On the Dimensional Approach to Adolescent Psychopathology: a Systematic Review.

In child and adolescent psychiatry, the clinical presentation of disorders in adolescents is complex, and categorical approaches have limitations by focusing on individual disorders. The intricate system of psychopathology during adolescence can be effectively modeled using network science, which integrates statistical and computational techniques through artificial intelligence tools. Network analysis of psychometric data from psychiatric disorder assessment tests has been extensively studied in both general psychiatry and child psychiatry. However, a comprehensive evaluation of existing network approaches that model multiple psychiatric or neurodevelopmental disorders encountered in adolescents remains necessary. We conducted a systematic literature review across two different databases - PubMed and Scopus - using the keywords "network analysis", "adolescent" and "psychiatry" to address this question. The selection of articles was based on age criteria and the number of pathological entities studied. Out of 406 articles, 69 were selected and analyzed. The results from some of these studies are described in this article. Notably, we observe significant heterogeneity in the findings, highlighting both the richness and complexity of adolescent psychopathology. Further research is needed to validate the already proposed results and standardize the models studied.

Exploring the Impact of Medical Complexity on Nursing Complexity of Care in Paediatric Patients: A Retrospective Observational Study.

AIMS: To explore the impact of medical complexity, defined by the number of chronic conditions, on the complexity of care, as described by the frequency of nursing diagnoses (NDs) and nursing actions (NAs), in paediatric patients. DESIGN: Retrospective observational study. METHODS: This study was conducted in an Italian university hospital and involved the analysis of electronic health records for neonatal and paediatric patients who were consecutively admitted from January to December 2022. The sample was classified into three categories-non-chronic, single chronic and multimorbid patients-according to their clinical profiles. NDs recorded within the first 24 h from patient hospital admission and NAs performed throughout the hospital stay were counted for each group. RESULTS: Distinct variations in the prevalence and patterns of NDs and NAs were observed across different levels of medical complexity. A significant moderate positive correlation between the number of NDs and NAs was found. However, the frequency of NDs did not directly correlate with the number of chronic conditions. Conversely, a weak but significant negative correlation was identified between the quantity of NAs and the number of chronic conditions. While the frequency of NDs showed a stable but decreasing trend as the number of chronic conditions increased, a higher number of chronic conditions were associated with a lower quantity of NAs. CONCLUSIONS: We discovered a notable variation in the complexity of care across varying levels of medical complexity in paediatric patients. Our findings suggest that the complexity of care does not necessarily correspond to the degree of medical complexity. The observed negative relationship between the number of chronic conditions and the quantity of NAs underscores the need for further research to explore this unexpected finding and its implications for clinical practice. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Without the adoption of standardised nursing terminologies, such as nursing diagnoses (NDs) and nursing actions (NAs), assessing the complexity of care in paediatric settings can be challenging. Integrating clinical nursing information systems that incorporate standardised NDs and NAs into electronic health records is crucial for accurately documenting and analysing the complexity of care and its relationship with medical complexity. IMPACT: In paediatric patients, the frequency of nursing diagnoses (NDs) at hospital admission is significantly associated with the quantity of nursing actions (NAs) delivered during hospitalisation. However, there is no correlation between the frequency of NDs and medical complexity, as defined by the number of chronic disorders. Specifically, the frequency of NDs decreases with increasing medical complexity, while the quantity of NAs is negatively associated with the number of chronic disorders. This indicates that the complexity of care cannot be inferred solely from medical complexity, and additional factors need to be explored. These findings enhance understanding of how complexity of care relates to medical complexity in paediatric patients. Insights into the prevalence and patterns of NDs and NAs can benefit nurses, managers, researchers and policymakers by informing clinical and organisational decision-making to ensure high-quality care. REPORTING METHOD: The study adhered to the RECORD Statement. PATIENT OR PUBLIC CONTRIBUTION: Patients, service users, caregivers or public members were not directly involved in the design, conduct, analysis and interpretation of data or in writing this paper. Patients contributed only to data collection.

It's never simple! People, power and relationships in the United Kingdom Olympic sport policy system. A commentary.

