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Reality monitoring across disorders of reality:Systematic and narrative reviews of dissociation and psychosis
Get PDFReality monitoring is the ability to remember whether information was internally- or externally-generated and is often impaired in clinical populations. Though an altered sense of reality characterizes both dissociation and psychosis, no review has compared reality monitoring between them. This paper compares these fields to inform the relation between dissociation and psychosis and the role of reality monitoring in mental health. First, a systematic review identified four eligible high-quality papers (according to Kmet and Lee's Quantitative Checklist; n = 482) which measured dissociation directly and tested reality monitoring experimentally. Meta-analysis indicated a small significant negative association between reality monitoring and dissociation (Correlation = -0.013, [-0.22, -0.04]), implying reality monitoring impairment in dissociation. Papers were identified from inception to May 15, 2025 through searching Web of Science, Scopus, PsycINFO, PsycARTICLES, EMBASE, and MEDLINE. Next, a narrative review of psychosis and reality monitoring, covering pre-existing systematic reviews and original articles, indicated variation across the clinical spectrum. While clinical psychosis was robustly associated with impaired reality monitoring ability and externalising bias, results at non-clinical and sub-clinical levels were mixed. Finally, the reviews were compared to understand how reality monitoring and research practices vary across dissociation and psychosis. This indicated that both dissociation and psychosis are associated with impaired reality monitoring. Though this suggests a shared cognitive basis, no papers on dissociation included clinical presentations or bias towards internalising/externalising the item's source, meaning any comparison is incomplete. Future research should consider clinical dissociation, reality monitoring bias in dissociation, and compare dissociation and psychosis directly.</p
Intensifying Drought Patterns and Agricultural Water Stress in Erbil Governorate, Iraq:A Spatiotemporal Climate Analysis
No full textDrought is a prolonged lack of rainfall that causes water shortages for agricultural land by reducing soil moisture and limiting crop yields. This study assesses the impacts of drought in Erbil, Iraq, using 28 years of data from the southern, central, and northern regions. A soil‐water‐balance framework integrates precipitation with reference evapotranspiration (ETo), crop evapotranspiration (ETc), and actual evapotranspiration measures to address seasonal water deficits. According to the Standardized Precipitation Index (SPI), the area experienced basin‐wide droughts in 1998–2000, 2007–2009, a renewed event in 2020–2021, and significant negative anomalies in 2024–2025. Analyzing drought frequency shows that “near‐normal” conditions are most common (around 57%–79%), with occasional moderate to extreme events. The study reveals that winter wheat undergoes severe stress, with ETc reaching 200–250 mm month during dry years and ETa dropping to 15–30 mm/month, resulting in June deficits of nearly 277 mm. It also notes high variation in annual precipitation, with coefficients of variation (CV) ranging from 26.1% to 51.7%. ARIMA (1,0,1) models suggest weak persistence and zone‐specific accuracy, with MAPE values of 37.8% in the south, 33.9% in the central region, and 28.8% in the north. The results underscore the importance of climate‐resilient water and agricultural planning
Muscle bursting and corticomotor excitability mark impaired impulse control in Parkinson's disease
Get PDFDopamine agonists in Parkinson's disease increase the risk of impulse control disorders, yet the underlying neural mechanisms remain unclear. This study aimed to identify objective neurophysiological markers of impaired impulse control in Parkinson's linking to impulsivity problems. Nineteen people with Parkinson's (PwPD) on ropinirole and 18 healthy older adults performed an impulse control task requiring response withholding and inhibition. Transcranial magnetic stimulation was delivered, with corticomotor excitability (CME) and muscle bursts measured via electromyography. During response withholding, PwPD showed early relative increases in CME and more frequent dysfunctional muscle bursts, leading to more variable responses. During response inhibition, PwPD exhibited reduced CME suppression and increased muscle bursting, leading to delayed inhibition which was associated with problematic impulsive behaviours. The neurophysiological measures were associated with more advanced disease and may serve as early, objective markers of impulse control dysfunction, with future work required to assess their utility in predicting impulsive disorders.</p
