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Intersectionality scholarship has yet to systematically recognize the importance of citizenship status for the mutual shaping of inequalities. In this article, we bring attention to the combined structuring force of criminal law and citizenship status (and the related concepts of 'illegal' or 'irregular' status) in intersecting with other categories of social disadvantage, such as those created by racialization, class, gender and ethnicity. Drawing on ethnographic fieldwork and interviews with women in prisons for 'foreign nationals' and health clinics for 'undocumented' migrants in Norway and Denmark, this article shows how citizenship status has a central role in the co-constitution of gendered, classed and racialized social disadvantages. [ABSTRACT FROM AUTHOR]

Background: Existing therapeutic interventions to treat diabetes are well known, yet the majority of people with diabetes do not consistently achieve blood glucose targets (even individual therapy targets) for optimal health, despite the large range of treatment options available. Such outcomes have remained stubbornly poor for decades with <25% adults with diabetes achieving glycaemic targets. Patient behaviour, individually supported in routine clinical care, is an important missing component to improved outcomes, in a medical healthcare model not ideally suited to supporting successful diabetes management.Methods: A multi-centre, parallel group, individually randomised trial comparing consultation duration in adults with type 1, type 2 or pre-diabetes using the Spotlight Consultations pre-clinic assessment compared to usual care in the Spotlight-AQ study. Two hundred adults with type 1, type 2 or pre-diabetes attending routine care outpatient appointments across up to ten participating sites will be invited to participate.Intervention: An outpatient pre-clinic intervention delivered within 1 week prior to scheduled routine outpatient appointment.Primary Outcome Measure: Duration of routine outpatient consultation.Secondary Outcome Measures: Functional health status Diabetes distress Depression Treatment satisfaction Impact on self-care behaviours HCP burnout HCP treatment satisfaction and burden Hypoglycaemia (time less than 70mg/dL) Hyperglycaemia (time above 180 mg/dL) Change in weight Change in HbA1c Cost effectiveness of intervention DISCUSSION: Results from the study will provide valuable insights into patient-professional communication practices within routine care and recommendations will be made, as necessary, for improvements to that. If the intervention is shown to be clinically and cost-effective, the feedback from participants and healthcare professionals will be used to make any improvements prior to its deployment to support improved communication and associated health outcomes.Ethics and Dissemination: The trial was approved by the Wales REC7 Research Ethics Committee (21/WA/0020). Results will be disseminated through national and international conferences, scientific journals, newsletters, magazines and social media. Target audiences include consultants and other clinicians in diabetes, and medical professionals or scientists overall.Trial Registration: ISRCTN15511689 . Registered on 10 November 2021. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to (i) evaluate the effectiveness of mindfulness‐based interventions in improving self‐efficacy, reducing stress and anxiety among peritoneal dialysis patients, and (ii) compare the most effective method of mindfulness based interventions. Methods: This randomized three‐arm controlled trial recruited first‐time peritoneal dialysis patients from the peritoneal dialysis outpatient clinic in Singapore. Patients were randomly allocated to either video‐assisted mindfulness training, therapist‐assisted mindfulness training or treatment‐as‐usual. All groups received 4.5 days of structured peritoneal dialysis training at the peritoneal dialysis centre, while video‐assisted mindfulness training and therapist‐assisted mindfulness training groups were taught additional mindfulness‐based techniques. The perceived stress scale, self‐efficacy, and anxiety (State and Trait Anxiety Inventory) were measured at baseline, 4‐ and 12 weeks post‐randomization, using reliable and valid instruments. Results: Thirty‐nine patients were recruited (13 in each group). All the therapies showed a significant time trend in anxiety. Only therapist‐ and video‐assisted mindfulness training showed a significant trend in perceived stress scale scores but not treatment‐as‐usual. All Intervention X Time interactions were not significant. Patients in therapist‐ and video‐assisted mindfulness training groups had reduced perceived stress scale scores compared to treatment‐as‐usual at week 12. Conclusion: This study demonstrated the potential of mindfulness‐based interventions in reducing stress among first‐time PD patients. Summary Statement: What is already known about this topic? Mindfulness‐based interventions have been recommended to mediate stressful events.Mindfulness‐based interventions as complementary therapy can be taught to patients who are starting peritoneal dialysis for the first time; however, the best method to guide mindfulness‐based interventions is unknown. What this paper adds? The findings showed that mindfulness‐based interventions can potentially reduce stress and anxiety but have no statistically significant effect on self‐efficacy for patients undergoing peritoneal dialysis for the first time.Video‐ or therapist‐guided mindfulness training is just as effective in teaching mindfulness‐based interventions. The implications of this paper: Nurses hold an essential role in improving the experience of patients undergoing peritoneal dialysis by advocating and facilitating the use of MBI during dialysis, especially those who display high levels of stress and anxiety, as well as signs of coping issues. [ABSTRACT FROM AUTHOR]

In this paper, we apply Lin's method to study the existence of heteroclinic orbits near the degenerate heteroclinic chain under m$$ m $$‐dimensional periodic perturbations. The heteroclinic chain consists of two degenerate heteroclinic orbits γ1$$ {\gamma}_1 $$ and γ2$$ {\gamma}_2 $$ connected by three hyperbolic saddle points q1,q2,q3$$ {q}_1,{q}_2,{q}_3 $$. Assume that the degeneracy of the unperturbed heteroclinic orbit γi$$ {\gamma}_i $$ is ni$$ {n}_i $$, the splitting index is δi$$ {\delta}_i $$. By applying Lin's method, we construct heteroclinic orbits connected q1$$ {q}_1 $$ and q3$$ {q}_3 $$ near the unperturbed heteroclinic chain. The existence of these orbits is equivalent to finding zeros of the corresponding bifurcation function. The lower order terms of the bifurcation function is the map from ℝn1+n2+m$$ {\mathrm{\mathbb{R}}}&#x0005E;{n_1&#x0002B;{n}_2&#x0002B;m} $$ to ℝn1+n2+δ1+δ2$$ {\mathrm{\mathbb{R}}}&#x0005E;{n_1&#x0002B;{n}_2&#x0002B;{\delta}_1&#x0002B;{\delta}_2} $$. Using the contraction mapping principle, we provide a detailed analysis on how zeros can exist based on different cases of splitting indices δ1$$ {\delta}_1 $$, δ2$$ {\delta}_2 $$ and then obtain the existence of the heteroclinic orbits which backward asymptotic to q1$$ {q}_1 $$ and forward asymptotic to q3$$ {q}_3 $$. [ABSTRACT FROM AUTHOR]

Background and Objectives: Patient experience narratives (narratives) are an increasingly important element of both measurement approaches and improvement efforts in healthcare. Prior studies show that narratives are considered by both clinicians and staff to be an appealing, meaningful, and credible form of evidence on performance. They also suggest that making concrete use of narratives within organizational settings to improve care can be complex and challenging. Our qualitative study was designed to explore how middle managers working in a health system’s outpatient clinics value and use written narratives in their day-to-day work. Methods: We conducted qualitative interviews with 20 middle managers working in 8 outpatient clinics. Interviews were fully transcribed, loaded into MAX-QDA software, and coded using thematic analysis techniques. Code reports were extracted and reanalyzed for subthemes related to the objectives of this paper. Results: Middle managers across sites described valuing narratives as a tool to: enable better patient experience assessment by augmenting data from patient experience scores; deepen understanding of and relationships with patients; provide insight about operational issues; identify areas for needed improvement and potential solutions; and facilitate strategic work. They reported using narratives for a range of activities related to their roles as supervisors, such as focusing attention on positive practices and needed improvements, promoting deeper group learning, motivating change, reinforcing sense of purpose for staff, recognizing staff strengths and training needs, and inspiring transformational thinking. Finally, interviewees reported numerous specific quality improvement projects (both short- and longer-term) that were informed by narratives-for example, by identifying an issue to be addressed or by suggesting a workable solution. Together, these interviews suggest a collective “narrative about narratives” woven by these organizational actors-a story which illustrates how narratives are highly relevant for how middle managers derive meaning from their work, put organizational values such as responsive service provision into practice, and enact their roles as supervisors. Conclusions: Our results add to the nascent literature a detailed description of how narratives can be used both as a tool for middle managers in their leadership and supervisory roles, and as a blueprint for improvement work within outpatient settings. They also illuminate why patient experience scores may improve when narrative data are collected and used. Finally, our results suggest that for middle managers, perhaps “nothing is more powerful than words” because narratives function as both an insight provider and a compelling tool that adds direction and meaning to workplace endeavors. [ABSTRACT FROM AUTHOR]

