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An empirical model for investigating the behaviour of CaCO3 polymorphs incorporating a shell model for oxygen has been created. The model was constructed by fitting to: the structure of aragonite and calcite; their elastic, static and high-frequency dielectric constants; phonon frequencies at the wave vectors [½ 0 2] and [0 0 0] of calcite; and vibrational frequencies of the carbonate deformation modes of calcite. The high-pressure phase transition between calcite I and II is observed. The potentials for the CO3 group were transferred to other carbonates, by refitting the interaction between CO3 and the cation to both the experimental structures and their bulk modulus, creating a set of potentials for calculating the properties of a wide range of carbonate materials. Defect energies of substitutional cation defects were analyzed for calcite and aragonite phases. The results were rationalized by studying the structure of calcite and aragonite in greater detail.

Early intervention in fluency disorders such as stammering is desirable but this depends on early referral of disfluent children to speech and language therapists. The willingness to refer young disfluent children depends on, among other things, the knowledge and attitudes of primary care practitioners who are likely to be the main sources of referral. A postal questionnaire survey was carried out of all general practitioners (GPs) and health visitors (HVs) in the area of the former Highland Community NHS Trust to elicit this information. The results indicated that these professionals were more likely to refer young disfluent children to speech and language therapy if they themselves had received some post-graduate training about this disorder. More GPs than HVs were uncertain about the natural history of the disorder and about whether young disfluent children should be enrolled for therapy. GPs were more inclined to believe that there were personality traits characteristic of those who stammer and they were also more influenced by waiting lists in their decisions about referral. It would seem that some primary care professionals may have beliefs about stammering which were acquired in their training and which have not been updated. Appropriate post-graduate training seems to increase referral numbers. Training programmes that meet the needs of primary care professionals should be supported and evaluated.

Early intervention in fluency disorders such as stammering is desirable but this depends on early referral of disfluent children to speech and language therapists. The willingness to refer young disfluent children depends on, among other things, the knowledge and attitudes of primary care practitioners who are likely to be the main sources of referral. A postal questionnaire survey was carried out of all general practitioners (GPs) and health visitors (HVs) in the area of the former Highland Community NHS Trust to elicit this information. The results indicated that these professionals were more likely to refer young disfluent children to speech and language therapy if they themselves had received some post-graduate training about this disorder. More GPs than HVs were uncertain about the natural history of the disorder and about whether young disfluent children should be enrolled for therapy. GPs were more inclined to believe that there were personality traits characteristic of those who stammer and they were also more influenced by waiting lists in their decisions about referral. It would seem that some primary care professionals may have beliefs about stammering which were acquired in their training and which have not been updated. Appropriate post-graduate training seems to increase referral numbers. Training programmes that meet the needs of primary care professionals should be supported and evaluated.

This paper explores how the phenomenon of Joint Attention (JA) drives certain core features of team sport and how sport illuminates the nature of JA. In JA, two or more agents focus on the same object in mutual awareness that the content of their experience is thus shared. JA is essential to joint sporting actions. The sporting context is particularly useful for illustrating the phenomenon of JA and provides a valuable lens through which to examine rival theoretical accounts of its workings. This paper draws novel connections between the respective philosophical literatures on JA and sport, suggesting prospects for mutually advantageous cross-pollination. I contend that the workings of JA within joint sporting action are misconstrued on intellectualistic and individualistic theories which posit reductive explanations in terms of the contents of individual minds. The best evidence and strongest philosophical arguments support ‘relational’ accounts whereby joint sporting actions exceed the sum of their parts. I reject the ‘extensionalist’ contention, associated with ‘lean’ versions of the relationalist approach, that objects of JA are individuated in terms of causal properties not sensitive to how they are perceived. Siding instead with ‘rich’ versions of the view, I argue that team collaboration depends on convergence in terms of the ‘aspectual shape’ of the objects of JA. Finally, a further possible application for these ideas is suggested: that JA plays a central role in the constitution of sport-specific kinds. On this proposal, JA facilitates collective perceptual recognition of particular objects and situations as embodying the general types described in the rulebook, playing an important role in creating and sustaining the public ‘social space’ of sporting competition.