Adapting Psychological Therapies for Individuals With Intellectual Disabilities:A Systematic Review
Get PDFThe aim of this systematic review was to identify how psychotherapies have been adapted to suit the needs of people with intellectual disabilities. A comprehensive literature search garnered 39,777 studies, which were screened for eligibility. Systematic searches, following PRISMA guidelines, identified 122 studies that met eligibility criteria, and findings were synthesised using framework synthesis. Six overarching adaptation categories were identified: (1) multisensory methods, (2) activities, (3) communication, (4) delivery medium, (5) additional support and (6) structure. Adaptations were primarily used to increase engagement, promote retention of information and improve communication between clients and clinicians. While a group of adaptations that aimed to improve the acceptability and accessibility of psychotherapy for people with intellectual disabilities were identified, larger studies are required to understand their efficacy
Identification of a Non-Coding Causative Variant Underlying Warsaw Breakage Syndrome Using Long-Read Based Genomic Sequencing and Transcriptome Analysis
No full textCurrently, exome and genome sequencing achieve a diagnostic rate of 30%–50% for rare genetic diseases. With multi-modal technologies profiling the genome, transcriptome, and epigenome, interrogation of genomic elements outside of protein-coding regions shows potential to improve this as demonstrated herein. Siblings with sensorineural hearing loss, microcephaly, intellectual impairment, and growth restriction were seen in consultation. Following extensive clinical testing, long-read whole genome and cDNA-based transcriptome sequencing on the Oxford Nanopore platform identified a homozygous 1.6 kb deletion of the 5′ UTR and promoter region of DDX11, a gene associated with Warsaw breakage syndrome. The deletion included the hypomethylated CpG island regulating DDX11, led to a loss of expression of DDX11 mRNA and protein, and resulted in the characteristic “railroad chromosome.” Identifying a causal variant for this family required expanding the search space for genomic variants beyond protein-coding regions, and multi-modal data integration enabled a more holistic approach to variant prioritization and classification prior to pursuing targeted protein and functional assays. This multi-modal genome-wide approach heralds promise for patients on the diagnostic odyssey and who have exhausted standard of care testing.</p
Unjust by Design? Problematising ‘good’ design and evaluating the justice impacts of urban design governance
No full textUrban design is often promoted as a means of creating more inclusive built environments, but efforts by public authorities to raise design standards in new developments can produce outcomes that are exclusionary and unjust. Tools such as design controls and review panels have been found to discriminate against minority groups, to raise development costs, catalyse gentrification, and cause displacements and evictions. A key challenge for public authorities is thus to reconcile the pursuit of high-quality urban design with justice considerations. Addressing this challenge, this paper makes three contributions. First, it problematises the way that ‘good’ design is currently pursued through planning systems, exposing its exclusionary potential. Second, it introduces a tool for assessing public authority design interventions from a justice perspective. Third, it uses this tool as part of a critical analysis of design guides and codes in England in 2024. Through this analysis, the authors highlight numerous ways in which existing design guides and codes are failing to support urban design justice. These include promoting characteristics that can have exclusionary effects, failing to acknowledge the drawbacks of ‘good’ design, ignoring existing forms of injustice, enabling tokenistic public participation, and failing to recognise user needs and preferences. Our analysis shows, overall, that support for urban design justice in England is largely rhetorical, and that unjust outcomes are likely where new developments meet policy requirements. The paper finishes by calling for public authorities to recognise the justice implications of their design interventions, including through what we term ‘just good enough’ approaches
Estrogen-Induced Hypermethylation Silencing of <i>RPS2</i> and <i>TMEM177</i> Inhibits Energy Metabolism and Reduces the Survival of CRC Cells
