Regent's University London

There is growing concern and controversy surrounding the rise of 'chemsex' - the use of psychoactive drugs during sex - among gay men. Concern centres on public health implications and the social costs of treatment, while the controversy relates to its psychological origins and appropriate interventions. Chemsex promotes disinhibition, confidence, libido and a sense of belonging; yet carries significant risks including sexually transmitted infections, mental illness, and death. Its use is often interpreted as a response to the historically homonegative social context of being gay, and the traumatic impact of the HIV pandemic. Although new HIV therapies may reduce fear of infection, research suggests that an HIV diagnosis remains traumatic for gay men, reinforcing anxiety about social acceptance. Chemsex can be understood at both individual and social levels through Fairbairn's object relations theory. The social context may be conceptualised as a dynamic of libidinal and anti-libidinal social forces or 'bad objects', with the HIV pandemic symbolising a 'traumatic release of bad objects'. For some gay men, this context precipitates release of repressed bad object relations rooted in early homophobic familial and communal experience. This fosters identification with bad objects and acceptance of the 'burden of badness'. Such dynamics create an 'internal saboteur', which directs aggression towards the object and the self for being exciting and needy, respectively. Thus, gay intimacy may be unconsciously sabotaged or permitted only with punitive consequence. This pattern appears in a growing subgroup of gay men who seek intimacy through the potentially damaging route of chemsex, as illustrated in a case vignette. The article encourages debate around formulation, intervention and resource. Therapies, while being affirmative, should not only support clients in addressing negative beliefs and social stigma, but also aim to integrate repressed bad object relations and associated feelings.

Interdependence in Public-Private Partnerships has long been overlooked in the literature due to its contractually stagnant nature. However, in the sovereign sector of extractive industries, interdependence is more dynamic and salient in Public-Private Joint Ventures (PPJVs), despite contractual stipulations. This dynamic interdependence results in managerial challenges and asymmetrical powers experienced by appointed public and private managers—both between themselves and with their respective parent firms. The tensions arising from these power asymmetries dictate managerial practices and influence how managers govern PPJVs. Adopting a network management lens, this study addresses the perceived managerial practices that influence PPJV governance under power asymmetries experienced by appointed managers. Qualitative empirical data was gathered through interviews with experienced public and private managers in the Egyptian extractive industry. The findings reveal four key practices across two levels of exchange. At the inter-organizational level, two practices were identified: Trust-Building, which all participants reported as mutually important for governing PPJVs, and Experience Compatibility, where participants showed contrasting views on its importance. At the intra-organizational level, two practices emerged: PPJV management autonomy and PPJV management appointment stability, both of which all participants identified as mutually important for governing PPJVs. This study offers both refinement and extension to the existing network management framework. First, it refines the inter-organizational exchange component by focusing on jointly operating entities and analysing the perspectives of appointed managers within PPJVs. Second, it extends the framework by incorporating intra-organizational exchange—a vertical level of exchange between appointed managers and their parent firms that has been largely neglected in PPJV management and governance literature. The study’s contribution lies in providing a managerial lens moderated by power asymmetries, offering a departure from structural/economic and contractual arguments while complementing the literature on PPP management, governance, and organization studies. Current literature has acknowledged the importance of managerial practices but has provided limited evidence of their micro-foundations. This study addresses this gap by examining partnerships rooted in tensions arising from unbalanced power dynamics that only appointed managers experience as a consequence of interdependence—both between each other and between them and their respective parent firms.

Background The use of fluoride-containing dentifrices can reduce the risk of dental caries. The systematic review was conducted to address two research questions: (i) the prevalence and frequency of fluoridated toothpaste use among Nigerian children and adolescents across geographic and demographic settings, and (ii) its association with dental caries prevalence, stratified by location and baseline caries risk. Methods This systematic review, registered with PROSPERO (CRD42022362116), followed the PRISMA guidelines. A PIO framework was applied to include children and adolescents (6 months–19 years) in Nigeria using fluoridated toothpaste, with caries outcomes measured via dmft/DMFT indices. A comprehensive search of PubMed, Web of Science, Scopus, Embase, AJOL, and Google Scholar was conducted from January 2001 to January 2026, supplemented by reference and grey literature searches. Study selection, data extraction, and risk of bias assessment using an adapted Hoy et al. tool were performed independently by multiple reviewers, with high inter-rater reliability (Kappa=0.90). Data were pooled using a random-effects model, with sensitivity, subgroup, and meta-regression analyses conducted to explore heterogeneity and effect modifiers. Publication bias was assessed using funnel plots and Egger’s test. Results Of 1,194 identified records, 18 studies (n=12,719 participants) were included. The use of fluoridated toothpaste was widespread (prevalence: 61.9% to 95.8%), yet its association with dental caries varied significantly by location. A meta-analysis of 14 studies indicated a significant 16% reduction in caries odds with fluoridated toothpaste use after removal of an influential outlier (OR = 0.84, 95% CI: 0.71–0.99, p=0.04). Subgroup analyses revealed this protective association was significant in urban and rural settings (p<0.05) but absent in suburban Nigeria. Furthermore, dental caries prevalence and severity (DMFT/dmft) were substantially higher in urban and rural areas, where the association was significant, compared to suburban regions. All studies were assessed as having a low risk of bias, and no significant publication bias was detected. Conclusion Fluoridated toothpaste is widely used in Nigeria and associated with a reduction in the prevalence of dental caries in Nigeria. It appears the relationship is moderated by residential location, and the DMFT/dmft. Longitudinal studies are needed to explore the interactions between the DMFT/dmft, use of fluoridated toothpaste, and residential location in Nigeria. ### Competing Interest Statement The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. ### Funding Statement This research was funded by the Nigerian Institute of Medical Research (grant number NM-ADJGT-22-0082) with a value of ~$260. The funder played no role in the conceptualization and execution of the meta-analysis. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The datasets analyzed for this study are publicly accessible.

Background As interest in psychedelics grows, concerns remain about ethical use and the documentation of adverse psychological effects. Use is increasing, yet long-term challenges - particularly among adolescents and young adults - are under-researched. This group is especially vulnerable, highlighting the need to understand how psychedelic-related challenges are experienced in naturalistic contexts. Methods This qualitative study used reflexive thematic analysis to explore the experiences of ten individuals aged 15–25 following challenging psychedelic episodes with extended difficulties lasting longer than a day. In-depth semi-structured interviews were conducted to examine themes around psychedelic integration, emerging adulthood, support-seeking strategies and available education about harm reduction strategies. Results Participants reported a range of emotional, cognitive and relational difficulties, as well as diverse strategies for making sense of their experiences. Key themes included the importance of preparation, supportive relationships and developmentally appropriate integration. Conclusions Findings underscore the need for age-specific harm reduction and integration services. Improved safety protocols and psychoeducation could help reduce long-term distress and support more ethical use of psychedelics in clinical and informal settings.

Featuring real-world examples and ethical guidance, the authors demystify prompt engineering, showing you how to craft effective prompts, streamline research, generate teaching materials, and foster creativity in both classroom and scholarly settings. With a focus on responsible management and quality education, chapters not only equip you with future-proof skills but also address the ethical considerations of AI in education. Discover how to boost productivity, maintain academic integrity, and stay ahead in a rapidly evolving digital landscape.