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Utilisation of mental health services before, during, and after COVID-19 restrictions: interrupted time-series analysis in England
Get PDFBackground: During the Coronavirus Disease 2019 (COVID-19) pandemic, the World Health Organisation reported a 25% increase in anxiety and depression, and multiple studies indicated that COVID-19 experiences might increase the prevalence of mental illness with subsequent high demands on mental health (MH) services. However, few studies have focussed upon MH across the entire period of pandemic restrictions within England or considered implications for pandemic preparedness. Methods: We conducted an interrupted time-series analysis of MH service utilisation across England's National Health Service, including primary care consultations, emergency department attendances, and telephone advice line contacts. The study period was January 1st 2019 to April 20th 2022. Using data from before and after pandemic restrictions, negative binomial regression models generated expected MH utilisation if the pandemic had not occurred. Expected and observed MH utilisation were compared. MH service indicators were analysed both overall and stratified by age group. Results: Early restrictions saw significant declines in access to MH services, telephone calls for MH advice reduced by 36.8% (95% CI -42.0, -31.9) and in hours consultations for depression decreased by 64.6% (95% CI -77.8, -53.3). Later restrictions revealed an increase in consultations in primary care for anxiety, with an increase of 41.8% (95% CI 38.7, 44.7) in out of hours. By the final period of restrictions, most MH indicators had either returned to expected levels or were significantly above expected presentations. Young people (15-24) exhibited MH utilisation differences —sharply reduced anxiety and MH during initial restrictions but increasing anxiety in later restrictions within primary care. Conclusions: COVID-19 restrictions were associated with overall decreases in the utilisation of MH services but increases from in person to remote services were observed. For future pandemic preparedness, remotely accessible MH services are important when in-person services are reduced and the surveillance sources used in this study offers the possibility of real-time decision making
SP-02 Clearing the way: co-produced solutions to improve the management of cough and secretions in motor neurone disease
No full textIntroduction: Respiratory and oropharyngeal secretions present significant challenges in motor neurone disease (MND). Symptoms such as choking and impaired cough compromise quality of life, place burdens on unpaid carers, and limit the effectiveness of interventions including non-invasive ventilation. Despite their prevalence, good symptom management is rare. Aims: The session Aims to: Describe the complexity of secretion management in MND. Consider the Impact of cough, choking, and secretion difficulties on patients and carers. Present emerging evidence and co-produced interventions to improve practice. Methods: Speakers will present perspectives informed by clinical research and co-production with people living with MND. Topics include healthcare professional challenges, development of assessment tools, co-designed clinical management plans for choking, and approaches to sialorrhea management in complex neurological disability. A person living with MND will provide a lived experience perspective. The 45-minute session will combine structured presentations with panel discussion and case studies. Results: The session will highlight the multifactorial nature of secretion management, the need for individualised approaches to cough augmentation, and the importance of equipping clinicians with confidence to respond to choking episodes. Co-production with patients and carers will underpin practical guidance and assessment tools, ensuring interventions are clinically relevant and acceptable. Lessons from specialist neurological care will broaden understanding of transferable strategies for secretion management. Conclusion: Effective management of cough and secretions in MND require integrated, patient-centred solutions. Collaborative approaches between clinicians, researchers, and people living with MND will generate interventions that address unmet needs in palliative care. Impact: This work will strengthen professional knowledge and confidence, support equitable palliative care for non-cancer conditions, and demonstrate the value of co-production. It will provide a model for improving symptom management and quality of life in MND and related neurodegenerative diseases
Few-Shot Video Object Segmentation in X-Ray Angiography Using Local Matching and Spatio-Temporal Consistency Loss