The International League Against Epilepsy ( ILAE) Classification of the Epilepsies has been updated to reflect our gain in understanding of the epilepsies and their underlying mechanisms following the major scientific advances that have taken place since the last ratified classification in 1989. As a critical tool for the practicing clinician, epilepsy classification must be relevant and dynamic to changes in thinking, yet robust and translatable to all areas of the globe. Its primary purpose is for diagnosis of patients, but it is also critical for epilepsy research, development of antiepileptic therapies, and communication around the world. The new classification originates from a draft document submitted for public comments in 2013, which was revised to incorporate extensive feedback from the international epilepsy community over several rounds of consultation. It presents three levels, starting with seizure type, where it assumes that the patient is having epileptic seizures as defined by the new 2017 ILAE Seizure Classification. After diagnosis of the seizure type, the next step is diagnosis of epilepsy type, including focal epilepsy, generalized epilepsy, combined generalized, and focal epilepsy, and also an unknown epilepsy group. The third level is that of epilepsy syndrome, where a specific syndromic diagnosis can be made. The new classification incorporates etiology along each stage, emphasizing the need to consider etiology at each step of diagnosis, as it often carries significant treatment implications. Etiology is broken into six subgroups, selected because of their potential therapeutic consequences. New terminology is introduced such as developmental and epileptic encephalopathy. The term benign is replaced by the terms self-limited and pharmacoresponsive, to be used where appropriate. It is hoped that this new framework will assist in improving epilepsy care and research in the 21st century. [ABSTRACT FROM AUTHOR]

In this paper, the properties of equilibriums in planar polynomial dynamical systems are studied. The homoclinic networks of sources, sinks, and saddles in self-univariate polynomial systems are discussed, and the numbers of sources, sinks, and saddles are determined through a theorem, and the first integral manifolds are determined. The corresponding proof of the theorem is completed, and a few illustrations of networks for source, sinks, and saddles are presented for a better understanding of the homoclinic networks. Such homoclinic networks are without any centers even if the networks are separated by the homoclinic orbits. The homoclinic networks of positive and negative saddles with clockwise and counterclockwise limit cycles in crossing-univariate polynomial systems are studied secondly, and the numbers of saddles and centers are determined through a theorem, and the first integral manifolds are determined through polynomial functions. The corresponding proof of the theorem is given, and a few illustrations of networks of saddles and centers are given to show the corresponding geometric structures. Such homoclinic networks of saddles and centers are without any sources and sinks. Since the maximum equilibriums for such two types of planar polynomial systems with the same degrees are discussed, the maximum centers and saddles should be obtained, and maximum sinks, sources, and saddles should be achieved. This paper may provide a different way to determine limit cycles in the Hilbert 16th problem. [ABSTRACT FROM AUTHOR]

Although the axis-symmetric heteroclinic orbits of Lorenz-like systems have been intensively studied in the past decades, scholars seem to pay scant attention to the centro-symmetric ones. To achieve this target, the present paper introduces a new subquadratic centro-symmetric three-dimensional Lorenz-like system: x ˙ = a (y − x) , y ˙ = c x − x 2 3 z , z ˙ = − b z + x 2 3 y , and proves the existence of a pair of centro-symmetric to E 0 and E ± combining the definitions of α-limit and ω-limit set, Lyapunov functions. The effectiveness and correctness of the theoretical conclusions are verified via a few numerical examples. Not only does the study provide new ideas for finding heteroclinic orbits, but also it poses an interesting question that the existence of heteroclinic orbits may depend on the degrees of the considered models. [ABSTRACT FROM AUTHOR]

This paper studies the effect of Gaussian white noise on homoclinic bifurcations and chaotic dynamics of a bistable, vibro-impact Smooth-and-Discontinuous (SD) oscillator. First, the SD oscillator is reproduced and generalized by installing a slider on a fixed rod, so the slider is connected by a pair of linear springs initially pre-compressed in the vertical direction to achieve bistable vibration characteristics, and two screw nuts are installed on the rod as two adjustable bilateral rigid constraints to generate the vibro-impact. A discontinuous dynamical equation with a map defined on switching boundaries to represent velocity loss during each collision is derived to describe the vibration pattern of the bistable, vibro-impact SD oscillator through studying the persistence of the unique, unperturbed, nonsmooth, homoclinic structure. Second, the general framework of random Melnikov process for a class of bistable, vibro-impact systems contaminated with Gaussian white noise is derived and employed through the corresponding Melnikov function to obtain the necessary parameter thresholds for homoclinic tangency and possible chaos of the bistable, vibro-impact SD oscillator. Third, the effectiveness of a semi-analytical prediction by the Melnikov function is verified using the largest Lyapunov exponent, bifurcation series, and 0–1 test. Finally, the sensitivity to the initial values of chaos is verified by the fractal attractor basins, and the influence of the Gaussian white noise on periodic and chaotic structures is studied through Poincaré mapping to show the rich dynamical geometric structures. [ABSTRACT FROM AUTHOR]

Background: During the past two decades of cannabis legalization, the prevalence of medical cannabis (MC) use has increased and there has also been an upward trend in alcohol consumption. As less restricted cannabis laws generate more adult cannabis users, there is concern that more individuals may be simultaneously using medical cannabis with alcohol. A few studies have examined simultaneous use of medical cannabis with alcohol, but none of those studies also assessed patients' current or previous non-medical cannabis use. This paper explores simultaneous alcohol and medical cannabis use among medical cannabis patients with a specific focus on previous history of cannabis use and current non-medical cannabis use. Methods: A retrospective cohort study of MC patients (N = 319) from four dispensaries located in New York. Bivariate chi-square tests and multivariable logistic regression are used to estimate the extent to which sociodemographic and other factors were associated with simultaneous use. Results: Approximately 29% of the sample engaged in simultaneous use and a large share of these users report previous (44%) or current (66%) use of cannabis for non-medical purposes. MC patients who either previously or currently use cannabis non-medicinally, men, and patients using MC to treat a pain-related condition, were significantly more likely to report simultaneous alcohol/MC use. Conclusions: Findings indicate that there may be differential risks related to alcohol/MC use, which should be considered by cannabis regulatory policies and prevention/treatment programs. If patients are using cannabis and/or alcohol to manage pain, clinicians should screen for both alcohol and cannabis use risk factors. [ABSTRACT FROM AUTHOR]

Background: Children with phonological impairment present with pattern‐based errors in their speech production. While some children have difficulties with speech perception and/or the establishment of robust underlying phonological representations, the nature of phonological impairment in children is still not well understood. Given that phonological and lexical development are closely linked, one way to better understand the nature of the problem in phonological impairment is to examine word learning abilities in children. Aims: To examine word learning and its relationship with speech perception, speech production and vocabulary knowledge in children aged 4–5 years. There were two variables of interest: speech production abilities ranging from phonological impairment to typical speech; and vocabulary abilities ranging from typical to above average ('lexically precocious'). Methods & Procedures: Participants were 49 Australian‐English‐speaking children aged 48–69 months. Children were each taught four novel non‐words (out of a selection of eight) through stories, and word learning was assessed at 1 week post‐initial exposure. Word learning was assessed using two measures: confrontation naming and story retell naming. Data were analysed by group using independent‐samples t‐tests and Mann–Whitney U‐tests, and continuously using multiple linear regression. Outcomes & Results: There was no significant difference in word learning ability of children with and without phonological impairment, but regardless of speech group, children with above average vocabulary had significantly better word learning abilities than children with average vocabulary. In multiple linear regression, vocabulary was the only significant predictor of variance in word learning ability. Conclusions & Implications: Children with phonological impairment can be lexically precocious and learn new words like their peers without phonological impairment. Contrary to expectations, vocabulary knowledge rather than expressive phonological ability explained variance in measures of word learning. These findings question an assumption that children with phonological impairment have underspecified phonological representations. They also highlight the heterogeneity among children with phonological impairment and the need to better understand the nature of their difficulty learning the phonological system of the ambient language. WHAT THIS PAPER ADDS: What is already known on the subject: There is limited research examining the word learning abilities of children with phonological impairment. Most previous research focuses on word properties such as phonotactic probability and neighbourhood density. Within the existing literature there are different reports and conclusions regarding the word learning abilities of children with phonological impairment and whether their word learning differs from that of children with typically developing speech. What this study adds to existing knowledge: This study found that vocabulary was the strongest predictor of word learning across children with and without phonological impairment. There was no significant difference in word learning ability between children with and without phonological impairment. However, children with lexically precocious vocabulary abilities were significantly better at word learning than children with average vocabulary abilities. What are the potential or actual clinical implications of this work?: Findings from this study support the importance of assessing and considering measures of word learning—including vocabulary—when working with children with phonological impairment. This study indicates that it is possible to use stories coupled with measures of confrontation naming and story retell to gain deeper insight into children's word learning abilities. [ABSTRACT FROM AUTHOR]

