National Health Service

Introduction: This study aims to investigate the access to leadership development opportunities among European psychiatric trainees and early career psychiatrists (ECPs) and their perceptions and needs related to leadership skills training.

ABSTRACT Background At present, there are no approved pharmacological treatments for people at clinical high risk for psychosis (CHR-P). We sought to assess the acceptability of cannabidiol (CBD): a promising candidate treatment for this population. Methods CHR-P individuals completed a survey which assessed their views on the acceptability of CBD, its expected effectiveness and side effects, and on formulation preferences. Results The sample comprised 55 CHR-P individuals (24.3 years and 69% female). Most (91%) were familiar with CBD, and had previously used cannabis (64%), and around half (42%) had tried over-the-counter CBD. 75% were willing to take CBD as an intervention for mental health problems. Most participants anticipated fewer side effects with CBD than with existing medications, and preferred tablet or capsule formulations over liquids. Discussion CBD is perceived as a highly acceptable treatment among CHR-P individuals.

Global healthcare providers are exploring the use of large language models (LLMs) to provide medical advice to the public. LLMs now achieve nearly perfect scores on medical licensing exams, but this does not necessarily translate to accurate performance in real-world settings. We tested whether LLMs can assist members of the public in identifying underlying conditions and choosing a course of action (disposition) in ten medical scenarios in a controlled study with 1,298 participants. Participants were randomly assigned to receive assistance from an LLM (GPT-4o, Llama 3, Command R+) or a source of their choice (control). Tested alone, LLMs complete the scenarios accurately, correctly identifying conditions in 94.9% of cases and disposition in 56.3% on average. However, participants using the same LLMs identified relevant conditions in fewer than 34.5% of cases and disposition in fewer than 44.2%, both no better than the control group. We identify user interactions as a challenge to the deployment of LLMs for medical advice. Standard benchmarks for medical knowledge and simulated patient interactions do not predict the failures we find with human participants. Moving forward, we recommend systematic human user testing to evaluate interactive capabilities before public deployments in healthcare.

Recent insights into impaired glutamylation caused by distal truncating variants in RPGR ORF15 and its association with the cone-dominated phenotype have provided the first molecular evidence of a genotype-phenotype correlation in male individuals with X-linked RPGR-related retinal dystrophy, though this correlation remains unexplored in female carriers. To characterize the clinical phenotype in female carriers of RPGR variants causing X-linked cone dystrophy in hemizygous male individuals. This case-control study was conducted at a specialist genetics clinic from May to December 2024. A total of 11 patients were examined, including female carriers with RPGR variants causing cone dystrophy (n = 7) and age-similar female carriers of RPGR variants causing rod-cone dystrophy as controls (n = 4). RPGR variants associated with X-linked cone dystrophy in hemizygous male individuals. Results of ophthalmic examination, multimodal retinal imaging, and functional testing. Seven female carriers aged 11 to 71 years were identified from RPGR cone dystrophy pedigrees. Visual acuity ranged from 6/4.8 to 6/7.5 (Snellen, 20/16 to 20/25), and 4 of the 7 participants experienced photophobia. Myopia and high cylindrical powers were common (6/7 [86%]), with myopia greater than -6.00 D in 2 patients. Fundus autofluorescence imaging revealed a diffuse, granular hyperautofluorescence pattern limited to the posterior pole, compared with the typical spoke pattern that extended into the far periphery in female carriers from RPGR rod-cone pedigrees. Green reflectance imaging most sensitively detected an abnormality in the form of an en face tapetallike sheen, which colocalized with a hyperreflective outer retinal band observed on optical coherence tomography. Ultra-widefield retinal imaging demonstrated no peripheral abnormalities. A mosaic pattern of reduced retinal sensitivity was found within the central 20° on microperimetry, which did not correlate with features observed on retinal imaging. Normal rod responses were measured on electroretinography, but average cone responses were 60.1% of the lower normal limit compared with 36% in male probands. This study identified a distinct phenotype in female carriers of RPGR variants causing X-linked cone dystrophy. In this cohort, the phenotype was consistent with mild cone dysfunction and anatomical macular changes. Depending on X-inactivation skew and rate of disease progression, some female carriers may be suitable for emerging gene therapies currently in clinical trials for affected male individuals.

