Search

The amphipod family Chevaliidae Myers & Lowry, 2003 (Amphipoda: Senticaudata) contains two genera: Chevalia Walker, 1904 (13 species), and Bryoconversor Lörz, Myers & Gordon, 2014 (1 species). Chevalia is a marine genus with a cosmopolitan distribution in circumtropical and temperate waters. Prior to this study, records of Chevalia from Australian waters were limited. Here, we describe five new species of Chevalia from Australian waters, C. bardi sp. nov., C. burrewarra sp. nov., C. csiro sp. nov., C. freycinet sp. nov. and C. sprightly sp. nov. The original description of Chevalia aviculae no longer adequately defined the species and is redescribed based on syntypic material from East Cheval Paar, Sri Lanka. Additionally, new distribution records are provided for the New Zealand species Bryoconversor tutus Lörz, Myers & Gordon, 2014. Material reported is from both shallow and deep-water samples from 1–660 m depth. The prevalence of various gender and intersex states within specimens of chevaliids is discussed. An updated key to the 19 world species of Chevaliidae and a field guide to the seven known Australian and New Zealand species is provided.

Abstract Background The aim of this study was to develop a web-based tool for patients with multiple chronic conditions (MCC) to communicate concerns about treatment burden to their healthcare providers. Methods Patients and providers from primary-care clinics participated. We conducted focus groups to identify content for a prototype clinical tool to screen for treatment burden by reviewing domains and items from a previously validated measure, the Patient Experience with Treatment and Self-management (PETS). Following review of the prototype, a quasi-experimental pilot study determined acceptability of using the tool in clinical practice. The study protocol was modified to accommodate limitations due to the Covid-19 pandemic. Results Fifteen patients with MCC and 18 providers participated in focus groups to review existing PETS content. The pilot tool (named PETS-Now) consisted of eight domains (Living Healthy, Health Costs, Monitoring Health, Medicine, Personal Relationships, Getting Healthcare, Health Information, and Medical Equipment) with each domain represented by a checklist of potential concerns. Administrative burden was minimized by limiting patients to selection of one domain. To test acceptability, 17 primary-care providers first saw 92 patients under standard care (control) conditions followed by another 90 patients using the PETS-Now tool (intervention). Each treatment burden domain was selected at least once by patients in the intervention. No significant differences were observed in overall care quality between patients in the control and intervention conditions with mean care quality rated high in both groups (9.3 and 9.2, respectively, out of 10). There were no differences in provider impressions of patient encounters under the two conditions with providers reporting that patient concerns were addressed in 95% of the visits in both conditions. Most intervention group patients (94%) found that the PETS-Now was easy to use and helped focus the conversation with the provider on their biggest concern (98%). Most providers (81%) felt they had learned something new about the patient from the PETS-Now. Conclusion The PETS-Now holds promise for quickly screening and monitoring treatment burden in people with MCC and may provide information for care planning. While acceptable to patients and clinicians, integration of information into the electronic medical record should be prioritized.

Background Broad-spectrum micronutrients (minerals and vitamins) have shown benefit for treatment of depressive symptoms. Aims To determine whether additional micronutrients reduce symptoms of antenatal depression. Method Eighty-eight medication-free pregnant women at 12–24 weeks gestation, who scored ≥13 on the Edinburgh Postnatal Depression Scale (EPDS), were randomised 1:1 to micronutrients or active placebo (containing iodine and riboflavin), for 12 weeks. Micronutrient doses were generally between recommended dietary allowance and tolerable upper level. Primary outcomes (EPDS and Clinical Global Impression – Improvement Scale (CGI-I)) were analysed with constrained longitudinal data analysis. Results Seventeen (19%) women dropped out, with no group differences, and four (4.5%) gave birth before trial completion. Both groups improved on the EPDS, with no group differences (P = 0.1018); 77.3% taking micronutrients and 72.7% taking placebos were considered recovered. However, the micronutrient group demonstrated significantly greater improvement, based on CGI-I clinician ratings, over time (P = 0.0196). The micronutrient group had significantly greater improvement on sleep and global assessment of functioning, and were more likely to identify themselves as ‘much’ to ‘very much’ improved (68.8%) compared with placebo (38.5%) (odds ratio 3.52, P = 0.011; number needed to treat: 3). There were no significant group differences on treatment-emergent adverse events, including suicidal ideation. Homocysteine decreased significantly more in the micronutrient group. Presence of personality difficulties, history of psychiatric medication use and higher social support tended to increase micronutrient response compared with placebo. Conclusions This study highlights the benefits of active monitoring on antenatal depression, with added efficacy for overall functioning when taking micronutrients, with no evidence of harm. Trial replication with larger samples and clinically diagnosed depression are needed.

Abstract Background Adult smoking rates in the USA are highest in economically depressed rural Appalachia. Pharmacist-delivered tobacco cessation support that incorporates medication therapy management (such as the QuitAid intervention) is a promising approach to address this need. Methods Twenty-four adult smokers recruited between September and November 2021 through an independent pharmacy in rural Appalachia were randomized in a non-blinded 2 × 2 × 2 factorial design to (1) pharmacist delivered QuitAid intervention (yes vs. no); (2) combination nicotine replacement therapy (NRT) gum + NRT patch (vs. NRT patch); and/or (3) 8 weeks of NRT (vs. standard 4 weeks). Participants received 4 weeks of NRT patch in addition to the components to which they were assigned. Participants completed baseline and 3-month follow-up assessments. Primary outcomes were feasibility of recruitment and randomization, retention, treatment adherence, and fidelity. Results Participants were recruited in 7 weeks primarily through a referral process, commonly referred to as ask-advise-connect (61%). Participants were on average 52.4 years old, 29.2% were male and the majority were white (91.6%) and Non-Hispanic (91.7%). There was a high level of adherence to the interventions, with 85% of QuitAid sessions completed, 83.3% of the patch used, and 54.5% of gum used. Participants reported a high level of satisfaction with the program, and there was a high level of retention (92%). Conclusions This demonstration pilot randomized controlled study indicates that an ask-advise-connect model for connecting rural smokers to smoking cessation support and providing QuitAid for smoking cessation is feasible and acceptable among rural Appalachian smokers and independent pharmacists. Further investigation into the efficacy of a pharmacist-delivered approach for smoking cessation is needed. Trial registration The trial was retrospectively registered at ClinicalTrials.gov. Trial #: NCT05649241.

ABSTRACTThis paper assesses the relationship between economic resilience in English regions and the allocation of the UK government’s Community Renewal Fund (CRF). The CRF is part of the government’s ‘Levelling Up’ agenda to address place-based inequalities. Economic resilience is measured using a composite index comprising productivity, skills, unemployment, population density and household income. Data were obtained for the five indicators at local authority (LA) level in England. Regional resilience scores were produced by calculating the weighted mean score of the constituent LAs. Regional resilience values were used to generate an ‘expected share’ funding allocation, which was compared with the actual allocation using differences and correlation. Regional resilience scores ranged from 28.5 (North East) to 66.6 (London). A total of £125.56 million was allocated in the first round of the CRF. All regions in the North received less than their expected share allocation of the CRF, with the least resilient region in England (North East) receiving £13.4 million less. The South West received £9.9 million more than their expected share. All regions in the North of England received less than their expected share allocation of the CRF. There was no significant correlation between resilience values and CRF allocations (r = −0.16, p = 0.68). The current method for CRF allocation may therefore widen existing inequalities rather than ‘level up’.