Background. Kyphosis is a prevalent condition in older women that can significantly impact their mobility. Various therapeutic approaches and modalities can be used to treat hyperkyphosis. Cervicothoracic fascia stretching reduces kyphotic angle, decreases cervical pain, and improves various dimensions of thoracic mobility. Purpose of the study. The aim of this study is to evaluate the effect of the cervicothoracic fascia stretch on the thoracic mobility of older women. Subjects and methods. Sixty older women with non-specific neck discomfort, whose ages ranged from 60 to 70, were recruited from the outpatient clinics at Heliopolis University. The recruited patients were randomly divided into two groups of equal numbers of subjects: Group A included 30 patients who underwent cervicothoracic fascia stretching, and 30 patients were included in Group B who underwent diaphragmatic breathing exercises three times a week for four weeks. The neck pain was assessed utilizing the Neck Pain and Disability Scale (NPAD), while thoracic kyphosis was assessed utilizing a flexion curve ruler. Moreover, thoracic circumference excursion was measured using tape, while transverse and latero-lateral dimensions of the thorax were assessed using a chest depth caliper. Results. The comparison between pre- and post-study results showed a significant enhancement in all measured variables, including neck pain, thoracic circumference, chest width dimension, chest depth dimension, and kyphotic angle in both groups. Our findings indicated a statistically significant decrease in neck pain and kyphotic angle. Conversely, there was a statistically significant increase in thoracic circumference and chest width dimension for the cervicothoracic stretch group after treatment. Conclusions. Both interventions, such as intrathoracic fascia stretch and diaphragmatic breathing exercises exhibited extraordinary effectiveness in the management of reduced thoracic mobility and neck pain in older women with better results in favor of cervicothoracic stretch. [ABSTRACT FROM AUTHOR]

This paper critically interrogates care and violence, demonstrating how they are both spatialised and mutually constitutive within the shelters and clinics of Singapore for migrant workers. While there are seemingly disconnected sites, both clinics and shelters are utilized to provide different forms of care, discursively represented as spaces of protection and healing. Drawing on ethnographic research with migrant domestic workers at these sites, this paper will, however, argue that shelters and clinics are also spaces where violence is enacted and experienced. Indeed, despite having lived through different forms of violence in their employers' homes, this paper will reveal how domestic workers were subjected to further suffering and bodily harm; all while, paradoxically, receiving different forms of care. Building on social and cultural geographic debates, and particularly on feminist scholarship that foregrounds care, violence, and the body, this paper will argue that care and violence are mutually constitutive in these sites. Moreover, it will show that the migratory regime in Singapore creates spaces where the care that is practiced cannot be abstracted from violence. Beyond coexisting, in these geographies care and violence are shown to be inextricably connected. [ABSTRACT FROM AUTHOR]

Objectives: Integrated respiratory and palliative care services for people with advanced lung disease provide disease-orientated care until the end of life, alongside symptom management and discussions about future care. This study aimed to explore patient, caregiver and general practitioner perspectives of an integrated respiratory and palliative care service, to understand which components of the service were considered valued and effective. Methods: We approached patients, caregivers and general practitioners, to participate in semi-structured phone interviews. A grounded theory approach guided data collection and qualitative analysis. Results: Between July and December 2019, 10 patients, eight caregivers and five general practitioners completed interviews. The overarching theme was that of valuing integrated care – the provision of disease-orientated care along with palliative care. Four other major themes emerged: Valuing communication and engagement between patient, caregiver and healthcare professionals – who spoke of 'growing this plan together'; the delivery of person-centred care – where physicians 'actually listen and you are not treated like a number'; the reality of action plan use in serious illness – while many found plans 'certainly' do help, others described when they were simply 'too ill to do the action plan'; and finally, divergent preferences for discussions about future care – while some patients felt this subject was 'better left alone', caregivers consistently reported their preference was to 'make a plan.' Conclusion: Consumer perspectives highlight the service was valued for delivering personalised care with high communication standards. Similar services should appreciate the usefulness and limitations of action plan use in advanced lung disease, and be sensitive to potential diverging preferences of the patient and caregiver when discussing future care. What is known about the topic? Integrated respiratory and palliative care services for people with advanced lung disease may improve quality of life and decrease acute healthcare utilisation and cost. What does this paper add? This paper adds to our understanding of patients', caregivers' and general practitioners' perspectives of this integrated care model. Participants highly valued this integrated service for providing person-centred care. Participants outlined both the effectiveness and limitations of action plan use in advanced lung disease, and of diverging preferences between patients and caregivers for discussions about future care. What are the implications for practitioners? The integration of disease-orientated care along with the provision of palliative care is highly valued from a consumer perspective. [ABSTRACT FROM AUTHOR]

Background: Gender dysphoria among transgender adolescents has predominantly been examined in relation to body dissatisfaction. While in adult transgender samples, body dissatisfaction is higher than in cisgender controls, this has so far rarely been investigated for adolescents. In the context of a cisnormative society, the impact of influences from the social environment on body dissatisfaction and gender dysphoria has been neglected in research. Therefore, this study aimed to (1) provide a detailed analysis of body dissatisfaction among young transgender people and (2) investigate whether body dissatisfaction and gender dysphoria are associated with experiences of minority stress such as trans hostility and poor peer relations (PPR). Methods: The paper presents a cross-sectional study among a sample of transgender adolescents, presenting at a specialized outpatient counseling clinic (N = 99; age M = 15.36, SD = 1.85). First, body dissatisfaction (assessed by the Body-Image-Scale; BIS), was explored and compared to data from a population-based control group of cisgender peers (N = 527; age M = 14.43, SD = 0.97). Second, within a clinic-referred transgender subsample (n = 74), associations between body dissatisfaction and gender dysphoria (measured by Utrecht Gender Dysphoria Scale; UGDS), PPR (measured by the Youth-Self-Report; YSR-R), and trans hostile experiences (assessed in clinical interview) were examined by correlations, t-tests and multivariate regression. Results: Transgender adolescents reported more body dissatisfaction than cisgender peers. The dissatisfaction with sex characteristics, non-hormonal reactive body regions and the total score for body dissatisfaction were positively related with gender dysphoria. The majority had experienced trans hostility in the present and/or past (54.1%) and PPR (63.5%). More body dissatisfaction was correlated with more PPR regarding visible body parts i.e., hair, overall appearance and muscles, whilst PPR and gender dysphoria were not associated. Transgender adolescents who experienced trans hostility showed higher gender dysphoria and PPR, but not more body dissatisfaction. In multiple regression, trans hostility predicted gender dysphoria, whilst age and PPR predicted body dissatisfaction. Discussion: Experiences of minority-stress differentially interact with body dissatisfaction and gender dysphoria among transgender adolescents. Social correlates of body dissatisfaction and gender dysphoria must be considered when working with young transgender people. [ABSTRACT FROM AUTHOR]

Introduction: This study characterized the extent to which (1) financial barriers and (2) abortion care-seeking within a person's country of residence were associated with delays in abortion access among those travelling to England and the Netherlands for abortion care from European countries where abortion is legal on broad grounds in the first trimester but where access past the first trimester is limited to specific circumstances. Methodology: We drew on cross-sectional survey data collected at five abortion clinics in England and the Netherlands from 2017 to 2019 (n = 164). We assessed the relationship between difficulty paying for the abortion/travel, acute financial insecurity, and in-country care seeking on delays to abortion using multivariable discrete-time hazards models. Results: Participants who reported facing both difficulty paying for the abortion procedure and/or travel and difficulty covering basic living costs in the last month reported longer delays in accessing care than those who had no financial difficulty (adjusted hazard odds ratio: 0.39 95% CI 0.21–0.74). This group delayed paying other expenses (39%) or sold something of value (13%) to fund their abortion, resulting in ~ 60% of those with financial difficulty reporting it took them over a week to raise the funds needed for their abortion. Having contacted or visited an abortion provider in the country of residence was associated with delays in presenting abroad for an abortion. Discussion: These findings point to inequities in access to timely abortion care based on socioeconomic status. Legal time limits on abortion may intersect with individuals' interactions with the health care system to delay care. Plain Language Summary: This paper explores delays in accessing abortion care associated with financial and medical system barriers. We focus on residents of countries in Europe where abortion is available on broad grounds in the first trimester seeking abortion care outside of their country of residence. This study demonstrates an association between difficulty covering abortion costs for people facing financial insecurity and in-country care seeking and delays in accessing abortion abroad. Policy barriers, medical system barriers, as well as financial barriers may interact to delay access to care for people in European countries with broad grounds for abortion access in the first trimester but restrictions thereafter, especially for people later in pregnancy. [ABSTRACT FROM AUTHOR]

