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INTRODUCTION: Elective surgical hubs focusing on high-volume routine surgery using protected facilities and ringfenced resources are key to NHS England's elective recovery strategy. In May 2021, the Getting It Right First Time initiative introduced the high-volume low-complexity programme to coordinate new and existing hubs nationally, and to provide a framework for delivery. This paper presents results from the first national survey to identify their prevalence, location and configuration, the provision of care offered and the contextual setting within healthcare providers in order to provide a strong foundation for future research. METHODS: NHS regional leads were invited to participate in a survey conducted in March 2022 and disseminated by NHS England. RESULTS: A total of 87 elective surgical hubs were identified across 64 acute NHS trusts in England. London, the Midlands and the South East had the greatest concentration of hubs per trust. The contextual setting of hubs within healthcare providers varied widely. Two-fifths (43%) were configured as stand-alone, 34% as integrated and 23% as ringfenced hubs. Half (49%) were established before 2019. Seventy-six per cent catered for patients attending for either day-case or inpatient surgery. The majority (72%) covered multiple specialties, with 80% specialising in trauma and orthopaedic surgery. Two-fifths (43%) provided enhanced care. CONCLUSIONS: Elective surgical hubs are widespread across NHS regions in England. There is wide variation in hub configuration and capacity as well as in the provision of care offered and their contextual setting within healthcare providers, suggesting that the optimal hub model has not been established. Further research into the efficacy of elective hubs is required to aid their potential role in reducing waiting lists and improving quality of care. [ABSTRACT FROM AUTHOR]

Highlights This study examined whether parental sensitivity during distressing and non‐distressing mother–infant interactions predicts changes in young children's respiratory sinus arrhythmia (RSA) activity. Baseline RSA levels were collected from 83 children (49% female, 51% male) when children were 7 and 18 months old. Children's RSA reactivity and RSA recovery during the still‐face paradigm were collected when children were 7 months and during the strange situation procedure at 18 months. Controlling for stability of RSA activity over time, maternal sensitivity during distressing interactions at 7 months predicted changes in children's baseline RSA levels (β = −0.30) and children's RSA recovery (β = 0.25). Young children who experienced higher levels of sensitivity at 7 months had lower resting RSA levels and exhibited greater RSA recovery at 18 months. These results suggest that changes in young children's RSA activity are meaningfully related to their early caregiving experiences. We examined whether maternal sensitivity during infancy predicts changes in children's RSA activity from infancy to toddlerhood. Children who experienced higher levels of maternal sensitivity during infancy showed greater RSA recovery from a stressor during toddlerhood. Children who experienced higher levels of maternal sensitivity during infancy had lower resting RSA levels during toddlerhood. [ABSTRACT FROM AUTHOR]

This article argues for the utility of Mikhail Bakhtin's literary theories in developing dialogic and decolonial filmmaking practices. Using the example of our research-led documentary film, All That Is Buried, we challenge traditionally hierarchical structures of film production in which primary authorship lies with the Director/Producer, by implementing dialogic methods of co-creation between filmmakers, researchers and participants. We explain how Bakhtin's work on dialogism, chronotope, transgredience, polyphony and participative thinking provides the production and filmic tools and methods to host the distinct and equal voices of the South African creatives featured in the film – Zizipho Bam, Sindiswa Busuku, Haroon Gunn-Salie, and Dizu Plaatjies – maintaining throughout a sense of shared and equal investment in the project, and ethical responsibility to the collective. All That Is Buried shows the four participants discussing their work, ideas and experiences as they move between their homes, places of work, sites of inspiration, and artistic installations in and around Cape Town over the course of a day. In both process and product, we demonstrate how our co-creative methods support, and are supported by, practices of decolonial filmmaking, and provide a model useful and replicable for capturing Arts and Humanities research on film. [ABSTRACT FROM AUTHOR]

We argue that academia's performative obsession is inherently dehumanising. We seek to rehumanise academia by sharing a method for collective research and writing. Through a fresh approach to Freirean Reading Circles (FRCs), we offer a series of images and conversations from our circle meetings to demonstrate aspects of humanity often erased in traditional academic writing. Although FRCs can be adapted to different cultural artefacts, our choice of the Japanese novel Convenience Store Woman is purposeful. We explore the novel's theme of what it means to be both human and worker, and challenge the patriarchal bias of ‘great’ literature. Grounded in Paulo Freire's ideas, we demonstrate how academia's dehumanising tendencies can be challenged from within. To humanise our writing, we celebrate the joy and messiness of collective processes, foregrounding the human selves often hidden in sanitised academic writing. We invite you, as readers, to resist dehumanisation by extending our emancipatory project. [ABSTRACT FROM AUTHOR]

