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Background The development of digital health interventions (DHIs) for severe mental health problems is fast-paced. Researchers are beginning to consult service users to inform DHIs; however, much of this involvement has been limited to feedback on specific interventions post-DHI development. This study had two aims: 1. explore service user views towards DHIs for severe mental health problems; and 2. make recommendations for specific content within DHIs based on service user needs and suggestions. Methods Qualitative interviews with eighteen people with severe mental health problems focussed on two domains: 1) views about DHIs for severe mental health problems; and 2) ideas for future DHI content and design features. Data were analysed thematically. Results Participants responses were captured in five key themes: 1) DHIs could be empowering tools that instigate reflection and change; 2) society is already divided; DHIs will further increase this divide; 3) considerations must be made about who has access to DHI data and how this data may be used; 4) DHIs should not be delivered without other support options; and 5) DHIs should provide a positive, fun, practical and interactive method for self-management. Conclusions Participants found DHIs acceptable due to the empowering nature of self-management and ability to take ownership of their own healthcare needs. However, concerns included the potential for digital exclusion, privacy and confidentiality and fears about DHIs being used to replace other mental health services. Service users want tools to help them self-manage their mental health, but also provide positive and recovery-focussed content that can be used in conjunction with other support options.

Background There is a notable a gap between promising research findings and implementation of digital health tools. Understanding and addressing barriers to use is key to widespread implementation. Methods A survey was administered to a self-selecting sample in-person ( n  = 157) or online ( n  = 58), with questions examining: i) ownership and usage rates of digital devices among people with psychosis; ii) interest in using technology to engage with mental health services; and iii) facilitators of and barriers to using digital tools in a mental healthcare context. Results Device ownership: Virtually all participants owned a mobile phone (95%) or smartphone (90%), with Android phones slightly more prevalent than iPhones. Only a minority owned a fitness tracker (15%) or smartwatch (13%). Device ownership was significantly lower in unemployed people and those without secondary education. Device cost and paranoid ideation were barriers to ownership. Technology and mental health services: Most participants (88%) said they would willingly try a mental health app. Symptom monitoring apps were most popular, then appointment reminders and medication reminders. Half the sample would prefer an app alongside face-to-face support; the other half preferred remote support or no other mental health support. Facilitators: Participants thought using a mental health app could increase their understanding of psychosis generally, and of their own symptoms. They valued the flexibility of digital tools in enabling access to support anywhere, anytime. Barriers: Prominent barriers to using mental health apps were forgetting, lack of motivation, security concerns, and concerns it would replace face-to-face care. Overall participants reported no substantial effects of technology on their mental health, although a quarter said using a phone worsened paranoid ideation. A third used technology more when psychotic symptoms were higher, whereas a third used it less. Around half used technology more when experiencing low mood. Conclusions Our findings suggest rapidly increasing device ownership among people with psychosis, mirroring patterns in the general population. Smartphones appear appropriate for delivering internet-enabled support for psychosis. However, for a sub-group of people with psychosis, the sometimes complex interaction between technology and mental health may act as a barrier to engagement, alongside more prosaic factors such as forgetting.

Evidence suggests that dissociation is associated with psychotic experiences, particularly hallucinations, but also other symptoms. However, until now, symptom-specific relationships with dissociation have not been comprehensively synthesized. This is the first prospectively registered (CRD42017058214) meta-analysis to quantify the magnitude of association between dissociative experiences and all symptoms of psychosis. MEDLINE, PsycINFO, PubMed, and Scopus databases were searched using exhaustive terms denoting dissociation and psychotic symptoms. We included both nonclinical (58 studies; 16 557 participants) and clinical (46 studies; 3879 patient participants) samples and evaluated study quality. Ninety-three eligible articles considering 20 436 participants were retained for analysis. There was a robust association between dissociation and clinical and nonclinical positive psychotic symptoms (r = .437; 95%CI: .386 −.486), with the observed effect larger in nonclinical studies. Symptom-specific associations were also evident across clinical and nonclinical studies, and included significant summary effects for hallucinations (r = .461; 95%CI: .386 −.531), delusions (r = .418; 95%CI: .370 −.464), paranoia (r = .447; 95%CI: .393 −.499), and disorganization (r = .346; 95%CI: .249 −.436). Associations with negative symptoms were small and, in some cases, not significant. Overall, these findings confirm that dissociative phenomena are not only robustly related to hallucinations but also to multiple positive symptoms, and less robustly related to negative symptoms. Our findings are consistent with proposals that suggest certain psychotic symptoms might be better conceptualized as dissociative in nature and support the development of interventions targeting dissociation in formulating and treating psychotic experiences.

