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Background Since the 60s, the recovery‐oriented approach has greatly influenced mental health policy and practice, and much research has been devoted to exploring it. In the face of a generic definition of the ‘recovery’ construct, to which many articles refer, a closer examination of the literature reveals a plurality of theories and ways about how changes related to the recovery occur and how to evaluate them. Aims This narrative review explores the different definitions of recovery available in the literature, by investigating the adjectives that qualify it and the theoretical construct the adjective refers to. Method From the online databases PubMed, Scopus, Google Scholar and PsycINFO, 43 articles were selected for the review. Results Seven definitions of recovery emerged, each supported by specific theoretical perspectives: clinical, personal, narrative, social, family, cultural and relational recovery. The adjectives refer to theoretical frameworks often very distant from each other and in epistemological competition; nevertheless, many papers assume a reconcilability and possible integration. The authors critically discuss the advantages and risks of considering such different constructs as complementary. Conclusions Keeping theoretical descriptions and models of healing open and plural means enabling mental health practitioners not to monologise discourses of change by imposing their point of view on users. It means supporting users to authentically seek their healing pathways without conforming to clinicians' expectations. It also means abandoning misleading and naive simplifications and strictly using the appropriate terms relevant to the specific healing construct that researchers refer to from time to time. This is particularly important when it comes to the relational component, which seems to be receiving more and more attention in the literature, and about which there is more confusion. Patient or Public Involvement The study involved two experts by experience, or peer support specialists, in a more than active role as components of the research team. They participated equally with the other team members in all phases of the work: the design and conduct of the study, the discussion of findings and advice about implications and dissemination.

The role of the Peer Support Worker (PSW) has gained increasing prominence in mental health services, yet its institutionalisation raises questions about balancing autonomy and assimilation into service logics. This study examines the narrative positionings of three PSWs, focusing on how they construct professional identity in relation to mandate, collaboration with practitioners, and service organisation. A qualitative design was adopted using semi-structured interviews with three PSWs. Data were analysed through Positioning Theory (Davies and Harré 1999) and Bamberg's three-level model (2022), which investigates positioning in relation to temporality, the other and agency. Particular attention was given to positions regarding the professional mandate, collaboration with practitioners, psychiatric and psychotherapeutic practices, and the services in which participants had placements or are currently engaged. PSW positioning emerged as dynamic and multifaceted, constantly negotiated between institutional mandates and fidelity to lived experience. Three configurations were identified: (1) a critical and independent stance, maintaining symbolic distance from services whilst collaborating with them; (2) an integrated stance, balancing institutional logics with attentiveness to user experience; and (3) a fluid stance, affirming the coexistence of PSW and service-user roles and challenging conventional boundaries between clinical and experiential knowledge. Across all narratives, PSWs located themselves in liminal spaces that foster transformative possibilities for mental health services. PSW identity is not fixed but articulated through multiple positionings, ranging from critical autonomy to institutional integration and fluid coexistence of service-user and professional roles. This plurality, rather than constituting ambiguity, represents an epistemic and ethical resource that extends the transformative potential of services beyond the dichotomy of transformation versus assimilation. Recognising this plurality means valuing PSW agency and fostering flexible, participatory practices responsive to the complexity of lived experience. The research team included both academics and PSWs in a co-participatory design initiated through voluntary applications. Only interviews with explicit consent were included. The first draft of the analyses was submitted for participant validation: each PSW reviewed their own transcript and related comments, with the option to modify or expand the analysis. Materials were then shared within the group to enable collective reflection and refinement of interpretation. Through this collective process, the group co-authored the present version of the article. Does not fit.

Oceanic Transform Faults are major plate boundaries representing the most seismogenic part of the mid ocean ridge system. Nonetheless, their structure and deformation mechanisms at depth are largely unknown due to rare exposures of deep sections. Here we study the mineral fabric of deformed mantle peridotites - ultramafic mylonites - collected from the transpressive Atobá ridge, along the northern fault of the St. Paul transform system in the Equatorial Atlantic Ocean. We show that, at pressure and temperature conditions of the lower oceanic lithosphere, the dominant deformation mechanism is fluid-assisted dissolution-precipitation creep. Grain size reduction during deformation is enhanced by dissolution of coarser pyroxene grains in presence of fluid and contextual precipitation of small interstitial ones, leading to strain localization at lower stresses than dislocation creep. This mechanism potentially represents the dominant weakening factor in the oceanic lithosphere and a main driver for the onset and maintenance of oceanic transform faults. Deformed mantle rocks exhumed by oceanic transform faults recorded fluid-assisted ductile deformation at high temperatures and pressures, corresponding to the root of the fault. This deformation mechanism controls deep faulting at plate boundaries.