No full textHigh-quality, densely annotated data serve as a crucial foundation for developing robust X-ray angiography segmentation models. However, obtaining per-object pixel-level annotations in the medical domain is both expensive and time-consuming, often requiring close collaboration between clinical experts and developers. This paper aims to reduce the annotation costs of X-ray angiography videos by leveraging few-shot video object segmentation (FSVOS), which separates target objects from the background using only a single annotated frame during inference. We introduce a novel FSVOS model that employs a local matching strategy to restrict the search space to the most relevant neighboring pixels. Rather than relying on inefficient standard im2col-like implementations (e.g., spatial convolutions, depthwise convolutions and feature-shifting mechanisms) or hardware-specific CUDA kernels (e.g., deformable and neighborhood attention), which often suffer from limited portability across non-CUDA devices, we reorganize the local sampling process through a direction-based sampling perspective. Specifically, we implement a non-parametric sampling mechanism that enables dynamically varying sampling regions. This approach provides the flexibility to adapt to diverse spatial structures without the computational costs of parametric layers and the need for model retraining. To further enhance feature coherence across frames, we design a supervised spatio-temporal contrastive learning scheme that enforces consistency in feature representations. In addition, we introduce a publicly available benchmark dataset for multi-object segmentation in X-ray angiography videos (MOSXAV), featuring detailed, manually labeled segmentation ground truth. Extensive experiments on the CADICA, XACV, and MOSXAV datasets show that our proposed FSVOS method outperforms current state-of-the-art video segmentation methods in terms of segmentation accuracy and generalization capability (i.e., seen and unseen categories). This work offers enhanced flexibility and potential for a wide range of clinical applications. Our code will be made publicly available
Global trends and socioeconomic disparities in cancer burden among adolescents and young adults, 1990-2021
No full textBackground: Adolescents and young adults (AYAs, 10–24 years) constitute a distinct cancer population in whom malignancy arises during critical life transitions yet leads to substantial long-term morbidity and socioeconomic consequences. However, their global cancer burden and risk-factor profile remain incompletely characterized, especially in low- and middle-income settings. Methods: We conducted a secondary analysis of the Global Burden of Disease 2021 dataset, synthesizing estimates of cancer incidence, mortality, and disability-adjusted life years (DALYs) for 32 cancer types among AYAs across 204 countries and territories. Temporal trends (1990–2021) and associations with the socio-demographic index (SDI) were evaluated using log-linear and Spearman’s correlation analyses. Results: Globally, from 1990 to 2021, AYA cancer incidence rose slightly (+0.12% per year), while mortality and DALY rates declined (−1.02% per year). The fastest-rising incidence involved multiple myeloma (2.39% annually), breast, testicular, thyroid, and prostate cancers, whereas stomach, liver, esophageal, nasopharynx, and lung showed the steepest declines. In 2021, incidence correlated positively with SDI, but mortality and DALY rates correlated negatively. Modifiable risks accounted for 4.32% of DALYs, dominated by unsafe sex (2.54%) in low-SDI regions versus high body mass index (0.83%) and alcohol (0.64%) in higher-SDI settings. Conclusions: Global AYA cancer epidemiology reveals substantial geographical, temporal, and socioeconomic disparities. Rising incidence and burden of certain cancers highlight unmet prevention and diagnostic needs. Effective interventions, particularly targeting modifiable risks and promoting equitable healthcare access, are essential to reduce the global burden of AYA cancers
The first seismo-volcanological observatory on Montserrat
No full textThe first seismo-volcanological observatory in the anglophone Caribbean was established on Montserrat in 1936, in response to a volcano-seismic crisis that began with repeated felt events in 1933. Staff at Montserrat's agricultural office began routinely recording earthquake shocks in 1934. In 1936, following a scientific expedition dispatched by the Royal Society, an observatory was established at the Grove Botanical Station, Plymouth. This was run by volcano-seismic observers who managed an instrumental network, and monitored gas and steam emissions and air quality. The observatory functioned until 1946. We reconstruct the decision-making and evolution of the instrument networks as the observatory was established, and highlight the personnel involved, including the first female seismo-volcanic observer on Montserrat, Greta Scotland. Observations from the 1930s crisis emphasise the persistent seismicity and gas emissions associated with this extended episode of unrest, and suggest that there were minor phreatic explosions at the height of the crisis. We draw parallels with long-term observations of the activity of the Soufrière Hills Volcano since the 1990s
When 'Yes' Means No: Understanding Infiltration as Refusal of Cultural Heritage Research in Palestine
No full textSix experiments to understand the use of stone battle-axes and axe-hammers from northern Britain and the Isle of Man through experimental archaeology and use-wear analysis
No full textA combined approach of use-wear analysis and experimental archaeology can be highly beneficial when assessing the functionalities and itineraries of artefacts and has huge potential for analysis of bladed ground and polished stone artefacts. Despite this, their application to bladed ground and polished stone artefacts is limited. The function of bladed ground stone artefacts, such as British and Manx Early Bronze Age (EBA) ground and polished stone battle-axes and axe-hammers, are often based on form and the damage which is visible macroscopically. This approach can lead to productive hypotheses, but only when methods are devised which can test such propositions. This paper presents the first application of experimental archaeology combined with use-wear analysis to question the non-functional hypotheses of northern British and Manx battle-axes and axe-hammers. Successful comparison with the archaeological records was enabled by analysis of use-wear development throughout the experiments. The experiments included chopping and splitting wood, land clearance and animal slaughter. The research determines that these implements were utilitarian tools, which could be used easily when hafted correctly. As such, the application of the experimental and use-wear methodology created a reference collection of use-wear formations which can be comparable to other types of bladed stone tools and has been used to successfully infer the function of the archaeological assemblage of battle-axes and axe-hammers
