Thinking clearly about climate change and mental health

Objective: To examine the quality and strength of evidence for an association between temperature increases caused by climate change and suicide used in policy documents to advocate for radical changes to healthcare systems in pursuit of decarbonisation. Method: The designs of articles collected in a systematic review which concluded that there was an association between climate change and increased rates of suicide were analysed for their capacity to support this conclusion. Complete US data covering temperatures and suicide rates between 1968 and 2004 was aggregated and analysed using linear regression to evaluate evidence for an association between temperature and suicide. Results: None of the articles collected in the review has a design capable of investigating whether there is an association between temperature increases caused by climate change and rates of suicide. At the national level increased annual US temperatures were associated with a decrease in the rate of suicide, and at the state level it was common for high average temperature states to have low rates of suicide and vice versa. Conclusions: Policy recommendations for radical changes in healthcare services have been based on misrepresented evidence. Policy makers should beware of recommendations that ignore scientific evidence to pursue faith-based goals

Modelling the rate of trainees transitioning to Fellowship before achieving competence under the RANZCP’s Alternative Assessment Pathway to the Objective Structured Clinical Examination

Objective: The Objective Structured Clinical Examination (OSCE) has been removed from the Royal Australian and New Zealand College of Psychiatrists’ (RANZCP) training pathway. This decision occurred in the context of an Alternative Assessment Pathway (AAP) necessitated by Covid-19, justified by logistical, methodological and equity concerns. The false positive rate of trainees progressing to Fellowship before achieving competence is a key indicator for evaluating any assessment leading to psychiatric Fellowship. Variations in the statistical properties of the AAP and OSCE were analysed for their impact on pre-competent trainees progressing to Fellowship. Method: Starting with the false positive scenario presented to justify discontinuing the OSCE, false positive rates associated with the AAP and OSCE were calculated based on different assumptions about reliability and accuracy. Results: The analyses suggest that less reliable and less accurate alternatives to the OSCE, such as the AAP, increase the number of pre-competent trainees progressing to Fellowship. Conclusions: Given possible increases in pre-competent trainees progressing to Fellowship while alternatives to the OSCE are finalised, confidence in the RANZCP's training program demands robust public analyses of those alternatives

The importance of appraising articles and conducting psychiatric journal clubs

Objective: To describe the importance of scientifically rigorous journal clubs in psychiatric education, and to provide a framework to effectively run journal clubs and appraise articles in a journal club format. This paper explores the concept of journal clubs and describes issues with the current state of academic science. It then lists factors associated with effectiveness of journal clubs and outlines a structure for appraising articles relevant to psychiatric practice in a journal club format. Conclusions: Current models of academic research and publishing, which can reward practices vulnerable to multiple forms of bias, make the consistent and valued use of journal clubs in psychiatric education and continuing professional development more important than ever. The literature shows that journal clubs can provide a valuable forum for mental health clinicians to update themselves on recent medical and scientific knowledge, while practicing and teaching skills in critical appraisal of research, statistics, clinical decision-making and epidemiology

Identifying emerging topics in the peer‑reviewed literature to facilitate curriculum renewal and development

This article reports a bibliometric analysis of emerging topics in the psychiatric literature indexed in the MEDLINE database as a technique for renewal of clinical training curricula. Summary data of English-language articles indexed in the MEDLINE database between 1971-2018 were downloaded. Emerging topics in nine demi-decades between 1972-1976 and 2012-2016 were identified by the incremental incidence of individual Medical Subject Headings (MeSH) compared with previous years. Co-word analysis was used to investigate and visualise the relationships between emerging topics in each demi-decade. Summaries of 18 million articles annotated with psychiatric/psychological MeSH were retrieved and used to identify emerging topics. Peaks in the number of articles annotated by the top 20 emerging topics in 9 demi-decades coincided with release of the third and fourth editions of the Diagnostic and Statistical Manual which codifies psychiatric diagnoses. Themes emerging from network visualisations of the most common emerging MeSH in each demi-decade were consistent with movements in psychiatric/psychological theory and practice since the 1970s, including the recent focus on psychological and social factors implicated in suicide and suicide prevention. The identification of emerging topics within the published medical literature is a viable technique for use in curriculum renewal projects as a counterweight to biases driven by expert judgement. While indices like MEDLINE make the published literature an appealing initial step in building an empirical basis for curriculum development, it also demonstrates the potential value of less public and less structured data, such as health service electronic medical record

Systematic review of specialist selection methods with implications for diversity in the medical workforce