Drawing on insights from the United Kingdom [UK], this commentary highlights the complexity of the Olympic sport policy process and proposes a novel conceptual approach that situates people at the forefront of the analysis. Informed by process sociology, the approach demonstrates the importance of understanding complexity as the consequence of interdependent relationships that bind people together. Extracts from interviews undertaken with nine senior National Governing Body employees, who are responsible for implementing Olympic sport policy, are drawn on to inform and illuminate the proposed approach. Their extracts showcase that conversations and dialogue, often undertaken in the context of meetings, are central to the policy process. Managing emotions, navigating opacity, deep personal involvement and associated personal wellbeing impacts are all features of the Olympic sport policy process not readily accounted for in the extant literature or practice. The process, increasingly games like, never wholly represents the actions of any one group or individual as they navigate choices constrained by the interlacing of many relationships over time. We therefore conclude that it may be conceptually better to now describe the organisation of Olympic sport in the UK as a figuration of people rather than as a "system".

The tensor as an informational resource.

A tensor is a multidimensional array of numbers that can be used to store data, encode a computational relation, and represent quantum entanglement. In this sense, a tensor can be viewed as valuable resource whose transformation can lead to an understanding of structure in data, computational complexity, and quantum information. In order to facilitate the understanding of this resource, we propose a family of information-theoretically constructed preorders on tensors, which can be used to compare tensors with each other and to assess the existence of transformations between them. The construction places copies of a given tensor at the edges of a hypergraph and allows transformations at the vertices. A preorder is then induced by the transformations possible in a given growing sequence of hypergraphs. The new family of preorders generalizes the asymptotic restriction preorder which Strassen defined in order to study the computational complexity of matrix multiplication. We derive general properties of the preorders and their associated asymptotic notions of tensor rank and view recent results on tensor rank nonadditivity, tensor networks, and algebraic complexity in this unifying frame. We hope that this work will provide a useful vantage point for exploring tensors in applied mathematics, physics, and computer science but also from a purely mathematical point of view.

Where are the values in evaluating palliative care? Learning from community-based palliative care provision.

Background: The World Health Organization Astana Declaration of 2018 sees primary healthcare as key to universal health coverage and gives further support to the goal of building sustainable models of community palliative care. Yet evaluating the benefits of such models continues to pose methodological and conceptual challenges. Objective: To explore evaluation issues associated with a community-based palliative care approach in Kerala, India. Design: An illuminative case study using a rapid evaluation methodology. Methodology: Qualitative interviews, documentary analysis and observations of home care and community organising. Results: We appraise a community palliative care programme in Kerala, India, using three linked 'canvases' of enquiry: (1) 'complex' multi-factorial community-based interventions and implications for evaluation; (2) 'axiological' orientations that foreground values in any evaluation process and (3) the status of evaluative evidence in postcolonial contexts. Three values underpinning the care process were significant: heterogeneity, voice and decentralisation. We identify 'objects of interest' related to first-, second- and third-order outcomes: (1) individuals and organisations; (2) unintended targets outside the core domain and (3) indirect, distal effects within and outside the domain. Conclusion: We show how evaluation of palliative care in complex community circumstances can be successfully accomplished when attending to the significance of community care values.

Where are the values in evaluating palliative care? Learning from community-based palliative care provision The evaluation of any intervention or service will inevitably involve a series of decisions on what we measure, what criteria we use to judge whether the intervention has been successful (or not), what type of data we actually collect and what methods we use to do this. When evaluating a range of palliative care interventions, we suggest that these decisions have often been taken in a concealed way and tend to favour relatively narrow quantitative measures linked to end outcomes. Our paper reports on the evaluation of a community-based palliative care intervention on Kerala, India. In it, we suggest that such complex work requires a broader approach to evaluation that: makes the values being used to assess success explicit; draws on a range of data types; is interested in delivery processes; and places the voices of participants at the heart of the assessment. The paper concludes with some broader observations on how these principles might be applied more widely within palliative care.

Impact of care coordination on service utilisation for children with medically complex cerebral palsy.