Steady-state visual evoked potential (SSVEP)-based brain-computer interfaces (BCIs) enable people to control external devices by focusing on repetitive visual stimuli (RVS). However, RVS can be visually annoying and cause user discomfort. To address this issue, this study proposes subtle flickering RVS to enhance visual comfort with SSVEP-based BCIs. Previous research on mitigating this discomfort has explored various stimuli characteristics, such as frequencies, colors, and patterns, but some studies are contradicting and have their limitations. This study investigates whether modulation depth (MD) can reduce user discomfort when using LCD-displayed stimuli. Specifically, MDs ranging from 1 down to 0.0125 and their effect on SSVEP response and BCI performance have been computed. Results demonstrate that stimuli with a 0.5 MD achieve accuracy and information-transfer rate (ITR) performance of 80.06% and 41.6 bpm which are at par with a baseline BCI having stimuli with a MD of 1, having 79.98% accuracy and 41.08 bpm ITR. These findings demonstrate that a lower flicker annoyance may be obtained with stimuli having a MD of 0.5. By reducing user discomfort, the proposed subtle flickering RVS can improve user experience without significant degradation in performance, potentially increasing the adoption and usability of SSVEP-based BCIs. [ABSTRACT FROM AUTHOR]

The article focuses on the work of working‐class women (WCW) amid turbulent times. Its timespan is just prior to and during the Covid‐19 pandemic in the UK. The women's work, and the key skills involved, are fundamental to everyday lives, but both have been under‐valued and under‐rewarded. The pandemic shone a fresh light on the societal importance of this work and highlighted how its under‐valuation and the women's systemic low pay and inferior working conditions have serious ramifications not only for individual workers and their families but for the provision of key services. The article centres WCW, at the intersection of classed and gendered disadvantage, to ask about inequalities in work experiences. Analysing nationally representative samples of thousands of workers in the UK prior to and as Covid‐19 rolled out, we compare WCW with other workers. We show that the women faced both persistent and new inequalities at work: enduring low earnings, pandemic‐led risks to jobs and paid hours, little opportunity to work from home or flexibly, and stressful key working roles. We reveal the heavily classed nature of some of these findings, show that others were more strongly gendered, while still others were classed and gendered outcomes that require intersectional analyses of the women's working lives. [ABSTRACT FROM AUTHOR]

Older adults with cognitive impairment often experience low mobility and functional decline in hospital, transfer to facility-based transitional care programs, and have poorer outcomes compared to those without cognitive impairment. This protocol paper describes a study which aims to determine the feasibility of, satisfaction with, and efficacy of a nurse-led mobility intervention (OASIS Walking Intervention) for older adults with cognitive impairment in facility-based transitional care programs in Ontario, Canada. A quasi-experimental one-group time series feasibility study will be conducted. A sample size of 26 participants will be recruited from two transitional care programs in Ontario, Canada. Participants will receive the OASIS Walking Intervention for up to 45 minutes per session, 5 sessions per week, for 6 weeks. The intervention consists of: 1) a patient-centered communication care plan; 2) sit to stand activity; and 3) a walking program. Feasibility will be determined by: a) recruitment rate; b) retention rate; and c) adherence. Efficacy of the intervention will be determined by the change over time in older adults' lower extremity muscle strength, mobility, and functional status and by their discharge destination (home vs. nursing home). Satisfaction will be measured using the Client Satisfaction Questionnaire. Efficacy outcomes will be measured before the start of the intervention, after 3 weeks of the intervention, and immediately after 6-week intervention. Descriptive statistics will be used for measures of feasibility, satisfaction, and discharge destination. Repeated measures analysis of variance (RM-ANOVA) will be used to analyze efficacy. Ethics approval has been received for this study. Findings from the study will be used to refine the intervention for use in a definitive pilot trial. Results will be disseminated via peer-reviewed publications, international conferences, through group presentations at the study sites, and through the study site networks. Trial registration: The trial has been registered on Clinicaltrials.gov (NCT06150339). [ABSTRACT FROM AUTHOR]