Depression is a major public health concern. Depressed individuals have received increasing treatment with antidepressants in Western countries. In this study, we examine the relationship among individual symptoms (sadness, worry and unhappiness), human development factors and antidepressant use in 29 OECD countries. We report that increased antidepressant prescribing is not associated with decreased prevalence of sadness, worry or unhappiness. However, income, education and life expectancy (measured using the Human Development Index) are associated with lower prevalence of all these symptoms. This suggests that increasing spending on depression treatment may not be as effective as general public health interventions at reducing depression in communities.

Key points 1. Surveyed UK breast screening readers supported the introduction of AI. 2. Respondents approved of the replacement of one of the two initial readers. 3. Participants objected to the replacement of all human readers. 4. Respondents preferred the AI to graphically indicate the suspected tumour area. 5. Screen readers preferred forms of evidence based on national guidelines, national representative datasets, and independent prospective studies.

Nuclear fission is still one of the most complex physical processes due to the interplay between macroscopic and microscopic nuclear properties that decide the output. An example of this coupling is the presence of nuclear dissipation as an important ingredient that contributes to drive the dynamics and has a clear impact on the time of the process. However, different theoretical interpretations and scarce experimental data make it poorly understood. At low excitation energy, the relative yields of fragments even and odd atomic numbers show a clear difference, which can be quantified with the so-called even-odd effect. This seemingly mundane property can be used to obtain information about the energy dissipated during the process and the role of structure in its dynamics. In this paper, the study of the even-odd effect for elasticand transfer-induced fission data is discussed. A clear connection with particular fragment shells and the dissipation energy is found, as detailed in Ref. [1]. In addition, preliminary results from quasi-fission data show the formation of a relatively large even-odd effect, which suggests a process with low dissipation mainly consisting in the exchange of nucleon pairs.

Abstract Changes in brain morphology have been reported during development, ageing and in relation to different pathologies. Brain morphology described by the shape complexity of gyri and sulci can be captured and quantified using fractal dimension (FD). This measure of brain structural complexity, as well as brain volume, are associated with intelligence, but less is known about the sexual dimorphism of these relationships. In this paper, sex differences in the relationship between brain structural complexity and general intelligence (g) in two diverse geographic and cultural populations (UK and Indian) are investigated. 3D T1-weighted magnetic resonance imaging (MRI) data and a battery of cognitive tests were acquired from participants belonging to three different cohorts: Mysore Parthenon Cohort (MPC); Aberdeen Children of the 1950s (ACONF) and UK Biobank. We computed MRI derived structural brain complexity and g estimated from a battery of cognitive tests for each group. Brain complexity and volume were both positively corelated with intelligence, with the correlations being significant in women but not always in men. This relationship is seen across populations of differing ages and geographical locations and improves understanding of neurobiological sex-differences.

Objective: We sought to train a foundational convolutional neural network (CNN) for screening computed tomography (CT) angiography (CTA) scans for the presence of infrarenal abdominal aortic aneurysms (AAAs) for future predictive modeling and other artificial intelligence applications. Methods: From January 2015 to January 2020, a HIPAA (Health Insurance and Accountability Act)-compliant, institutional review board–approved, retrospective clinical study analyzed contrast-enhanced abdominopelvic CTA scans from 200 patients with infrarenal AAAs and 200 propensity-matched control patients with non–aneurysmal infrarenal abdominal aortas. A CNN was trained to binary classification on the input. For model improvement and testing, transfer learning using the ImageNet database was applied to the VGG-16 base model. The image dataset was randomized to sets of 60%, 10%, and 30% for model training, validation, and testing, respectively. A stochastic gradient descent was used for optimization. The models were assessed by testing validation accuracy and the area under the receiver operating characteristic curve. Results: Preliminary data demonstrated a nonrandom pattern of accuracy and detectability. Iterations (≤10) of the model characteristics generated a final custom CNN model reporting an accuracy of 99.1% and area under the receiver operating characteristic curve of 0.99. Misjudgments were analyzed through review of the heat maps generated via gradient weighted class activation mapping overlaid on the original CT images. The greatest misjudgments were seen in small aneurysms (

Background Psychological therapies following an episode of self-harm should happen quickly to ensure patients receive the care they need and to reduce the likelihood of repetition. Aims We sought to explore patients' subjective experience of accessing psychological therapies following self-harm and their views on improving practice. Method Between March and November 2019, we recruited 128 patients and 23 carers aged 18 years or over from 16 English mental health trusts, from community organisations and via social media. Thematic analyses were used to interpret the data. Results Participants reported long waiting times, multiple failed promises and rejection when trying to access psychological therapies following self-harm. Poor communication and information provision contributed to uncertainty, worsening mental health and further self-harm. Other barriers included: lack of tailored interventions, stigmatising responses, use of exclusionary thresholds to access services, and punitive approaches to treating these patients. Participant recommendations to improve access to psychological therapies included: (a) the importance of compassionate and informed staff; (b) having timely access to aftercare from well-funded and well-resourced teams; (c) continuity of care, improved communication, and support during waiting times and while navigating the referral process; (d) greater information on the availability and benefits of psychological therapies; and (e) greater choice and flexibility over interventions. Conclusion Our findings identify long waiting times and inadequate service provision as barriers to high-quality and safe aftercare for patients who have self-harmed. Consistent with clinical guidelines, all patients should receive prompt aftercare and access to tailored psychological treatments following a self-harm episode.

Background Family involvement has been identified as a key aspect of clinical practice that may help to prevent suicide. Aims To investigate how families can be effectively involved in supporting a patient accessing crisis mental health services. Method A multi-site ethnographic investigation was undertaken with two crisis resolution home treatment teams in England. Data included 27 observations of clinical practice and interviews with 6 patients, 4 family members, and 13 healthcare professionals. Data were analysed using framework analysis. Results Three overarching themes described how families and carers are involved in mental healthcare. Families played a key role in keeping patients safe by reducing access to means of self-harm. They also provided useful contextual information to healthcare professionals delivering the service. However, delivering a home-based service can be challenging in the absence of a supportive family environment or because of practical problems such as the lack of suitable private spaces within the home. At an organisational level, service design and delivery can be adjusted to promote family involvement. Conclusions Findings from this study indicate that better communication and dissemination of safety and care plans, shared learning, signposting to carer groups and support for carers may facilitate better family involvement. Organisationally, offering flexible appointment times and alternative spaces for appointments may help improve services for patients.

Background Timely provision of aftercare following self-harm may reduce risks of repetition and premature death, but existing services are frequently reported as being inadequate. Aims To explore barriers and facilitators to accessing aftercare and psychological therapies for patients presenting to hospital following self-harm, from the perspective of liaison psychiatry practitioners. Method Between March 2019 and December 2020, we interviewed 51 staff members across 32 liaison psychiatry services in England. We used thematic analyses to interpret the interview data. Results Barriers to accessing services may heighten risk of further self-harm for patients and burnout for staff. Barriers included: perceived risk, exclusionary thresholds, long waiting times, siloed working and bureaucracy. Strategies to increase access to aftercare included: (a) improving assessments and care plans via input from skilled staff working in multidisciplinary teams (e.g. including social workers and clinical psychologists); (b) supporting staff to focus on assessments as therapeutic intervention; (c) probing boundaries and involving senior staff to negotiate risk and advocate for patients; and (d) building relationships and integration across services. Conclusions Our findings highlight practitioners’ views on barriers to accessing aftercare and strategies to circumvent some of these impediments. Provision of aftercare and psychological therapies as part of the liaison psychiatry service were deemed as an essential mechanism for optimising patient safety and experience and staff well-being. To close treatment gaps and reduce inequalities, it is important to work closely with staff and patients, learn from experiences of good practice and implement change more widely across services.