Lichen sclerosus is a chronic inflammatory condition of unknown etiology that affects the genital and extragenital skin, which can lead to sexual dysfunction and has been associated with vulvar cancer. The vaginal microbiome has a critical role in gynecologic health, but little is known about the microbiome in lichen sclerosus. This study investigated the vaginal and vulvar microbiomes of 27 post-menopausal women with lichen sclerosus. The most abundant genera detected in the vaginal microbiome were Lactobacillus , Gardnerella , and Anaerococcus , while Lactobacillus, Anaerococcus , and Staphylococcus were the most abundant in the vulvar microbiome . The vaginal samples clustered into two main groups, Lactobacillus dominant (n = 6, > 50% microbiome Lactobacillus ) and polymicrobial (n = 21) with no dominant genus. The vulvar samples were mainly polymicrobial (n = 25). Actinomyces, Anaerococcus , and Ezakiella in the vaginal microbiome and Actinomyces and Ezakiella in the vulvar microbiome were significantly associated with lichen sclerosus symptoms (adjusted p  < 0.05). In this population of post-menopausal women with lichen sclerosus the majority have diverse, non- Lactobacillus dominant microbiomes, which is considered less optimal for gynecologic health based on studies of pre-menopausal women. Actinomyces, Ezakiella , and Anaerococcus were associated with lichen sclerosus symptoms. Understanding the role of these bacteria in lichen sclerosus pathogenesis will be an essential future investigation.

Mental health issues are a growing concern in the workplace, linked to negative outcomes including reduced productivity, increased absenteeism, and increased turnover. Employer-sponsored mental health benefits that are accessible and proactive may help address these concerns. The aim of this retrospective cohort study was to evaluate the impact of a digital mental health benefit (Spring Health) on frontline healthcare service workers’ clinical and workplace outcomes. The benefit was sponsored by a national health services company from 2021–2022 and included mental health screening, care navigation, psychotherapy and/or medication management. We hypothesized program use would be associated with improvements in depression and anxiety symptoms, and increased productivity and retention. Participants were employees enrolled in the benefit program, had at least moderate anxiety or depression, at least 1 treatment appointment, and at least 2 outcome assessments. Clinical improvement measures were PHQ-9 scale (range, 0–27) for depression and GAD-7 scale (range, 0–21) for anxiety; workplace measures were employee retention and the Sheehan Disability Scale (SDS) for functional impairment. A total of 686 participants were included. Participants using the mental health benefit had a 5.60 point (95% CI, 4.40–6.79, d = 1.28) reduction in depression and a 5.48 point (95% CI, 3.88–7.08, d = 1.64) reduction in anxiety across 6 months. 69.9% (95% CI, 61.8%–78.1%) of participants reliably improved (≥5 point change) and 84.1% (95% CI, 78.2%–90.1%) achieved reliable improvement or recovery (<10 points). Participants reported 0.70 (95% CI, 0.26–1.14) fewer workdays per week impacted by mental health issues, corresponding to$3,491 (95% CI, $ 1305– $5677) salary savings at approximately federal median wage ($ 50,000). Furthermore, employees using the benefit were retained at 1.58 (95% CI, 1.4–1.76) times the rate of those who did not. Overall, this evaluation suggests that accessible, proactive, and comprehensive mental health benefits for frontline health services workers can lead to positive clinical and workplace outcomes.

The insulin-signaling pathway is evolutionarily conserved in animals and regulates growth, reproduction, metabolic homeostasis, stress resistance and life span. In Drosophila seven insulin-like peptides (DILP1-7) are known, some of which are produced in the brain, others in fat body or intestine. Here we show that DILP5 is expressed in principal cells of the renal tubules of Drosophila and affects survival at stress. Renal (Malpighian) tubules regulate water and ion homeostasis, but also play roles in immune responses and oxidative stress. We investigated the control of DILP5 signaling in the renal tubules by Drosophila tachykinin peptide (DTK) and its receptor DTKR during desiccative, nutritional and oxidative stress. The DILP5 levels in principal cells of the tubules are affected by stress and manipulations of DTKR expression in the same cells. Targeted knockdown of DTKR, DILP5 and the insulin receptor dInR in principal cells or mutation of Dilp5 resulted in increased survival at either stress, whereas over-expression of these components produced the opposite phenotype. Thus, stress seems to induce hormonal release of DTK that acts on the renal tubules to regulate DILP5 signaling. Manipulations of S6 kinase and superoxide dismutase (SOD2) in principal cells also affect survival at stress, suggesting that DILP5 acts locally on tubules, possibly in oxidative stress regulation. Our findings are the first to demonstrate DILP signaling originating in the renal tubules and that this signaling is under control of stress-induced release of peptide hormone.