Culture is important for the development of social skills in children, including empathy. Although empathy has long been linked with prosocial behaviors and attitudes, there is little research that links culture with development of empathy in children. This project sought to investigate and identify specific culturally related empathy elements in a sample of Dene and Inuit children from Northern Canada. Across seven different grade (primary) schools, 92 children aged 7 to 9 years participated in the study. Children's drawings, and interviews about those pictures, were uniquely employed as empirical data which allowed researchers to gain access to the children's perspective about what aspects of culture were important to them. Using empathy as the theoretical framework, a thematic analysis was conducted in a top-down deductive approach. The research paradigm elicited a rich data set revealing three major themes: sharing; knowledge of self and others; and acceptance of differences. The identified themes were found to have strong links with empathy constructs such as sharing, helping, perspective-taking, and self–other knowledges, revealing the important role that culture may play in the development of empathy. Findings from this study can help researchers explore and identify specific cultural elements that may contribute to the development of empathy in children. [ABSTRACT FROM AUTHOR]

In Australia, social scientists have long understood the importance of national symbols and the role they play in both the construction and maintenance of the nation, but in-depth analysis of the national flag has been overlooked. In particular, the cultural significance of the British flag that sits within the Australian national flag warrants focused consideration, as it symbolises the moment Australia became a British possession in multifarious ways. In this article, a critical analysis of the Australian flag demonstrates how the primary symbol of the nation can heighten White privilege through its official point of honour. Vexillology and Indigenist Standpoint Pedagogy provide a framework from which to deconstruct the Australian flag. This article conducts a critical examination of the social, institutional and historical frameworks that support the flag to argue that it is an ongoing signifier of White cultural power. [ABSTRACT FROM AUTHOR]

A variety of theories have been proposed to explain why states pass legislation to regulate professional groups, and why, more recently, they have acted to curtail professional privileges. While these theories have drawn attention to the importance of power dynamics and public protection, among other factors, the role of political interests has been downplayed. This article builds on ecological theory to argue that, with some modifications, the theory illuminates the centrality of state‐profession relations and politics to regulatory change. The theory is applied to a case study of regulatory change in British Columbia, Canada impacting resources‐sector professions, with particular attention to the controversies and political considerations that shaped reform. The case study suggests that when the political and professions ecologies are overlapping and symbiotic, as they were in BC, a challenge in the political ecology can implicate professions, prompting a solution that brings change within both ecologies. [ABSTRACT FROM AUTHOR]

The increase in online education has implications for mathematics teacher educators who are tasked with teaching mathematics content and pedagogy to pre-service teachers (PSTs) who do not attend on-campus. Concerns about PSTs' content knowledge continues to be an ongoing issue, and ways to address this, especially in an online environment, require further investigation. While online courses offer accessibility and flexibility, it can be challenging to translate synchronous on campus teaching and experiences into the online environment. The importance of productive mathematical discourse has been identified as an appropriate pedagogy, yet the opportunity to engage in such discourse can be limited in the online environment. This paper provides the results from a case study of an online forum, which highlights how pre-service teachers can be engaged in productive online mathematical discussions, particularly when facilitated by the instructor's and other learners' interactions and presence. The findings indicated that social, cognitive, and teaching presence influenced the nature and frequency of online mathematical discourse. The study contributes to existing research through conceptualizing how productive mathematical conversations can occur outside of the classroom setting, with implications for mathematics teacher educators who are tasked with teaching content, pedagogy and practices to PSTs. [ABSTRACT FROM AUTHOR]

Introduction Ongoing health reforms in the Military Health System (MHS) are expected to shift locations of ambulatory care for up to 1.9 million beneficiaries. We sought to model the impact of this policy by determining potentially avoidable hospitalizations in the MHS based on different primary care settings. Materials and Methods We used the MHS Data Repository to conduct a retrospective cross-sectional study of TRICARE Prime and Prime Plus beneficiaries aged 18 to 64 years during fiscal years 2018–2019. Crude and adjusted risk ratios for each Agency for Healthcare Research and Quality prevention quality indicator based on primary care setting were calcualated to determine the total probability of admission for any of the Agency for Healthcare Research and Quality prevention indicators. Results We identified a total of 260,690 hospital admissions by patients in the MHS with a designated primary care manager (PCM) from fiscal year 2018 to 2019. Of the total admissions, 11,067 (4.25%) were for Agency for Healthcare Research and Quality prevention quality indicators, 3.63% by direct care PCM at a military treatment facility, and 0.61% by a civilian private sector PCM. Risk of admission was lower for private sector PCMs for urinary tract infection, hypertension, perforated appendix, and angina without the procedure. We did not observe a statistically significant adjusted odds ratio of admission in patients managed by private sector PCMs (1.04 adjusted odds ratio; 95% CI, 0.97-1.11). Conclusions Our findings indicate no difference in the likelihood of avoidable hospitalizations for beneficiaries with a private sector PCM when looking at all conditions together. Patients with a private sector PCM are protected against hospitalization for several conditions. Our findings indicate no adverse impact on avoidable hospitalizations for beneficiaries transitioned to private sector care from direct care. [ABSTRACT FROM AUTHOR]