BackgroundPrimary retroperitoneal sarcoma (RPS) may require multivisceral resection (MVR). Clinical outcome (morbidity and renal function) and quality of life (QoL) are not as well reported as the oncologic outcome.MethodsPatients with primary RPS who underwent surgery between 2014 and 2016 were prospectively enrolled in an observational longitudinal study. At baseline, then at 4 and 12 months, the study measured Clavien–Dindo morbidity, estimated glomerular filtration rate (EGFR), EORTC QLQ-C30, QLQ-CR29, DN4 (neuropathic pain [NP]), lower-extremity functional scale (LEFS), and the brief pain inventory. The primary end point was the difference in global health status (GHS/QoL). The secondary end points were EGFR changes, difference in other QLQ-C30 scales, pain intensity, NP, and LEFS. The study is registered at ClinTrials.gov (NCT03480399).ResultsOf 74 patients, 58 were evaluable. Morbidity grade 3 or higher was 24.1%, and mortality was 1.3%. After nephrectomy, the mean 1-year EGFR change was −33.9%. The GHS/QoL at baseline was 58.6 and had increased of 6.9 points at 1 year, comparable with that of the general population. A transient worsening in pain and diarrhea had recovered at 12 months. Average pain was mild and did not differ at 12 months. However, NP was found in 41.4% of the patients and was significantly associated with resection of the psoas muscle. At baseline, LEFS was already lower than the normative value, and worsening after surgery was not clinically relevant.ConclusionA QoL measure after MVR in primary RPS is complex and requires multiple tools. Whereas overall MVR is safe and associated with an improvement in GHS/QoL, chronic NP is frequent and deserves specific attention. Pre-surgery rehabilitation tracks may help to prevent or reduce chronic NP.

Accretionary processes at mid‐ocean ridge segments with low magma input have seldom been investigated over the long term. The evolution of such magma‐starved segments over time is still largely unknown. We present a study on the structure and evolution of the southernmost intra‐transform ridge segment of the St. Paul Transform Fault System in the Equatorial Mid‐Atlantic Ridge, based on new bathymetry, gravity, and rock sampling data. We show that this area evolves differently from previously described tectonics along ridge segments of similar spreading rate. On the flanks of the axial ridge segment, we observe a succession of structures exhumed by detachment faulting, evolving from east‐facing, long‐lived, corrugated oceanic core complexes (∼6 Ma ago), to short‐lived detachment faults exposing lower crust and mantle rocks and facing alternatively east and west in the more recent part of the segment. The oldest detachment faults have been repeatedly split and partially transferred to the opposite flank through the formation of new detachments into the footwall. The terminations of three old, east‐facing detachments are observed on the east flank of the segment. The westward relocations of the plate boundary appear to compensate for the asymmetry of accretion through detachment faulting, overall creating the same amount of lithosphere on both flanks of the ridge. We interpret the observed changes in the time of the accretionary processes to reflect a decrease of the melt supply over the last ∼6 Myr. Plain Language Summary The generation of new seafloor at mid‐ocean ridges where cold underlying mantle delivers low magma supply has not been investigated over the long term. Here we present the analysis of new bathymetry, gravity, and rock sampling data over such a ridge segment located within the St. Paul Transform Fault system in the Equatorial Mid‐Atlantic Ridge, which allowed us to bring constraints on its structure and evolution over the last ∼6 Myr. We show that this area evolves differently from previously described ridge segments of similar spreading rate. We observe the remnants of very large normal faults called detachment faults, which have been active for very long times, forming domes called oceanic core complexes. The fault surfaces have been dissected by further extensional deformation, until the plate motion became accommodated along a new detachment fault formed west of the previous plate boundary. The emergence lines of the detachment faults are observed on the eastern flank of the ridge segment. We also observe a change in time of the structures, from typical oceanic core complexes to shorter ridges formed by the exhumation of mantle rocks. We interpret these changes to possibly reflect a decrease in the melt supply in the last 6 Myr. Key Points The southern intra‐transform ridge segment in the St. Paul transform fault system, over the last ∼6 Myr is dominated by detachment faulting Several detachments have been split and partly transferred to the opposite ridge flank through ridge axis relocation The change in the accretionary processes, from Oceanic Core Complexes to mantle exhumation, suggests a decrease in the time of the melt supply