To identify longitudinal trajectories of fruit and vegetable intakes from toddlerhood to adolescence and examine integrative pathways with maternal and child factors in a multi-ethnic Asian cohort. Data of 817 mother-child dyads from the GUSTO Study was used. Group-based trajectory modelling examined intake trajectories of fruits and vegetables from ages 18months to 12years. Generalized structural equation modelling evaluated the integrative direct and mediational pathways linking maternal and child factors to fruit and vegetable intake trajectories. Two fruit intake trajectories: “High stable”(83.2%), “Low stable to decreasing”(16.8%) and three vegetable intake trajectories: “Consistently high”(78.8%), “Low to stable”(9.2%), “High decreasing”(12.0%) were identified. Malay ethnicity (vs. Indian) and boys (vs. girls) were directly and significantly associated with higher odds of adhering to the suboptimal “Low stable to decreasing” fruit intake (ORs 1.87 and 2.32) or “Low to stable/High decreasing” vegetable intake (ORs 3.49 and 1.80) trajectories, respectively. Every unit increase in maternal pregnancy diet quality score was significantly associated with 3–4% lower odds of following the suboptimal fruit or vegetable intake trajectory. Significant direct inverse associations were also observed between breastfeeding duration ≥ 6months (vs. <6months) or maternal university education and lower odds of following the suboptimal fruit or vegetable intake trajectory. Pregnancy diet quality partially mediated the association between maternal ethnicity and suboptimal fruit or vegetable intake trajectory. Interventions to promote child fruit and vegetable intakes should begin preconception or during pregnancy, prioritise Malay mothers, those with lower education, families with boys, and improve maternal diet quality while promoting breastfeeding.

According to Manns et al. (2025), Canada struggles to turn good ideas into routine care because functions for evidence, funding, procurement and delivery are fragmented. In the UK, these functions are, in part, connected within a tax-funded service free at the point of use. This commentary maps the architecture, linking research translation, independent assessment, regulation, procurement, adoption support and data and explains how evidence moves into practice through principles aligned with the nonadoption, abandonment, scale-up, spread and sustainability framework, which addresses nonadoption, abandonment, the challenges of scale-up, spread and sustainability. Two worked examples, placental growth factor testing and stroke imaging artificial intelligence, show that national assessment, adoption support and procurement enabled rapid adoption at a national scale. Practical implications for Canada include a single repeatable pathway from promising evidence to routine use, conditional adoption with evidence generation, national frameworks that reduce transaction costs, investment in implementation capability and secure data environments for real-world evaluation.

Microbiome research focusing on late and moderate preterm infants (LMPT; 32 to 36 weeks gestation) is limited, despite rising LMPT births, large healthcare burdens, and increased risks of multiple morbidities, potentially microbially related. In this longitudinal cohort study, 16S rRNA gene sequencing was used to analyze 371 stool and 402 saliva samples from 160 LMPT infants, collected at five time points between birth and 12 months corrected age (CA), to describe spatial and temporal variability in gut and oral microbiomes. Paired stool and saliva samples (n = 337) were analyzed for potential microbial relationships. Early LMPT samples (up to 60 days of life; DOL) were also compared with data from seven extremely preterm infants (EP; <28 weeks gestation; stool n = 14, saliva n = 14). LMPT stool and saliva were composed of distinct microbial communities at each time point, and both sample types showed increasing alpha diversity over time. Stool was initially dominated by Escherichia/Shigella, Klebsiella, and Streptococcus, with Bifidobacterium becoming dominant from term equivalent age (TEA). Contrarily, saliva was dominated by Streptococcus throughout the first year, with early contributions from Staphylococcus and later Veillonella. LMPT infants had higher stool and lower saliva diversity compared with EP infants. Both sample types from EP infants were taxonomically distinct from LMPTs, with Escherichia/Shigella dominating both EP sample types throughout the first 60 DOL. The results highlight the unique trajectories of LMPT microbiomes and emphasize the role of gestational maturity in shaping microbial communities.IMPORTANCEThe oral and gut microbiome develops from birth and plays important roles in health. This has been well studied in extremely preterm infants (EP; born <32 weeks gestation) and term infants (born >38 weeks gestation), but there is a paucity of research describing oral and gut microbiome development in late and moderate preterm infants (LMPT; 32 to 36 weeks gestation). Our study analyzed microbiome development in 160 LMPT infants from birth to 12 months corrected age. The results showed distinct microbial communities in stool and saliva, with increasing alpha diversity and niche specification over time. LMPT infants' gut microbiome became dominated by Bifidobacterium by month 3, while the oral community was consistently dominated by Streptococcus. These results highlight that LMPT infants have gut and oral microbiome development that is more like term infants than EP infants, which has important implications for the care of LMPT infants.