Introduction Congenital heart disease (CHD) has an incidence of 0.8% to 1.2% worldwide, making it the most common birth defect. Researchers have compared high-volume to low-volume hospitals and found significant hospital-level variation in major complications, health resource utilization, and mortality after CHD surgery. In addition, researchers found critical CHD patients at low-volume/non-teaching facilities to be associated with higher odds of inpatient mortality when compared to CHD patients at high-volume/teaching hospitals (odds ratio 1.76). We examined the effects of high-quality hospital (HQH) use on health care outcomes and health care costs in pediatric CHD care using an instrumental variable (IV) approach. Materials and Methods Using nationwide representative claim data from the United States Military Health System from 2016 to 2020, TRICARE beneficiaries with a diagnosis of CHD were tabulated based on relevant ICD-10 (International Classification of Diseases, 10th revision) codes. We examined the relationships between annual readmissions, annual emergency room (ER) use, and mortality and HQH use. We applied both the naive linear probability model (LPM), controlling for the observed patient and hospital characteristics, and the two-stage least squares (2SLS) model, accounting for the unobserved confounding factors. The differential distance between the patient and the closest HQH at the index date and the patient and nearest non-HQH was used as the IV. This protocol was approved by the Institutional Review Board at the University of Maryland, College Park (Approval Number: 1576246-2). Results The naive LPM indicated that HQH use was associated with a higher probability of annual readmissions (marginal effect, 18%; 95% CI, 0.12 to 0.23). The naive LPM indicated that HQH use was associated with a higher probability of mortality (marginal effect, 2.2%; 95% CI, 0.01 to 0.03). Using the differential distance of closest HQH and non-HQH, we identified a significant association between HQH use and annual ER use (marginal effect, −14%; 95% CI, −0.24 to −0.03). Conclusions After controlling for patient-level and facility-level covariates and adjusting for endogeneity, (1) HQH use did not increase the probability of more than one admission post 1-year CHD diagnosis, (2) HQH use lowered the probability of annual ER use post 1-year CHD diagnosis, and (3) HQH use did not increase the probability of mortality post 1-year CHD diagnosis. Patients who may have benefited from utilizing HQH for CHD care did not, alluding to potential barriers to access, such as health insurance restrictions or lack of patient awareness. Although we used hospital quality rating for congenital cardiac surgery as reported by the Society of Thoracic Surgeons, the contributing data span a 4-year period and may not reflect real-time changes in center performance. Since this study focused on inpatient care within the first-year post-initial CHD diagnosis, it may not reflect the full range of health system utilization. It is necessary for clinicians and patient advocacy groups to collaborate with policymakers to promote the development of an overarching HQH designation authority for CHD care. Such establishment will facilitate access to HQH for military beneficiary populations suffering from CHD. [ABSTRACT FROM AUTHOR]

Hidradenitis suppurativa (HS) is a chronic inflammatory skin condition that can be challenging to treat. Biologics and targeted small molecules have become an increasingly popular area of investigation for therapeutic development for moderate-to-severe HS, though only three biologics—adalimumab, secukinumab, and bimekizumab—have received US Food and Drug Administration (FDA) or European Medicines Evaluation Agency approval for treating HS. Promising agents under investigation are targeting interleukin 17A/F, JAK/STAT pathway, interleukin 36, interleukin 1, and more. [ABSTRACT FROM AUTHOR]

Undertaking an authentic interprofessional simulation experience may be a useful and consistent strategy for healthcare professional students to build competencies required for a rural healthcare context. An observational comparative study design was adopted to evaluate a clinical simulation experience created to develop the interprofessional competencies of a sample of healthcare professional students at a regional university situated on multiple campuses in New South Wales (NSW), Australia. Over 200 students across three campuses of the university were involved in a simulation experience that included four interprofessional activities. Of these students, 189 (89%) agreed to participate in the study. The healthcare professional students who participated in the study were from second year occupational therapy, physiotherapy, and podiatry, and third year speech pathology programs. Retrospective pre and post self-assessed interprofessional collaborative competencies were compared for all students using the revised Interprofessional Collaborative Attainment Survey (ICCAS). Results demonstrated a statistically significant improvement in self-perceived scores using the validated revised ICCAS survey. The findings of this study suggest that carefully designed and authentic interprofessional simulation experiences can facilitate the development of competencies required for effective interprofessional practice, which are necessary for successful rural practice. [ABSTRACT FROM AUTHOR]