In the present paper, we obtain infinitely many pairs of homoclinic solutions for a class of nonsmooth second-order differential systems when the energy functional associated is not continuously differentiable and does not satisfy the Palais-Smale condition. [ABSTRACT FROM AUTHOR]

This paper is concerned with the following first-order Hamiltonian system -z = JHz(t, z), where the Hamiltonian function H(t, z) = 12 Lz · z + A(?t)G(|z|) and - > 0 is a small parameter. Under some natural conditions, we obtain a new existence result for ground state homoclinic orbits by applying variational methods. Moreover, the concentration behavior and exponential decay of these ground state homoclinic orbits are also investigated. [ABSTRACT FROM AUTHOR]

In this paper, we study baroclinic waves from both the experimental and the theoretical perspective. We obtain data from a rotating annulus experiment capable of producing a series of baroclinic eddies similar to those found in the mid-latitude atmosphere. We analyze the experimental outputs using two methods. First, we apply a technique that involves filtering data using the empirical orthogonal function (EOF) analysis, which is applied to both velocity and surface temperature fields. The second method relies on the construction of a simple kinematic model based on key parameters derived from the experimental data. To analyze eddy-driven fluid transport, we apply the method of Lagrangian descriptors to the underlying velocity field, revealing the attracting material curves that act as transport barriers in the system. These structures effectively capture the essential characteristics of the baroclinic flow and the associated transport phenomena. Our results show that these barriers are in good agreement with the transport patterns observed in the rotating annulus experiment. In particular, we observe that the structures obtained from the kinematic model, or the one derived in terms of filtered velocities, perform well in this regard. [ABSTRACT FROM AUTHOR]

Gait analysis is recognized as a useful assessment tool in the field of human movement research. However, doubts remain on its real effectiveness as a clinical tool, i.e. on its capability to change the diagnostic-therapeutic practice. In particular, the conditions in which evidence of a favorable cost-benefit ratio is found and the methodology for properly conducting and interpreting the exam are not identified clearly. To provide guidelines for the use of Gait Analysis in the context of rehabilitation medicine, SIAMOC (the Italian Society of Clinical Movement Analysis) promoted a National Consensus Conference which was held in Bologna on September 14th, 2013. The resulting recommendations were the result of a three-stage process entailing i) the preparation of working documents on specific open issues, ii) the holding of the consensus meeting, and iii) the drafting of consensus statements by an external Jury. The statements were formulated based on scientific evidence or experts' opinion, when the quality/quantity of the relevant literature was deemed insufficient. The aim of this work is to disseminate the consensus statements. These are divided into 13 questions grouped in three areas of interest: 1) General requirements and management, 2) Methodological and instrumental issues, and 3) Scientific evidence and clinical appropriateness. SIAMOC hopes that this document will contribute to improve clinical practice and help promoting further research in the field. [ABSTRACT FROM AUTHOR]

Mobile devices are increasingly used to administer self-report measures of mental health symptoms. There are significant differences, however, in the way that information is presented on mobile devices compared to the traditional paper forms that were used to administer such measures. Such differences may systematically alter responses. The present study evaluated if and how responses differed for a self-report measure, the PTSD Checklist (PCL), administered via mobile device relative to paper and pencil. Participants were 153 trauma-exposed individuals who completed counterbalanced administrations of the PCL on a mobile device and on paper. PCL total scores (d = 0.07) and item responses did not meaningfully or significantly differ across administrations. Power was sufficient to detect a difference in total score between administrations determined by prior work of 3.46 with a d = 0.23. The magnitude of differences between administration formats was unrelated to prior use of mobile devices or participant age. These findings suggest that responses to self-report measures administered via mobile device are equivalent to those obtained via paper and they can be used with experienced as well as naïve users of mobile devices. [ABSTRACT FROM AUTHOR]

Accessible summary: What is known on the subject?: Self‐management comprises five core skills: "Problem Solving, Decision‐Making, Resource Utilization, Forming a Patient/Healthcare Provider Partnership and Taking Action."Effective self‐management among patients diagnosed with anxiety can reduce the number of relapses and improve treatment outcomes.Knowledge of the impact of the family atmosphere, well‐being and illness symptoms on self‐management in patients diagnosed with anxiety disorders is limited. What does the paper add to the existing knowledge?: This is the first study in China to explore whether family atmosphere and well‐being of patients diagnosed with anxiety disorders affects self‐management.This paper adds to the list of factors influencing self‐management among patients diagnosed with anxiety disorders.SAS scores are a major factor influencing self‐management among patients diagnosed with anxiety disorders.The subjective well‐being of patients diagnosed with anxiety disorders can influence their self‐management behaviour.Patients who experienced family harmony had significantly higher self‐management scores than those who experienced family disharmony. What are the implications for practice?: Nurses should encourage patients diagnosed with anxiety disorders to manage their condition while receiving treatment at home.Nurses should focus on patients diagnosed with anxiety disorders who have significant anxiety symptoms and low well‐being.Nurses should emphasize the importance of the home environment in family self‐management and affirm that a good home environment promotes patient self‐management. Introduction: Better self‐management can improve treatment outcomes and reduce the number of relapses for patients diagnosed with anxiety disorders. However, the impact of well‐being and the home environment on self‐management among patients diagnosed with anxiety disorders is unclear in China. Aim: This study sought to determine the impact of the home environment, well‐being and illness symptoms on self‐management during home treatment for patients diagnosed with anxiety disorders. Method: This cross‐sectional study was conducted with patients diagnosed with anxiety disorders. Data were collected with SAS, Self‐Management Scale for People with Anxiety Disorders and Index of Well‐being. Frequency, percentage, analysis of variance, Kruskal–Wallis and multiple linear regression analyses were used. Results: Home environment (p <.001), self‐perceived quality of life (p =.015), well‐being index (p =.002) and SAS total score (p =.033) had a major impact on self‐management in patients diagnosed with anxiety disorders (n = 245). Discussion: Family disharmony, poor self‐perceived quality of life, high SAS scores and low levels of well‐being were significant influences on self‐management among people diagnosed with anxiety disorders. Implications for Practice: Nurses should focus on the self‐management of patients diagnosed with significant anxiety symptoms and low well‐being and value the importance of the home environment in facilitating self‐management among patients diagnosed with anxiety disorders. [ABSTRACT FROM AUTHOR]

Background: The results of germline genetic testing for hereditary cancer are of importance not only to the patients under investigation but also to their genetic at-risk relatives. Standard care is to encourage the proband (first family member under investigation) to pass on this risk information to the relatives. Previous research suggests that with family-mediated disclosure, only about a third of at-risk relatives contact health care to receive genetic counselling. In some studies, complementing family-mediated risk disclosure with healthcare-assisted risk disclosure almost doubles the uptake of genetic counselling in at-risk relatives. In this study, we evaluate healthcare-assisted direct letters to relatives at risk of hereditary cancer syndromes in a randomized controlled trial. Methods: Probands are recruited from Swedish outpatient cancer genetics clinics to this two-arm randomized controlled trial. The study recruits probands with either a pathogenic variant in a cancer susceptibility gene (BRCA1, BRCA2, PALB2, MLH1, MSH2, MSH6, PMS2) or probands with familial breast and colorectal cancer based on clinical and pedigree criteria. In both arms, probands receive standard care, i.e., are encouraged and supported to pass on information to relatives. In the intervention arm, the proband is also offered to have direct letters sent to the at-risk relatives. The primary outcome measure is the proportion of at-risk relatives contacting a Swedish cancer genetics clinic within 12 months of the proband receiving the test results. Discussion: This paper describes the protocol of a randomized controlled clinical trial evaluating a healthcare-assisted approach to risk disclosure by offering the probands to send direct letters to their at-risk relatives. The results of this study should be informative in the future development of risk disclosure practices in cancer genetics clinics. Trial registration: ClinicalTrials.gov. Identifier NCT04197856 (pre-trial registration on December 13, 2019). Also registered at the website "RCC Cancerstudier i Sverige" as study #86719. [ABSTRACT FROM AUTHOR]