Analysis of data from forest plants worldwide shows that margins between threshold xylem pressures at which plants suffer damage and the lowest xylem pressures experienced are small, with no difference between dry and wet forests, providing insight into why drought-induced forest decline is occurring in both arid and wet forests. Forests facing threat of drought Forest dieback resulting from extreme drought events has the potential to cause widespread loss of biodiversity, with a major impact on the global carbon balance. Plants undergoing drought stress experience reduced xylem pressure, and each species can tolerate a different degree of reduction before xylem damage and, eventually, hydraulic failure occur. This study looks at the safety margin between minimum experienced xylem pressure and the damage threshold for 226 forest species from 81 sites worldwide and shows that most species across both dry and wet biomes have small safety margins against injurious levels of drought stress. These plants are potentially vulnerable to the combination of rising temperatures and declining rainfall that is predicted to cause droughts of increasing intensity and duration in the near future. Shifts in rainfall patterns and increasing temperatures associated with climate change are likely to cause widespread forest decline in regions where droughts are predicted to increase in duration and severity 1 . One primary cause of productivity loss and plant mortality during drought is hydraulic failure 2 , 3 , 4 . Drought stress creates trapped gas emboli in the water transport system, which reduces the ability of plants to supply water to leaves for photosynthetic gas exchange and can ultimately result in desiccation and mortality. At present we lack a clear picture of how thresholds to hydraulic failure vary across a broad range of species and environments, despite many individual experiments. Here we draw together published and unpublished data on the vulnerability of the transport system to drought-induced embolism for a large number of woody species, with a view to examining the likely consequences of climate change for forest biomes. We show that 70% of 226 forest species from 81 sites worldwide operate with narrow (<1 megapascal) hydraulic safety margins against injurious levels of drought stress and therefore potentially face long-term reductions in productivity and survival if temperature and aridity increase as predicted for many regions across the globe 5 , 6 . Safety margins are largely independent of mean annual precipitation, showing that there is global convergence in the vulnerability of forests to drought, with all forest biomes equally vulnerable to hydraulic failure regardless of their current rainfall environment. These findings provide insight into why drought-induced forest decline is occurring not only in arid regions but also in wet forests not normally considered at drought risk 7 , 8 .

Background Digital health interventions have the potential to improve the efficacy and accessibility of mental health services for people with severe mental health problems, but their integration into routine practice is a challenge. The real-world implementation of digital health interventions should be considered alongside digital intervention development. However, little is known about the quality of implementation research in this area, including the extent to which implementation science theories, models and frameworks are used. The aim of this review was to synthesise evidence regarding the application of theories, models and frameworks in research investigating the implementation of digital health interventions in services for people with severe mental health problems. Secondary aims were to consider the contexts within which studies had been undertaken and the degree of service user involvement in this research. Methods A scoping review method was employed. Electronic databases were systematically searched for published papers in English and reference lists of included studies were hand searched. Included studies used an implementation science theory, model, or framework to understand, guide or evaluate the implementation of digital health interventions in services for people with severe mental health problems. Results Twelve eligible studies were identified. Studies were primarily undertaken in community mental health services with staff participants and there was variation in the types of digital interventions that were investigated. Eight different implementation science theories, models, and frameworks were used and were mainly employed to guide qualitative analysis. Most studies were undertaken in the early exploratory stages of implementation projects and there was little evidence regarding factors affecting the longer-term sustainment of digital health interventions in practice. Only one study reported the inclusion of service users in the design of the implementation study. Conclusions The use of implementation theories, models, and frameworks in efforts to implement digital health interventions in routine care for people with severe mental health problems is limited. Researchers should consider integrating such approaches throughout the research process and ensure service users are involved in this work. Further research regarding implementation processes, and the reach and sustainment of digital health interventions in routine practice, is required.

Introduction Globally, many people experience mental health difficulties, and the current workforce capacity is insufficient to meet this demand, with growth not keeping pace with need. Digital devices that passively collect data and utilise machine learning to generate insights could enhance current mental health practices and help service users manage their mental health. However, little is known about mental healthcare professionals' perspectives on these approaches. This study aims to explore mental health professionals' views on using digital devices to passively collect data and apply machine learning in mental healthcare, as well as the potential barriers and facilitators to their implementation in practice. Methods Qualitative semi‐structured interviews were conducted with 15 multidisciplinary staff who work in secondary mental health settings. Interview topics included the use of digital devices for passive sensing, developing machine learning algorithms from this data, the clinician's role, and the barriers and facilitators to their use in practice. Interview data were analysed using reflexive thematic analysis. Results Participants noted that digital devices for healthcare can motivate and empower users, but caution is needed to prevent feelings of abandonment and widening inequalities. Passive sensing can enhance assessment objectivity, but it raises concerns about privacy, data storage, consent and data accuracy. Machine learning algorithms may increase awareness of support needs, yet lack context, risking misdiagnosis. Barriers for service users include access, accessibility and the impact of receiving insights from passively collected data. For staff, barriers involve infrastructure and increased workload. Staff support facilitated service users' adoption of digital systems, while for staff, training, ease of use and feeling supported were key enablers. Conclusions Several recommendations have arisen from this study, including ensuring devices are user‐friendly and equitably applied in clinical practice. Being with a blended approach to prevent service users from feeling abandoned and provide staff with training and access to technology to enhance uptake. Patient or Public Contribution The study design, protocol and topic guide were informed by a lived experience community group that advises on research projects at the authors' affiliation.