Get PDFEstrogen (E2, 17β estradiol) is recognized for its regulatory role in numerous genes associated with energy metabolism and for its ability to disrupt mitochondrial function in various cancer types. However, the influence of E2 on the metabolism of colorectal cancer (CRC) cells remains largely unexplored. In this study, we examined how E2 affects mitochondrial function and energy production in CRC cells, utilizing two distinct CRC cell lines, HCT-116 and SW480. Cell viability, mitochondrial function, and the expression of several genes involved in oxidative phosphorylation (OXPHOS) were assessed in estrogen receptor α (ERα)-expressing and ERα-silenced cells treated with increasing concentrations of E2 for 48 h. Our results indicated that the cytotoxicity of E2 against CRC cells is mediated by the E2/ERα complex, which induces disturbances in mitochondrial function and the OXPHOS pathway. Furthermore, we identified two novel targets, RPS2 and TMEM177, which displayed overexpression, hypomethylation, and a negative association with ERα expression in CRC tissue. E2 treatment in CRC cells reduced the expression of both targets through promoter hypermethylation. Treatment with 5-Aza-2-deoxycytidine increased the expression of RPS2 and TMEM177. This epigenetic effect disrupts the mitochondrial membrane potential (MMP), resulting in decreased activity of the OXPHOS pathway and inhibition of CRC cell growth. Knockdown of RPS2 or TMEM177 in CRC cells resulted in anti-cancer effects and disruption of MMP and OXPHOS. These findings suggest that E2 exerts ERα-dependent epigenetic reprogramming that leads to significant mitochondria-related anti-growth effects in CRC
Feminist Constellations in Legal History
No full textAstronomers use constellations—groups of named patterns or sets of stars—to map the galaxies around us. More than simply maps of the sky, for centuries constellations and stars within them have enabled us to look into the past, as well as to navigate pathways into the future. So much for space, but what about law? What if legal historians were to look to the constellations? What if legal historians were to apply the tools and techniques of astronomers to feminists’ relationship with law and law reform? What might feminist legal constellations look like? And how might they inform our understandings of law and feminist activism? In this article we outline a new methodology: a feminist constellations approach to legal history. We argue that if feminist legal history is to be truly transformative, it needs to be bolder, and to go further than it does at present. And to do this, it needs to locate feminists and feminist endeavour within feminist constellations in law
Sickness absence in the working age population:a retrospective cohort study using primary care health record data
No full textBackground: Economic inactivity rate in the UK reached 22.2% in 2024, driven largely by increased long-term sickness, and exceeds those reported in comparable high-income countries. Sickness absence remains a major challenge, imposing substantial costs on individuals and society. This study aimed to assess sickness absence rates and associated economic output losses in primary care for working-age adults in England.Methods: This was a population-based retrospective cohort study using primary care data from the Clinical Practice Research Datalink (CPRD) Aurum database. 10 million adults aged 18–65 years was followed from January 2017 to December 2019 (pre-COVID-19 pandemic period) and March 2022 to February 2023 (late pandemic period). Sickness absence was measured using fit notes (“statements of fitness for work”) issued in primary care. We quantified annual fit note rates, identified underlying medical causes, explored associations between fit note provision, patient’s sociodemographic and health-related factors using random-effect negative binomial regression models, and estimated economic losses due to sickness absence.Results: Age-standardised fit note rates were 23.5 per 100 person-years pre-pandemic and 24.0 per 100 person-years in the late pandemic period. Fit notes were issued more frequently among females, older individuals, black ethnic groups, lower-income groups, those with obesity, smokers, and those with higher levels of comorbidity. Depression and anxiety were the leading medical diagnoses associated with fit note provision. The estimated total annual cost of sickness absence in England was around £13.3 billion (95% CI £13.3 to £13.4 bn) in the pre-pandemic period, and £15.9 bn (95% CI £15.8 to £15.9 bn) in the late pandemic period.Conclusions: Fit note provision in primary care and associated costs rose substantially from the pre-pandemic to the late pandemic period. This was primarily associated with poor mental health and varied among different population groups. Towards the end of the pandemic, this represented approximately £16 billion in annual economic losses in England. This underscores the need for targeted policy interventions and further research to mitigate the health and financial burden of sickness absence, particularly for people with poor mental health
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