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Eating disorders are severe psychiatric conditions associated with high mortality rates, particularly among young people. These disorders often co-occur with self-harm and suicidal ideation, yet the temporal dynamics between these variables remain poorly understood.
Aims
This study aims to elucidate the longitudinal associations between symptoms of body dissatisfaction and disordered eating, self-harm and suicidal ideation using structural equation modelling.
Method
Repeated measures of these phenotypes were used to construct a hypothetical model that includes cross-path analyses within and between the variables in two cohorts: the Twins Early Development Study (TEDS; ages 16, 21 and 26 years; N = 5196), representing a general population sample, and the COVID-19 Psychiatry and Neurological Genetics study (COPING; data collected between June 2020 and July 2021; N = 490), which focused on individuals with a history of anxiety or depression. In the TEDS cohort, symptoms of disordered eating, self-harm and suicidal ideation showed limited continuity across adolescence and young adulthood, with peak symptom severity at age 21 years.
Results
Cross-domain associations revealed that both self-harm and suicidal ideation at age 21 years were more strongly associated with disordered eating at 26 years than the reverse. In contrast, the COPING cohort exhibited greater stability in symptoms over time but showed minimal cross-domain effects.
Conclusions
The effects of self-harm and suicidal ideation on disordered eating in early adulthood are stronger than the influence of disordered eating on suicidality.
To assess preparedness for Candida auris in Canadian hospitals.
Design:
Cross-sectional survey.
Setting:
Canadian Nosocomial Infection Surveillance Program (CNISP) hospitals.
Methods:
In June 2024, surveys were e-mailed to the infection prevention and control departments of 109 CNISP hospitals and their 33 microbiology laboratories. The surveys assessed policies for patient screening/management and laboratory processes supporting C. auris transmission prevention. Results were compared to a similar 2018 survey.
Results:
All 109 hospitals and 32/33 laboratories responded. Most hospitals had policies for admission screening (80%, 87/109) and policies/defined plans for post-exposure screening (95%, 104/109). Policy presence increased from 18% to 73% in 56 hospitals completing both 2018 and 2024 surveys (P < 0.001). Among hospitals with admission screening policies, 69% (60/87) screened for recent out-of-country hospitalization. All but one hospital implemented transmission-based precautions for cases; 70% (76/109) continued precautions indefinitely. Overall, 94% (99/105; excluding hospitals with exclusively private rooms) and 55% (60/109) of hospitals screened roommates and wardmates, respectively. Frequency and timing of screening and policies regarding precautions for exposed patients varied. All hospitals used axilla and groin swabs, at minimum, for screening. Most (81%, 26/32) laboratories identified all clinically significant Candida isolates to species level, increasing from 48% to 85% (P < 0.001) in the 27 laboratories completing both 2018 and 2024 surveys. Twenty-four laboratories (75%) had standard operating procedures for processing screening specimens; 96% (23/24) used direct plating onto chromogenic agar.
Conclusions:
Despite progress in C. auris preparedness, areas for improvement remain. Variability in practice may be related to evidence gaps and resource constraints.
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.
This collection gathers thirteen contributions by a number of historians, friends, colleagues and/or students of Jinty’s, who were asked to pick their favourite article by her and say a few words about it for an event held in her memory on 15 January 2025 at King’s College London. We offer this collection in print now for a wider audience not so much because it has any claim to be exhaustive or authoritative, but because taken all together these pieces seemed to add up to a useful retrospective on Jinty’s work, its wider context, and its impact on the field over the decades. We hope that, for those who know her work well already, this may be an opportunity to remember some of her classic (and a few less classic) articles, while at the same time serving as an accessible introduction to her research for anyone who knew her without necessarily knowing about her field, as well as for a new and younger generation of readers.
The digital twin approach has gained recognition as a promising solution to the challenges faced by the Architecture, Engineering, Construction, Operations, and Management (AECOM) industries. However, its broader application across some AECOM sectors remains limited. A significant obstacle is that traditional DTs rely on deterministic models, which require deterministic input parameters. This limits their accuracy, as they do not account for the substantial uncertainties that are inherent in AECOM projects. These uncertainties are particularly pronounced in geotechnical design and construction. To address this challenge, we propose a probabilistic digital twin (PDT) framework that extends traditional DT methodologies by incorporating uncertainties and is tailored to the requirements of geotechnical design and construction. The PDT framework provides a structured approach to integrating all sources of uncertainty, including aleatoric, data, model, and prediction uncertainties, and propagates them throughout the entire modeling process. To ensure that site-specific conditions are accurately reflected as additional information is obtained, the PDT leverages Bayesian methods for model updating. The effectiveness of the PDT framework is showcased through an application to a highway foundation construction project, demonstrating its potential to integrate existing probabilistic methods to improve decision-making and project outcomes in the face of significant uncertainties. By embedding these methods within the PDT framework, we lower the barriers to practical implementation, making probabilistic approaches more accessible and applicable in real-world engineering workflows.