AIM: Complex care programmes for children with medically complex cerebral palsy (CP) exist; however, evidence for their impact is limited. This study (i) explored the impact of The Royal Children's Hospital Complex Care Hub (CCH) on hospital service utilisation rates over a 3-year period for children with medically complex CP compared with those eligible but received routine care, and (ii) compared health, disability and socio-demographic characteristics of children and their families in both groups. METHODS: Electronic medical record data from 78 children (mean age 9.43 years, females n = 37) with medically complex CP who accessed CCH services, and 92 (mean age 10.86 years, females, n = 39) who received routine care were included. Multivariable regression was used to analyse service utilisation: number of emergency department (ED) presentations, length/number of inpatient and intensive care unit admissions and number/type of hospital appointments. Critical health-care needs, functioning/disability profile and child/family demographics for each group were compared. RESULTS: More children in the CCH group had a mixed motor type (73.1% vs. 15.2%), were classified within Gross Motor Function Classification System level V (76.9% vs. 34.8%), had respiratory, nutrition and social support needs and epilepsy. Children receiving CCH services had higher service utilisation rates; ED presentations (rate ratio (RR) = 1.81, 95% confidence interval (CI): 1.09-3.01), inpatient admissions (RR = 2.77, 95% CI: 2.01-3.83), outpatient encounters (RR = 1.69, 95% CI: 1.31-2.18) and telephone encounters (RR = 6.05, 95% CI: 4.56-8.02). CONCLUSIONS: Children with medically complex CP accessing a complex care service have higher service utilisation rates yet have more complex clinical presentations and higher support needs.

A Complex Case: Tubercular Pleural Effusion, Infarct, and Multisystem Involvement.

Tuberculous pleural effusion, the second most common type of tuberculosis, poses diagnostic and management challenges, especially in patients with multiple comorbidities. A 58-year-old female with a history of poorly controlled diabetes mellitus, hypertension, hypothyroidism, coronary artery disease post-angioplasty, and stable chronic kidney disease presented with fever with chills, reduced appetite, dyspnea, and dysuria. A chest X-ray showed a blunted right costophrenic angle and ultrasonography revealed a moderate pleural effusion on the right side. Pleural fluid analysis confirmed tuberculous pleural effusion. Five days later, she developed slurred speech and a tingling sensation on the left side of her body. A computed tomography scan showed a left non-hemorrhagic lacunar infarct in the frontal lobe, which was confirmed by magnetic resonance imaging. Cerebrospinal fluid was negative for tuberculosis. She was started on antiplatelets for the infarct. Electroencephalography was normal. She had hypocalcemia and hyponatremia related to renal failure, which were also corrected. This case illustrates the challenges of managing tuberculous pleural effusion in patients with multiple comorbidities. Timely diagnosis and a comprehensive multidisciplinary approach are crucial for navigating the complexities of the case.

Topographic heterogeneity triggers complementary cascades that enhance ecosystem multifunctionality.

Topographic heterogeneity sets the stage for community assembly, but its effects on ecosystem functioning remain poorly understood. Here, we test the hypothesis that topographic heterogeneity underpins multiple cascading species interactions and functional pathways that indirectly control multifunctionality. To do so, we combined experimental manipulation of a form of topographic heterogeneity on rocky shores (holes of various sizes) with a comprehensive assessment of naturally assembled communities and multifunctionality. Structural equation modeling indicated that heterogeneity: (1) enhanced biodiversity by supporting filter feeder richness; (2) triggered a facilitation cascade via reef-forming (polychaete) and biomass-dominant (macroalga) foundation species, which in turn broadly supported functionally diverse epibiotic and understory assemblages; and (3) inhibited a key consumer (limpet). The model supported that these mechanisms exerted complementary positive effects on individual functions (e.g., water filtration, ecosystem metabolism, nutrient uptake) and, in turn, collectively enhanced multifunctionality. Topographic heterogeneity may therefore serve as a cornerstone physical attribute by initiating multiple cascades that propagate through ecological communities via foundation species, ultimately manifesting disproportionate effects on ecosystem multifunctionality.

Navigating Nephrology's Decline Through a GPT-4 Analysis of Internal Medicine Specialties in the United States: Qualitative Study.