Introduction: Despite legislation mandating accommodation policies in postsecondary education, support for students with disabilities is often not implemented within health and human services (HHS) education programs, particularly in fieldwork settings. As part of a Canada‐wide study exploring the experiences of disabled students in 10 HHS programs, we examined how HHS students described their experiences accessing accommodations in fieldwork to understand how conceptions of disability relate to students' fieldwork experiences. Using a critical disability studies framework, we explored how HHS fieldwork education understands disability, accommodations and professional competence and what those understandings reveal about the discrepancy between mandated accommodations and what happens in practice. Methods: Thirty‐five students requiring accommodations in HHS fieldwork education participated in interviews. Through a critical interpretive analysis of interview data, we developed first‐person composite narratives to show the richness and complexity of the students' diverse, yet similar, subjective experiences with fieldwork accommodations. Findings: Two composite narratives demonstrate how conceptions of disability incommensurate with professional competence expectations influenced student experiences with disclosing disability and obtaining accommodations in fieldwork. Fear of stigma and having one's competence questioned, or having accommodation requests denied for being misaligned with professional expectations, demonstrate how HHS fieldwork education and practice are upheld by ableist systemic structures. Discussion The dominant medical model of disability in HHS education creates institutional barriers that require students to constantly (re)construct their 'professional' identity in relation to their 'patient' identity. This patient–professional identity construction relates to HHS professional competency standards and assumptions about what makes a 'good' professional. Suggestions include reworking competency standards and implementing critical pedagogical approaches to teach future and current HHS professionals to question both personal and practice assumptions. With institutional backing, such changes may support diversity within HHS and a culture shift toward more equitable education and health care. Student experiences seeking accommodations in health and human services fieldwork education show how ableist structures lead to marginalization despite legal mandates to accommodate. [ABSTRACT FROM AUTHOR]

Background: There are 1.3 billion people with disabilities globally, and they frequently face barriers to accessing healthcare, contributing to their worse health and higher mortality. However, little research has explored patient-reported approaches to improve healthcare for persons with disabilities. Consequently, this study aimed to explore possible solutions and recommendations to address the existing barriers to access to healthcare for persons with disabilities in rural Uganda. Methods: We conducted 27 semi-structured interviews with individuals with various disabilities in rural Luuka district, Eastern Uganda, between September and November 2022. The participants included individuals with visual impairment (n = 5), physical impairment (n = 5), hearing impairment (n = 6), multiple impairments (n = 5), intellectual/cognitive impairment (n = 5), and albinism (n = 1). Interviews were recorded, transcribed verbatim, and thematically analysed. We categorized the solutions using the Missing Billion disability-inclusive health systems framework. Results: Our findings, framed within the health systems framework, revealed several critical themes. On the demand side, suggested solutions emphasized advocacy and sensitization for persons with disabilities, their communities, and caregivers about healthcare needs. Socio-economic empowerment and community-based health services were also highlighted as essential. On the supply side, participants stressed the importance of training healthcare workers on disability, facilitating dialogue and experience-sharing sessions, and employing health workers with disabilities. Additional recommendations included improving accessibility and reasonable accommodation, organizing inclusive services like special clinic days and outreaches, ensuring representation in health facility management, and establishing comprehensive rehabilitation services with affordable assistive devices. Conclusion: The multifaceted solutions proposed by persons with disabilities highlight the complex challenges they face in accessing healthcare services and highlight the necessity for comprehensive, sustainable interventions. The call to action for policymakers and healthcare providers is to prioritise the incorporation of disability-inclusive practices and explore multi-dimensional approaches that foster a more inclusive healthcare environment that adequately meets the needs of persons with disabilities. [ABSTRACT FROM AUTHOR]

Objective Methods Results Conclusion This experimental study investigated the weight loss parameters and resulting end weight that influence clinician confidence in diagnosing atypical anorexia nervosa (AAN).Clinicians (N = 67) read a series of vignettes where patient weight loss and end weight varied, then rated their confidence in an AAN diagnosis and alternatives. Using repeated measures ANOVAs, we examined patient (weight loss, end weight) and the possible relationship between clinician (e.g., age, profession) characteristics and confidence in diagnosing AAN.Clinicians were most confident in an AAN diagnosis when patients had lost 10% or 15% of their body weight, leaving them at a high or normal weight. Clinicians considered 5% as significant weight loss for AAN, but only when the patient ended at a high or normal weight. However, they did not clearly differentiate AAN from unspecified feeding and eating disorder (UFED) when there was a 5% weight loss resulting in high or normal end weight. Clinician characteristics did not impact on confidence in diagnoses.The DSM's ‘significant weight loss’ criterion leaves room for clinicians to interpret it idiosyncratically. The lack of a clear pattern of UFED and AAN diagnosis has important clinical implications, as UFED tends to be dismissed as being less serious. [ABSTRACT FROM AUTHOR]