Electronic and Inertial Effects of Methylation on Excited-State Hydrogen Transfer
No full textExcited-state intramolecular hydrogen transfer (ESIHT) is among the fastest chemical reactions and is a key design element in photoprotective molecules and functional chromophores. Despite the apparent simplicity of the symmetric HO−C�C−C�O ESIHT prototype, its multifunctional nature enables competing nonradiative decay channels, including C�C torsional motion. Here, we compare malonaldehyde (MA), the minimal motif, with its methylated derivative acetylacetone (AcAc) to investigate how electronic and inertial effects of methylation shape the ultrafast dynamics initiated on S2(ππ*). XMSCASPT2 nonadiabatic dynamics on the singlet manifold reveal bond-length alternation that drives the wavepacket toward the H-transfer intersection seam rather than undergoing torsional motion directly out of the Franck− Condon region. Methylation destabilizes the S1(nπ*) state, reducing the S2/S1-energy gap and enhancing the asymmetry of the Htransfer intersection seam. As a result, S2/S1-decay precedes H-transfer, which mostly takes place only after the population arrives on S1. Moreover, the methyl groups in AcAc introduce an inertial mismatch between the central methine hydrogen and the terminal methyl groups, which gives rise to two distinct behaviors on S1: (i) an early ballistic rise in ground-state population within ∼75 fs via twist-pyramidalized geometries akin to the behavior of α,β-enones and (ii) a slower repopulation through torsional motion, with the majority of the population remaining near the planar S1-minimum. In contrast, MA displays no ballistic channel. Our results for AcAc are consistent with recent time-resolved photoelectron spectroscopy, confirming the ultrafast S2-lifetime. We propose extending such experiments into the X-ray regime, where the evolution of the oxygen 1s binding energies offers direct, site-specific sensitivity to the H-transfer-mediated motion governing the early decay
Rethinking interlevel experiments: no remainder from evidence for causal relations
No full textThis paper examines the transformation of Craver’s (2009) mutual manipulability (MM) account into the matched interlevel experiments (MIE) framework (Craver et al., 2021) and argues that it amounts to a theoretical reduction of mechanistic constitutive relations to causal mediation. While the MIE account successfully resolves the incoherence challenge that plagued MM, it does so by eliminating the distinctive theoretical content that constitutive categories were supposed to provide. The processual reframing that enables this solution replaces hierarchical part-whole relationships with temporal causal sequences, changing what mechanistic explanations are understood to accomplish. Drawing on paradigmatic action potential experiments, I demonstrate that practices satisfying MIE’s formal requirements consistently establish causal mediation relationships without requiring constitutive interpretation. I address several theoretical defenses of constitutive categories—including interpretive objections about two types of constitution, arguments for distinctive explanatory value, and appeals to mechanistic levels—showing that none can rescue constitutive distinctiveness once constitution is explicitly identified with causal betweenness. Rather than undermining mechanistic approaches, this analysis suggests that their explanatory power derives from methodological sophistication in investigating complex, multi-scale causal structures rather than from categorically distinct constitutive relationships
Biodiversity implications of land-intensive carbon dioxide removal
Get PDFPathways consistent with global climate objectives typically deploy billions of tonnes of carbon dioxide removal (CDR) from land-intensive methods such as forestation and bioenergy with carbon capture and storage. Such large-scale deployment of land-intensive CDR may have negative consequences for biodiversity. Here we assess scenarios across five integrated assessment models and show that scenarios consistent with limiting warming to 1.5 °C allocate up to 13% of global areas of high biodiversity importance for land-intensive CDR. These overlaps are distributed unevenly, with higher shares in low- and middle-income countries. Understanding the potential conflicts between climate action and biodiversity conservation is crucial. An illustrative analysis shows that if current biodiversity hotspots were protected from land-use change, over half the land allocated for forestation and bioenergy with carbon capture and storage in the assessed scenarios would be unavailable unless synergies between climate and conservation goals are leveraged. Our analysis also indicates CDR-related biodiversity benefits due to avoided warming