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Climate Anxiety in Perspective: A Look at Dominant Stressors in Youth Mental Health and Sleep
Get PDFThere is growing evidence that climate anxiety is associated with significant effects on the mental health and wellbeing of young people. However, the relative importance of climate anxiety for young people's mental health has hitherto been unclear, as climate anxiety has largely been studied in isolation from other common stressors. This study sought to contextualize the significance of climate anxiety for the mental health of UK young adults relative to other concurrent psychological stressors. We surveyed university students (N = 461) and a general population sample aged 18–25 (N = 400). The results showed that while climate anxiety was significantly associated with poorer mental health and worse insomnia when examined alone, this association became nonsignificant or greatly diminished when other stressors were considered. Loneliness was found to be the most important predictor of mental health, and financial anxiety the most important predictor of insomnia severity. The findings suggest that climate anxiety, while concerning, may not be an especially dominant factor in young people's mental health. Our research highlights the need to consider the broader context of young people's lives, and the complex interplay of various psychological stressors, in efforts to map pathways between climate change and mental health
Cultural impacts on shared decision-making: A cross-European study of psychiatrist preferences in 38 countries
No full textBackground Shared decision-making (SDM) is a collaborative process between clinicians and service users to select treatment, guided by evidence and service user preferences. SDM has clinical, economic, and ethical benefits compared to clinician-led decision-making; yet, implementation remains challenging. An important knowledge gap is the influence of culture on implementation. Cultural impacts on service user decision-making preferences have been documented, but little is known about how culture impacts clinician preferences. This study examined associations between country-level cultural characteristics and decision-making preferences of psychiatrists in routine care settings across Europe. Methods We analysed data from 751 psychiatrists and trainees in 38 European countries, who completed the Clinical Decision-Making Style-Staff (CDMS-S) scale. Country-level Hofstede cultural dimensions were linked to CDMS-S scores using univariate and multivariate regression models. Mixed-effects models were used to account for country-level clustering and controlling for professional and economic variables. Results In univariate analyses, all six dimensions were associated with SDM preferences. However, only three remained significant in mixed-effects models. Higher levels of Indulgence and Individualism were associated with stronger preferences for SDM, while higher Power Distance was associated with more clinician-led decision-making. These associations did not remain significant in fully adjusted multivariate models, suggesting professional and systematic factors mediate cultural influences. Conclusions Indulgence, Individualism, and Power Distance are associated with psychiatrists' decision-making preferences across Europe. Culturally sensitive SDM interventions should address not only clinician attitudes but also healthcare structures and patient expectations. Findings offer an empirical foundation for tailoring SDM training and policy to diverse cultural contexts within European psychiatry
Unitization Based Memory Enhancement in Younger and Older Adults
Get PDFMemory for episodic associations declines with ageing due to decreased recollection abilities. Unitization—the encoding of multiple items as one integrated entity—has been shown to support familiarity-based retrieval that is independent of recollection and is relatively preserved in healthy ageing. Accordingly, unitization has been proposed as a promising strategy to attenuate age-related associative deficits, but evidence regarding its utility was lacking. The current study aimed to establish unitization as a viable mnemonic strategy. First, to ensure that unitization can attenuate the age-related associative deficit for initially unrelated materials, top-down unitization was used. Namely, participants were given an initially unrelated word pair in the context of either a definition which allows the words to be encoded as a unitized compound or a sentence in which the words are encoded as separate entities. Second, to ensure that unitization can be used as a self-initiated strategy, participants also completed the task by generating their own binding information (definitions/sentences). As expected, a unitization effect had emerged, such that associative memory was enhanced following definition encoding. However, this effect only occurred when binding information was provided. Additionally, a general memory advantage for the self-generation condition had emerged, but this was (generally) similar across unitization conditions and age groups. Taken together, the results show that unitization can be used as a mnemonic strategy under certain conditions, and highlight additional steps that should be taken before it can be effectively used beyond lab settings
The multidimensional relationship between alpha oscillations and cognition.