Abstract Background Cross-national comparisons of the prevalence of mental disorders have relied on lay-administered interviews scored using complex diagnostic algorithms. However, this approach has led to some paradoxical findings, with more vulnerable countries showing lower prevalence, and its appropriateness for cross-national comparisons has been questioned. This study used an alternative method involving simple questions from social surveys to assess the prevalence of specific depression and anxiety symptoms, and investigated their association with national indicators of human development, quality of government, mental health resources, and mental health governance. Methods The study used data on the prevalence of three symptoms indicating depression or anxiety: sadness, worry, and unhappiness. These data were taken from the Gallup World Poll (142 countries) and the World Values Survey (77 countries). National characteristics examined covered indicators of human development (income, life span, education, gender equality), quality of government (human freedom, perceptions of corruption), mental health resources (per capita numbers of psychiatrists, mental health nurses, psychologists, and social workers), and mental health governance (whether there is a national mental health plan and a mental health law). Results All the human development and quality of government indicators, and some of the mental health resource indicators, were strongly associated with a lower prevalence of symptoms. Conclusion Populations of nations with higher human development, quality of government, and mental health resources have better mental health when measured by the prevalence of specific symptoms.

Little is known about the effects of grassland degradation on the carbohydrate-active enzyme (CAZYme) genes responsible for C cycling. Here we used a metagenomic approach to reveal variation in abundance and composition of CAZyme genes in grassland experiencing a range of degradation severity (i.e., non-, light, moderately, and severely degraded) in two soil layers (0–10 cm, 10–20 cm) in a steppe grassland in northern China. We observed a higher CAZyme abundance in severely degraded grassland compared with the other three degradation severities. Glycoside hydrolase (GH) and glycosyltransferase (GT) were identified as the most abundant gene families. The Mantel test and variation partitioning suggested an interactive effect of degradation severity and soil depth with respect to CAZyme gene composition. Structural equation modeling indicated that total soil carbon, microbial biomass carbon and organic carbon were the three soil characteristics most important to CAZyme abundance, which suggests an interaction between degradation and soil carbon fractions in determining CAZyme gene composition. Both above- and below-ground factors linked to soil organic matter play a central role in determining the abundance of CAZyme gene families.

Objective: To identify confounding variables influencing the accuracy of a convolutional neural network (CNN) specific for infrarenal abdominal aortic aneurysms (AAAs) on computed tomography angiograms (CTAs). Methods: A Health Insurance Portability and Accountability Act-compliant, institutional review board-approved, retrospective study analyzed abdominopelvic CTA scans from 200 patients with infrarenal AAAs and 200 propensity-matched control patients. An AAA-specific trained CNN was developed by the application of transfer learning to the VGG-16 base model using model training, validation, and testing techniques. Model accuracy and area under the curve were analyzed based on data sets (selected, balanced, or unbalanced), aneurysm size, extra-abdominal extension, dissections, and mural thrombus. Misjudgments were analyzed by review of heatmaps, via gradient weighted class activation, overlaid on CTA images. Results: The trained custom CNN model reported high test group accuracies of 94.1%, 99.1%, and 99.6% and area under the curve of 0.9900, 0.9998, and 0.9993 in selected (n = 120), balanced (n = 3704), and unbalanced image sets (n = 31,899), respectively. Despite an eightfold difference between balanced and unbalanced image sets, the CNN model demonstrated high test group sensitivities (98.7% vs 98.9%) and specificities (99.7% vs 99.3%) in unbalanced and balanced image sets, respectively. For aneurysm size, the CNN model demonstrates decreasing misjudgments as aneurysm size increases: 47% (16/34) for aneurysms 5 cm. Aneurysms containing measurable mural thrombus were over-represented within type II (false-negative) misjudgments compared with type I (false-positive) misjudgments (71% vs 15%, P < .05). Inclusion of extra-abdominal aneurysm extension (thoracic or iliac artery) or dissection flaps in these imaging sets did not decrease the model's overall accuracy, indicating that the model performance was excellent without the need to clean the data set of confounding or comorbid diagnoses. Conclusions: Analysis of an AAA-specific CNN model can accurately screen and identify infrarenal AAAs on CTA despite varying pathology and quantitative data sets. The highest anatomic misjudgments were with small aneurysms (

Background: Emotional dysregulation (ED) is a significant contributing factor to psychological distress in young people. ED is a transdiagnostic dimension characterized by an excessive reactivity to negative emotional stimuli with affective (anger) and behavioral (aggression) components, and is present across anxiety, mood and behavioral disorders. Due to early onset, high prevalence and persistence, ED in childhood is one of the most psychosocially impairing and cost-intensive mental health conditions, with not enough children improving with conventional treatments. Clinical trials have established preliminary efficacy of micronutrients (vitamins and minerals) in the treatment of ED. This project expands the research to examine micronutrient efficacy for teenagers with ED. Methods: This study is the first double-blind (participant and investigators) 8 week randomized controlled trial (with 8 week open-label extension and one year follow-up) designed to explore the efficacy and safety of micronutrients compared with placebo in 150 medication-free emotionally dysregulated youth (12–17 years), referred via self-referral, delivered remotely throughout New Zealand, using a website for monitoring symptoms, with a psychologist available online via text, email and video for assessment and monitoring. The primary outcome measures will be the Clinical Global Impression (CGI-I), the reactivity subscale of the Emotion Dysregulation Inventory (EDI) and the Clinician Rated Temper and Irritability Scale (CL-ARI). Discussion: Micronutrient intervention delivered alongside online assessment and monitoring has the potential to transform delivery of mental health care to young people who may not be willing or able to access traditional therapies. We also hope that this intervention shows acceptability across different ethnicities.

Abstract Background Older people are the fastest-growing demographic group among prisoners in England and Wales and they have complex health and social care needs. Their care is frequently ad hoc and uncoordinated. No previous research has explored how to identify and appropriately address the needs of older adults in prison. We hypothesised that the Older prisoner Health and Social Care Assessment and Plan (OHSCAP) would significantly increase the proportion of met health and social care needs 3 months after prison entry, compared to treatment as usual (TAU). Methods The study was a parallel randomised controlled trial (RCT) recruiting male prisoners aged 50 and over from 10 prisons in northern England. Participants received the OHSCAP or TAU. A clinical trials unit used minimisation with a random element as the allocation procedure. Data analysis was conducted blind to allocation status. The intervention group had their needs assessed using the OHSCAP tool and care plans were devised; processes that lasted approximately 30 min in total per prisoner. TAU included the standard prison health assessment and care. The intention to treat principle was followed. The trial was registered with the UK Clinical Research Network Portfolio (ISRCTN ID: 11841493) and was closed on 30 November 2016. Results Data were collected between 28 January 2014 and 06 April 2016. Two hundred and forty nine older prisoners were assigned TAU of which 32 transferred prison; 12 were released; 2 withdrew and 1 was deemed unsafe to interview. Two hundred and fifty three 3 prisoners were assigned the OHSCAP of which 33 transferred prison; 11 were released; 6 withdrew and 1 was deemed unsafe to interview. Consequently, data from 202 participants were analysed in each of the two groups. There were no significant differences in the number of unmet needs as measured by the Camberwell Assessment of Needs – Forensic Short Version (CANFOR-S). The mean number of unmet needs for the OHSCAP group at follow-up was 2.03 (SD = 2.07) and 2.06 (SD = 2.11) for the TAU group (mean difference = 0.088; 95% CI − 0.276 to 0.449, p = 0.621). No adverse events were reported. Conclusion The OHSCAP was fundamentally not implemented as planned, partly due to the national prison staffing crisis that ensued during the study period. Therefore, those receiving the OHSCAP did not experience improved outcomes compared to those who received TAU. Trial registration Current Controlled Trials: ISRCTN11841493 , 25/10/2012.