The need to respect and (physically) protect the dead is well established under international and national laws and extends to human remains found in mass graves. Once mass graves are discovered, and prior to any investigation, the dead in mass graves should be secured to an extent through the protection of the site itself. Should investigations follow (due to human rights abuses or breaches of international humanitarian or international criminal law), then the dead, if excavated, are in the custody and protection of the investigating authorities. Following successful identification of human remains, their return to the next of kin may be possible, or appropriate reburial may ensue.
Engagement with mass graves is complex: no two mass graves are the same, and contexts differ, as may the legal framework governing mass graves. Building on the Minnesota Protocol, international standards for a rights-informed response to human remains found in mass graves are proffered by the Bournemouth Protocol on Mass Grave Protection and Investigation. A new research project now collates information to generate a digital global map of mass graves and asks how and to what extent this holds protective value. Such regularized mass grave mapping was advocated by former United Nations Special Rapporteur Agnès Callamard; indeed, mapping is increasingly employed in human rights contexts as a protection and justice-monitoring measure.
By combining legal, forensic and anthropological insights in responding to the question of data collation in relation to mass graves, this paper sheds light on ways of both conceptualizing and operationalizing digital mapping of mass graves and appraises what kind of protection this may hold for the dead. Structured into four main interrelated sections, the paper briefly anchors data collation as a protection measure under international legal provisions; it then examines the challenges associated with the curation and creation of a global map of mass graves by adopting anthropological, forensic and legal lenses on the subject of mass graves and the data generated surrounding the dead. In a third step, the paper outlines the methodological challenges encountered during the pilot phase of the study, before then offering analysis and discussion on our preliminary findings, where we conclude that the informative value of mass grave mapping holds protective potential, particularly in the absence of physical protection.
As well as offering an original inquiry that fits well with the theme of “protection of the dead”, the paper investigates the very boundaries of protection measures in the context of mass graves and what value they may hold. Such contribution to knowledge and practice is increasingly pressing in situations where physical protection of the dead is not forthcoming, and as an avenue to offer some (albeit incomplete) protection mechanisms for emerging mass grave landscapes: migratory deaths and the threat of mass fatalities arising from extreme climatic events.
There is a significant mortality gap between the general population and people with psychosis. Completion rates of regular physical health assessments for cardiovascular risk in this group are suboptimal. Point-of-care testing (POCT) for diabetes and hyperlipidaemia – providing an immediate result from a finger-prick – could improve these rates.
Aims
To evaluate the impact on patient–clinician encounters and on physical health check completion rates of implementing POCT for cardiovascular risk markers in early intervention in psychosis (EIP) services in South East England.
Method
A mixed-methods, real-world evaluation study was performed, with 40 POCT machines introduced across EIP teams in all eight mental health trusts in South East England from March to May 2021. Clinician training and support was provided. Numbers of completed physical health checks, HbA1c and lipid panel blood tests completed 6 and 12 months before and 6 months after introduction of POCT were collected for individual patients. Data were compared with those from the South West region, which acted as a control. Clinician questionnaires were administered at 2 and 8 months, capturing device usability and impacts on patient interactions.
Results
Post-POCT, South East England saw significant increases in HbA1c testing (odds ratio 2.02, 95% CI 1.17–3.49), lipid testing (odds ratio 2.38, 95% CI 1.43–3.97) and total completed health checks (odds ratio 3.61, 95% CI 1.94–7.94). These increases were not seen in the South West. Questionnaires revealed improved patient engagement, clinician empowerment and patients’ preference for POCT over traditional blood tests.
Conclusions
POCT is associated with improvements in the completion and quality of physical health checks, and thus could be a tool to enhance holistic care for individuals with psychosis.
Eating disorders, including anorexia nervosa, bulimia nervosa and binge eating disorder, are psychiatric conditions associated with high mortality rates, particularly due to suicide. Although eating disorders are strongly associated with suicidal ideation, attempts, and fatalities, the precise relationship between these conditions remains poorly understood. While substantial genetic influences have been identified for both eating disorders and suicidality, the shared genetics contributing to their co-occurrence remain unclear. In this study, we utilized a multivariate approach to examine the shared genetic architecture of eating disorder symptoms, suicidal thoughts and behaviors in ~20,000 participants from the COVID-19 Psychiatry and Neurological Genetics (COPING) study. We applied individual-level structural equation modeling to explore the factor structure underlying eating disorder symptoms and suicidal ideation, followed by genetic correlation analyses. We modeled the general factor of susceptibility to eating disorders and suicidal ideation that was as strongly genetically influenced as both conditions, with mean SNP heritability of 9%. Importantly, despite the frequent co-occurrence of eating disorders with other psychiatric conditions, our findings highlight the specificity of the relationship between eating disorders and suicidality, independent of other co-occurring psychopathology, such as depression and anxiety. This specificity highlights the need for targeted approaches in understanding the shared susceptibility factors.