Triosephosphate isomerase deficiency (TPI Df) is a rare multisystem disorder with severe neuromuscular symptoms which arises exclusively from mutations within the TPI1 gene. Studies of TPI Df have been limited due to the absence of mammalian disease models and difficulties obtaining patient samples. Recently, we developed a novel murine model of TPI Df which models the most common disease-causing mutation in humans, TPI1E105D. Using our model in the present study, the underlying pathogenesis of neuromuscular symptoms has been elucidated. This is the first report detailing studies of neuromuscular pathology within a murine model of TPI Df. We identified several contributors to neuromuscular symptoms, including neurodegeneration in the brain, alterations in neurotransmission at the neuromuscular junction, and reduced muscle fiber size. TPI Df mice also exhibited signs of cardiac pathology and displayed a deficit in vascular smooth muscle functionality. Together, these findings provide insight into pathogenesis of the neuromuscular symptoms in TPI Df and can guide the future development of therapeutics. [ABSTRACT FROM AUTHOR]

Background: Aboriginal and Torres Strait Islander peoples are disproportionately impacted by type 2 diabetes. Continuous glucose monitoring (CGM) technology (such as Abbott Freestyle Libre 2, previously referred to as Flash Glucose Monitoring) offers real-time glucose monitoring that is convenient and easy to use compared to self-monitoring of blood glucose (SMBG). However, this technology's use is neither widespread nor subsidised for Aboriginal and Torres Strait Islander peoples with type 2 diabetes. Building on existing collaborations with a national network of Aboriginal and Torres Strait Islander communities, this randomised controlled trial aims to assess the effect of CGM compared to SMBG on (i) haemoglobin A1c (HbA1c), (ii) achieving blood glucose targets, (iii) reducing hypoglycaemic episodes and (iv) cost-effective healthcare in an Aboriginal and Torres Strait Islander people health setting. Methods: This is a non-masked, parallel-group, two-arm, individually randomised, controlled trial (ACTRN12621000753853). Aboriginal and Torres Strait Islander adults with type 2 diabetes on injectable therapy and HbA1c ≥ 7.5% (n = 350) will be randomised (1:1) to CGM or SMBG for 6 months. The primary outcome is change in HbA1c level from baseline to 6 months. Secondary outcomes include (i) CGM-derived metrics, (ii) frequency of hypoglycaemic episodes, (iii) health-related quality of life and (iv) incremental cost per quality-adjusted life year gained associated with the CGM compared to SMBG. Clinical trial sites include Aboriginal Community Controlled Organisations, Aboriginal Medical Services, primary care centres and tertiary hospitals across urban, rural, regional and remote Australia. Discussion: The trial will assess the effect of CGM compared to SMBG on HbA1c for Aboriginal and Torres Strait Islander people with type 2 diabetes in Australia. This trial could have long-term benefits in improving diabetes management and providing evidence for funding of CGM in this population. Trial registration: Australian and New Zealand Clinical Trials Registry ACTRN12621000753853. Registered on 15th June 2021. [ABSTRACT FROM AUTHOR]

It is estimated that up to 1 in 20 people in the United States may have a fetal alcohol spectrum disorder (FASD), or the array of physical, cognitive, emotional, and social disorders caused by exposure to alcohol during prenatal development (May et al., JAMA 319:474–82, 2018). While this condition is present in a broad range of individuals and families, it has not previously been examined in the military community, where cultural factors including an increased prevalence of alcohol misuse may pose a unique set of challenges (Health.mil, Alcohol misuse, 2024). The Uniformed Services University of the Health Sciences (USUHS), in conjunction with FASD United, hosted the second annual Workshop on Fetal Alcohol Spectrum Disorders Prevention and Clinical Guidelines Research on 20 September 2023 in Washington, DC. Organized as part of a four-year, federally-funded health services research initiative on FASD in the U.S. Department of Defense (DoD) Military Health System (MHS), the workshop provided a forum for exploring the initiative's focus and progress; examining current knowledge and practice in the research and clinical spheres; and identifying potential strategies to further improve prevention, screening, diagnosis, interventions, and family support. Building off of the 2022 workshop that covered the state of the science surrounding prenatal alcohol exposure and FASD, the 2023 focused primarily on FASD and efforts aimed at identification and management (Koehlmoos et al., BMC Proc 17 Suppl 12:19, 2023). One hundred and thirty attendees from academia, healthcare, federal agencies, and patient advocacy organizations gathered to share research findings; learn from lived experiences; and discuss initiatives to advance research, screening, and services for at-risk pregnant women as well as families and caregivers supporting individuals with FASD. [ABSTRACT FROM AUTHOR]