Background: The 2024 Nephrology fellowship match data show the declining interest in nephrology in the United States, with an 11% drop in candidates and a mere 66% (321/488) of positions filled. Objective: The study aims to discern the factors influencing this trend using ChatGPT, a leading chatbot model, for insights into the comparative appeal of nephrology versus other internal medicine specialties. Methods: Using the GPT-4 model, the study compared nephrology with 13 other internal medicine specialties, evaluating each on 7 criteria including intellectual complexity, work-life balance, procedural involvement, research opportunities, patient relationships, career demand, and financial compensation. Each criterion was assigned scores from 1 to 10, with the cumulative score determining the ranking. The approach included counteracting potential bias by instructing GPT-4 to favor other specialties over nephrology in reverse scenarios. Results: GPT-4 ranked nephrology only above sleep medicine. While nephrology scored higher than hospice and palliative medicine, it fell short in key criteria such as work-life balance, patient relationships, and career demand. When examining the percentage of filled positions in the 2024 appointment year match, nephrology's filled rate was 66%, only higher than the 45% (155/348) filled rate of geriatric medicine. Nephrology's score decreased by 4%-14% in 5 criteria including intellectual challenge and complexity, procedural involvement, career opportunity and demand, research and academic opportunities, and financial compensation. Conclusions: ChatGPT does not favor nephrology over most internal medicine specialties, highlighting its diminishing appeal as a career choice. This trend raises significant concerns, especially considering the overall physician shortage, and prompts a reevaluation of factors affecting specialty choice among medical residents.

Superior temporal sulcus folding, functional network connectivity, and autistic-like traits in a non-clinical population.

BACKGROUND: Autistic-like traits (ALT) are prevalent across the general population and might be linked to some facets of a broader autism spectrum disorder (ASD) phenotype. Recent studies suggest an association of these traits with both genetic and brain structural markers in non-autistic individuals, showing similar spatial location of findings observed in ASD and thus suggesting a potential neurobiological continuum. METHODS: In this study, we first tested an association of ALTs (assessed with the AQ questionnaire) with cortical complexity, a cortical surface marker of early neurodevelopment, and then the association with disrupted functional connectivity. We analysed structural T1-weighted and resting-state functional MRI scans in 250 psychiatrically healthy individuals without a history of early developmental disorders, in a first step using the CAT12 toolbox for cortical complexity analysis and in a second step we used regional cortical complexity findings to apply the CONN toolbox for seed-based functional connectivity analysis. RESULTS: Our findings show a significant negative correlation of both AQ total and AQ attention switching subscores with left superior temporal sulcus (STS) cortical folding complexity, with the former being significantly correlated with STS to left lateral occipital cortex connectivity, while the latter showed significant positive correlation of STS to left inferior/middle frontal gyrus connectivity (n = 233; all p < 0.05, FWE cluster-level corrected). Additional analyses also revealed a significant correlation of AQ attention to detail subscores with STS to left lateral occipital cortex connectivity. LIMITATIONS: Phenotyping might affect association results (e.g. choice of inventories); in addition, our study was limited to subclinical expressions of autistic-like traits. CONCLUSIONS: Our findings provide further evidence for biological correlates of ALT even in the absence of clinical ASD, while establishing a link between structural variation of early developmental origin and functional connectivity.

Impact of climate warming on soil microbial communities during the restoration of the inner Mongolian desert steppe.

Introduction: Grazer exclosure is widely regarded as an effective measure for restoring degraded grasslands, having positive effects on soil microbial diversity. The Intergovernmental Panel on Climate Change (IPCC) predicts that global surface temperatures will increase by 1.5-4.5°C by the end of the 21st century, which may affect restoration practices for degraded grasslands. This inevitability highlights the urgent need to study the effect of temperature on grassland soil microbial communities, given their critical ecological functions. Methods: Here, we assessed the effects of heavy grazing (control), grazer exclosure, and grazer exclosure plus warming by 1.5°C on soil microbial community diversity and network properties as well as their relationships to soil physicochemical properties. Results and discussion: Our results showed that grazer closure increased soil microbial richness relative to heavy grazing controls. Specifically, bacterial richness increased by 7.9%, fungal richness increased by 20.2%, and the number of fungal network nodes and edges increased without altering network complexity and stability. By contrast, grazer exclosure plus warming decreased bacterial richness by 9.2% and network complexity by 12.4% compared to heavy grazing controls, while increasing fungal network complexity by 25.8%. Grazer exclosure without warming increased soil ammonium nitrogen content, while warming increased soil nitrate nitrogen content. Soil pH and organic carbon were not affected by either exclosure strategy, but nitrate nitrogen was the dominant soil factor explaining changes in bacterial communities. Conclusion: Our findings show that grazer exclosure increases soil microbial diversity which are effective soil restoration measures for degraded desert steppe, but this effect is weakened under warming conditions. Thus, global climate change should be considered when formulating restoration measures for degraded grasslands.