When making decisions, people tend to look back and forth between the alternatives until they eventually make a choice. Eye-tracking research has established that these shifts in attention are strongly linked to choice outcomes. A predominant framework for understanding the dynamics of the choice process, and thus the effects of attention, is sequential sampling of information. However, existing methods for estimating the attention parameters in these models are computationally costly and overly flexible, and yield estimates with unknown precision and bias. Here we propose an estimation method that relies on a link between sequential sampling models and random utility models (RUM). This method uses familiar econometric tools (i.e., logistic regression) and yields estimates that appear to be unbiased and relatively precise compared to existing methods, in a small fraction of the computation time. The RUM thus appears to be a useful tool for estimating the effects of attention on choice.
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: Determine how a history of unpredictable foot shock in mice affects brain wide patterns of neural activation to future stressors. Additionally, we aimed to characterize how the paraventricular nucleus of the thalamus (PVT) is involved in the fear sensitization process. METHODS/STUDY POPULATION: We used a mouse model of stress enhanced fear learning, where stressed mice are first subjected to a series of unpredictable foot shocks in a novel context while control mice undergo exposure to the novel context without experiencing foot shock. Mice are then left undisturbed for 28 days, following which they are exposed to a single foot shock in a novel context. Mice are tested in the second context 24 hours after single shock, and the amount of time spent frozen in the context provides a measure of fear sensitization. Whole brain patterns of activation during the second context test will be assessed via whole brain optical clearing with antibody staining of immediate early genes. The role of the PVT in fear sensitization will be characterized using chemogenetic approaches. RESULTS/ANTICIPATED RESULTS: Our preliminary results demonstrate that mice display enhanced fear acquisition long after the initial experience of unpredictable shocks. We anticipate to identify regions previously implicated in fear learning and novel regions not previously described through our brain clearing approach. In addition, we anticipate chemogenetic inhibition of the PVT will reduce freezing to an auditory cue associated with the shock in the second context but not to the context itself. DISCUSSION/SIGNIFICANCE: Our findings will provide a comprehensive view of how a history of unpredictable stress affects whole brain processing of subsequent stressful experiences, and describe the role of the PVT in cued fear sensitization.
The brain can be represented as a network, with nodes as brain regions and edges as region-to-region connections. Nodes with the most connections (hubs) are central to efficient brain function. Current findings on structural differences in Major Depressive Disorder (MDD) identified using network approaches remain inconsistent, potentially due to small sample sizes. It is still uncertain at what level of the connectome hierarchy differences may exist, and whether they are concentrated in hubs, disrupting fundamental brain connectivity.
Methods
We utilized two large cohorts, UK Biobank (UKB, N = 5104) and Generation Scotland (GS, N = 725), to investigate MDD case–control differences in brain network properties. Network analysis was done across four hierarchical levels: (1) global, (2) tier (nodes grouped into four tiers based on degree) and rich club (between-hub connections), (3) nodal, and (4) connection.
Results
In UKB, reductions in network efficiency were observed in MDD cases globally (d = −0.076, pFDR = 0.033), across all tiers (d = −0.069 to −0.079, pFDR = 0.020), and in hubs (d = −0.080 to −0.113, pFDR = 0.013–0.035). No differences in rich club organization and region-to-region connections were identified. The effect sizes and direction for these associations were generally consistent in GS, albeit not significant in our lower-N replication sample.
Conclusion
Our results suggest that the brain's fundamental rich club structure is similar in MDD cases and controls, but subtle topological differences exist across the brain. Consistent with recent large-scale neuroimaging findings, our findings offer a connectomic perspective on a similar scale and support the idea that minimal differences exist between MDD cases and controls.
Helium or neopentane can be used as surrogate gas fill for deuterium (D2) or deuterium-tritium (DT) in laser-plasma interaction studies. Surrogates are convenient to avoid flammability hazards or the integration of cryogenics in an experiment. To test the degree of equivalency between deuterium and helium, experiments were conducted in the Pecos target chamber at Sandia National Laboratories. Observables such as laser propagation and signatures of laser-plasma instabilities (LPI) were recorded for multiple laser and target configurations. It was found that some observables can differ significantly despite the apparent similarity of the gases with respect to molecular charge and weight. While a qualitative behaviour of the interaction may very well be studied by finding a suitable compromise of laser absorption, electron density, and LPI cross sections, a quantitative investigation of expected values for deuterium fills at high laser intensities is not likely to succeed with surrogate gases.