Get PDFAlpha oscillations are a robust neurophysiological phenomenon associated with cortical suppression and synaptic input gating, functionally interpreted as a mechanism of selective attention. Here we highlight known dissociations between alpha oscillations and selective attention that question the specificity of this interpretation. We postulate that the inconsistencies are accounted for when we consider alpha oscillations as a neurophysiological mechanism that tracks cortical excitability, but one that can be modulated by a multitude of factors that include but are not limited to selective attention and include bottom-up and top-down interactions, internal processes, and regulatory system influences on cortical excitability. Thus, reverse inference regarding the cognitive role of alpha modulations may depend on experimental context. Importantly, this perspective reiterates that there exists a significant need for research that disentangles the mechanistic bases of alpha oscillations across different cognitive phenomena
Plasma and Urinary KIM-1 in Chronic Kidney Disease: Prognostic Value, Associations with Albuminuria, and Implications for Kidney Failure and Mortality
Get PDFIntroductionKidney injury molecule-1 (KIM-1) expression reflects proximal renal tubular damage, but plasma and urine KIM-1 have not been jointly studied in a CKD cohort.MethodsPlasma and urine KIM-1 were measured in 2581 adults from the NURTuRE-CKD cohort, a multicentre, non-dialysis-dependent CKD cohort. Survival analyses, C-statistics, and net reclassification improvement were used to assess associations and predictive performance of plasma and urine KIM-1 for kidney failure (KF), all-cause mortality and a secondary endpoint of combined CKD progression end-point (CKE) (KF or >40% decline in eGFR) in the total cohort, and in KDIGO albuminuria categories, early CKD (eGFR >45ml/min/1.73m2) and four plasma/urine KIM-1 groups, dichotomised above and below the median value.ResultsMedian age was 65 years, baseline eGFR 34.8 ml/min/1.73m², and urine albumin-to-creatinine ratio (uACR) 22.3 mg/mmol. During median follow-up of 48.8 months, 616 (23.9%) participants developed KF, 817 (32%) experienced CKE and 344 (13.3%) died. Plasma and urine KIM-1 levels increased with lower eGFR, higher uACR, and diabetes. Plasma KIM-1 was independently associated with kidney failure, while urine KIM-1 was associated with pre-kidney failure death. The combination of high plasma and high urine KIM-1 conferred the greatest hazards of kidney failure and all-cause mortality. Combining plasma and urine KIM-1 led to a 24.1% improvement in net reclassification index for kidney failure. In earlier stages of CKD, both biomarkers were associated with CKD progression and there were large improvements in risk prediction for plasma KIM-1 alone. Increased albuminuria amplified the relationship between plasma and urine KIM-1 and kidney failure risk.ConclusionsThis study highlights distinct prognostic associations of plasma and urine KIM-1 in CKD. Measuring both may be useful in improving risk stratification in people with CKD. For early stage CKD the need to use a combined CKD progression end-point, including decline in eGFR, is emphasised as few of these people developed KF
Debate: Are we overpathologising young people's mental health? Research shows otherwise – mental health conditions are not being recognised or diagnosed in healthcare settings
Get PDFOver recent years, there have been increasing societal, political and media concerns in relation to the ‘over-diagnosis’ and ‘self-diagnosis’ of common mental health conditions or emotional disorders, such as depression and anxiety. Using two large research projects as illustrative examples, we highlight that there is a mismatch between concern about ‘over-pathologising’ young people's mental health and the recognition and diagnosis of emotional mental health conditions in health and care settings. Concerns around labelling risks us losing a shared understanding and language around mental health and mental health care, within services, between sectors, and for young people and families
Steady-State DC Offsets Suppression of the Dual Active Bridge Converter for More-Electric Aircraft Applications
Get PDFThe paper analyses the steady-state DC offset currents on both sides of the high-frequency transformer in a dual-active bridge (DAB) converter for more-electric aircraft (MEA) applications. These converters are widely used for high voltage-ratio power transfer between 270 and 28V DC buses, as well as for bidirectional energy exchange with storage devices. However, mismatched resistances in different commutation paths introduce DC components into the AC current waveforms on both sides of the converter. This effect is further exacerbated on the low voltage (LV) side due to the high voltage ratio, potentially leading to increased losses and performance degradation. To address this issue, this paper firstly developed a comprehensive model through detailed analysis of different operation modes of the DAB converter. Then, using this model, a proportion integration (PI) controller and a moving discretized control set model predictive control (MDCS-MPC) controller have been proposed and designed. A comparison is presented to illustrate the steady-state control performances between both control strategies. Both PI and MDCS-MPC controllers can mitigate the DC offset issue, but it seems MDCS-MPS is with much faster response. These findings have been validated with thorough simulation and experimental studies
