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1 The aim of this study was to document patterns in tree reproductive phenology in a rain forest of central Borneo and examine relationships between phenology and climatic patterns. 2 A 10-year data set (1990-2000) of monthly observations of flowering and fruit production of 171 trees (including 39 members of the Dipterocarpaceae) at Barito Ulu, Central Kalimantan, Indonesia, showed that most trees (73%) underwent reproductive activity on a supra-annual timescale. 3 There were three general flowering (GF) events, in 1991, 1994 and 1997, which were preceded by major drought periods (30-day sliding total rainfall of less than 100 mm for more than 10 days) in which at least 40% of dipterocarps and at least 18% of all other trees underwent synchronized reproductive activity; there was also a minor event in 1990. Around 1.3% of trees flowered and 3.8% produced fruit in months outside of these four events. 4 At the community level, the strongest negative correlation was found between the percentage of flowering individuals and total rainfall in the preceding 150 days. 5 Within three genera of dipterocarps examined in more detail (Dipterocarpus, Shorea and Vatica) there were clear and consistent patterns of sequential flowering with certain species flowering early in the GF events and others towards the end of these events. 6 Our results confirm the importance of large-scale climatic fluctuations (El Niño-Southern Oscillation) on plant reproductive phenology in South-east Asian tropical forests and indicate that drought may be a more important cue than low night-time temperatures.

Background The incidence of acute kidney injury in pregnancy (P-AKI) is rising and is associated with detrimental maternal and foetal outcomes. Ethnic disparities in pregnancy outcomes are well recognized, with females who identify as Black or Asian being more likely to die during pregnancy compared to females who identify as White ethnicity. Methods This study reports rates of P-AKI and associated risk factors in pregnant females of different ethnicities. All pregnancies were recorded between 2016 and 2020. AKI episodes were identified using electronic alerts. Ethnicity, AKI stage (1–3), obstetric outcomes and risk factors for P-AKI (chronic hypertension, pregnancy-induced hypertension and pre-eclampsia, and haemorrhage) were assessed. Results There were 649 P-AKI episodes from 16,943 deliveries (3.8%). Black females were more likely to have P-AKI (5.72%) compared to those who were White (3.12%), Asian (3.74%), mixed ethnicity (2.89%) and Other/Not Stated (3.10%). Black females, compared to White females, were at greater risk of developing P-AKI if they had haemorrhage requiring blood transfusion (OR 2.44, 95% CI 1.31,4.54; p  < 0.001) or pregnancy-induced hypertension (OR 1.79, 95% CI 1.12, 2.86; p  < 0.001). After adjusting for risk factors, Black females had increased risk of developing P-AKI (OR 1.52, 95% CI 1.22, 1.80; p  < 0.001) compared to White females. Black females were at increased risk of developing P-AKI compared to White females. Mode of delivery, pregnancy-induced hypertension and haemorrhage are likely to have contributed. The increased risk persists despite accounting for these variables, suggesting that other factors such as socioeconomic disparities need to be considered. Conclusions The incidence of P-AKI is likely higher than previously stated in the literature. However, caution must be exercised, particularly with AKI stage 1, as the KDIGO system is not validated in pregnancy and gestational changes in renal physiology need to be considered. Pregnancy-specific AKI definitions are needed. Graphical abstract

ObjectiveThere is interest in identifying reliable prognostic biomarkers in schizophrenia and related disorders. Serum inflammatory markers, such as white cell count and C-reactive protein (CRP), have been shown to be elevated during psychotic episodes; however, their pathogenic role is uncertain. There is limited data relating to their variability in clinical practice and relationship to clinical outcome. We have sought to investigate whether routine clinical case records contain the necessary data to further understand the relationship between serum inflammatory markers and prognosis.MethodThis is a retrospective case note review of patients admitted to an inner city female acute psychiatry ward. Cases were identified by reviewing electronic ward round records. Patients included had a diagnosis of non-affective, non-drug induced psychosis (schizophrenia, acute and transient psychotic disorder, persistent delusional disorder, schizotypal disorder and nonorganic psychosis) and had received a routine admission blood test. Exclusion criteria included pregnancy, significant recreational drug use prior to admission, clinical evidence of infection or history of inflammatory or haematological disease.ResultsA total of 20 patients met the inclusion criteria between April 2015 and October 2016. Mean age was 43 years (SD=15) and the most common ethnicities were White British (23%), Mixed Ethnicity (23%), and Caribbean (23%). The majority of cases were detained under the Mental Health Act (68%) and had previously been treated with antipsychotic medication (94%). Mean admission duration was 38 days (SD=30) and average time from admission to routine admission blood test was 4 days (SD=3 days). Admission duration was moderately positively correlated with white cell count (r=0.41, n=20, p=0.07), platelet count (r=0.40, n=20, p=0.08) and albumin (r=0.42, n=20, p=0.07). Admission duration was weakly correlated with neutrophil count (r=0.27, n=20, p=0.24) and CRP (r=−0.22, n=20, p=0.35). When patients split according to those above and below the median admission length, patients with longer admissions had significantly higher platelet count (p<0.05) only.ConclusionThis small retrospective review suggests that in routine clinical case practice information is collected which could be used to explore the role of inflammatory markers as prognostic biomarkers in patients with schizophrenia and related disorders. Despite our extremely small sample we have found a positive correlation between platelet count and admission length. However this needs to be considered in the presence of multiple confounders. Use of electronic patient databases may be helpful in extending the sample to formally establish any prognostic relationships.

IntroductionDecentering describes the ability to voluntarily adopt an objective self-perspective from which to notice internal, typically distressing, stressors (eg, difficult thoughts, memories and feelings). The reinforcement of this skill may be an active ingredient through which different psychological interventions accrue reductions in anxiety and/or depression. However, it is unclear if decentering can be selectively trained at a young age and if this might reduce psychological distress. The aim of the current trial is to address this research gap.Methods and analysisAdolescents, recruited from schools in the UK and Ireland (n=57 per group, age range=16–19 years), will be randomised to complete 5 weeks of decentering training, or an active control group that will take part in a combination of light physical exercise and cognitive training. The coprimary training outcomes include a self-reported decentering inventory (ie, the Experiences Questionnaire) and the momentary use of decentering in response to psychological stressors, using experience sampling. The secondary mental health outcomes will include self-reported inventories of depression and anxiety symptoms, as well as psychological well-being. Initial statistical analysis will use between-group analysis of covariance to estimate the effect of training condition on self-rated inventories, adjusted for baseline scores. Additionally, experience sampling data will be examined using hierarchical linear models.Ethics and disseminationThis study was approved by the Cambridge Psychology Research Ethics Committee, University of Cambridge (PRE.2019.109). Findings will be disseminated through typical academic routes including poster/paper presentations at (inter)national conferences, academic institutes and through publication in peer-reviewed journals.Trial registration numberISRCTN14329613.