative associations between nodal degree and resilient functioning may therefore potentially resemble a more mature structural network configuration in individuals with higher resilient functioning.
In the United Kingdom, 14.6 million people reported having a disability in the year 2020–2021. Cognition may be one factor that contributes to disability, as previous studies have shown that cognitive abilities predict later health outcomes and prevalence of disability increases with decreasing cognitive function. Furthermore, studies have demonstrated a link between cognition and common psychiatric disorders, such as depression and anxiety. To our knowledge, no studies have examined the role of current mental health in the association between cognition and disability in a general population sample. The aim of this study was to examine the relationship between cognition, mental health and measures of disability/daily functioning in an online population sample. Our hypotheses were: 1) that lower cognitive performance would be associated with increased reported disability, and 2) that this association would be partly explained by current depression and anxiety symptoms.
Methods
The sample consisted of 3679 participants recruited from HealthWise Wales. Participants completed the Cardiff ONline Cognitive Assessment, a web-based battery of five tasks assessing processing speed, working memory, vocabulary, reasoning, and emotion identification. Disability was assessed using the World Health Organisation Disability Assessment Schedule (WHODAS). Real world measures of functioning were also included (currently employed, living with a partner, children and ever married). Current depression and anxiety symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS). Linear and logistic regressions were conducted to assess the associations between cognitive performance and measures of disability/functioning. Structural equation modelling was performed to assess whether these associations could be partially explained by HADS scores, as well as measures of education and health/lifestyle factors.
Results
Higher cognitive performance was associated with lower overall WHODAS scores (B=−0.1, SE = 0.01, P = 1 × 10–13), living with a partner (OR = 1.13, 95% CIs = 1.06–1.21, P = 4.3 × 10–4) and being in employment or education (OR = 1.22, 95% CIs = 1.13–1.33, P = 2.1 × 10-6). HADS scores partially explained the relationship between cognition and: 1) WHODAS (80%), 2) employment (63%) and 3) living with a partner (37%). In addition, smoking status explained 3% of the relationship between cognition and WHODAS.
Conclusion
Current symptoms of depression and anxiety partially explained the relationship between cognition and three measures of disability/functioning. Alleviating these symptoms may improve patients’ daily difficulties. Future research should establish the direction of causality of these associations.
Women with bipolar disorder have a high recurrence rate in the perinatal period. However, the use of prophylactic medication can be a concern during pregnancy and breastfeeding. There are few studies looking at the impact of prophylactic medication on the risk of recurrence.The aims of this study are to describe the use of medication in women with bipolar disorder in the perinatal period and the impact of that prophylactic medication on the rate of postnatal recurrence.
Methods
The BDRN (Bipolar Disorder Research Network Study) is the largest individual network of individuals with bipolar disorder and related mood disorders in the world. The BDRN pregnancy study is a prospective observational study which took place in the UK. We collected sociodemographic, clinical and medication data from pregnant women with a diagnosis of bipolar disorder and who were euthymic entering the postpartum period. The clinical data were collected via interviews during pregnancy and the postpartum and access to clinical records where those were available.
Data were analysed for association using χ2 tests and logistic regression.
Results
Our total sample for this analysis comprised of 103 women who met the criteria.
We found that 71 (70%) were taking medication at delivery: 43 (43%) antipsychotics, 9 (9%) antidepressants, 10 (10%) mood stabilisers, (6 lithium, 4 anticonvulsants and 9 multiple medication classes).
Of the total sample, 44 (43%) experienced a postpartum recurrence: 21 (20%) had an episode of postpartum psychosis, 15 (15%) of non-psychotic depression and 8 (8%) of hypomania. Of the postpartum psychotic episodes 11 were of mania with psychosis, 8 of mania without psychosis and 2 of psychotic depression.
There was no significant association between taking medication at delivery and postpartum recurrence χ2 (1)=0.116, p=0.73.
In a multivariable analysis there continued to be no association when adjusted for age, ethnicity, parity, severity (previous admissions, age at impairment, bipolar subtype) and previous psychotic symptoms aOR 1.35 95%CI [0.45; 4.00], p=0.59.
Conclusion
A high number of bipolar women are taking medication at delivery and in the majority, antipsychotics are prescribed. The postnatal recurrence rate in both medicated and unmedicated women is high.
Our findings align with recent electronic health records and observational studies, but differ from older clinical cohort and higher Lithium-prescribing sample studies. Limitations include the study design and confounding by indication. Further research in larger populations is necessary to inform clinical decision-making for women and their healthcare providers.
This book explores how the uncertainties of the twenty-first century present existential challenges to civil society. Presenting original empirical findings, it highlights transferable lessons that will inform policy and practice in today's age of uncertainty.
The density structure of firn has implications for hydrological and climate modelling, and ice-shelf stability. The structure of firn can be evaluated from depth models of seismic velocity, widely obtained with Herglotz–Wiechert inversion (HWI), an approach that considers the slowness of refracted seismic arrivals. However, HWI is strictly appropriate only for steady-state firn profiles and the inversion accuracy can be compromised where firn contains ice layers. In these cases, full waveform inversion (FWI) may yield more success than HWI. FWI extends HWI capabilities by considering the full seismic waveform and incorporates reflected arrivals. Using synthetic firn density profiles, assuming both steady- and non-steady-state accumulation, we show that FWI outperforms HWI for detecting ice slab boundaries (5–80 m thick, 5–80 m deep) and velocity anomalies within firn. FWI can detect slabs thicker than one wavelength (here, 20 m, assuming a maximum frequency of 60 Hz) but requires the starting velocity model to be accurate to ±2.5%. We recommend for field practice that the shallowest layers of velocity models are constrained with ground-truth data. Nonetheless, FWI shows advantages over established methods, and should be considered when the characterisation of firn ice slabs is the goal of the seismic survey.
