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Background: Higher education institutions face challenges in providing effective mental health services for diverse student needs. In the UK, discrepancies between healthcare and education service provision create barriers for students and require stronger alignment through partnerships., Objectives: This study aimed to identify risks, barriers and enablers to developing service partnerships between universities and the National Health Service (NHS) in England. It investigated existing partnerships and strategies that facilitate effective collaborative working., Design and Setting: A case study approach was employed, including coproduction and stakeholder involvement with staff and service users, to gather information from eight English universities developing regional student mental health hubs. This research received appropriate ethical approval., Participants: In total, 27 professional staff from counselling, mental health, disability and well-being services participated and represented their respective services., Outcome Measures: Descriptive information was collected from service websites, handbooks, reports and 11 focus groups using a standardised data collection template. Inter-rater reliability was used to determine the agreement between coders and finalise focus group themes. EQUATOR (Enhancing the QUAlity and Transparency Of health Research) Standards for Reporting Qualitative Research were adopted., Results: Using inductive thematic analysis, five themes were identified for developing partnerships: building blocks, facing barriers, achieving positive outcomes, shaping student services and developing coordinated care. Fleiss' kappa showed strong agreement between raters regarding the partnership factors ( k =0.84 (95% CI 0.81 to 0.87), p<0.0005). Effective communication, shared understanding and trust were essential. Barriers included restrictions to information sharing and incompatible data infrastructures between services., Conclusions: Stronger partnerships between universities and NHS are needed to meet increasing student mental health demands. Addressing barriers and implementing strategies to develop partnerships can enhance student services., Preregistration: https://osf.io/u54qk/., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Multiple cortical (planum temporale, supramarginal gyrus, fusiform gyrus) and subcortical (caudate, putamen, and thalamus) regions have shown different functional lateralization patterns for skilled vs. dyslexic readers. The extent to which skilled and dyslexic adult readers show differential structural lateralization remains to be seen. Method: Participants included 72 adults (N = 41 skilled; N = 31 dyslexic) who underwent a high-resolution MRI brain scan. The grey matter volume of the cortical and subcortical structures was extracted. Results: While there were clear behavioral differences between the groups, there were no differences in any of the isolated structures (i.e., either total size or asymmetry index) and limited evidence for any brain-behavior relationships. We did find a significant cortical-cortical relationship ( p = 0.006) and a subcortical-subcortical relationship ( p = 0.008), but not cross-over relationships. Overall, this work provides unique information on neural structures as they relate to reading in skilled and dyslexic readers.

There are increasing rates of internalising difficulties, particularly anxiety and depression, being reported in children and young people in England. School-based universal prevention programmes are thought to be one way of helping tackle such difficulties. This paper describes an update to a four-arm cluster randomised controlled trial ( http://www.isrctn.com/ISRCTN16386254 ), investigating the effectiveness of three different interventions when compared to usual provision, in English primary and secondary pupils. Due to the COVID-19 pandemic, the trial was put on hold and subsequently prolonged. Data collection will now run until 2024. The key changes to the trial outlined here include clarification of the inclusion and exclusion criteria, an amended timeline reflecting changes to the recruitment period of the trial due to the COVID-19 pandemic and clarification of the data that will be included in the statistical analysis, since the second wave of the trial was disrupted due to COVID-19.Trial registration ISRCTN Registry ISRCTN16386254. Registered on 30 August 2018., (© 2023. The Author(s).)

The amount of carbon stored in deadwood is equivalent to about 8 per cent of the global forest carbon stocks 1 . The decomposition of deadwood is largely governed by climate 2-5 with decomposer groups-such as microorganisms and insects-contributing to variations in the decomposition rates 2,6,7 . At the global scale, the contribution of insects to the decomposition of deadwood and carbon release remains poorly understood 7 . Here we present a field experiment of wood decomposition across 55 forest sites and 6 continents. We find that the deadwood decomposition rates increase with temperature, and the strongest temperature effect is found at high precipitation levels. Precipitation affects the decomposition rates negatively at low temperatures and positively at high temperatures. As a net effect-including the direct consumption by insects and indirect effects through interactions with microorganisms-insects accelerate the decomposition in tropical forests (3.9% median mass loss per year). In temperate and boreal forests, we find weak positive and negative effects with a median mass loss of 0.9 per cent and -0.1 per cent per year, respectively. Furthermore, we apply the experimentally derived decomposition function to a global map of deadwood carbon synthesized from empirical and remote-sensing data, obtaining an estimate of 10.9 ± 3.2 petagram of carbon per year released from deadwood globally, with 93 per cent originating from tropical forests. Globally, the net effect of insects may account for 29 per cent of the carbon flux from deadwood, which suggests a functional importance of insects in the decomposition of deadwood and the carbon cycle., (© 2021. The Author(s), under exclusive licence to Springer Nature Limited.)

