There is some consensus that better ways of evaluating complex public health programmes are needed as experimental methods are limited in explaining the 'how' and 'why' of change. Methods like 'theory-of-change,' 'realist evaluation,' and 'systems evaluation' try to give a more complete picture of change by looking at the context of the programme. However, when these methods are used to study programmes that aim to reduce health inequalities, they often miss a crucial issue: how power affects people's health and engagement with programmes. This paper addresses that gap by reporting an ethnographic study of a community health promotion programme that was informed by a social theory of power (figurational sociology). When looking at how power dynamics played out in the targeted community, we could see why residents often did not trust the people running the programme, and why local status was so important to them. When programme staff understood these power dynamics, they were better able to connect with residents and help them improve their wellbeing. We argue that combining this way of looking at power with our observational approach gives us a much clearer understanding of how complex public health programmes work and why they succeed or fail in their aims.

Jellyfish are being increasingly targeted by fisheries, but their complex life cycles make it difficult to predict stock availability. The seasonal recruitment of juvenile jellyfish (ephyrae) is regulated by the reproductive output of the benthic polyp life stage. Within temperate environments, polyps typically undergo strobilation and produce ephyrae in spring. While previous works have documented how winter conditions can influence strobilation success, the potential role of pre-winter environmental conditions on ephyra production remains unknown. This research investigated a well-studied jellyfish species of bioresource interest ( Aurelia aurita ) in a multi-phase experiment designed to a) quantify the effects of temperature and food availability on polyp development, and b) determine how the environmental conditions in which polyps were reared in influence ephyra production and size following a controlled winter simulation. The results demonstrated that warmer pre-winter conditions not only enhanced initial somatic growth rates and bud production, but also increased the likelihood of mature polyps strobilating after temperatures had been reduced. Although polyps grew larger and subsequently produced more ephyrae when pre-winter food availability was increased, the likelihood of strobilation and total ephyra production of polyp populations was unaffected by previous feeding regimes. There was also no relationship between the diameter of parent polyps prior to winter simulation and the mean diameter of their ephyra progeny. Warmer pre-winter conditions could promote strobilation by increasing development rates or strengthening the environmental stimulus when temperatures decrease. These results demonstrate the potential value of considering pre-winter temperature when forecasting the recruitment of jellyfish stocks during summer. • Pre-winter conditions significantly influenced post-winter jellyfish production. • Polyp populations produced more jellyfish when conditioned to higher temperatures. • Food availability had opposite effects on metamorphosis and reproductive output. • Accounting for full seasonal cycles may improve predictions of jellyfish blooms.

Abstract This paper investigates the strong convergence of a fully discrete scheme for the stochastic Allen–Cahn equation with multiplicative noise, combining a tamed Milstein method for the temporal discretization with the finite element method in space. The proposed method is shown to be unconditionally stable in spatial dimensions $$d\in \{1,2,3\}$$ d ∈ { 1 , 2 , 3 } . Beyond the inherent challenges caused by, see, e.g., [1], the cubic non-globally Lipschitz drift term and multiplicative driving noise in the convergence analysis, the Milstein scheme further complicates the error estimation of the noise term compared to the Euler-Maruyama discretization. By introducing a novel auxiliary process, we rigorously establish strong convergence rates in both space and time under mild assumptions for $$d\in \{1,2\}$$ d ∈ { 1 , 2 } . Our analysis shows that the temporal convergence order is doubled compared to that of tamed Euler-Maruyama scheme. Numerical experiments are provided to confirm the theoretical results and to demonstrate that the proposed scheme exhibits improved robustness over the pure semi-implicit Milstein method.

ABSTRACT Background This article uses suicide notes to explore the reasons individuals gave to end their life, and the links between suicide and the actualising tendency (AT). Suicide remains one of the most complex and challenging presentations in the mental health field. While much research has focused on risk factors, protective factors and epidemiological trends, relatively less attention has been paid to first‐person accounts of suicidal experience. The AT, defined by Rogers as the inherent drive within all living organisms to develop, grow, and realise their full potential, provides a provocative lens through which to explore the paradox of suicidal behaviour. Method and Findings Using stanza and narrative analysis, 31 suicide notes were analysed which identified the reasons individuals provided for ending their life. Notes were also analysed in relation to propositions of the actualising tendency. Four predominate narratives were identified: ‘Can't live with’, ‘Can't live without’, ‘The other’ and ‘No other’. In addition, it was concluded that four notes indicated that suicide was an expression of the actualising tendency. Conclusion This research sheds light on the complex and sometimes contradictory nature of the AT. It shows that behaviours that appear harmful on the surface may, in fact, be driven by a deep, often unconscious, need to protect the self from greater perceived harm.

Purpose Autism is a complex neurodevelopmental condition thought to affect 1 in 100 children globally. More commonly diagnosed in males, and during childhood, diagnoses are increasingly being made throughout adulthood. This study aims to establish what age autistic people receive their diagnosis, and whether the age of diagnosis was influenced by their sex and by the presence of intellectual disability. Design/methodology/approach A quantitative, cross-sectional, retrospective study. Data was collected from the Primary Care records of six GP Practices covering Ellesmere Port, a large town in Northwest England with 71,210 people registered. Mean age of diagnosis was calculated for the group then for each subgroup, to allow comparison between males and females, and those with and without a documented intellectual disability. Findings Data from 1,130 autistic participants were analysed. Age of participants was between 3 and 81 years with an age of autism diagnosis of 1–72 years. In total, 85.6% of participants were diagnosed with autism by the age of 25 years, most commonly at 3 years of age (11.9%). The average age of diagnosis was 2.48 years later for females diagnosed across the lifespan. Average age of diagnosis was 5.05 years later for those with a learning disability. Practical implications This study highlights the importance of healthcare professionals, educators and care givers recognising autistic traits in people across the lifespan, including the potential for diagnostic overshadowing. There are implications for commissioning autistic services, to ensure adequate assessment pathway capacity for adolescents and adults as well as children. Originality/value This study used Primary Care records from all the practices covering a large town, aiming to reduce recruitment bias and allowing a snapshot of a large sample size with a common referral pathway.