A regional ocean ensemble simulation with slightly different initial conditions demonstrates that internal variability is formed (not only) in the Bohai and Yellow Sea. In this paper, we analyze the relationship between the internal variability and the baroclinic instability, (represented by the Eady predicted theoretical diffusivity K t ; the larger the K t , the stronger the baroclinic instability level). In the ensemble, with tidal forcing, the spatial correlation between the Eady predicted theoretical diffusivity K t and the internal variability amounts to 0.80. Also, the time evolution trends of baroclinic instability and internal variability are similar. Based on this evidence, baroclinic instability may be a significant driver for internal variability. This hypothesis is validated using an additional ensemble of simulations, which is identical to the first ensemble, but this time, the tides are inactivated. This modification leads to an increase in internal variability, combined with the strengthening of baroclinic instability. In addition, the baroclinic instability level and internal variability variation co-vary consistently when comparing summer and winter seasons, both with and without tides. Our interpretation is that a stronger baroclinic instability causes more potential energy to be transformed into kinetic energy, allowing the unforced disturbances to grow. [ABSTRACT FROM AUTHOR]

Introduction: Older carers or 'care partners' of older people experiencing care needs often provide essential support, at times while neglecting their own health and well‐being. This is an increasingly frequent scenario due to both demographic changes and policy shifts towards ageing in place. Multiple community stakeholders within the care and support ecosystem hold valuable expertise about the needs of older care partners, and the programme and policy responses that may better support their health and well‐being. The aim of this study was to identify the perspectives of stakeholders obtained through the codesign phase of a multicomponent research project investigating new models of care and support for older care partners suitable for the Australian context. Methods: Principles of codesign were used to engage a purposeful sample of older care partners, health professionals, researchers, policy makers and health service administrators. Participants took part in a series of three codesign workshops conducted remotely via video conferencing. The workshops were supported with briefing material and generated consensus‐based summaries, arriving at a preferred service model. Findings: This paper reports the research design and structure of the codesign panels, the range of findings identified as important to support the health and well‐being of older carers of older people, and the resulting service model principles. The codesigned and preferred model of care is currently being prepared for implementation and evaluation in Australia. Public Contribution: This study was conducted using codesign methodology, whereby stakeholders including older care partners and others involved in supporting older carers, were integrally involved with design, development, results and conclusions. [ABSTRACT FROM AUTHOR]

Background: Undergraduate podiatry degrees are designed to enable students to become professional podiatrists. To be successful students must manage academic and practical activity to ultimately acquire a professional identity. Little is known about the practices and processes which underpin the acquisition of a professional podiatry identity. It is the aim of this paper to begin to address this absence of knowledge. Community of Practice theory, arguably the dominant contemporary learning theory, represents identity shift as an interaction of imagination, engagement and alignment which enables students to successfully participate in higher education, and ultimately, the professional context. This success is underpinned through assisting students to develop an enabling identity in their learning and doing. Methods: Here we present findings that emerged from a yearlong ethnography in a successful higher education podiatry department. The project followed students and staff in the classroom and the clinic and explored their experiences through interviews. Results: The findings suggest that the journey to professional identity is facilitated through meaningful learning relationships between staff and students and clarity around professional practices. Here we discuss how those relationships form and enable undergraduates to become podiatrists. Conclusions: Our findings offer a model for the transition from student to professional and highlight the importance of relationship and experience in becoming a podiatrist. There is a paucity of research around not only podiatry but also other allied health professions around this topic and given the increasing emphasis around employability skills in HE, more research in a range of contexts is needed. [ABSTRACT FROM AUTHOR]

In‐vitro fertilization clinics across the world currently use the body mass index (BMI) to assess risk for and determine access to in‐vitro fertilization (IVF); however, clinics vary widely in both setting specific BMI limits for access to IVF and articulating the reasons for their policies. Given that scholars have begun to question the usefulness of BMI for individual health risk assessment, it is striking that ethicists have not yet systematically evaluated the reasons given for using BMI in assessing individuals' risk in IVF treatments. In this paper, I provide the first systematic analysis of the chief arguments currently offered by IVF programs for using BMI as a criterion for risk assessment. Specifically, I articulate empirical concerns about the success of IVF in high‐BMI patients, practical concerns about the ability of high‐BMI patients to safely undergo procedures associated with IVF, and ethical concerns about the risk‐to‐reward ratio for high‐BMI patients and their potential children. I advance a series of objections to those arguments, using empirical data regarding IVF procedures and analogies with other high‐risk conditions including systemic lupus erythematosus, and science regarding the diagnosis of BMI‐correlated comorbidities such as high blood pressure or diabetes to argue that BMI alone is not a reasonable criterion for risk assessment in IVF; moreover, the usage of BMI may involve unacceptable violations of the bioethical principles of justice and respect for autonomy. Instead, I hold that IVF programs should rely on more precise laboratory and clinical measurements to evaluate risk in IVF. [ABSTRACT FROM AUTHOR]

PURPOSE: Patient portal technology offers important new opportunities to support person-centered clinician-patient communication. METHODS: Questionnaires relating to understanding of illness and treatment intent were sent quarterly via portal to all patients scheduled for follow-up in GI medical oncology clinics. For patients in selected clinics, items eliciting health-related values were added. Patient responses were available to all oncology team members in the electronic health record. Workflow and content of clinician-patient discussions about illness, treatment, and care goals stayed within clinicians' discretion. Feasibility (patient response rate), patient understanding, acceptability (three-item patient questionnaire), and efficacy (quality of clinician communication) were evaluated. RESULTS: From May 2021 through December 2022, a total of 12,233 questionnaires about illness/treatment understanding were sent to 6,325 patients (one to six per patient), with 97% response, including 9,358 with both open- and closed-ended responses. Fewer than 0.1% of patients indicated distress related to the questionnaire/process. Open-ended responses complemented closed-ended answers by revealing prognostic awareness and illness concerns. Of 48 patients approached to complete the full questionnaire including values items via portal, 15 first received and completed them in clinic (5 on iPad, 10 on paper), while 33 received and 27 (82%) completed the portal questionnaire. Patients found the portal process acceptable, and ratings of clinician communication were higher after clinic visits informed by patients' questionnaire responses (average prescore 6.8 v 5.9 post; P =.03). CONCLUSION: Almost all patients in this large GI cancer cohort responded via the portal about their understanding of illness and treatment goals. Eliciting their personal values by portal was also feasible, accepted by patients, and improved patient ratings of clinicians' communication. Portals represent a promising tool for scaling assessment of essential patient-reported elements of person-centered communication. Patient portals can help scale assessment of patient-reported elements of person-centered communication. [ABSTRACT FROM AUTHOR]

Palliative care social workers are trained to identify how trauma manifests over the course of serious and chronic illness. This expertise can guide patients and team members to ensure a trauma-informed experience of care. This paper identifies the growth of outpatient palliative care clinics as an opportunity for palliative care social workers to emphasize this clinical skill set and assume a leadership role in the implementation of trauma-informed practices early in the trajectory of serious illness. [ABSTRACT FROM AUTHOR]