Background: Clinician utilization of practice guidelines can reduce inappropriate opioid prescribing and harm in chronic non-cancer pain; yet, implementation of "opioid guidelines" is subpar. We hypothesized that a multi-component quality improvement (QI) augmentation of "routine" system-level implementation efforts would increase clinician adherence to the opioid guideline-driven policy recommendations., Methods: Opioid policy was implemented system-wide in 26 primary care clinics. A convenience sample of 9 clinics received the QI augmentation (one-hour academic detailing; 2 online educational modules; 4-6 monthly one-hour practice facilitation sessions) in this non-randomized stepped-wedge QI project. The QI participants were volunteer clinic staff. The target patient population was adults with chronic non-cancer pain treated with long-term opioids. The outcomes included the clinic-level percentage of target patients with a current treatment agreement (primary outcome), rates of opioid-benzodiazepine co-prescribing, urine drug testing, depression and opioid misuse risk screening, and prescription drug monitoring database check; additional measures included daily morphine-equivalent dose (MED), and the percentages of all target patients and patients prescribed ≥90 mg/day MED. T-test, mixed-regression and stepped-wedge-based analyses evaluated the QI impact, with significance and effect size assessed with two-tailed p < 0.05, 95% confidence intervals and/or Cohen's d., Results: Two-hundred-fifteen QI participants, a subset of clinical staff, received at least one QI component; 1255 patients in the QI and 1632 patients in the 17 comparison clinics were prescribed long-term opioids. At baseline, more QI than comparison clinic patients were screened for depression (8.1% vs 1.1%, p = 0.019) and prescribed ≥90 mg/day MED (23.0% vs 15.5%, p = 0.038). The stepped-wedge analysis did not show statistically significant changes in outcomes in the QI clinics, when accounting for the comparison clinics' trends. The Cohen's d values favored the QI clinics in all outcomes except opioid-benzodiazepine co-prescribing. Subgroup analysis showed that patients prescribed ≥90 mg/day MED in the QI compared to comparison clinics improved urine drug screening rates (38.8% vs 19.1%, p = 0.02), but not other outcomes (p ≥ 0.05)., Conclusions: Augmenting routine policy implementation with targeted QI intervention, delivered to volunteer clinic staff, did not additionally improve clinic-level, opioid guideline-concordant care metrics. However, the observed effect sizes suggested this approach may be effective, especially in higher-risk patients, if broadly implemented., Trial Registration: Not applicable.

Background: Systematic implementation of guidelines for opioid therapy management in chronic non-cancer pain can reduce opioid-related harms. However, implementation of guideline-recommended practices in routine care is subpar. The goal of this quality improvement (QI) project is to assess whether a clinic-tailored QI intervention improves the implementation of a health system-wide, guideline-driven policy on opioid prescribing in primary care. This manuscript describes the protocol for this QI project., Methods: A health system with 28 primary care clinics caring for approximately 294,000 primary care patients developed and implemented a guideline-driven policy on long-term opioid therapy in adults with opioid-treated chronic non-cancer pain (estimated N = 3980). The policy provided multiple recommendations, including the universal use of treatment agreements, urine drug testing, depression and opioid misuse risk screening, and standardized documentation of the chronic pain diagnosis and treatment plan. The project team drew upon existing guidelines, feedback from end-users, experts and health system leadership to develop a robust QI intervention, targeting clinic-level implementation of policy-directed practices. The resulting multi-pronged QI intervention included clinic-wide and individual clinician-level educational interventions. The QI intervention will augment the health system's "routine rollout" method, consisting of a single educational presentation to clinicians in group settings and a separate presentation for staff. A stepped-wedge design will enable 9 primary care clinics to receive the intervention and assessment of within-clinic and between-clinic changes in adherence to the policy items measured by clinic-level electronic health record-based measures and process measures of the experience with the intervention., Discussion: Developing methods for a health system-tailored QI intervention required a multi-step process to incorporate end-user feedback and account for the needs of targeted clinic team members. Delivery of such tailored QI interventions has the potential to enhance uptake of opioid therapy management policies in primary care. Results from this study are anticipated to elucidate the relative value of such QI activities.

Objectives: To review suicide patterns among Inuit in Canada and highlight new developments in Inuit-driven and community-based suicide prevention. Study design. Narrative overview of suicide among Inuit in Canada, strides towards Inuit autonomy, and community and government action towards suicide prevention., Methods: Review of Inuit meanings of mental health, movements towards Inuit control across Inuit Nunaat (the 4 Inuit regions) of Canada, and of community and government action towards suicide prevention., Results: Economic advancement is occurring in Inuit Nunaat following land claim settlements, and territorial and provincial governments are overseeing Inuit well-being. Inuit community engagement in suicide prevention is taking place and studies are being planned to evaluate the efficacy of such action for suicide prevention and community mental health. Initial evidence demonstrates that community control over suicide prevention itself can be effective towards preventing suicide., Conclusions: A new orientation is taking place in Canada in the name of Aboriginal community empowerment. There is a new hope for the model of meaningful community engagement and partnership with the Canadian government in suicide prevention and well-being.