Dynamic regulation of autophagy during Semliki Forest virus infection of neuroblastoma cells
Get PDFAutophagy can defend against infection by delivering viruses to lysosomes for degradation. Semliki Forest virus (SFV) is a positive-sense, single-stranded RNA virus of the alphavirus genus which has been used extensively as a model for arbovirus infection and neuronal encephalitis. Here, we show that autophagy is suppressed during the early hours of SFV infection of neurons. We also show that a switch between autophagy suppression and upregulation between the early and later stages was mediated through modulation of the mammalian target of rapamycin (mTOR) activity during infection. At later stages of infection, autophagosomes colocalize with SFV nonstructural proteins suggesting the formation of a platform for virus replication. Inhibition of mTOR by torin reduced infectious virus production and intracellular virus gene expression while improving cell survival during infection. The results suggest that autophagy is suppressed early during infection of neurons to increase cell survival and then upregulated at later times to facilitate replication. This biphasic regulation of autophagy seen for SFV may be important for other arboviruses, and knowledge about the regulation of autophagy by alphaviruses may be useful for the development of antiviral therapies
Outcomes from the urgent assessment pathway in selective ultrasonographic screening for developmental dysplasia of the hip (DDH)
No full textThe selective screening programme in the UK aims to identify infants with significant hip dysplasia for early intervention. The purpose of this study is to evaluate the impact of providing an urgent, early scan for infants where an objective hip abnormality has been identified in neonatal hip examination. A review of all children referred for an urgent hip scan between 1 January 2006 and 1 January 2021 was conducted to assess referral indications, treatment, and outcomes with a minimum 6-month follow-up. Pathological dysplasia was defined as Graf III or IV, while Graf IIA and IIC were considered immature due to the potential for spontaneous resolution. Exclusion criteria included children with their first scan after 6 weeks or those with neurodevelopmental disorders. A total of 226 eligible children were referred. Of these, 93.8% had scans within 4 weeks of life. Normal hips were identified in 119 (52.7%) infants. One child with an initially normal scan progressed to Graf III subluxation, eventually requiring open reduction; all other normal scans required no further intervention. Pathological dysplasia was identified in 28 infants; four required surgical reduction, 22 responded to the Pavlik harness, and two resolved spontaneously. Immature hips were observed in 79 children, with six Graf IIa and 12 Graf IIC hips requiring Pavlik harness treatment; none required surgery. In conclusion, urgent referrals constitute a modest portion of the overall hip screening workload but are beneficial for reassuring families of normal hips and enabling early, nonsurgical management of pathological hips
Validity and contributions to pain from the central aspects of pain questionnaire in rheumatoid arthritis
Get PDFIntroduction: The central nervous system (CNS) contributes to pain perception across musculoskeletal conditions. The central aspects of pain (CAP) questionnaire captures a single score associated with quantitative sensory testing (QST) evidence of CNS dysfunction validated in knee osteoarthritis.Objectives: Given the different pathophysiology of rheumatoid arthritis (RA), an inflammatory polyarthritis, this cross-sectional study assessed CAP's psychometric properties and its association with pain in RA.Methods: Adults with RA were recruited from Nottinghamshire, London, and Cardiff. Participants completed CAP and reported pain using a numerical rating scale. A subgroup underwent additional assessments, including quantitative sensory testing (QST; Pressure Pain detection Threshold, Temporal Summation, Conditioned Pain Modulation), Disease Activity Score-28, C-reactive protein, questionnaires addressing pain and related characteristics, and Central Sensitization Inventory short form (CSI-9). Cronbach alpha, confirmatory factor (CFA), and Rasch measurement theory assessed CAP's reliability and validity. Multivariable linear regression modelled contributions to pain by inflammation indices and CAP or CSI-9.Results: The 380 participants (73% female, median 63 years) reported average pain over the past 4 weeks of 6/10 and a CAP score of 9/16. Central aspects of pain demonstrated acceptable reliability (ICC(2,1) = 0.71), CFA fit (comparative fit index = 0.99, Tucker–Lewis index = 0.99, root mean square error of approximation = 0.034, standardized root mean residuals = 0.03), and internal consistency (α = 0.82). Central aspects of pain was significantly associated with pain (0.50 ≤ β ≤ 0.57) but not QST. Central aspects of pain explained 33% of pain variance, rising to 42% with inflammation, age, sex, and body mass index. Central Sensitization Inventory-9 correlated with pain, not QST and explained less pain variance than CAP.Conclusion: Central aspects of pain is reliable and valid for use with people with RA and explains RA pain variance better than inflammation or CSI-9
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