Gestational diabetes mellitus (GDM) causes both maternal and fetal adverse outcomes. The deregulation of microRNAs (miRNAs) in GDM suggests their involvement in GDM pathogenesis and complications. Exosomes are extracellular vesicles (EVs) of endosomal origin, released via exocytosis into the extracellular compartment. Through EVs, miRNAs are delivered in distant target cells and are able to affect gene expression. In this study, miRNA expression was analyzed to find new miRNAs that could improve GDM classification and molecular characterization. MiRNA were profiled in total plasma and EVs in GDM patients and normal glucose tolerance (NGT) women. Samples were collected at third trimester of gestation from two diabetes centers. MiRNA expression was profiled in a discovery cohort using the multiplexed NanoString nCounter Human v3 miRNA. Validation analysis was performed in a second independent cohort using RT-qPCR. A set of miRNAs resulted to be differentially expressed (DE) in total plasma and EVs in GDM. Among them, total plasma miR-222-3p and miR-409-3p were validated in the independent cohort. MiR-222-3p levels correlated with fasting plasma glucose (FPG) (p < 0.001) and birth weight (p = 0.012), whereas miR-409-3p expression correlated with FPG (p < 0.001) and inversely with gestational age (p = 0.001). The major validated target genes of the deregulated miRNAs were consistently linked to type 2 diabetes and GDM pathophysiology. MiR-222-3p and miR-409-3p are two circulating biomarkers that could improve GDM classification power and act in the context of the molecular events leading to the metabolic alterations observed in GDM.

Frailty is a geriatric, multi‐dimensional syndrome that reflects multisystem physiological change and is a transversal measure of reduced resilience to negative events. It is characterized by weakness, frequent falls, cognitive decline, increased hospitalization and dead and represents a risk factor for the development of Alzheimer's disease (AD). The fact that frailty is recognized as a reversible condition encourages the identification of earlier biomarkers to timely predict and prevent its occurrence. SAMP8 (Senescence‐Accelerated Mouse Prone‐8) mice represent the most appropriate preclinical model to this aim and were used in this study to carry transcriptional and metabolic analyses in the brain and plasma, respectively, upon a characterization at cognitive, motor, structural, and neuropathological level at 2.5, 6, and 9 months of age. At 2.5 months, SAMP8 mice started displaying memory deficits, muscle weakness, and motor impairment. Functional alterations were associated with a neurodevelopmental deficiency associated with reduced neuronal density and glial cell loss. Through transcriptomics, we identified specific genetic signatures well distinguishing SAMP8 mice at 6 months, whereas plasma metabolomics allowed to segregate SAMP8 mice from SAMR1 already at 2.5 months of age by detecting constitutively lower levels of acylcarnitines and lipids in SAMP8 at all ages investigated correlating with functional deficits and neuropathological signs. Our findings suggest that specific genetic alterations at central level, as well as metabolomic changes in plasma, might allow to early assess a frail condition leading to dementia development, which paves the foundation for future investigation in a clinical setting. SAMP8 frail mice display progressive cognitive and motor dysfunctions from 2.5 to 9 months of age, associated with brain damages. At 2.5 and 6 months, brain transcriptomics identified specific genetic signatures and de‐regulated pathways. Plasma metabolomics detected constitutively lower levels of acylcarnitines and lipids in SAMP8 already at 2.5 months of age, correlating with functional deficits and neuropathological signs at the ages investigated.