Abstract Background Colorectal cancer (CRC) disparities vary by country and population group, but often have spatial features. This study of the United States state of Virginia assessed CRC outcomes, and identified demographic, socioeconomic and healthcare access contributors to CRC disparities. Methods County- and city-level cross-sectional data for 2011–2015 CRC incidence, mortality, and mortality-incidence ratio (MIR) were analyzed for geographically determined clusters (hotspots and cold spots) and their correlates. Spatial regression examined predictors including proportion of African American (AA) residents, rural-urban status, socioeconomic (SES) index, CRC screening rate, and densities of primary care providers (PCP) and gastroenterologists. Stationarity, which assesses spatial equality, was examined with geographically weighted regression. Results For incidence, one CRC hotspot and two cold spots were identified, including one large hotspot for MIR in southwest Virginia. In the spatial distribution of mortality, no clusters were found. Rurality and AA population were most associated with incidence. SES index, rurality, and PCP density were associated with spatial distribution of mortality. SES index and rurality were associated with MIR. Local coefficients indicated stronger associations of predictor variables in the southwestern region. Conclusions Rurality, low SES, and racial distribution were important predictors of CRC incidence, mortality, and MIR. Regions with concentrations of one or more factors of disparities face additional hurdles to improving CRC outcomes. A large cluster of high MIR in southwest Virginia region requires further investigation to improve early cancer detection and support survivorship. Spatial analysis can identify high-disparity populations and be used to inform targeted cancer control programming.

Abstract Salicornia rubra is a commonly occurring annual species of the salt playas of the Great Basin Desert of the western United States. In such habitats, plants experience high levels of ultraviolet radiation, which could potentially damage DNA. As a member of the Amaranthaceae (Caryophyllales), S. rubra shoots typically contain high concentrations of the red‐violet pigments called betacyanins, which are ultraviolet‐absorbing compounds. Nevertheless, some specimens of S. rubra are green even when growing with full exposure to the sun. We, therefore, tested several hypotheses regarding the causes of variation among S. rubra plants in betacyanin concentration and the role of betacyanins in the absorption of ultraviolet radiation. We measured ultraviolet radiation absorption and the concentrations of betacyanins and phenolic compounds of the cell sap expressed from red and green plants growing in full sun, as well as plants grown under various levels of shade. We found that while betacyanin concentrations were predictable from plant color (red plants contained more betacyanins than green plants), the ability to absorb ultraviolet radiation was determined primarily by the concentration of phenolic compounds, which was determined by the level of exposure to the sun. Therefore, the DNA of green plants growing in full sun appears to be at no greater risk than the DNA of red plants.

Summary: Background: The initiation and cessation of opioid agonist treatment (OAT) have both been associated with elevated risk of fatal overdose. We examined risk of non-fatal overdose during OAT initiation and cessation and specifically between methadone versus buprenorphine recipients. Methods: We utilised primary care electronic health records from the Clinical Practice Research Datalink to delineate a study cohort of adults aged 18-64 who were prescribed OAT between Jan 1, 1998 and Dec 31, 2017. These records were linked to hospitalisation, mortality records and patient neighbourhood and practice-level Index of Multiple Deprivation quintiles. With inverse probability treatment weights applied and negative binomial regression models we estimated incidence rate ratios for hospital admissions among patients who experienced multiple overdoses. Findings: A total of 20898 patients were prescribed methadone or buprenorphine over 83856 person-years of follow-up. Compared with periods in treatment, patients not in treatment were 51% more likely to experience a non-fatal overdose that required hospitalisation (weighted rate ratio, wRR 1·51; 95% CI 1·42, 1·60), especially during the four weeks of OAT initiation (5·59; 5·31, 5·89) and following cessation (13·39; 12·78, 14·03). The wRR of overdose during (0·37; 0·34, 0·39) and after treatment (0·36; 0·34, 0·38) favoured buprenorphine compared to methadone. Interpretation: OAT is associated with decreased non-fatal overdose risk. Buprenorphine may act more protectively than methadone, especially during the first four weeks of treatment. Funding: National Institute for Health and Care Research (NIHR) Greater Manchester Patient Safety Translational Research Centre (PSTRC-2016-003).

Summary: Background: Predicted increases in suicide were not generally observed in the early months of the COVID-19 pandemic. However, the picture may be changing and patterns might vary across demographic groups. We aimed to provide a timely, granular picture of the pandemic's impact on suicides globally. Methods: We identified suicide data from official public-sector sources for countries/areas-within-countries, searching websites and academic literature and contacting data custodians and authors as necessary. We sent our first data request on 22nd June 2021 and stopped collecting data on 31st October 2021. We used interrupted time series (ITS) analyses to model the association between the pandemic's emergence and total suicides and suicides by sex-, age- and sex-by-age in each country/area-within-country. We compared the observed and expected numbers of suicides in the pandemic's first nine and first 10-15 months and used meta-regression to explore sources of variation. Findings: We sourced data from 33 countries (24 high-income, six upper-middle-income, three lower-middle-income; 25 with whole-country data, 12 with data for area(s)-within-the-country, four with both). There was no evidence of greater-than-expected numbers of suicides in the majority of countries/areas-within-countries in any analysis; more commonly, there was evidence of lower-than-expected numbers. Certain sex, age and sex-by-age groups stood out as potentially concerning, but these were not consistent across countries/areas-within-countries. In the meta-regression, different patterns were not explained by countries’ COVID-19 mortality rate, stringency of public health response, economic support level, or presence of a national suicide prevention strategy. Nor were they explained by countries’ income level, although the meta-regression only included data from high-income and upper-middle-income countries, and there were suggestions from the ITS analyses that lower-middle-income countries fared less well. Interpretation: Although there are some countries/areas-within-countries where overall suicide numbers and numbers for certain sex- and age-based groups are greater-than-expected, these countries/areas-within-countries are in the minority. Any upward movement in suicide numbers in any place or group is concerning, and we need to remain alert to and respond to changes as the pandemic and its mental health and economic consequences continue. Funding: None.

Dual harm is the co-occurrence of self-harm and aggression during an individual’s lifetime. This behaviour is especially prevalent within criminal justice and forensic settings. The forms of aggression that should be included in the definition of dual harm have not yet been established. This study aimed to use network analysis to inform an evidence-based definition of dual harm by assessing the relationship between self-harm and different forms of aggressive behaviour in young people (N = 3,579). We used data from the Avon Longitudinal Study of Parents and Children (ALSPAC). Results revealed low correlations between the variables, leading to sparse network models with weak connections. We found that when separated into their distinct forms, aggressive acts and self-harm are only weakly correlated. Our work provides preliminary evidence to assist in understanding and managing dual harm within clinical and forensic settings and informs recommendations for future research.