Objective: The Samoan community has a disproportionately higher incidence of gestational diabetes mellitus (GDM). We explored consumer and healthcare providers' insight into perceptions of risk, attitudes to lifestyle behaviour change and experiences of GDM among Australian Samoan women in South Western Sydney. Methods: Semi-structured interviews and a focus group with Samoan women recruited through three churches, a diabetes and pregnancy clinic in South Western Sydney and via social media were conducted. Semi-structured interviews with healthcare providers' were also conducted. Main themes were thematically analysed to identify recurring patterns using Quirkos software. Identified themes were framed against the constructs of the Health Belief Model. Results: One focus group (n=4) and 12 one-to-one interviews were conducted among Samoan women. Eighteen semi-structured interviews with healthcare providers' were also conducted. There was a high concordance between Samoan women and healthcare providers' regarding perception of risk and barriers to maintaining a healthy lifestyle. However, Samoan women reported negative interactions with healthcare providers' that hindered their behaviour change, while healthcare providers' reported that normalisation of diabetes, confusion of GDM with type 2 diabetes and spiritual health beliefs were deterrents to behaviour change among Samoan women. Conclusion: Cross-cultural factors can influence the uptake of a healthy lifestyle. Future research should consider use of culturally tailored strategies when developing educational resources targeting Samoan women. Implications for research, policy and practice: The participants' viewpoints expressed in this study suggest a critical need for the development of culturally-tailored health promotion strategies for Samoan women and cultural training for healthcare providers', to improve GDM care and subsequent pregnancy outcomes. What is already known about the topic? * There is limited data and research on GDM particularly among the Australian-Samoan community though the available data highlight the significant morbidity and mortality due to diabetes in this population. * Samoan women are at an increased risk of gestational diabetes mellitus. What this paper adds: * This paper provides knowledge and understanding on ways to prevent and manage GDM by investigating the perception of risk and experiences of GDM among Australian Samoan women and healthcare professionals in Sydney. * It provides current evidence base for policy makers and researchers to develop health promotion strategies and interventions that are relevant to the Samoan and other culturally and linguistically diverse (CALD) communities in Australia. [ABSTRACT FROM AUTHOR]

Background: In everyday conversations, a person with aphasia (PWA) compensates for their language impairment by relying on multimodal and material resources, as well as on their conversation partners. However, some social actions people perform in authentic interaction, proposing a joint future activity, for example, ordinarily rely on a speaker producing a multi‐word utterance. Thus, the language impairment connected to aphasia may impede the production of such proposals, consequently hindering the participation of PWAs in the planning of future activities. Aims: To investigate (1) how people with post‐stroke chronic aphasia construct proposals of joint future activities in everyday conversations compared with their familiar conversation partners (FCPs); and (2) how aphasia severity impacts on such proposals and their uptake. Methods & Procedures: Ten hours of video‐recorded everyday conversations from seven persons with mild and severe aphasia of varying subtypes and their FCPs were explored using conversation analysis. We identified 59 instances where either party proposed a joint future activity and grouped such proposals according to their linguistic format and sequential position. Data are in Finnish. Outcomes & Results: People with mild aphasia made about the same number of proposals as their FCPs and used similar linguistic formats to their FCPs when proposing joint future activities. This included comparable patterns associated with producing a time reference, which was routinely used when a proposal initiated a planning activity. Mild aphasia manifested itself as within‐turn word searches that were typically self‐repaired. In contrast, people with severe aphasia made considerably fewer proposals compared with their FCPs, the proposal formats being linguistically unidentifiable. This resulted in delayed acknowledgement of the PWAs' talk as a proposal. Conclusions & Implications: Mild aphasia appears not to impede PWAs' ability to participate in the planning of joint future activities, whereas severe aphasia is a potential limitation. To address this possible participatory barrier, we discuss clinical implications for both therapist‐led aphasia treatment and conversation partner training. WHAT THIS PAPER ADDS: What is already known on the subject: PWAs use multimodal resources to compensate for their language impairment in everyday conversations. However, certain social actions, such as proposing a joint future activity, cannot ordinarily be accomplished without language. What this paper adds to existing knowledge: The study demonstrates that proposing joint future activities is a common social action in everyday conversations between PWAs and their family members. People with mild aphasia used typical linguistic proposal formats, and aphasic word‐finding problems did not prevent FCPs from understanding the talk as a proposal. People with severe aphasia constructed proposals infrequently using their remaining linguistic resources, a newspaper connecting the talk to the future and the support from FCPs. What are the potential or actual clinical implications of this work?: We suggest designing aphasia treatment with reference to the social action of proposing a joint future activity. Therapist‐led treatment could model typical linguistic proposal formats, whereas communication partner training could incorporate FCP strategies that scaffold PWAs' opportunities to construct proposals of joint future activities. This would enhance aphasia treatment's ecological validity, promote its generalization and ultimately enable PWAs to participate in everyday planning activities. [ABSTRACT FROM AUTHOR]

This paper was presented at the Association of Child Psychotherapy (ACP) annual conference, alongside images of birds' nests of all shapes and sizes, to illustrate their versatile and unique qualities specifically required for their young. It explores the experience of parenting children who come from 'other' worlds, with a focus on adoptive parents, and examines how parenting, or being parented by someone who appears to be so very different to ourselves, can be extremely complicated and can cause significant distress. The paper will refer to some of the challenges of being good enough or secure enough, when it comes to building 'home' or nest. These challenges are also experienced by professionals, who can feel that they have limited resources to offer these children given their complex needs. It can feel as though they are continuing the cycle of deprivation, balancing on the edge of the nest with vulnerable fledglings, and preparing them for flight which they may not yet be ready for. These themes are also relevant when considering the context and 'edginess' of our times – coming out of the pandemic, many of us have had the experience of being cast out of the workplace and other connected or communal spaces, feeling less protected at home, while being exposed to more of the threat normally held within our clinics. We have all found ourselves living in a changed world. [ABSTRACT FROM AUTHOR]

Objective: There has been a large amount of research in the field of artificial intelligence (AI) as applied to clinical radiology. However, these studies vary in design and quality and systematic reviews of the entire field are lacking.This systematic review aimed to identify all papers that used deep learning in radiology to survey the literature and to evaluate their methods. We aimed to identify the key questions being addressed in the literature and to identify the most effective methods employed. Methods: We followed the PRISMA guidelines and performed a systematic review of studies of AI in radiology published from 2015 to 2019. Our published protocol was prospectively registered. Results: Our search yielded 11,083 results. Seven hundred sixty-seven full texts were reviewed, and 535 articles were included. Ninety-eight percent were retrospective cohort studies. The median number of patients included was 460. Most studies involved MRI (37%). Neuroradiology was the most common subspecialty. Eighty-eight percent used supervised learning. The majority of studies undertook a segmentation task (39%). Performance comparison was with a state-of-the-art model in 37%. The most used established architecture was UNet (14%). The median performance for the most utilised evaluation metrics was Dice of 0.89 (range.49–.99), AUC of 0.903 (range 1.00–0.61) and Accuracy of 89.4 (range 70.2–100). Of the 77 studies that externally validated their results and allowed for direct comparison, performance on average decreased by 6% at external validation (range increase of 4% to decrease 44%). Conclusion: This systematic review has surveyed the major advances in AI as applied to clinical radiology. Key Points: • While there are many papers reporting expert-level results by using deep learning in radiology, most apply only a narrow range of techniques to a narrow selection of use cases. • The literature is dominated by retrospective cohort studies with limited external validation with high potential for bias. • The recent advent of AI extensions to systematic reporting guidelines and prospective trial registration along with a focus on external validation and explanations show potential for translation of the hype surrounding AI from code to clinic. [ABSTRACT FROM AUTHOR]

Background: Influenza (flu) vaccination rates in UK care home staff are extremely low. Less than 40% of staff in care homes are vaccinated for influenza (flu), presenting risks to the health of frail residents and potential staff absence from cross-infection. Staff often do not perceive a need for vaccination and are unaware they are entitled to free flu vaccination. The FluCare study, a cluster randomised control trial (RCT), uses behavioural interventions to address barriers. Videos, posters, and leaflets are intended to raise awareness of flu vaccination benefits and debunk myths. On-site staff vaccination clinics increase accessibility. Financial incentives to care homes for improved vaccination rates and regular monitoring influence the environment. This paper outlines the planned process evaluation which will describe the intervention's mechanisms of action, explain any changes in outcomes, identify local adaptations, and inform design of the implementation phase. Methods/design: A mixed method process evaluation to inform the interpretation of trial findings. Objectives: • Describe the intervention as delivered in terms of dose and fidelity, including adaptations and variations across care homes. • Explore the effects of individual intervention components on primary outcomes. • Investigate the mechanisms of impact. • Describe the perceived effectiveness of relevant intervention components (including videos, leaflets, posters, and flu clinics) from participant perspectives (care home manager, care home staff, flu clinic providers). • Describe the characteristics of care homes and participants to assess reach. A purposive sample of twenty care homes (ten in the intervention arm, ten in the control arm) for inclusion in the process evaluation. Data will include (1) study records including care home site profiles, (2) responses to a mechanism of action questionnaire, and (3) semi-structured interviews with care home staff and clinic providers. Quantitative data will be descriptively reported. Interview data will be thematically analysed and then categories mapped to the Theoretical Domains Framework. Discussion: Adopting this systematic and comprehensive process evaluation approach will help ensure data is captured on all aspects of the trial, enabling a full understanding of the intervention implementation and RCT findings. Trial registration: ISRCTN ISRCTN22729870. Registered on 24 August 2022. [ABSTRACT FROM AUTHOR]