Earth’s crust diverges and extends along mid-ocean ridges. Analyses of gravity and seismic data from the equatorial Atlantic show that propagation of ridge segments can compress the crust and create sufficient uplift to create small islands. Mantle exhumation at slow-spreading ridges is favoured by extensional tectonics through low-angle detachment faults 1 , 2 , 3 , 4 , and, along transforms, by transtension due to changes in ridge/transform geometry 5 , 6 . Less common, exhumation by compressive stresses has been proposed for the large-offset transforms of the equatorial Atlantic 7 , 8 . Here we show, using high-resolution bathymetry, seismic and gravity data, that the northern transform fault of the St Paul system has been controlled by compressive deformation since ∼10 million years ago. The long-lived transpression resulted from ridge overlap due to the propagation of the northern Mid-Atlantic Ridge segment into the transform domain, which induced the migration and segmentation of the transform fault creating restraining stepovers. An anticlockwise change in plate motion at ∼11 million years ago 5 initially favoured extension in the left-stepping transform, triggering the formation of a transverse ridge, later uplifted through transpression, forming the St Peter and St Paul islets. Enhanced melt supply at the ridge axis due to the nearby Sierra Leone thermo chemical anomaly 9 is responsible for the robust response of the northern Mid-Atlantic Ridge segment to the kinematic change. The long-lived process at the origin of the compressive stresses is directly linked to the nature of the underlying mantle and not to a change in the far-field stress regime.

AimsGestational diabetes mellitus (GDM) is defined as glucose intolerance that is first diagnosed during pregnancy. Maternal adipose tissue and fetal membranes secrete various molecules that are relevant players in the pathogenesis of GDM. This pilot study aimed to examine whether the expression of the high mobility group box 1 protein (HMGB1) and its receptor for advanced glycation end products (RAGE), and the vasoactive intestinal peptide (VIP) and its receptors (VPAC-1,-2) were modified in pregnant women with GDM.MethodsFetal membranes (FMs), omental adipose tissue (VAT) explants, and serum samples were obtained from 12 women with GDM and 12 with normal glucose tolerance (NGT) at delivery. The expression of HMGB1, RAGE and VIP, VPAC-1,-2 was detected by Western Blotting in explants; circulating levels and “in vitro” release of HMGB1 and VIP were measured by ELISA tests.ResultsHMGB1 tissue expression was higher in FMs obtained from GDM women (p = 0.02) than in FMs from NGT women. VPAC2 (p = 0.03) and RAGE (p = 0.03) tissue expressions were significantly increased in VAT from GDM subjects. Only FMs of NGT released detectable levels of HMGB1, which was not observed in samples obtained from GDM. VAT of GDM released lower levels of VIP (p = 0.05) than NGT samples.ConclusionsThis study indicates that a fine tuned regulation exists between FMs and VAT throughout pregnancy to maintain immune metabolic homeostasis. In GDM a balance between inflammatory and anti-inflammatory mediators has been observed. Further studies are needed to establish their exact role on fetal and maternal outcomes in GDM.

Purpose Cancer pain (CP) management is challenging. In recent years, efforts were undertaken to achieve better CP management, e.g. clinical research, new treatment modalities, development of guidelines, education and focus on implementation. The aim of the present study was to compare the prevalence and characteristics of pain and breakthrough pain (BTP) between cross-sectional studies conducted in 2008 and 2014. It was hypothesized that an improvement in pain control would be observed the years in between. Methods Two cross-sectional studies were conducted where adult cancer patients answered questions from Brief Pain Inventory and the Alberta Breakthrough Pain Assessment Tool for cancer patients. Physicians reported socio-demographic and medical data. Regression models were applied for analysis. Results In total, 168 inpatients, 92 in 2008 and 76 in 2014, and 675 outpatients, 301 in 2008 and 374 in 2014, were included. The patient characteristics of the samples were comparable. Prevalence of CP among inpatients was 55 % in 2008 and 53 % in 2014, and among outpatients, 39 and 35 %, respectively. Inpatients reported average pain intensity (0–10 numerical rating scale, NRS) of 3.60 (standard deviation, SD 1.84) (2008) and 4.08 (SD 2.11) (2014); prevalence of BTP was 52 % (2008) and 41 % (2014). For outpatients, average pain intensity was 3.60 (SD 2.04) (2008) and 3.86 (SD 2.20) (2014); prevalence of BTP was 43 % (2008) and 37 % (2014). None of the differences were statistically significant. Conclusion Unexpectedly, no improvement in pain control was observed. Efforts are still needed to improve cancer pain management.