Purpose: To examine [a] the association of caregiver health-related quality of life (HRQOL) and service member/veteran (SMV) neurobehavioral outcomes with caregiver resilience; [b] longitudinal change in resilience at the group and individual level; and [c] the magnitude of change at the individual level. Methods: Caregivers (N = 232) of SMVs with traumatic brain injury completed a resilience measure, and 18 caregiver HRQOL and SMV neurobehavioral outcome measures at a baseline evaluation and follow-up evaluation three years later. Caregivers were divided into two resilience groups at baseline and follow-up: [1] Low Resilience (≤ 45 T, baseline n = 99, follow-up n = 93) and [2] High Resilience (> 45 T, baseline n = 133, follow-up n = 139). Results: At baseline and follow-up, significant effects were found between Low and High Resilience groups for the majority of outcome measures. There were no significant differences in resilience from baseline to follow-up at the group-mean level. At the individual level, caregivers were classified into four longitudinal resilience groups: [1] Persistently Low Resilience (Baseline + Follow-up = Low Resilience, n = 60), [2] Reduced Resilience (Baseline = High Resilience + Follow-up = Low Resilience, n = 33), [3] Improved Resilience (Baseline = Low Resilience + Follow-up = High Resilience, n = 39), and [4] Persistently High Resilience (Baseline + Follow-up = High Resilience, n = 100). From baseline to follow-up, approximately a third of the Reduced and Improved Resilience groups reported a meaningful change in resilience (≥ 10 T). Nearly all of the Persistently High and Persistently Low Resilience groups did not report meaningful change in resilience (< 10 T). Conclusion: Resilience was not a fixed state for all caregivers. Early intervention may stall the negative caregiving stress-health trajectory and improve caregiver resilience. [ABSTRACT FROM AUTHOR]

The purpose of this cross-sectional study was to examine the influence of subthreshold posttraumatic stress disorder (PTSD) and full PTSD on quality of life following mild traumatic brain injury (mTBI). Participants were 734 service members and veterans (SMV) classified into two injury groups: uncomplicated mild TBI (MTBI; n = 596) and injured controls (IC, n = 139). Participants completed a battery of neurobehavioral measures, 12-or-more months post-injury, that included the PTSD Checklist Civilian version, Neurobehavioral Symptom Inventory, and select scales from the TBI-QOL and MPAI. The MTBI group was divided into three PTSD subgroups: No-PTSD (n = 266), Subthreshold PTSD (n = 139), and Full-PTSD (n = 190). There was a linear relationship between PTSD severity and neurobehavioral functioning/quality of life in the MTBI sample. As PTSD severity increased, significantly worse scores were found on 11 of the 12 measures (i.e., MTBI: Full-PTSD > Sub-PTSD > No-PTSD). When considering the number of clinically elevated scores, a linear relationship between PTSD severity and neurobehavioral functioning/quality of life was again observed in the MTBI sample (e.g., 3-or-more elevated scores: Full-PTSD = 92.1 %, Sub-PTSD = 61.9 %, No-PTSD = 19.9 %). Limitations included the use of a self-report measure to determine diagnostic status that may under/overcount or mischaracterize individuals. PTSD symptoms, whether at the level of diagnosable PTSD, or falling short of that because of the intensity or characterization of symptoms, have a significant negative impact on one's quality of life following MTBI. Clinicians' treatment targets should focus on the symptoms that are most troubling for an individual and the individual's perception of quality of life, regardless of the diagnosis itself. [ABSTRACT FROM AUTHOR]

