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This paper traces the stimulating and encouraging experience of two decades of bringing a psychoanalytic frame to clinical psychologists in training in an Irish university setting. I am taking this as one area in which our work of reaching over between psychoanalysis and other fields can be fruitful. Starting with a portrayal of the nature of this training, including its central components and the demands it makes on trainees, I consider how the psychoanalytic classes I have engaged in with trainees have been organised, and the observations I have made about what has been useful in these, and the kinds of themes that have arisen. This work has instilled a belief in the value of a psychoanalytic approach to help to develop an overall understanding of what we meet in clinical services – a person, presenting with a symptom, carrying meaning, and requiring attention and allowing for a wider exploration of the place it has in the person’s life. I describe some of the struggles experienced by trainees in this compressed training, and the assistance that psychoanalytic thinking can have in this. I draw out five themes that have arisen within my work: (1) Toying with a symmetrical approach; (2) Reflection without pressure to act; (3) A joy in found ideas; (4) Finding meaning in distress; and (5) Valuing the freedom to think.

Normal brain function is highly dependent on oxygen and nutrient supply and when the demand for oxygen exceeds its supply, hypoxia is induced. Acute episodes of hypoxia may cause a depression in synaptic activity in many brain regions, whilst prolonged exposure to hypoxia leads to neuronal cell loss and death. Acute inadequate oxygen supply may cause anaerobic metabolism and increased respiration in an attempt to increase oxygen intake whilst chronic hypoxia may give rise to angiogenesis and erythropoiesis in order to promote oxygen delivery to peripheral tissues. The effects of hypoxia on neuronal tissue are exacerbated by the release of many inflammatory agents from glia and neuronal cells. Cytokines, such as TNF-α, and IL-1β are known to be released during the early stages of hypoxia, causing either local or systemic inflammation, which can result in cell death. Another growing body of evidence suggests that inflammation can result in neuroprotection, such as preconditioning to cerebral ischemia, causing ischemic tolerance. In the following review we discuss the effects of acute and chronic hypoxia and the release of pro-inflammatory cytokines on synaptic transmission and plasticity in the central nervous system. Specifically we discuss the effects of the pro-inflammatory agent TNF-α during a hypoxic event.

Seismological findings show a complex scenario of plume upwellings from a deep thermo-chemical anomaly (superplume) beneath the East African Rift System (EARS). It is unclear if these geophysical observations represent a true picture of the superplume and its influence on magmatism along the EARS. Thus, it is essential to find a geochemical tracer to establish where upwellings are connected to the deep-seated thermo-chemical anomaly. Here we identify a unique non-volatile superplume isotopic signature (‘C’) in the youngest (after 10 Ma) phase of widespread EARS rift-related magmatism where it extends into the Indian Ocean and the Red Sea. This is the first sound evidence that the superplume influences the EARS far from the low seismic velocities in the magma-rich northern half. Our finding shows for the first time that superplume mantle exists beneath the rift the length of Africa from the Red Sea to the Indian Ocean offshore southern Mozambique. Low seismic velocity anomalies reveal a complex scenario of plume upwellings from a deep thermo-chemical anomaly (superplume) in the mantle below the East African Rift, however, geophysical observations alone are insufficient to identify the extent of plume influence on the magmatism along the rift. Here, the authors use Sr-Nd-Pb isotope data to show that superplume mantle underlies the entire rift system, from the Red Sea to the Indian Ocean south of Mozambique.

Background Total hip arthroplasties (THA) are cost-effective interventions for patients with osteoarthritis refractory to physical therapy or medical management. Most individuals report positive surgical outcomes with reduction in pain and improved joint function. Multiple recent studies demonstrated the influence of patient mental health on surgical success. We sought to determine the relationship between patient preoperative psychological factors and postoperative THA outcomes, specifically pain and function. Methods PubMed, EMBASE and Cochrane Reviews databases were queried using terms “(mental OR psychological OR psychiatric) AND (function OR trait OR state OR predictor OR health) AND (outcome OR success OR recovery OR response) AND total joint arthroplasty).” A total of 21 of 1,286 studies fulfilled inclusion criteria and were included in the review. All studies were analyzed using GRADE and Risk of Bias criteria. Results Overall, compared to cohorts with a normal psychological status, patients with higher objective measures of preoperative depression and anxiety reported increased postoperative pain, decreased functionality and greater complications following THA. Additionally, participants with lower self-efficacy or somatization were found to have worse functional outcomes. Conclusions Preoperative depression, anxiety and somatization may negatively impact patient reported postoperative pain, functionality and complications following THA. Surgeons should consider preoperative psychological status when counseling patients regarding expected surgical outcomes. Level of evidence 3.