BackgroundLittle is known about people who are admitted to medium secure services (MSSs) from prison, including characteristics and factors that influence clinical pathways and subsequent discharge. We recently published the first study to establish the circumstances by which MSS “prison-transfer” patients are returned to prison. Of particular concern was the finding that a quarter of prison-transfer patients were returned to prison by Responsible Medical Officers (RMOs) because they were not engaging with treatment or were deemed too “high risk” to remain detained within the services, circumstances that would be unacceptable when considering discharge via a community care pathway. It is important to further explore the characteristics of people admitted to MSSs from prison, and to investigate how these may differ for individuals who are returned to prison, as compared to those discharged into the community.Aim(a) To describe the characteristics of prison-transfers who receive an RMO directed discharge from MSSs; and (b) to compare these characteristics by discharge destination; prison return and community discharge.MethodsProspective cohort comparative study: all prison-transfer patients discharged under the instruction of their RMO over a 6-month period, from 33 NHS medium secure units across England and Wales. Data on patient demographic, clinical and legal characteristics were extracted via full patient health record review and collateral information from clinicians was also obtained. This information was used to complete The Historical, Clinical and Risk-−20 items (HCR-20v3) and The Structured Assessment of Protective Factors (SAPROF). Individuals who were returned to prison were compared with those who were discharged to the community.ResultsPersons returned to prison represented a vulnerable group at time of discharge as compared to those discharged into the community and had a significantly shorter length of stay in MSSs. Over half of those returned to prison had a length of stay of

Abstract Background There has been growing concern in the UK over recent years that a perceived mental health crisis is affecting children and adolescents, although published epidemiological evidence is limited. Methods Two population-based UK primary care cohorts were delineated in the Aurum and GOLD datasets of the Clinical Practice Research Datalink (CPRD). We included data from 9,133,246 individuals aged 1–20 who contributed 117,682,651 person-years of observation time. Sex- and age-stratified annual incidence rates were estimated for attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) (age groups: 1–5, 6–9, 10–12, 13–16, 17–19), depression, anxiety disorders (6–9, 10–12, 13–16, 17–19), eating disorders and self-harm (10–12, 13–16, 17–19) during 2003–2018. We fitted negative binomial regressions to estimate incidence rate ratios (IRRs) to examine change in incidence between the first (2003) and final year (2018) year of observation and to examine sex-specific incidence. Results The results indicated that the overall incidence has increased substantially in both boys and girls in between 2003 and 2018 for anxiety disorders (IRR 3.51 95% CI 3.18–3.89), depression (2.37; 2.03–2.77), ASD (2.36; 1.72–3.26), ADHD (2.3; 1.73–3.25), and self-harm (2.25; 1.82–2.79). The incidence for eating disorders also increased (IRR 1.3 95% CI 1.06–1.61), but less sharply. The incidence of anxiety disorders, depression, self-harm and eating disorders was in absolute terms higher in girls, whereas the opposite was true for the incidence of ADHD and ASD, which were higher among boys. The largest relative increases in incidence were observed for neurodevelopmental disorders, particularly among girls diagnosed with ADHD or ASD. However, in absolute terms, the incidence was much higher for depression and anxiety disorders. Conclusion The number of young people seeking help for psychological distress appears to have increased in recent years. Changes to diagnostic criteria, reduced stigma, and increased awareness may partly explain our results, but we cannot rule out true increases in incidence occurring in the population. Whatever the explanation, the marked rise in demand for healthcare services means that it may be more challenging for affected young people to promptly access the care and support that they need.

Abstract Background Patient and public involvement (PPI) is becoming more commonplace in mental health research. There are strong moral and ethical arguments for good quality PPI. Few studies have documented and evaluated PPI in self‐harm and suicide research. Inconsistent reporting of PPI makes it difficult to discern practices that deliver quality, effective and meaningful involvement. It is important to understand and address emotional support needs of PPI members contributing to sensitive topics such as suicide and self‐harm. Therefore, this study will examine the effect of PPI on self‐harm and suicide research and explore patients', carers' and researchers' experiences and views in relation to the quality of PPI practice and provision of appropriate support for PPI members. Methods This protocol outlines the longitudinal, mixed methodological approach that will be taken. Qualitative and quantitative data will be collected via baseline and repeated questionnaires, document review and semi‐structured interviews. Both PPI members and researchers will be invited to participate in this study. The two‐year data collection period will enable evaluation of PPI throughout the entire research cycle. An integrated approach will be taken to data analysis, using inductive thematic analysis and descriptive and repeated measures analyses, to address specified study aims. Dissemination Findings from this study will inform practical guidance to support self‐harm and suicide researchers in effectively involving people with experiential knowledge in their research. Analyses will offer insight into the effect of PPI throughout the research process and assess changes in PPI members' and researchers' experiences of involvement across a two‐year period.

Abstract Background Links between parental socioeconomic position during childhood and subsequent risks of developing mental disorders have rarely been examined across the diagnostic spectrum. We conducted a comprehensive analysis of parental income level, including income mobility, during childhood and risks for developing mental disorders diagnosed in secondary care in young adulthood. Methods National cohort study of persons born in Denmark 1980–2000 (N = 1,051,265). Parental income was measured during birth year and at ages 5, 10 and 15. Follow-up began from 15th birthday until mental disorder diagnosis or 31 December 2016, whichever occurred first. Hazard ratios and cumulative incidence were estimated. Results A quarter (25.2%; 95% CI 24.8–25.6%) of children born in the lowest income quintile families will have a secondary care-diagnosed mental disorder by age 37, versus 13.5% (13.2–13.9%) of those born in the highest income quintile. Longer time spent living in low-income families was associated with higher risks of developing mental disorders. Associations were strongest for substance misuse and personality disorders and weaker for mood disorders and anxiety/somatoform disorders. An exception was eating disorders, with low parental income being associated with attenuated risk. For all diagnostic categories examined except for eating disorders, downward socioeconomic mobility was linked with higher subsequent risk and upward socioeconomic mobility with lower subsequent risk of developing mental disorders. Conclusions Except for eating disorders, low parental income during childhood is associated with subsequent increased risk of mental disorders diagnosed in secondary care across the diagnostic spectrum. Early interventions to mitigate the disadvantages linked with low income, and better opportunities for upward socioeconomic mobility could reduce social and mental health inequalities.

ABSTRACT Pesticide environmental risks and increased weed resistance have encouraged studies for alternatives to herbicides. Among these are weed thermal control methods by controlled heat application machines. Thus, this study aimed to test a prototype of heat-applicator machine as a function of changes in gas pressure, travel speed, and tire traffic effect on plants. Then, three experimental factors were tested: gas pressure (98, 196, and 245 kPa), travel speed (0.56, 0.78, and 1.17 m s−1), and tire traffic effect on plants (with and without traffic). The results showed that tire traffic effect on plants and subsequent heat application had no effect on control rate. Weed control rates reached levels considered satisfactory using a heat application speed of 0.56 m s−1 associated with gas pressures of 245 or 196 kPa, as well as a heat application speed of 0.78 m s−1 associated with a gas pressure of 245 kPa. A total between 60.9 and 84.9 kg ha−1 liquefied petroleum gas was required for weed control of around 80%.