Background: Undergraduate podiatry degrees are designed to enable students to become professional podiatrists. To be successful students must manage academic and practical activity to ultimately acquire a professional identity. Little is known about the practices and processes which underpin the acquisition of a professional podiatry identity. It is the aim of this paper to begin to address this absence of knowledge. Community of Practice theory, arguably the dominant contemporary learning theory, represents identity shift as an interaction of imagination, engagement and alignment which enables students to successfully participate in higher education, and ultimately, the professional context. This success is underpinned through assisting students to develop an enabling identity in their learning and doing. Methods: Here we present findings that emerged from a yearlong ethnography in a successful higher education podiatry department. The project followed students and staff in the classroom and the clinic and explored their experiences through interviews. Results: The findings suggest that the journey to professional identity is facilitated through meaningful learning relationships between staff and students and clarity around professional practices. Here we discuss how those relationships form and enable undergraduates to become podiatrists. Conclusions: Our findings offer a model for the transition from student to professional and highlight the importance of relationship and experience in becoming a podiatrist. There is a paucity of research around not only podiatry but also other allied health professions around this topic and given the increasing emphasis around employability skills in HE, more research in a range of contexts is needed. [ABSTRACT FROM AUTHOR]

Aims Bacteria are one of the main factors involved in the process of tooth decay and are the main cause of pulp and periapical diseases. Their presence in the crown pulp and dental canal causes symptoms in the teeth. This study aimed to investigate the molecular analysis of anaerobic bacteria in primary and necrotic teeth of children and to determine the relationship between these bacteria and clinical signs and symptoms. Materials & Methods In this analytical cross-sectional study, 90 children aged 4-12 years were divided into five equal groups (n=18), including reversible pulpitis without irritant pain, reversible pulpitis with irritant pain, irreversible pulpitis, necrosis with abscess, and necrosis without abscess. Clinical symptoms of the patient, such as history of pain, luxation, sensitivity to percussion, status of the dental pulp, and presence of swelling were recorded, and samples were taken from coronal pulp tissue and root canals during pulp treatment using sterile paper points. To identify anaerobic bacteria, clinical samples were cultured under anaerobic conditions. The 16s rRNA sequencing was used for molecular identification of anaerobic bacteria at species level. Findings In 90 patients, 9 different Lactobacillus spp. were identified which among them L. fermentum (37.8%), L. rhamnosus (15.6%), L. salivarius (10%), and L. gasseri (5.6%) were the most prevalent. L. fermentum was the most common species found in all clinical samples that was related to pain (p=0.034). Conclusion L. fermentum is the most common species found in all clinical samples that is related to pain. [ABSTRACT FROM AUTHOR]

In this paper, we study the dynamics of a Lotka–Volterra model with an Allee effect, which is included in the predator population and has an abstract functional form. We classify the original system as a slow–fast system when the conversion rate and mortality of the predator population are relatively low compared to the prey population. In comparison to numerical simulation results that indicate at most three limit cycles in the system [Sen et al., J. Math. Biol. 84(1), 1–27 (2022)], we prove the uniqueness and stability of the slow–fast limit periodic set of the system in the two-scale framework. We also discuss canard explosion phenomena and homoclinic bifurcation. Furthermore, we use the enter–exit function to demonstrate the existence of relaxation oscillations. We construct a transition map to show the appearance of homoclinic loops including turning or jump points. To the best of our knowledge, the homoclinic loop of fast slow jump slow type, as classified by Dumortier, is uncommon. Our biological results demonstrate that under certain parameter conditions, population density does not change uniformly, but instead presents slow–fast periodic fluctuations. This phenomenon may explain sudden population density explosions in populations. [ABSTRACT FROM AUTHOR]

A clinical study has been conducted to test the efficacy of Ecocid® S, a biocidal agent. The active substance is potassium peroxysulphate and is used in clinical practice after the mechanical cleaning of various surfaces that act as potential sources of infection transmission. We determined 29 swabbing points, from which 87 samples were collected with cotton swabs. Swabs were submitted for microbiological testing to evaluate microbial contamination before cleaning, and before and after disinfection with Ecocid® S. We submitted 63 swabs from 21 swabbing points for further statistical analysis. Five swabs were excluded because the presence of bacteria in the swabs before disinfection had not been determined. The clinical study on the efficacy of Ecocid® S disinfectant showed that it is effective with an average reduction in contamination of 95.75%. The disinfectant was also active with a significantly reduced time of action: it was removed with dry paper towels from all sampling points, except the floor scales, only 5 to 10 minutes after application. The time required for the proper preparation of examination tables and other equipment in clinical practice is of vital importance for a smooth workflow. [ABSTRACT FROM AUTHOR]

A clinical study has been conducted to test the efficacy of Ecocid® S, a biocidal agent. The active substance is potassium peroxysulphate and is used in clinical practice after the mechanical cleaning of various surfaces that act as potential sources of infection transmission. We determined 29 swabbing points, from which 87 samples were collected with cotton swabs. Swabs were submitted for microbiological testing to evaluate microbial contamination before cleaning, and before and after disinfection with Ecocid® S. We submitted 63 swabs from 21 swabbing points for further statistical analysis. Five swabs were excluded because the presence of bacteria in the swabs before disinfection had not been determined. The clinical study on the efficacy of Ecocid® S disinfectant showed that it is effective with an average reduction in contamination of 95.75%. The disinfectant was also active with a significantly reduced time of action: it was removed with dry paper towels from all sampling points, except the floor scales, only 5 to 10 minutes after application. The time required for the proper preparation of examination tables and other equipment in clinical practice is of vital importance for a smooth workflow. [ABSTRACT FROM AUTHOR]

In the present paper, we consider a fractional discrete Schrödinger equation with Kirchhoff term. Through the fountain theorem and the dual fountain theorem, we obtain two different conclusions about infinitely many homoclinic solutions to this equation. [ABSTRACT FROM AUTHOR]

Mental health professionals working in hospitals or community clinics inevitably face the realisation that we possess imperfect conceptual means to understand mental disorders. In this paper the authors bring together ideas from the fields of Philosophy, Psychiatry, Cognitive Psychology and Linguistics to reflect on the ways we represent phenomena of high practical importance that we often take for granted, but are nevertheless difficult to define in ontological terms. The paper follows through the development of the concept of psychosis over the last two centuries in the interplay of three different conceptual orientations: the categorical, dimensional and network approaches. Each of these represent the available knowledge and dominant thinking styles of the era in which they emerged and take markedly different stances regarding the nature of mental phenomena. Without particular commitment to any ontological positions or models described, the authors invite the reader into a thinking process about the strengths and weaknesses of these models, and how they can be reconciled in multidisciplinary settings to benefit the process of patient care. [ABSTRACT FROM AUTHOR]

Mental health professionals working in hospitals or community clinics inevitably face the realisation that we possess imperfect conceptual means to understand mental disorders. In this paper the authors bring together ideas from the fields of Philosophy, Psychiatry, Cognitive Psychology and Linguistics to reflect on the ways we represent phenomena of high practical importance that we often take for granted, but are nevertheless difficult to define in ontological terms. The paper follows through the development of the concept of psychosis over the last two centuries in the interplay of three different conceptual orientations: the categorical, dimensional and network approaches. Each of these represent the available knowledge and dominant thinking styles of the era in which they emerged and take markedly different stances regarding the nature of mental phenomena. Without particular commitment to any ontological positions or models described, the authors invite the reader into a thinking process about the strengths and weaknesses of these models, and how they can be reconciled in multidisciplinary settings to benefit the process of patient care. [ABSTRACT FROM AUTHOR]