The Easter mantle plume has produced one of the longest hotspot tracks in the Pacific Ocean. While previous studies have focused on the eastern side extending across the Nazca Plate, we use 40 Ar/ 39 Ar isotopic and geochemical data to investigate the less explored western side around the Easter Microplate. We propose a dynamic model in which a deeper (600 km-depth), less buoyant mantle exerts a westward force on the East Pacific Rise (EPR), while a more buoyant plume region drives Easter hotspot volcanism and a localised acceleration in seafloor spreading. Our findings suggest that the Easter hotspot is the more focused surface expression of the most buoyant region of a vast, deep-seated mantle plume extending from the Pacific Large Low Shear Velocity Province (LLSVP). This challenges the traditional view of hotspots as isolated phenomena and suggests they are part of broader LLSVP-related mantle structures. Our results imply a more intricate, large-scale relationship between hotspots, mantle plumes, spreading ridges, and mantle dynamics. Examination of the Easter hotspot reveals it as part of a vast, deep-seated mantle system, influencing seafloor spreading and shaping the Pacific Ocean, which challenges the view of hotspots as isolated volcanic centres.

Despite progress in understanding seafloor accretion at ultraslow spreading ridges, the ultimate driving force is still unknown. Here we use 40 Ar/ 39 Ar isotopic dating of mid-ocean ridge basalts recovered at variable distances from the axis of the Gakkel Ridge to provide new constraints on the spatial and temporal distribution of volcanic eruptions at various sections of an ultraslow spreading ridge. Our age data show that magmatic-dominated sections of the Gakkel Ridge spread at a steady rate of ~11.1 ± 0.9 mm/yr whereas amagmatic sections have a more widely distributed melt supply yielding ambiguous spreading rate information. These variations in spreading rate and crustal accretion correlate with locations of hotter thermochemical anomalies in the asthenosphere beneath the ridge. We conclude therefore that seafloor generation in ultra-slow spreading centres broadly reflects the distribution of thermochemical anomalies in the upper mantle. The ultimate driver of ultraslow spreading ridges is unknown. Here the authors use spreading rates derived directly from isotopic ages of seafloor samples to link magmatic and amagmatic segments with thermochemical variations in the upper mantle.

Chronic airway infection and inflammation resulting in progressive, obstructive lung disease is the leading cause of morbidity and mortality in cystic fibrosis. Understanding the lower airway microbiota across the ages can provide valuable insight and potential therapeutic targets. To characterize and compare the lower airway microbiota in cystic fibrosis and disease control subjects across the pediatric age spectrum. Bronchoalveolar lavage fluid samples from 191 subjects (63 with cystic fibrosis) aged 0 to 21 years were collected along with relevant clinical data. We measured total bacterial load using quantitative polymerase chain reaction and performed 16S rRNA gene sequencing to characterize bacterial communities with species-level sensitivity for select genera. Clinical comparisons were investigated. Cystic fibrosis samples had higher total bacterial load and lower microbial diversity, with a divergence from disease controls around 2-5 years of age, as well as higher neutrophilic inflammation relative to bacterial burden. Cystic fibrosis samples had increased abundance of traditional cystic fibrosis pathogens and decreased abundance of the Streptococcus mitis species group in older subjects. Interestingly, increased diversity in the heterogeneous disease controls was independent of diagnosis and indication. Sequencing was more sensitive than culture, and antibiotic exposure was more common in disease controls, which showed a negative relationship with load and neutrophilic inflammation. Analysis of lower airway samples from people with cystic fibrosis and disease controls across the ages revealed key differences in airway microbiota and inflammation. The divergence in subjects during early childhood may represent a window of opportunity for intervention and additional study.

Transcriptomic personalisation of radiation therapy has gained considerable interest in recent years. However, independent model testing on in vitro data has shown poor performance. In this work, we assess the reproducibility in clinical applications of radiosensitivity signatures. Agreement between radiosensitivity predictions from published signatures using different microarray normalization methods was assessed. Control signatures developed from resampled in vitro data were benchmarked in clinical cohorts. Survival analysis was performed using each gene in the clinical transcriptomic data, and gene set enrichment analysis was used to determine pathways related to model performance in predicting survival and recurrence. The normalisation approach impacted calculated radiosensitivity index (RSI) values. Indeed, the limits of agreement exceeded 20% with different normalisation approaches. No published signature significantly improved on the resampled controls for prediction of clinical outcomes. Functional annotation of gene models suggested that many overlapping biological processes are associated with cancer outcomes in RT treated and non-RT treated patients, including proliferation and immune responses. In summary, different normalisation methods should not be used interchangeably. The utility of published signatures remains unclear given the large proportion of genes relating to cancer outcome. Biological processes influencing outcome overlapped for patients treated with or without radiation suggest that existing signatures may lack specificity.