Abstract Background In primary care there is a need for more quality measures of person-centered outcomes, especially ones applicable to patients with multiple chronic conditions (MCCs). The aim of this study was to derive and validate a short-form version of the Patient Experience with Treatment and Self-management (PETS), an established measure of treatment burden, to help fill the gap in quality measurement. Methods Patient interviews (30) and provider surveys (30) were used to winnow items from the PETS (60 items) to a subset targeting person-centered care quality. Results were reviewed by a panel of healthcare providers and health-services researchers who finalized a pilot version. The Brief PETS was tested in surveys of 200 clinic and 200 community-dwelling MCC patients. Surveys containing the Brief PETS and additional measures (e.g., health status, medication adherence, quality of care, demographics) were administered at baseline and follow-up. Correlations and t-tests were used to assess validity, including responsiveness to change of the Brief PETS. Effect sizes (ES) were calculated on mean differences. Results Winnowing and panel review resulted in a 34-item Brief PETS pilot measure that was tested in the combined sample of 400 (mean age = 57.9 years, 50% female, 48% white, median number of conditions = 5). Reliability of most scales was acceptable (alpha > 0.70). Brief PETS scores were associated with age, income, health status, and quality of chronic illness care at baseline (P

ABSTRACT The use of microgranular fertilizers is currently increasing, with low application rates as an obstacle in the mechanization. This study aimed to verify the performance of helical metering mechanisms using microgranular fertilizer. Four different fertilizer-metering mechanisms were tested at two pre-established dose rates (35 and 50 kg ha−1) and seven longitudinal angles (−15°, −10°, −5°, 0°, +5°, +10°, and +15°). The experiment was carried out according to Brazilian standards. The results showed that the longitudinal inclination affects the actual fertilizer dose in all tested metering systems. Metering mechanisms with a helicoid with longitudinal and lateral overflow presented a similar dose, according to the variation of the longitudinal inclination. The metering mechanism with two helicoids showed the highest dose variation, while the metering mechanism with a helical thread and longitudinal overflow, filled between the shaft and the helicoid, had the best performance.

Abstract Background Untreated antenatal depression and anxiety can be associated with short and long term health impacts on the pregnant woman, her infant and the rest of the family. Alternative interventions to those currently available are needed. This clinical trial aims to investigate the efficacy and safety of a broad-spectrum multinutrient formula as a treatment for symptoms of depression and anxiety in pregnant women and to determine the impact supplementation has on the general health and development of the infant. Methods This randomised, controlled trial will be conducted in Canterbury, New Zealand between April 2017 and June 2022. One hundred and twenty women aged over 16 years, between 12 and 24 weeks gestation and who score ≥ 13 on the Edinburgh Postnatal Depression Scale (EPDS) will be randomly assigned to take the intervention (n = 60) or an active control formula containing iodine and riboflavin (n = 60) for 12 weeks. After 12 weeks, participants can enter an open-label phase until the birth of their infant and naturalistically followed for the first 12 months postpartum. Infants will be followed until 12 months of age. Randomisation will be computer-generated, with allocation concealment by opaque sequentially numbered envelopes. Participants and the research team including data analysts will be blinded to group assignment. The EPDS and the Clinical Global Impressions Scale of Improvement (CGI-I) will be the maternal primary outcome measures of this study and will assess the incidence of depression and anxiety and the improvement of symptomatology respectively. Generalized linear mixed effects regression models will analyse statistical differences between the multinutrient and active control group on an intent-to-treat basis. A minimum of a three-point difference in EPDS scores between the groups will identify clinical significance. Pregnancy outcomes, adverse events and side effects will also be monitored and reported. Discussion Should the multinutrient formula be shown to be beneficial for both the mother and the infant, then an alternative treatment option that may also improve the biopsychosocial development of their infants can be provided for pregnant women experiencing symptoms of depression and anxiety. Trial registration Trial ID: ACTRN12617000354381 ; prospectively registered at Australian New Zealand Clinical Trials Registry on 08/03/2017.

Background Deaths in the first year of the Coronavirus Disease 2019 (COVID-19) pandemic in England and Wales were unevenly distributed socioeconomically and geographically. However, the full scale of inequalities may have been underestimated to date, as most measures of excess mortality do not adequately account for varying age profiles of deaths between social groups. We measured years of life lost (YLL) attributable to the pandemic, directly or indirectly, comparing mortality across geographic and socioeconomic groups. Methods and findings We used national mortality registers in England and Wales, from 27 December 2014 until 25 December 2020, covering 3,265,937 deaths. YLLs (main outcome) were calculated using 2019 single year sex-specific life tables for England and Wales. Interrupted time-series analyses, with panel time-series models, were used to estimate expected YLL by sex, geographical region, and deprivation quintile between 7 March 2020 and 25 December 2020 by cause: direct deaths (COVID-19 and other respiratory diseases), cardiovascular disease and diabetes, cancer, and other indirect deaths (all other causes). Excess YLL during the pandemic period were calculated by subtracting observed from expected values. Additional analyses focused on excess deaths for region and deprivation strata, by age-group. Between 7 March 2020 and 25 December 2020, there were an estimated 763,550 (95% CI: 696,826 to 830,273) excess YLL in England and Wales, equivalent to a 15% (95% CI: 14 to 16) increase in YLL compared to the equivalent time period in 2019. There was a strong deprivation gradient in all-cause excess YLL, with rates per 100,000 population ranging from 916 (95% CI: 820 to 1,012) for the least deprived quintile to 1,645 (95% CI: 1,472 to 1,819) for the most deprived. The differences in excess YLL between deprivation quintiles were greatest in younger age groups; for all-cause deaths, a mean of 9.1 years per death (95% CI: 8.2 to 10.0) were lost in the least deprived quintile, compared to 10.8 (95% CI: 10.0 to 11.6) in the most deprived; for COVID-19 and other respiratory deaths, a mean of 8.9 years per death (95% CI: 8.7 to 9.1) were lost in the least deprived quintile, compared to 11.2 (95% CI: 11.0 to 11.5) in the most deprived. For all-cause mortality, estimated deaths in the most deprived compared to the most affluent areas were much higher in younger age groups, but similar for those aged 85 or over. There was marked variability in both all-cause and direct excess YLL by region, with the highest rates in the North West. Limitations include the quasi-experimental nature of the research design and the requirement for accurate and timely recording. Conclusions In this study, we observed strong socioeconomic and geographical health inequalities in YLL, during the first calendar year of the COVID-19 pandemic. These were in line with long-standing existing inequalities in England and Wales, with the most deprived areas reporting the largest numbers in potential YLL. In a registry-based study, Evangelos Kontopantelis and colleagues examine the excess years of life lost to COVID-19 and other causes of death by sex, neighbourhood deprivation and region in England & Wales during 2020. Author summary Why was this study done? The Coronavirus Disease 2019 (COVID-19) pandemic generated large numbers of excess deaths (additional deaths over those predicted from trends in previous years). These excess deaths were also unevenly distributed across different geographic areas and socioeconomic groups, exacerbating prepandemic inequalities. Up to a quarter of the excess deaths during the pandemic were attributable to coronary heart disease, dementia, and other noninfectious causes, and not directly to COVID-19 infection. Most measures of excess deaths do not fully account for differences in the ages at which people die in different social groups. If the pandemic killed disproportionally more young people in more deprived areas, then inequalities resulting from the pandemic will have been underestimated. Measuring years of life lost (YLL) rather than excess deaths would address this problem. What did the researchers do and find? In England and Wales, there were an estimated 763,550 (95% CI: 696,826 to 830,273) excess YLL during the first 42 weeks of the pandemic, of which 15% were not directly attributed to COVID-19 or another respiratory cause. For all-cause mortality, estimated deaths in the most deprived compared to the most affluent areas were as follows: 11 times as many for 15- to 44-year-olds, 3 times as many for 45- to 64-year-olds, 40% higher in 75- to 84-year-olds, and not significantly higher for those aged 85 or over. This pattern of disproportionately higher mortality in younger age groups exacerbated prepandemic inequalities between the most and least deprived areas, and varied widely across regions, with the North West particularly affected. What do these findings mean? Inequalities between socioeconomic and geographic groups resulting from the COVID-19 pandemic are more pronounced than previously reported. Future plans to manage pandemics, including decisions about vaccination rollout, should include an understanding of regional and socioeconomic variation in YLL and how this has exacerbated long-standing health inequalities. Immediate and longer-term recovery planning for communities and their health and social services should reflect historical disparities as well as the impact of the pandemic on YLL. Limitations of this study include the observational nature of the data and the need for accurate and timely recording of the deaths and their causes.