Correlation between insulin-like growth factor and complexity of glucose time series index in patients with newly diagnosed acromegaly: a PILOT study.

BACKGROUND: Acromegaly has a high risk of abnormal glucose metabolism. The complexity of the glucose time series index (CGI) is calculated from refined composite multi-scale entropy analysis of the continuous glucose monitoring (CGM) data. CGI is a new indicator of glucose imbalance based on ambulatory glucose monitoring technology, which allows for earlier response to glucose metabolism imbalance and correlates with patient prognosis. OBJECTIVE: To compare the differences in glucose metabolic profile and CGI between acromegaly with normal glucose tolerance (NGT) and healthy subjects. METHODS: Eight newly diagnosed patients with acromegaly (GH group) and eight age- and gender-matched healthy subjects (Control group) were included in this study. All participants underwent oral glucose tolerance test (OGTT) and 72-h CGM. A refined composite multi-scale entropy analysis was performed on the CGM data to calculate the CGI and we compare the differences in glycemic profiles and CGI between the two groups. RESULTS: After OGTT, compared with the control group, patients in the GH group had higher 2 h blood glucose (BG) (mmol/L) [GH vs control, 6.7 (6.1, 7.0) vs 5.2 (3.8, 6.3), P = 0.012], 3 h BG [5.1 (3.8, 6.5) vs 4.0 (3.4, 4.2), P = 0.046], mean BG [6.3 (6.1, 6.5) vs 5.5 (5.1, 5.9), P = 0.002], 2 h insulin (mU/L) [112.9 (46.8, 175.5) vs 34.1 (17.1, 55.6), P = 0.009], and 3 h insulin [26.8 (17.1, 55.4) vs 10.4 (4.2, 17.8), P = 0.016]. CGI was lower in the GH group [2.77 (1.92, 3.15) vs 4.2 (3.3, 4.8), P = 0.008]. Spearman's correlation analysis showed insulin-like growth factor (IGF) (r = -0.897, P < 0.001) and mean glucose (r = -0.717, P = 0.003) were significantly negatively correlated with CGI. Multiple linear stepwise regression showed that IGF-1 (r = -0.652, P = 0.028) was independent factor associated with CGI in acromegaly. CONCLUSION: IGF-1 was significantly associated with CGI, and CGI may serve as a novel marker to evaluate glucose homeostasis in acromegaly with normal glucose tolerance.

The Effects of Auxin Transport Inhibition on the Formation of Various Leaf and Vein Patterns.

Polar auxin transport (PAT) is a known component controlling leaf complexity and venation patterns in some model plant species. Evidence indicates that PAT generates auxin converge points (CPs) that in turn lead to local leaf formation and internally into major vein formation. However, the role of PAT in more diverse leaf arrangements and vein patterns is largely unknown. We used the pharmacological inhibition of PAT in developing pinnate tomato, trifoliate clover, palmate lupin, and bipinnate carrot leaves and observed dosage-dependent reduction to simple leaves in these eudicots. Leaf venation patterns changed from craspedodromous (clover, carrot), semi-craspedodromous (tomato), and brochidodromous (lupin) to more parallel patterning with PAT inhibition. The visualization of auxin responses in transgenic tomato plants showed that discrete and separate CPs in control plants were replaced by diffuse convergence areas near the margin. These effects indicate that PAT plays a universal role in the formation of different leaf and vein patterns in eudicot species via a mechanism that depends on the generation as well as the separation of auxin CPs. Computer simulations indicate that variations in PAT can alter the number of CPs, corresponding leaf lobe formation, and the position of major leaf veins along the leaf margin in support of experimental results.

