1. (1) To recognise and understand the development of PTSD following childbirth and baby loss.

2. (2) To understand how Ehlers and Clark’s (2000) cognitive model of PTSD can be applied to post-partum PTSD.

3. (3) To be able to apply cognitive therapy for PTSD to patients with perinatal PTSD, including traumatic baby loss through miscarriage or birth.

4. (4) To discover common personal meanings associated with birth trauma and baby loss and the steps to update them.

The United Nations' sustainable development goals (SDGs) articulate societal aspirations for people and our planet. Many scientists have criticised the SDGs and some have suggested that a better understanding of the complex interactions between society and the environment should underpin the next global development agenda. We further this discussion through the theory of social–ecological resilience, which emphasises the ability of systems to absorb, adapt, and transform in the face of change. We determine the strengths of the current SDGs, which should form a basis for the next agenda, and identify key gaps that should be filled.

The United Nations' sustainable development goals (SDGs) are past their halfway point and the next global development agenda will soon need to be developed. While laudable, the SDGs have received strong criticism from many, and scholars have proposed that adopting complex adaptive or social–ecological system approaches would increase the effectiveness of the agenda. Here we dive deeper into these discussions to explore how the theory of social–ecological resilience could serve as a strong foundation for the next global sustainable development agenda. We identify the strengths and weaknesses of the current SDGs by determining which of the 169 targets address each of 43 factors affecting social–ecological resilience that we have compiled from the literature. The SDGs with the strongest connections to social–ecological resilience are the environment-focus goals (SDGs 2, 6, 13, 14, 15), which are also the goals consistently under-prioritised in the implementation of the current agenda. In terms of the 43 factors affecting social–ecological resilience, the SDG strengths lie in their communication, inclusive decision making, financial support, regulatory incentives, economic diversity, and transparency in governance and law. On the contrary, ecological factors of resilience are seriously lacking in the SDGs, particularly with regards to scale, cross-scale interactions, and non-stationarity.

The post-2030 agenda should build on strengths of SDGs 2, 6, 13, 14, 15, and fill gaps in scale, variability, and feedbacks.

Childhood trauma and adversity are common across societies and have strong associations with physical and psychiatric morbidity throughout the life-course. One possible mechanism through which childhood trauma may predispose individuals to poor psychiatric outcomes is via associations with brain structure. This study aimed to elucidate the associations between childhood trauma and brain structure across two large, independent community cohorts.

The two samples comprised (i) a subsample of Generation Scotland (n=1,024); and (ii) individuals from UK Biobank (n=27,202). This comprised n=28,226 for mega-analysis. MRI scans were processed using Free Surfer, providing cortical, subcortical, and global brain metrics. Regression models were used to determine associations between childhood trauma measures and brain metrics and psychiatric phenotypes.

Childhood trauma associated with lifetime depression across cohorts (OR 1.06 GS, 1.23 UKB), and related to early onset and recurrent course within both samples. There was evidence for associations between childhood trauma and structural brain metrics. This included reduced global brain volume, and reduced cortical surface area with highest effects in the frontal (β=−0.0385, SE=0.0048, p(FDR)=5.43x10−15) and parietal lobes (β=−0.0387, SE=0.005, p(FDR)=1.56x10−14). At a regional level the ventral diencephalon (VDc) displayed significant associations with childhood trauma measures across both cohorts and at mega-analysis (β=−0.0232, SE=0.0039, p(FDR)=2.91x10−8). There were also associations with reduced hippocampus, thalamus, and nucleus accumbens volumes.

Associations between childhood trauma and reduced global and regional brain volumes were found, across two independent UK cohorts, and at mega-analysis. This provides robust evidence for a lasting effect of childhood adversity on brain structure.

The emerging concept of ‘food justice’ describes a social movement and a set of principles. It align with the goals of social justice, demanding recognition of human rights, equal opportunity, fair treatment and is participatory and community specific. The aim of this study was to investigate the conceptualisation of food justice and to explore how community participation is positioned in food justice scholarship.

A scoping review of peer-reviewed literature was conducted using the term ‘food justice’. This study used a five-step scoping review protocol. The databases included Scopus, Web of Science and Medline (OVID). Data were extracted on country of origin, research discipline, study type and conceptualisations of food justice. Reflexive thematic analysis was used to identify the themes.

The search identified 546 abstracts of which ninety peer-reviewed studies met the inclusion criteria. Thematic analysis identified five themes of food justice across these ninety studies: (1) social equity, (2) food security, (3) food systems transformation, (4) community participation and agency and (5) environmental sustainability.

Current conceptualisations of food justice are evolving. Together, these five themes, using the term food justice, embrace a more holistic and structural view of the food system. They emphasise healthy, sustainable and equitable food as a human right and acknowledge the need to address structural barriers to that right. Community participation and agency in food justice decision-making is critical for transformative change towards a healthy, sustainable, and more just food system.

Patient- and proxy-reported outcomes (PROs) are an important indicator of healthcare quality and can be used to inform treatment. Despite the widescale use of PROs in adult cardiology, they are underutilised in paediatric cardiac care. This study describes a six-center feasibility and pilot experience implementing PROs in the paediatric and young adult ventricular assist device population.

The Advanced Cardiac Therapies Improving Outcomes Network (ACTION) is a collaborative learning network comprised of 55 centres focused on improving clinical outcomes and the patient/family experience for children with heart failure and those supported by ventricular assist devices. The development of ACTION’s PRO programme via engagement with patient and parent stakeholders is described. Pilot feasibility, patient/parent and clinician feedback, and initial PRO findings of patients and families receiving paediatric ventricular assist support across six centres are detailed.

Thirty of the thirty-five eligible patients (85.7%) were enrolled in the PRO programme during the pilot study period. Clinicians and participating patients/parents reported positive experiences with the PRO pilot programme. The most common symptoms reported by patients/parents in the first month post-implant period included limitations in activities, dressing change distress, and post-operative pain. Poor sleep, dressing change distress, sadness, and fatigue were the most common symptoms endorsed >30 days post-implant. Parental sadness and worry were notable throughout the entirety of the post-implant experience.

This multi-center ACTION learning network-based PRO programme demonstrated initial success in this six-center pilot study experience and yields important next steps for larger-scale PRO collection, research, and clinical intervention.