The density structure of firn has implications for hydrological and climate modelling and for ice shelf stability. The firn structure can be evaluated from depth models of seismic velocity, widely obtained with Herglotz-Wiechert inversion (HWI), an approach that considers the slowness of refracted seismic arrivals. However, HWI is appropriate only for steady-state firn profiles and the inversion accuracy can be compromised where firn contains ice layers. In these cases, Full Waveform Inversion (FWI) can be more successful than HWI. FWI extends HWI capabilities by considering the full seismic waveform and incorporates reflected arrivals, thus offering a more accurate estimate of a velocity profile. We show the FWI characterisation of the velocity model has an error of only 1.7% for regions (vs. 4.2% with HWI) with an ice slab (20 m thick, 40 m deep) in an otherwise steady-state firn profile.
Current psychiatric diagnoses, although heritable, have not been clearly mapped onto distinct underlying pathogenic processes. The same symptoms often occur in multiple disorders, and a substantial proportion of both genetic and environmental risk factors are shared across disorders. However, the relationship between shared symptoms and shared genetic liability is still poorly understood.
Aims
Well-characterised, cross-disorder samples are needed to investigate this matter, but few currently exist. Our aim is to develop procedures to purposely curate and aggregate genotypic and phenotypic data in psychiatric research.
Method
As part of the Cardiff MRC Mental Health Data Pathfinder initiative, we have curated and harmonised phenotypic and genetic information from 15 studies to create a new data repository, DRAGON-Data. To date, DRAGON-Data includes over 45 000 individuals: adults and children with neurodevelopmental or psychiatric diagnoses, affected probands within collected families and individuals who carry a known neurodevelopmental risk copy number variant.
Results
We have processed the available phenotype information to derive core variables that can be reliably analysed across groups. In addition, all data-sets with genotype information have undergone rigorous quality control, imputation, copy number variant calling and polygenic score generation.
Conclusions
DRAGON-Data combines genetic and non-genetic information, and is available as a resource for research across traditional psychiatric diagnostic categories. Algorithms and pipelines used for data harmonisation are currently publicly available for the scientific community, and an appropriate data-sharing protocol will be developed as part of ongoing projects (DATAMIND) in partnership with Health Data Research UK.
Within the UK, and further afield, the spatial delineations of the ‘city region’ have seen a renaissance as the de facto spatial political units of governance for economic development (Clarke and Cochrane 2013, Sykes et al 2021). In the UK, successive governments have sought to reshape the ways in which economic development takes place, and although this shift in governmental delivery began under New Labour, it has been much vaunted by the UK coalition government (Deas 2013), and subsequently by the continuing Conservative administrations (Conservative Party 2015) and the Welsh Labour Party (Bristow and Healy 2015). This chapter, therefore, addresses the (re-)positioning of civil society within these new structures of city region governance. Based on stakeholder mapping and semi-structured interviews with key actors operating across each city region, the chapter illustrates how this has created several significant tensions as well as opportunities for civil society actors.
The chapter draws from four UK case study city regions (two in Wales and two in England from 2015 to 2019) and specifically looks at the ways city and devolution deals have impacted upon the positioning of civil society actors. It was funded by the Economic and Social Research Council under grant No: ES/L009099/1; part of WISERD’s ongoing civil society research programme. This methodology takes the form of thematically grouping stakeholder responses to look across the four differing city regions for points of convergence and divergence. This allows the chapter to consider the ways in which civil society organisations and individuals have sought to interpret, rationalise and respond to the challenges of the city region agenda. In doing this, we draw out three thematic tensions that straddle the development of each city region; the purpose being to highlight how the ongoing processes of restructuring sub-national economic space has significant impacts upon the ways in which civil society actors think and mobilise. This is important when much of the city region agenda has been primarily focused upon economic development, often to the detriment of more social concerns. In turn, this has significant implications for civil society autonomy and criticality.
The chapters in this edited collection have examined how the uncertainties of the age present diverse challenges to civil society at the beginning of the twenty-first century. We have drawn on a wide range of studies from WISERD’s Civil Society research programme. The first part of this concluding chapter summarises the different existential challenges with reference to the principal findings of each study and how they link to civic stratification. The second part outlines the common themes emerging from this volume and the associated prospects and perils for civil society organisations.
Principal findings, existential challenges and civic Stratification
Drawing upon David Lockwood’s (1996) conceptualisation, the present volume underlines how the existential challenges and the uncertainties facing civil society impact on civic stratification in the form of civic deficit and exclusion as well as civic expansion and gain. Lockwood posits that ‘the institutional unity of citizenship, market and bureaucratic relations is central to social cohesion’ (1996: 531). However, in a specific and qualified sense, the studies presented here point to the demise of institutional unity of citizenship. This is because of the global trend of state decentralisation and the rise of meso – or ‘regional’ – governance. Lockwood cannot be blamed for not foreseeing the full impact of this. He did, however, view demands for constitutional reform as a mode of civic expansion (p 535). His seminal work was formed in an era largely characterised by what Wimmer and Glick Schiller (2002: 301) term ‘methodological nationalism’, or the assumption that the state-wide practices are the natural social and political form of the modern world. As this volume’s findings illustrate, devolution in the UK is leading to the territorialisation of welfare citizenship, trust, identity and rights (see Chaney 2013, 2015, 2021c). For so-called ‘sub-state’ nations such as Wales and Scotland, the present may be a stepping-off point, a transitional stage on the way to independent statehood. What we do know from the studies in this volume is that the rise of territorial electoral politics and meso-government is significant because prevailing policy approaches in each UK nation are grounded in the different ideological orientations of the dominant parties.