Ada-LT IP: Functional Discriminant Analysis of Feature Extraction for Adaptive Long-Term Wi-Fi Indoor Localization in Evolving Environments.

Wi-Fi fingerprint-based indoor localization methods are effective in static environments but encounter challenges in dynamic, real-world scenarios due to evolving fingerprint patterns and feature spaces. This study investigates the temporal variations in signal strength over a 25-month period to enhance adaptive long-term Wi-Fi localization. Key aspects explored include the significance of signal features, the effects of sampling fluctuations, and overall accuracy measured by mean absolute error. Techniques such as mean-based feature selection, principal component analysis (PCA), and functional discriminant analysis (FDA) were employed to analyze signal features. The proposed algorithm, Ada-LT IP, which incorporates data reduction and transfer learning, shows improved accuracy compared to state-of-the-art methods evaluated in the study. Additionally, the study addresses multicollinearity through PCA and covariance analysis, revealing a reduction in computational complexity and enhanced accuracy for the proposed method, thereby providing valuable insights for improving adaptive long-term Wi-Fi indoor localization systems.

Inverse kinematics in cervical spine models: Effects of scaling and model degrees of freedom for extension and flexion movements.

Intervertebral kinematics can affect model-predicted loads and strains in the spine; therefore knowledge of expected vertebral kinematics error is important for understanding the limitations of model predictions. This study addressed how different kinematic models of the neck affect the prediction of intervertebral kinematics from markers on the head and trunk. Eight subjects executed head and neck extension-flexion motion with simultaneous motion capture and biplanar dynamic stereo-radiography (DSX) of vertebrae C1-C7. A generic head and neck model in OpenSim was scaled by marker data, and three versions of the model were used with an inverse kinematics solver. The models differed according to the number of independent degrees of freedom (DOF) between the head and trunk: 3 rotational DOF with constraints defining intervertebral kinematics as a function of overall head-trunk motion; 24DOF with 3 independent rotational DOF at each level, skull-T1; 48DOF with 3 rotational and 3 translational DOF at each level. Marker tracking error was lower for scaled models compared to generic models and decreased as model DOF increased. The largest mean absolute error (MAE) was found in extension-flexion angle and anterior-posterior translation at C1-C2, and superior-inferior translation at C2-C3. Model scaling and complexity did not have a statistically significant effect on most error metrics when corrected for multiple comparisons, but ranges of motion were significantly different from DSX in some cases. This study evaluated model kinematics in comparison to gold standard radiographic data and provides important information about intervertebral kinematics error that are foundational to model validity.

Analysis of Shannon's entropy to contrast between the Embodied and Neurocentrist hypothesis of conscious experience.

We usually accept that consciousness is in the brain. This statement corresponds to a Neurocentrist view. However, with all the physical and physiological data currently available, a convincing explanation of how consciousness emerges has not been given this topic is aborded by Anil Seth (2021). Because of this, a natural question arises: Is consciousness really in the brain or not? If the answer is no, this corresponds to the Embodied perspective. We cannot discriminate between these two points of view because we cannot identify how the organism processes the information. If we try to measure information processing in the brain, then the Neurocentrist view is unavoidable. For example, the information integration theory of Tononi's research group and the global work area theory developed by Dehaene and Baars, focus solely on the brain without considering aspects of Embodied vision (See Tononi, 2021; Dehaene, 2021). In this article, we propose an index based on Shannon's entropy, capable of identifying the leading processing elements acting: Are they mainly inner or external? In order to validate it, we performed simulations with networks accounting for different amounts of internal and outer layers. Since Shannon's entropy is an abstract measure of the information content, this index is not dependent on the physical network nor the proportion of different layers. Therefore, we validate the index as free of bias. This index is a way to discriminate between Embodied from Neurocentrist hypotheses.

Word length and frequency effects in natural Chinese reading: Evidence for character representations in lexical identification.