Mental health difficulties are highly prevalent worldwide. Passive sensing technologies and applied artificial intelligence (AI) methods can provide an innovative means of supporting the management of mental health problems and enhancing the quality of care. However, the views of stakeholders are important in understanding the potential barriers to and facilitators of their implementation. This study aims to review, critically appraise, and synthesize qualitative findings relating to the views of mental health care professionals on the use of passive sensing and AI in mental health care. A systematic search of qualitative studies was performed using 4 databases. A meta-synthesis approach was used, whereby studies were analyzed using an inductive thematic analysis approach within a critical realist epistemological framework. Overall, 10 studies met the eligibility criteria. The 3 main themes were uses of passive sensing and AI in clinical practice, barriers to and facilitators of use in practice, and consequences for service users. A total of 5 subthemes were identified: barriers, facilitators, empowerment, risk to well-being, and data privacy and protection issues. Although clinicians are open-minded about the use of passive sensing and AI in mental health care, important factors to consider are service user well-being, clinician workloads, and therapeutic relationships. Service users and clinicians must be involved in the development of digital technologies and systems to ensure ease of use. The development of, and training in, clear policies and guidelines on the use of passive sensing and AI in mental health care, including risk management and data security procedures, will also be key to facilitating clinician engagement. The means for clinicians and service users to provide feedback on how the use of passive sensing and AI in practice is being received should also be considered. PROSPERO International Prospective Register of Systematic Reviews CRD42022331698; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=331698.

The evolution of lignified xylem allowed for the efficient transport of water under tension, but also exposed the vascular network to the risk of gas emboli and the spread of gas between xylem conduits, thus impeding sap transport to the leaves. A well-known hypothesis proposes that the safety of xylem (its ability to resist embolism formation and spread) should trade off against xylem efficiency (its capacity to transport water). We tested this safety–efficiency hypothesis in branch xylem across 335 angiosperm and 89 gymnosperm species. Safety was considered at three levels: the xylem water potentials where 12%, 50% and 88% of maximal conductivity are lost. Although correlations between safety and efficiency were weak (r2 < 0.086), no species had high efficiency and high safety, supporting the idea for a safety–efficiency tradeoff. However, many species had low efficiency and low safety. Species with low efficiency and low safety were weakly associated (r2 < 0.02 in most cases) with higher wood density, lower leaf- to sapwood-area and shorter stature. There appears to be no persuasive explanation for the considerable number of species with both low efficiency and low safety. These species represent a real challenge for understanding the evolution of xylem.

Objective Smartphone apps (apps) are widely recognised as promising tools for improving access to mental healthcare. However, a key challenge is the development of digital interventions that are acceptable to end users. Co-production with providers and stakeholders is increasingly positioned as the gold standard for improving uptake, engagement, and healthcare outcomes. Nevertheless, clear guidance around the process of co-production is lacking. The objectives of this review were to: (i) present an overview of the methods and approaches to co-production when designing, producing, and evaluating digital mental health interventions; and (ii) explore the barriers and facilitators affecting co-production in this context. Methods A pre-registered (CRD42023414007) systematic review was completed in accordance with The Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Five databases were searched. A co-produced bespoke quality appraisal tool was developed with an expert by experience to assess the quality of the co-production methods and approaches. A narrative synthesis was conducted. Results Twenty-six studies across 24 digital mental health interventions met inclusion criteria. App interventions were rarely co-produced with end users throughout all stages of design, development, and evaluation. Co-producing digital mental health interventions added value by creating culturally sensitive and acceptable interventions. Reported challenges included resource issues exacerbated by the digital nature of the intervention, variability across stakeholder suggestions, and power imbalances between stakeholders and researchers. Conclusions Variation in approaches to co-producing digital mental health interventions is evident, with inconsistencies between stakeholder groups involved, stage of involvement, stakeholders’ roles and methods employed.

Foliar water uptake (FWU) has been reported for different species across several ecosystems types. However, little attention has been given to arid ecosystems, where FWU during dew formation or small rain events could ameliorate water deficits. FWU and their effects on leaf water potential (ψLeaf) were evaluated in grasses and shrubs exploring different soil water sources in a Patagonian steppe. Also, seasonal variability in FWU and the role of cell wall elasticity in determining the effects on? Leaf were assessed. Eleven small rain events (< 8 mm) and 45 days with dew formation were recorded during the study period. All species exhibited FWU after experimental wetting. There was a large variability in FWU across species, from 0.04 mmol m⁻² s⁻¹ in species with deep roots to 0.75 mmol m⁻² s⁻¹ in species with shallow roots. Species-specific mean FWU rates were positively correlated with mean transpiration rates. The increase in ψLeaf after leaf wetting varied between 0.65 MPa and 1.67 MPa across species and seasons. The effects of FWU on ψLeaf were inversely correlated with cell wall elasticity. FWU integrated over both seasons varied between 28 mol m⁻² in species with deep roots to 361 mol m⁻² in species with shallow roots. Taking into account the percentage of coverage of each species, accumulated FWU represented 1.6% of the total annual transpiration of grasses and shrubs in this ecosystem. Despite this low FWU integrated over time compared to transpiration, wetting leaves surfaces can help to avoid larger water deficit during the dry season.