Negative pressure wound therapy (NPWT) has significantly advanced wound care and continues to find new applications. Its effects at a molecular level however, remain a subject of debate. The aim of this systematic review is to summarize the current evidence regarding the molecular mechanisms of action of NPWT. Medline, Embase, EBSCO databases and clinical trial registries were searched from inception to January 2023. Clinical studies, animal models or in-vitro studies that quantitatively or semi-quantitatively evaluated the influence of NPWT on growth factors, cytokine or gene-expression in the circulation or wound-bed were included. Risk of Bias assessment was performed using the RoBANS tool for non-randomized studies, the COCHRANE's Risk of Bias 2(ROB-2) tool for randomized clinical studies, OHAT tool for in-vitro studies or the SYRCLE tool for animal model studies. A descriptive summary was collated and the aggregated data is presented as a narrative synthesis. This review included 19 clinical studies, 11 animal studies and 3 in-vitro studies. The effects of NPWT on 43 biomarkers and 17 gene expressions were studied across included studies. NPWT stimulates modulation of numerous local and circulating cytokines and growth factor expressions to promote an anti-inflammatory profile. This is most likely achieved by downregulation of TNFα, upregulation of VEGF, TGF-β and fibronectin.
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.
The UK Medical Licensing Assessment curriculum represents a consensus on core content, including ENT-related content for newly qualified doctors. No similar consensus exists as to how ENT content should be taught at medical school.
Method
A virtual consensus forum was held at the 2nd East of England ENT Conference in April 2021. A syllabus of ENT-related items was divided into ‘Presentations’, ‘Conditions’ and ‘Practical procedures’. Twenty-seven students, 11 foundation doctors and 7 other junior doctors voted via anonymous polling for the best three of nine methods for teaching each syllabus item.
Results
For ‘Presentations’ and ‘Conditions’, work-based or clinical-based learning and small-group seminars were more popular than other teaching methods. For ‘Practical procedures’, practical teaching methods were more popular than theoretical methods.
Conclusion
Students and junior doctors expressed a clear preference for clinical-based teaching and small-group seminars when learning ENT content. E-learning was poorly favoured despite its increasing use.
An intense public debate over the deaths of unarmed black persons has emerged at a time when the thesis of a postracial, colorblind America had inserted itself into mainstream thinking as evidence of the growing sentiment to move beyond race and erase its explicit, violent history. Among the findings arising from these killings is the split in the public reaction along distinctly racial lines. Othello’s dying speech raises related concerns insofar as he is anxiously aware of the possible outcome of having a white narrator tell his story. Such a narrator is a prototype for the modern scholar in a majority white field like Shakespeare studies who must confront new empirical data on whites’ diminished capacity to perform cross-racial reading and identification. Hazlitt and other critics appear to have little difficulty affirming that, “It is we who are Hamlet,” but the same has not been true of black Othello. By contrast, the chapter’s appeal, “We are Othello,” is meant to disrupt the silence around whiteness, to make visible and productively politicize the subject identities of critical practitioners in the field, and issue a call for a transformative, antiracist scholarship.
James Baldwin’s account of “looking away” in “Nobody Knows My Name,” points to the prevailing habit of ignoring the history and facts of blackness that continues to be replicated in American culture. “Looking away” is, however, only partial since it simultaneously demands and denies black existence, a paradoxical strategy designed to facilitate the work of whiteness and the cultural formation it engenders. One can be resistant to the facts of race while being preoccupied with the idea of race as advanced within a critique of modernity. This chapter argues that these complex and pervasive strategies inform a mental practice, a white epistemology that is the product of historical formation, from which the reader and reading are not immune. By contrast, the chapter’s review of early modern and current theories of reading indicates the continuing trend of racial avoidance. Building on Michel de Certeau’s class-inflected analysis that “the text has a meaning only through its readers,” this chapter argues, however, that whiteness exercises an elite racial function in reading that, following Charles W. Mills’ critique, produces distortion and misinterpretation.
Addressed to “the Great Variety of Readers,” the 1623 First Folio envisioned a reading subject whose importance time would realize. The unstated assumptions about readers lay in their unraced “variety,” and the significance of racial identity on the act of reading Shakespeare has been virtually taboo. With the advent of early modern critical race studies that challenged assumptions and methods in Shakespeare scholarship, the salience of Toni Morrison’s assertion in Playing in the Dark (1992) that readers are “positioned as white” needs investigation in relation to contemporary scholar-readers of Shakespeare. Whiteness studies, a subfield that Morrison’s text represents, intersects with early modern critical race studies in this book’s original examination of the reader as racial subject. Systemic whiteness, the historical and institutional formation of white racial identity and perception, has infused our cultural practices only to produce silence around the “white” reader. Racial literacy is proposed, therefore, as an acquired antiracist reading competence in response to the overdetermined critical practices of racial denial and erasure.