Word length and frequency are two of the "big three" factors that affect eye movements in natural reading. Although these factors have been extensively investigated, all previous studies manipulating word length have been confounded with changes in visual complexity (longer words have more letters and are more visually complex). We controlled stroke complexity across one-character (short) and two-character (long) high- and low-frequency Chinese words (to avoid complexity confounds) and recorded readers' eye movements during sentence reading. Both word length and frequency yielded strong main effects for fixation time measures. For saccadic targeting and skipping probability, word length effects, but not word frequency effects, occurred. Critically, the interaction was not significant regardless of stroke complexity, indicating that word length and frequency independently influence lexical identification and saccade target selection during Chinese reading. The results provide evidence for character-level representations during Chinese word recognition in natural reading.

Capturing the clinical complexity in young people presenting to primary mental health services: a data-driven approach.

AIMS: The specific and multifaceted service needs of young people have driven the development of youth-specific integrated primary mental healthcare models, such as the internationally pioneering headspace services in Australia. Although these services were designed for early intervention, they often need to cater for young people with severe conditions and complex needs, creating challenges in service planning and resource allocation. There is, however, a lack of understanding and consensus on the definition of complexity in such clinical settings. METHODS: This retrospective study involved analysis of headspace's clinical minimum data set from young people accessing services in Australia between 1 July 2018 and 30 June 2019. Based on consultations with experts, complexity factors were mapped from a range of demographic information, symptom severity, diagnoses, illness stage, primary presenting issues and service engagement patterns. Consensus clustering was used to identify complexity subgroups based on identified factors. Multinomial logistic regression was then used to evaluate whether these complexity subgroups were associated with other risk factors. RESULTS: A total of 81,622 episodes of care from 76,021 young people across 113 services were analysed. Around 20% of young people clustered into a 'high complexity' group, presenting with a variety of complexity factors, including severe disorders, a trauma history and psychosocial impairments. Two moderate complexity groups were identified representing 'distress complexity' and 'psychosocial complexity' (about 20% each). Compared with the 'distress complexity' group, young people in the 'psychosocial complexity' group presented with a higher proportion of education, employment and housing issues in addition to psychological distress, and had lower levels of service engagement. The distribution of complexity profiles also varied across different headspace services. CONCLUSIONS: The proposed data-driven complexity model offers valuable insights for clinical planning and resource allocation. The identified groups highlight the importance of adopting a holistic and multidisciplinary approach to address the diverse factors contributing to clinical complexity. The large number of young people presenting with moderate-to-high complexity to headspace early intervention services emphasises the need for systemic change in youth mental healthcare to ensure the availability of appropriate and timely support for all young people.

Pathogenic SHQ1 variants result in disruptions to neuronal development and the dopaminergic pathway.

BACKGROUND: Compound heterozygous variants of SHQ1, an assembly factor of H/ACA ribonucleoproteins (RNPs) involved in critical biological pathways, have been identified in patients with developmental delay, dystonia, epilepsy, and microcephaly. We investigated the role of SHQ1 in brain development and movement disorders. METHODS: SHQ1 expression was knocked down using short-hairpin RNA (shRNA) to investigate its effects on neurons. Shq1 shRNA and cDNA of WT and mutant SHQ1 were also introduced into neural progenitors in the embryonic mouse cortex through in utero electroporation. Co-immunoprecipitation was performed to investigate the interaction between SHQ1 and DKC1, a core protein of H/ACA RNPs. RESULTS: We found that SHQ1 was highly expressed in the developing mouse cortex. SHQ1 knockdown impaired the migration and neurite morphology of cortical neurons during brain development. Additionally, SHQ1 knockdown impaired neurite growth and sensitivity to glutamate toxicity in vitro. There was also increased dopaminergic function upon SHQ1 knockdown, which may underlie the increased glutamate toxicity of the cells. Most SHQ1 variants attenuated their binding ability toward DKC1, implying SHQ1 variants may influence brain development by disrupting the assembly and biogenesis of H/ACA RNPs. CONCLUSIONS: SHQ1 plays an essential role in brain development and dopaminergic function by upregulating dopaminergic pathways and regulating the behaviors of neural progenitors and their neuronal progeny, potentially leading to dystonia and developmental delay in patients. Our study provides insights into the functions of SHQ1 in neuronal development and dopaminergic function, providing a possible pathogenic mechanism for H/ACA RNPs-related disorders.