Wetlands are the largest natural source of terrestrial CH4 emissions. Afforestation can enhance soil CH4 oxidation and decrease methanogenesis, yet the driving mechanisms leading to these effects remain unclear. We analyzed the structures of communities of methanogenic and methanotrophic microbes, quantification of mcrA and pmoA genes, the soil microbial metagenome, soil properties and CH4 fluxes in afforested and non-afforested areas in the marshland of the Yangtze River. Compared to the non-afforested land use types, net CH4 emission decreased from bare land, natural vegetation and 5-year forest plantation and transitioned to net CH4 sinks in the 10- and 20-year forest plantations. Both abundances of mcrA and pmoA genes decreased significantly with increasing plantation age. By combining random forest analysis and structural equation modeling, our results provide evidence for an important role of the abundance of functional genes related to methane production in explaining the net CH4 flux in this ecosystem. The structures of methanogenic and methanotrophic microbial communities were of lower importance as explanatory factors than functional genes in terms of in situ CH4 flux. We also found a substantial interaction between functional genes and soil properties in the control of CH4 flux, particularly soil particle size. Our study provides empirical evidence that microbial community function has more explanatory power than taxonomic microbial community structure with respect to in situ CH4 fluxes. This suggests that focusing on gene abundances obtained, e.g., through metagenomics or quantitative/digital PCR could be more effective than community profiling in predicting CH4 fluxes, and such data should be considered for ecosystem modeling.

There is widespread concern over the potential impact of the COVID-19 pandemic on suicide and self-harm globally, particularly in low- and middle-income countries (LMIC) where the burden of these behaviours is greatest. We synthesised the evidence from the published literature on the impact of the pandemic on suicide and self-harm in LMIC. This review is nested within a living systematic review (PROSPERO ID CRD42020183326) that continuously identifies published evidence (all languages) through a comprehensive automated search of multiple databases (PubMed; Scopus; medRxiv, PsyArXiv; SocArXiv; bioRxiv; the WHO COVID-19 database; and the COVID-19 Open Research Dataset by Semantic Scholar (up to 11/2020), including data from Microsoft Academic, Elsevier, arXiv and PubMed Central.) All articles identified by the 4th August 2021 were screened. Papers reporting on data from a LMIC and presenting evidence on the impact of the pandemic on suicide or self-harm were included. Methodological quality was assessed using an appropriate tool, and a narrative synthesis presented. A total of 22 studies from LMIC were identified representing data from 12 countries. There was an absence of data from Africa, the Pacific, and the Caribbean. The reviewed studies mostly report on the early months of COVID-19 and were generally methodologically poor. Few studies directly assessed the impact of the pandemic. The most robust evidence, from time-series studies, indicate either a reduction or no change in suicide and self-harm behaviour. As LMIC continue to experience repeated waves of the virus and increased associated mortality, against a backdrop of vaccine inaccessibility and limited welfare support, continued efforts are needed to track the indirect impact of the pandemic on suicide and self-harm in these countries.

Many endophytic fungi have the potential to function as saprotrophs when living host tissues senesce and enter the litter pool. The consumption of plant litter by fungi obviously requires moisture but, in the arid, western USA, the native range of Quercus gambelii Nutt., most of the precipitation occurs during the coldest months of the year. Therefore, we hypothesized that the endophytic fungi of Q. gambelii have the potential to function as psychrotolerant saprotrophs, which we defined in this study as an organism capable of significant growth on leaf litter at 5°C. We further hypothesized that a tradeoff exists between growth of endophytic fungi at 5°C and at 17°C such that fungal isolates are either cold- or warm-temperature specialists. Consistent with our first hypothesis, we found that 36 of our 40 isolates consumed leaf litter at 5°C, but there was a surprisingly high degree of variability among isolates in this ability, even among isolates of a given species. Contrary to our second hypothesis, there was no tradeoff between saprotrophic growth at 5°C and saprotrophic growth at 17°C. Indeed, the isolates that grew poorly as saprotrophs at 5°C were generally those that grew poorly as saprotrophs at 17°C. By virtue of being endophytic, endophytic fungi have priority in litter over decomposer fungi that colonize plant tissues only after they enter the litter pool. Moreover, by virtue of being psychrotolerant, some endophytic fungi may function as saprotrophs during the cold months of the year when moisture is temporarily available. Therefore, we suggest that some endophytic fungi of Q. gambelii could play significant ecosystem roles in litter decomposition and nutrient cycling.

The low-lying structure of 15C has been investigated via the neutron-removal d(16C, t) reaction. The experiment was performed at GANIL using a secondary 16C beam produced by fragmentation in the LISE spectrometer at 17.2 MeV/nucleon with an intensity of 5 × 104 pps and 100% purity. The angle and energy of the light ejectile were detected by three MUST2 telescopes. The missing mass technique was used to reconstruct the excitation energy of 15C. In this spectrum, two bound states were observed (gs and the first excited state) and two unbound resonant states above the neutron separation threshold (S n = 1.218 MeV). From the differential cross sections, information on the angular momentum of the transferred nucleon and spectroscopic factors were deduced. The excitation energies and the deduced spectroscopic factors of the negative parity states placed above the neutron separation energy are an important measurement of the 2p-1h configurations in 15C. Our results show good agreement with shell-model calculations with the YSOX interaction and show a sensitivity to the N=8 shell gap.

Over the past decade, inverse kinematics has been increasingly employed in experimental studies of fission. This approach has yielded a wealth of new observables that can be obtained in single measurements, enabling their analysis and correlations. One ongoing application of this technique involves a series of experiments performed at GANIL using the variable-mode, large-acceptance VAMOS++ spectrometer. A recent experiment focused on examining the survival of nuclear structure effects at high excitation energy in both fission and quasi-fission. The results of the study involved a full isotopic identification of fragments, as well as an analysis of the elemental yields their relation to fission dynamics. The results indicate that fission and quasi-fission involve different mechanisms, which could be exploited to distinguish between the two phenomena.

During the last decade, the use of inverse kinematics in the experimental study of fission is bringing a wealth of new observables obtained in single measurements, allowing their analysis and their correlations. An ongoing application of this technique is the basis of a series of experiments performed with the variable-mode, large-acceptance VAMOS++ spectrometer at GANIL. A recent experiment has been focused on the survival of the nuclear structure effects at high excitation energy in fission and quasi-fission. The full isotopic identification of fragments, the fission dynamics and the ratio between the production of fragments with even and odd atomic numbers, the so-called proton even-odd effect, are shown. The latter shows a different mechanism for fission and quasi-fission that could be used to separate fission from quasi-fission.

