Explore the vast range of titles available.

Background People experiencing their first episode of psychosis are often deficient in vitamin D. Observational studies have reported an association between low vitamin D concentrations and poorer subsequent health outcomes in psychosis. A vitamin D deficiency in neonates and children has been linked to a later increased risk of schizophrenia and psychotic-like experiences. This trial aims to examine the effect of high-dose vitamin D supplementation on outcomes in early psychosis. We hypothesise that vitamin D supplementation will be associated with better mental health outcomes. Methods/design The DFEND study is a multicentre double-blind placebo-controlled parallel-group trial of vitamin D supplementation in people with early psychosis. Patients with an ICD-10 diagnosis of functional psychosis will be randomised in a 1:1 ratio to receive either 120,000 IU/month of vitamin D (cholecalciferol) or a matched placebo for 6 months. The primary outcome is the total Positive and Negative Syndrome Scale (PANSS) score at the 6-month follow-up for all patients. Secondary outcomes include assessment of mood (Calgary Depression Scale), general function (Global Assessment of Functioning), cardiovascular risk (body mass index, waist circumference, C-reactive protein, cholesterol and HbA1c) and vitamin D levels at the 6-month follow-up. Additionally, 3- and 6-month total PANSS scores will be analysed for those with inadequate vitamin D levels at the baseline. Discussion The DFEND study is the first trial to examine whether vitamin D supplementation in early psychosis is associated with better mental health outcomes. The findings of this study may help to resolve the clinical equipoise regarding the benefits and cost-effectiveness of routine vitamin D supplementation in people with psychosis. Trial registration ISRCTN, ISRCTN12424842 . Registered on 25 February 2015.

Over the past 40 years, the scale of environmental problems has increased to monumental proportions, while environmental politics has shrunk to the micro level. Injunctions for each individual to “do their part” by modifying their lifestyle and consumption habits multiplied, while collective action and policies targeting environmental degradation at the point of production diminished. This “individualization” of environmental politics has been described and critiqued, but no convincing explanation for it presented. In this article, I explore its origins through an historical case study of the paradigmatic example of individualized environmentalism: recycling. I wield original empirical material to both challenge and sharpen prevailing accounts of recycling’s institutionalization and to theorize the broader trend of individualization. Drawing on Antonio Gramsci’s theory of hegemony, I advance the thesis that the individualization of environmental politics is due to their skillful management by key corporate interests. In order to deter costly legislation, producers have created and implemented solutions that appeal to environmentalists’ concerns, yet in a way that defines individual consumers, not producers, as the source of environmental degradation. The lack of a mass environmental movement enabled producers to organize these solutions on the fertile grounds of civil society.

People with psychotic disorders have an increased risk of vitamin D deficiency, which is evident during first-episode psychosis (FEP) and associated with unfavorable mental and physical health outcomes. To examine whether vitamin D supplementation contributes to improved clinical outcomes in FEP. This multisite, double-blind, placebo-controlled, parallel-group randomized clinical trial from the UK examined adults 18 to 65 years of age within 3 years of a first presentation with a functional psychotic disorder who had no contraindication to vitamin D supplementation. A total of 2136 patients were assessed for eligibility, 835 were approached, 686 declined participation or were excluded, 149 were randomized, and 104 were followed up at 6 months. The study recruited participants from January 19, 2016, to June 14, 2019, with the final follow-up (after the last dose) completed on December 20, 2019. Monthly augmentation with 120 000 IU of cholecalciferol or placebo. The primary outcome measure was total Positive and Negative Syndrome Scale (PANSS) score at 6 months. Secondary outcomes included total PANSS score at 3 months; PANSS positive, negative, and general psychopathology subscale scores at 3 and 6 months; Global Assessment of Function scores (for symptoms and disability); Calgary Depression Scale score, waist circumference, body mass index, and glycated hemoglobin, total cholesterol, C-reactive protein, and vitamin D concentrations at 6 months; and a planned sensitivity analysis in those with insufficient vitamin D levels at baseline. A total of 149 participants (mean [SD] age, 28.1 (8.5) years; 89 [59.7%] male; 65 [43.6%] Black or of other minoritized racial and ethnic group; 84 [56.4%] White [British, Irish, or of other White ethnicity]) were randomized. No differences were observed in the intention-to-treat analysis in the primary outcome, total PANSS score at 6 months (mean difference, 3.57; 95% CI, -1.11 to 8.25; P = .13), or the secondary outcomes at 3 and 6 months (PANSS positive subscore: mean difference, -0.98; 95% CI, -2.23 to 0.27 at 3 months; mean difference, 0.68; 95% CI, -0.69 to 1.99 at 6 months; PANSS negative subscore: mean difference, 0.68; 95% CI, -1.39 to 2.76 at 3 months; mean difference, 1.56; 95% CI, -0.31 to 3.44 at 6 months; and general psychopathology subscore: mean difference, -2.09; 95% CI, -4.36 to 0.18 at 3 months; mean difference, 1.31; 95% CI, -1.42 to 4.05 at 6 months). There also were no significant differences in the Global Assessment of Function symptom score (mean difference, 0.02; 95% CI, -4.60 to 4.94); Global Assessment of Function disability score (mean difference, -0.01; 95% CI, -5.25 to 5.23), or Calgary Depression Scale score (mean difference, -0.39; 95% CI, -2.05 to 1.26) at 6 months. Vitamin D levels were very low in the study group, especially in Black participants and those who identified as another minoritized racial and ethnic group, 57 of 61 (93.4%) of whom had insufficient vitamin D. The treatment was safe and led to a significant increase in 25-hydroxyvitamin D concentrations. In this randomized clinical trial, no association was found between vitamin D supplementation and mental health or metabolic outcomes at 6 months. Because so few patients with FEP were vitamin D replete, the results of this study suggest that this group would benefit from active consideration in future population health strategies. isrctn.org Identifier: ISRCTN12424842.