Purpose: There is growing concern that inequities in methods of selection into medical specialties reduce specialist cohort diversity, particularly where measures designed for another purpose are adapted for specialist selection, prioritising reliability over validity. This review examined how empirical measures affect the diversity of specialist selection. The goals were to summarise the groups for which evidence is available, evaluate evidence that measures prioritising reliability over validity contribute to under-representation, and identify novel measures or processes that address under-representation, in order to make recommendations on selection into medical specialties and research required to support diversity. Method: In 2020–1, the authors implemented a comprehensive search strategy across 4 electronic databases (Medline, PsychINFO, Scopus, ERIC) covering years 2000–2020, supplemented with hand-search of key journals and reference lists from identified studies. Articles were screened using explicit inclusion and exclusion criteria designed to focus on empirical measures used in medical specialty selection decisions. Results: Thirty-five articles were included from 1344 retrieved from databases and hand-searches. In order of prevalence these papers addressed the under-representation of women (21/35), international medical graduates (10/35), and race/ethnicity (9/35). Apart from well-powered studies of selection into general practice training in the UK, the literature was exploratory, retrospective, and relied upon convenience samples with limited follow-up. There was preliminary evidence that bias in the measures used for selection into training might contribute to under-representation of some groups. Conclusions: The review did not find convincing evidence that measures prioritising reliability drive under-representation of some groups in medical specialties, although this may be due to limited power analyses. In addition, the review did not identify novel specialist selection methods likely to improve diversity. Nevertheless, significant and divergent efforts are being made to promote the evolution of selection processes that draw on all the diverse qualities required for specialist practice serving diverse populations. More rigorous prospective research across different national frameworks will be needed to clarify whether eliminating or reducing the weighting of reliable pre-selection academic results in selection decisions will increase or decrease diversity, and whether drawing on a broader range of assessments can achieve both reliable and socially desirable outcomes

Binding Site Prediction for Protein-Protein Interactions and Novel Motif Discovery using Re-occurring Polypeptide Sequences

Background: While there are many methods for predicting protein-protein interaction, very few can determine the specific site of interaction on each protein. Characterization of the specific sequence regions mediating interaction (binding sites) is crucial for an understanding of cellular pathways. Experimental methods often report false binding sites due to experimental limitations, while computational methods tend to require data which is not available at the proteome-scale. Here we present PIPE-Sites, a novel method of protein specific binding site prediction based on pairs of re-occurring polypeptide sequences, which have been previously shown to accurately predict proteinprotein interactions. PIPE-Sites operates at high specificity and requires only the sequences of query proteins and a database of known binary interactions with no binding site data, making it applicable to binding site prediction at the proteome-scale. Results: PIPE-Sites was evaluated using a dataset of 265 yeast and 423 human interacting proteins pairs with experimentally-determined binding sites. We found that PIPE-Sites predictions were closer to the confirmed binding site than those of two existing binding site prediction methods based on domain-domain interactions, when applied to the same dataset. Finally, we applied PIPE-Sites to two datasets of 2347 yeast and 14,438 human novel interacting protein pairs predicted to interact with high confidence. An analysis of the predicted interaction sites revealed a number of protein subsequences which are highly re-occurring in binding sites and which may represent novel binding motifs. Conclusions: PIPE-Sites is an accurate method for predicting protein binding sites and is applicable to the proteome-scale. Thus, PIPE-Sites could be useful for exhaustive analysis of protein binding patterns in whole proteomes as well as discovery of novel binding motifs. PIPE-Sites is available online a

Regulated Expression of Chromobox Homolog 5 Revealed in Tumors of ApcMin/+ ROSA11 Gene Trap Mice

The gene-trap lacZ reporter insertion, ROSA11, in the Cbx5 mouse gene illuminates the regulatory complexity of this locus in ApcMin/+ mice. The insertion site of the β-Geo gene-trap element lies in the 24-kb intron proximal to the coding region of Cbx5. Transcript analysis indicates that two promoters for Cbx5 flank this insertion site. Heterozygotes for the insertion express lacZ widely in fetal tissues but show limited expression in adult tissues. In the intestine, strong expression is limited to proliferative zones of crypts and tumors. Homozygotes for ROSA11, found at a lower than Mendelian frequency, express reduced levels of the coding region transcript in normal tissues, using a downstream promoter. Analysis via real-time polymerase chain reaction indicates that the upstream promoter is the dominant promoter in normal epithelium and tumors. Bioinformatic analysis of the Cbx5 locus indicates that WNT and its target transcription factor MYC can establish a feedback loop that may play a role in regulating the self-renewal of the normal intestinal epithelium and its tumors

Peptide based drug delivery systems to the brain

Abstract: With estimated worldwide cost over $1 trillion just for dementia, diseases of the central nervous system pose a major problem to health and healthcare systems, with significant socio-economic implications for sufferers and society at large. In the last two decades, numerous strategies and technologies have been developed and adapted to achieve drug penetration into the brain, evolving alongside our understanding of the physiological barriers between the brain and surrounding tissues. The blood brain barrier (BBB) has been known as the major barrier for drug delivery to the brain. Both invasive and minimally-invasive approaches have been investigated extensively, with the minimally-invasive approaches to drug delivery being more suitable. Peptide based brain targeting has been explored extensively in the last two decades. In this review paper, we focused on self-assembled peptides, shuttle peptides and nanoparticles drug delivery systems decorated/conjugated with peptides for brain penetration

Military maladaptation : counterinsurgency and the politics of failure

Tactical learning is critical to battlefield success, especially in a counterinsurgency. This article tests the existing model of military adaption against a ‘most-likely’ case: the British Army’s counterinsurgency in the Southern Cameroons (1960–61). Despite meeting all preconditions thought to enable adaptation – decentralization, leadership turnover, supportive leadership, poor organizational memory, feedback loops, and a clear threat – the British still failed to adapt. Archival evidence suggests politicians subverted bottom-up adaptation, because winning came at too high a price in terms of Britain’s broader strategic imperatives. Our finding identifies an important gap in the extant adaptation literature: it ignores politics.PostprintPeer reviewe