Background: Durable pulmonary vein isolation (PVI) is recommended for symptomatic paroxysmal atrial fibrillation (AF) treatment, but it has been demonstrated that it may not be enough to treat persistent AF (Pe-AF). Therefore, posterior wall isolation (PWI) is among the strategies adopted on top of PVI to treat Pe-AF patients. However, PWI using contiguous and optimized radiofrequency lesions remains challenging, and few studies have evaluated the impact of the Ablation Index (AI) on the efficacy of PWI. Moreover, previous papers did not evaluate arrhythmia recurrences using continuous monitoring. Methods: This is a prospective, observational, single-center study on patients affected by Pe-AF undergoing treated PVI plus AI-guided PWI. Procedures were performed using the CARTO mapping system, SmartTouch SF ablation catheter, and PentaRay multipolar mapping catheter. The AI settings were 500–550 for the anterior PV aspect and roofline, while the settings were 450–500 for the posterior PV aspect, bottom line, and/or PW lesions. All patients received an implantable loop recorder (ILR). All patients underwent clinical evaluation in the outpatient clinic at 1, 3, 6, 12, 18, and 24 months. A standard 12-lead ECG was performed at each visit, and device data from the ILR were reviewed to assess for arrhythmia recurrence. Results: Between January 2021 and December 2021, forty-one consecutive patients underwent PVI plus PWI guided by AI at our center and were prospectively enrolled in the study. PVI was achieved in all patients, first-pass roofline block was obtained in 82.9% of the patients, and first-pass block of the bottom line was achieved in 36.5% of the patients. In 39% of the patients, PWI was not performed with a "box-only" lesion set, but with scattered lesions across the PW to achieve PWI. AI on the anterior aspect of the left PVs was 528 ± 22, while on the posterior aspect of the left PVs, it was 474 ± 18; on the anterior aspect of the right PVs, it was 532 ± 27, while on the posterior aspect of the right PVs, it was 477 ± 16; on the PW, AI was 468 ± 19. No acute complications occurred at the end of the procedure. After the blanking period, 70.7% of the patients reported no arrhythmia recurrence during the 12-month follow-up period. Conclusions: In patients with Pe-AF undergoing catheter ablation, PWI guided by AI seems to be an effective and feasible strategy in addition to standard PVI. [ABSTRACT FROM AUTHOR]

This paper reports a new 3D sub-quadratic Lorenz-like system and proves the existence of two pairs of heteroclinic orbits to two pairs of nontrivial equilibria and the origin, which are completely different from the existing ones to the unstable origin and a pair of stable nontrivial equilibria in the published literature. This motivates one to further explore it and dig out its other hidden dynamics: Hopf bifurcation, invariant algebraic surface, ultimate boundedness, singularly degenerate heteroclinic cycle and so on. Particularly, numerical simulation illustrates that the Lorenz-like chaotic attractors coexist with one saddle in the origin and two stable nontrivial equilibria, which are created through the broken infinitely many singularly degenerate heteroclinic cycles and explosions of normally hyperbolic stable foci E z. [ABSTRACT FROM AUTHOR]

In this paper, the Richtmyer–Meshkov instability of a flat gas interface driven by perturbed and reflected shock waves is numerically investigated. The flat gas interface evolves into a "Λ"-shaped structure with a central N2 cavity and steps on both sides, due to the impaction of the perturbed shock wave. After the secondary collision of the reflected shock wave from the high-density region to the low-density region, the gas interface first undergoes phase inversion, and the "Λ" interface then evolves into a bubble and spike structure. Three cases of different Atwood numbers, N2/SF6, N2/Kr, and N2/CO2, are studied. The collision time and position of the reflected shock wave and the interface, the induced spikes, bubbles and gas mixing, are compared in detail. The formation of the spike and bubble is related to the RM instability developed by the collision of the reflected shock wave and the perturbed interface, in which the effect of baroclinic vorticity is highlighted. With the increase in the Atwood number, the density gradient and the baroclinic vorticity become larger, which induces more vortex along the interface. Kelvin Helmholtz unstable vortices are generated on the "legs" of the spikes due to shearing. The main spike structure is stretched and broken with the effect of the vortex, forming a turbulent mixing zone. [ABSTRACT FROM AUTHOR]

Vaccines are delicate biological substances that gradually become inactive over time and must be kept under a recommended temperature range of 2–8 °C for both short and long-term storage. Exposure to heat or freezing temperatures can highly affect the immunological properties of these vaccines and make them completely ineffective. Research shows that vaccine exposure to temperatures outside the recommended range is 33% in developed countries and 37.1% in developing countries. In practice, vaccines are stored in refrigerators, while thermometers and data loggers are used to record and monitor temperatures. However, traditional systems are unreliable due to lack of battery backup, human error, periodic logging of temperatures, etc. Therefore, an effective and reliable vaccine tracking and monitoring system is urgently needed. This paper proposes a blockchain-based, smart contract enabled solution that ensures an enhanced level of security, transparency, and traceability of stored vaccines in a health clinic, and enables the complete history of every vaccine to be checked from the day the vaccine is received by the health clinic to the date it is used or expires. We also formally analyze the resiliency of the proposed system against several attacks and compare the system with existing blockchain and non-blockchain-based solutions. [ABSTRACT FROM AUTHOR]

A homoclinic class is the closure of the transverse intersection points of the stable and unstable manifolds of a hyperbolic periodic orbit. In this paper, we prove, using the techniques presented in [1], that the Plykin and the Solenoid attractors are a homoclinic class. [ABSTRACT FROM AUTHOR]

Heteroclinic-induced spiral waves may arise in systems of partial differential equations that exhibit robust heteroclinic cycles between spatially uniform equilibria. Robust heteroclinic cycles arise naturally in systems with invariant subspaces, and their robustness is considered with respect to perturbations that preserve these invariances. We make use of particular symmetries in the system to formulate a relatively low-dimensional spatial two-point boundary-value problem in Fourier space that can be solved efficiently in conjunction with numerical continuation. The standard numerical set-up is formulated on an annulus with small inner radius, and Neumann boundary conditions are used on both inner and outer radial boundaries. We derive and implement alternative boundary conditions that allow for continuing the inner radius to zero and so compute spiral waves on a full disk. As our primary example, we investigate the formation of heteroclinic-induced spiral waves in a reaction–diffusion model that describes the spatiotemporal evolution of three competing populations in a 2D spatial domain—much like the Rock–Paper–Scissors game. We further illustrate the efficiency of our method with the computation of spiral waves in a larger network of cyclic dominance between five competing species, which describes the so-called Rock–Paper–Scissors–Lizard–Spock game. [ABSTRACT FROM AUTHOR]

Background: Child hospitalization is a stressful experience for both children and their parents. Parents should establish effective communication with healthcare professionals to be able to participate in the care of their children in the hospital environment. Aims and Objectives: The purpose of the study was to determine the effect of parental participation in the care of hospitalized children on parent satisfaction and parent and child anxiety. Design The design used for this study was randomized controlled trial. Methods: The study data were collected between 1 February and 31 May 2016. Frequency, percentage, paired t test, Mann–Whitney U and Wilcoxon were used to analyse the data. Results: The study compared the parents' pretest and posttest scores on the anxiety and found that there was a statistically significant difference between the posttest scores of intervention and control groups. There was also a statistically significant difference parental participation and overall satisfaction subscales of the parent satisfaction as well as their total scores and mean scores. Comparison of the children's posttest scores on the anxiety inventory also found a statistically significant difference. Conclusion: The study concluded that parental participation in the care of hospitalized children increases parent satisfaction with healthcare, and reduces anxiety of both parents and children. SUMMARY STATEMENT: What is already known about this topic? Child hospitalization is a stressful experience for both children and their families.Physical impairment, invasive interventions, surgery, death, pain and experiencing loss of control are among the reasons that children feel anxious in the hospital environment.Parental participation is an essential element of quality of care for children in hospital. However, there is often confusion in role perception between parents and nurses which may be affected by nurses' attitudes, their ability to provide information, their communication and interpersonal skills and willingness to relinquish control. What this paper adds? Parental participation in the care of hospitalized children increases parent satisfaction with healthcare, and reduces anxiety of both parents and children.Nurses confirmed the belief that parents' participation in the child's care is an important part of nursing in paediatric care and suggested that the nurses should play the role of being the communicator with the parents.The study indicates that there is a need for hospital management to develop clinical routines and staff guidelines for parental involvement in paediatric care. The implications of this paper: Nurses need to be aware of the impact their communication has on parents and help them to clarify their role as parents in hospital.For clinical practice, checklists and staff guidelines could be useful tools in arriving at an understanding of how to work with children's parents. One of the biggest challenges that lies ahead is to get hospital staff to strive toward a better understanding and attitude toward parental participation.Parents' participation is very important for nurses, children and families in adapting to hospitalization, but still, parents' participation is not at the desired level. [ABSTRACT FROM AUTHOR]