The Shefton Collection in Newcastle upon Tyne contains a fine array of Greek and Etruscan objects and takes its name from its founder Professor Brian Shefton (1919 – 2012). In spite of the importance of this collection it has not been widely published and remains something of a hidden gem. Brian Shefton was an insightful collector, as well as a distinguished scholar of Greek and Etruscan archaeology, and the 14 papers presented here reflect the broad scope of the collection; ranging across pottery, jewelery, terracottas and metalwork. The contributions, written by leading experts in the field, focus on specific objects or groups of objects in the Collection, providing new interpretations and bringing previously unpublished items to light. The history of the Shefton Collection is explored. Together these contributions provide a tribute to a remarkable individual who made a substantial and notable contribution to his discipline.

In a warming climate, net mass loss from perennial snow and ice (PSI) contributes a temporary source of unsustainable streamflow. However, the role of topography and wind in mediating the streamflow patterns of deglaciating watersheds is unknown. We compare lidar surveys of seasonal snow and PSI elevation change for five adjacent watersheds in the Wind River Range, Wyoming (WRR). Between 2019 and 2023, net mass loss from PSI is equivalent to ∼ 10 %–36 % of August–September streamflow. Across 338 manually classified PSI features >0.01 km2, glaciers contribute 68 % of the total mass loss, perennial snowfields contribute 8 %, rock glaciers contribute 1 %, buried ice contributes 6 %, and the remaining 17 % derives from semi-annual snowfields and small snow patches. Surprisingly, watersheds with more area-normalized seasonal snow produce less late-summer streamflow (r=-0.60), but this correlation is positive (r=0.88) considering only deep snow storage (SWE > 2 m). Most deep snow (87 %) is associated with topography that is conducive to wind drift formation. Deep seasonal snow limits the mass loss contribution of PSI features in topographic refugia. We show that watersheds with favorable topography exhibit deeper seasonal snow, more abundant PSI features (and hence greater mass loss in a warming climate), and elevated late-summer streamflow. As a result of deep seasonal snow, watersheds with the most abundant PSI would still produce 45 %–78 % more late-summer streamflow than nearby watersheds in a counterfactual scenario with zero net mass loss. Similar interrelationships may be applicable to mountain environments globally.

In partnership with NHS England, Genomics England’s ambitious plans to embed genomic medicine into routine patient care are well underway. Clare Turnbull and colleagues discuss its progress

Preterm birth places infants in an adverse environment that leads to abnormal brain development and cerebral injury through a poorly understood mechanism known to involve neuroinflammation. In this study, we integrate human and mouse molecular and neuroimaging data to investigate the role of microglia in preterm white matter damage. Using a mouse model where encephalopathy of prematurity is induced by systemic interleukin-1β administration, we undertake gene network analysis of the microglial transcriptomic response to injury, extend this by analysis of protein-protein interactions, transcription factors and human brain gene expression, and translate findings to living infants using imaging genomics. We show that DLG4 (PSD95) protein is synthesised by microglia in immature mouse and human, developmentally regulated, and modulated by inflammation; DLG4 is a hub protein in the microglial inflammatory response; and genetic variation in DLG4 is associated with structural differences in the preterm infant brain. DLG4 is thus apparently involved in brain development and impacts inter-individual susceptibility to injury after preterm birth. Inflammation mediated by microglia plays a key role in brain injury associated with preterm birth, but little is known about the microglial response in preterm infants. Here, the authors integrate molecular and imaging data from animal models and preterm infants, and find that microglial expression of DLG4 plays a role.