Background: The COVID-19 pandemic has had an impact on the mental health of healthcare and social care workers, and its potential effect on suicidal thoughts and behaviour is of particular concern. Methods: This systematic review identified and appraised the published literature that has reported on the impact of COVID-19 on suicidal thoughts and behaviour and self-harm amongst healthcare and social care workers worldwide up to May 31, 2021. Results: Out of 37 potentially relevant papers identified, ten met our eligibility criteria. Our review has highlighted that the impact of COVID-19 has varied as a function of setting, working relationships, occupational roles, and psychiatric comorbidities. Limitations: There have been no completed cohort studies comparing pre- and post-pandemic suicidal thoughts and behaviours. It is possible some papers may have been missed in the search. Conclusions: The current quality of evidence pertaining to suicidal behaviour in healthcare workers is poor, and evidence is entirely absent for those working in social care. The clinical relevance of this work is to bring attention to what evidence exists, and to encourage, in practice, proactive approaches to interventions for improving healthcare and social care worker mental health.

Background Community treatment orders (CTOs) enable patients to be treated in the community rather than under detention in hospital. Population-based studies of suicide among patients subject to a CTO are scarce. Aims To compare suicide rates among patients subject to a CTO with all discharged psychiatric patients and those detained for treatment but not subject to a CTO at discharge (‘CTO-eligible’ patients). Method From a national case series of patients who died by suicide within 12 months of contact with mental health services in England during 2009–2018, we estimated average annual suicide rates for all discharged patients, those on a CTO at the time of suicide, those ever treated under a CTO and CTO-eligible patients. Results Suicide rates for patients on a CTO at the time of suicide (191.3 per 100 000 patients) were lower than all discharged patients (482.3 per 100 000 discharges). Suicide rates were similar in those ever treated under a CTO (350.1 per 100 000 CTOs issued) and in CTO-eligible patients (382.9 per 100 000 discharges). Suicide rates within 12 months of discharge were higher in persons ever under a CTO (205.1 per 100 000 CTOs issued) than CTO-eligible patients (161.5 per 100 000 discharges), but this difference was reversed for rates after 12 months of discharge (153.2 per 100 000 CTOs issued v. 223.4 per 100 000 discharges). Conclusions CTOs may be effective in reducing suicide risk. The relative benefits of CTOs and intensive aftercare may be time-dependent, with the benefit of a CTO being less before 12 months after discharge but greater thereafter. CTO utilisation requires a careful balancing of patient safety versus autonomy.

Summary: Background: Surveillance of temporal trends in clinically treated self-harm is an important component of suicide prevention in the dynamic context of COVID-19. There is little evidence beyond the initial months following the onset of the pandemic, despite national and regional restrictions persisting to mid-2021. Methods: Descriptive time series analysis utilizing de-identified, primary care health records of 2.8 million patients from the Greater Manchester Care Record. Frequencies of self-harm episodes between 1st January 2019 and 31st May 2021 were examined, including stratification by sex, age group, ethnicity, and index of multiple deprivation quintile. Findings: There were 33,444 episodes of self-harm by 13,148 individuals recorded during the study period. Frequency ratios of incident and all episodes of self-harm were 0.59 (95% CI 0.51 to 0.69) and 0.69 (CI 0.63 to 0.75) respectively in April 2020 compared to February 2020. Between August 2020 and May 2021 frequency ratios were 0.92 (CI 0.88 to 0.96) for incident episodes and 0.86 (CI 0.84 to 0.88) for all episodes compared to the same months in 2019. Reductions were largest among men and people living in the most deprived neighbourhoods, while an increase in all-episode self-harm was observed for adolescents aged 10–17. Interpretation: Reductions in primary care-recorded self-harm persisted to May 2021, though they were less marked than in April 2020 during the first national lockdown. The observed reductions could represent longer term reluctance to seek help from health services. Our findings have implications for the ability for services to offer recommended care for patients who have harmed themselves.

Background: The COVID-19 pandemic has caused considerable morbidity, mortality and disruption to people’s lives around the world. There are concerns that rates of suicide and suicidal behaviour may rise during and in its aftermath. Our living systematic review synthesises findings from emerging literature on incidence and prevalence of suicidal behaviour as well as suicide prevention efforts in relation to COVID-19, with this iteration synthesising relevant evidence up to 19th October 2020. Method: Automated daily searches feed into a web-based database with screening and data extraction functionalities. Eligibility criteria include incidence/prevalence of suicidal behaviour, exposure-outcome relationships and effects of interventions in relation to the COVID-19 pandemic. Outcomes of interest are suicide, self-harm or attempted suicide and suicidal thoughts. No restrictions are placed on language or study type, except for single-person case reports. We exclude one-off cross-sectional studies without either pre-pandemic measures or comparisons of COVID-19 positive vs. unaffected individuals. Results: Searches identified 6,226 articles. Seventy-eight articles met our inclusion criteria. We identified a further 64 relevant cross-sectional studies that did not meet our revised inclusion criteria. Thirty-four articles were not peer-reviewed (e.g. research letters, pre-prints). All articles were based on observational studies. There was no consistent evidence of a rise in suicide but many studies noted adverse economic effects were evolving. There was evidence of a rise in community distress, fall in hospital presentation for suicidal behaviour and early evidence of an increased frequency of suicidal thoughts in those who had become infected with COVID-19. Conclusions: Research evidence of the impact of COVID-19 on suicidal behaviour is accumulating rapidly. This living review provides a regular synthesis of the most up-to-date research evidence to guide public health and clinical policy to mitigate the impact of COVID-19 on suicide risk as the longer term impacts of the pandemic on suicide risk are researched.

Abstract Background Suicide and non-fatal self-harm represent key patient safety events in mental healthcare services. However, additional important learning can also be derived by highlighting examples of optimal practice that help to keep patients safe. In this study, we aimed to explore clinicians’ views of what constitutes good practice in mental healthcare services in the context of suicide prevention. Methods Data were extracted from the National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH) database, a consecutive case series study of suicide by people in contact with mental healthcare services. A large national sample of clinicians’ responses was analysed with a hybrid thematic analysis. Results Responses (n = 2331) were submitted by clinicians across 62 mental healthcare providers. The following five themes illustrated good practice that helps to: 1) promote safer environments, 2) develop stronger relationships with patients and families, 3) provide timely access to tailored and appropriate care, 4) facilitate seamless transitions, and 5) establish a sufficiently skilled, resourced and supported staff team. Conclusion This study highlighted clinicians’ views on key elements of good practice in mental health services. Respondents included practice specific to mental health services that focus on enhancing patient safety via prevention of self-harm and suicide. Clinicians possess important understanding of optimal practice but there are few opportunities to share such insight on a broader scale. A further challenge is to implement optimal practice into routine, daily care to improve patient safety and reduce suicide risk.

Ultra-smooth metal structures are increasingly important in nanoscale device applications, from photonics to molecular electronics and 2D material growth. We describe three methods for achieving ultra-smooth platinum: patterned template stripping, chemical mechanical polishing and giant grain growth. Specifically, we demonstrate 1) the first use of spin-on glass as an adhesive for the transfer of a patterned platinum film via template stripping, enabling the film to be exposed to harsher solvents and at higher temperatures; 2) an updated CMP process for platinum with slurry materials that are currently available; 3) a giant grain growth process on a 4″ quartz substrate that uses a thinner Pt film than previously reported. Overall, root mean squared film roughness was decreased from ~14 Å for as-deposited platinum to

Chromatophores in cephalopod skin are known for fast changes in coloration due to light-scattering pigment granules. Here, authors demonstrate structural coloration facilitated by reflectin in sheath cells and offer insights into the interplay between structural and pigmentary coloration elements.