Apixaban, rivaroxaban, and warfarin have shown benefit for preventing major ischemic events—albeit with increased bleeding risk—among patients in the general population with atrial fibrillation (AF). However, data are scarce in patients with cirrhosis and AF. This study compared the effectiveness and safety of apixaban versus rivaroxaban and versus warfarin in patients with cirrhosis and AF. Visual Abstract. Comparative Effectiveness and Safety of Apixaban, Rivaroxaban, and Warfarin in Patients With Cirrhosis and Atrial Fibrillation: A Nationwide Cohort Study Apixaban, rivaroxaban, and warfarin have shown benefit for preventing major ischemic events—albeit with increased bleeding risk—among patients in the general population with atrial fibrillation (AF). However, data are scarce in patients with cirrhosis and AF. This study compared the effectiveness and safety of apixaban versus rivaroxaban and versus warfarin in patients with cirrhosis and AF. Background: Apixaban, rivaroxaban, and warfarin have shown benefit for preventing major ischemic events, albeit with increased bleeding risk, among patients in the general population with atrial fibrillation (AF). However, data are scarce in patients with cirrhosis and AF. Objective: To compare the effectiveness and safety of apixaban versus rivaroxaban and versus warfarin in patients with cirrhosis and AF. Design: Population-based cohort study. Setting: Two U.S. claims data sets (Medicare and Optum's de-identified Clinformatics Data Mart Database [2013 to 2022]). Participants: 1:1 propensity score (PS)–matched patients with cirrhosis and nonvalvular AF initiating use of apixaban, rivaroxaban, or warfarin. Measurements: Primary outcomes included ischemic stroke or systemic embolism and major hemorrhage (intracranial hemorrhage or major gastrointestinal bleeding). Database-specific and pooled PS-matched rate differences (RDs) per 1000 person-years (PY) and Cox proportional hazard ratios (HRs) with 95% CIs were estimated, controlling for 104 preexposure covariates. Results: Rivaroxaban initiators had significantly higher rates of major hemorrhagic events than apixaban initiators (RD, 33.1 per 1000 PY [95% CI, 12.9 to 53.2 per 1000 PY]; HR, 1.47 [CI, 1.11 to 1.94]) but no significant differences in rates of ischemic events or death. Consistently higher rates of major hemorrhage were found with rivaroxaban across subgroup and sensitivity analyses. Warfarin initiators also had significantly higher rates of major hemorrhage than apixaban initiators (RD, 26.1 per 1000 PY [CI, 6.8 to 45.3 per 1000 PY]; HR, 1.38 [CI, 1.03 to 1.84]), particularly hemorrhagic stroke (RD, 9.7 per 1000 PY [CI, 2.2 to 17.2 per 1000 PY]; HR, 2.85 [CI, 1.24 to 6.59]). Limitation: Nonrandomized treatment selection. Conclusion: Among patients with cirrhosis and nonvalvular AF, initiators of rivaroxaban versus apixaban had significantly higher rates of major hemorrhage and similar rates of ischemic events and death. Initiation of warfarin versus apixaban also contributed to significantly higher rates of major hemorrhagic events, including hemorrhagic stroke. Primary Funding Source: National Institutes of Health. [ABSTRACT FROM AUTHOR]

Background: A recent Lancet commission called for more research on palliative care in low- and middle-income (LMIC) countries such as Colombia. A research priority setting approach has been recommended by The Global Forum for Health Research to address the huge gap in research output between LMIC and high-income countries, with influential health service bodies recommending the active involvement of non-research expert stakeholders in establishing research priorities to address service user needs. Method: Priority setting partnership (PSP) following the four stages of the James Lind Alliance methodology; establishing the partnership, identifying evidence uncertainties, refining questions and uncertainties, and prioritization. Data from MS forms were analysed using descriptive statistics. Results: A total of 33 stakeholders attended an online PSP workshop and completed the Mentimeter exercise in Microsoft Teams. A total of 48 attended the subsequent in person prioritisation exercise in urban Bogota (n = 22) and rural Popayan (n = 25). The stakeholders were a diverse group of health professionals (physicians, medical students, nurses, dentists, physiotherapists, nutritionist, occupational and speech therapists), financial and administrative staff and patients with life-limiting illness and caregivers. Top research priorities included patient and caregiver needs, service provider education and training, and better integration of palliative care with cancer and non-cancer services. The key challenges included a lack of interest in palliative care research, along with funding, time and resource constraints. Key solutions included collaboration across disciplines and settings, highlighting benefits of palliative research to help secure adequate resources, and multicentre, mixed method research, with patient involvement from the research development stage. Conclusion: The findings of this PSP should be disseminated among palliative care associations worldwide to inform international multicentre studies, and among governmental and nongovernmental organisations that promote research in Colombia. A focus on patient and family caregiver palliative care needs in Colombia should be prioritised. [ABSTRACT FROM AUTHOR]

Animals can adjust their consumption of different nutrients to adaptively match their current or expected physiological state. Changes in diet preference can arise from social and sexual experience. For example, in female Drosophila melanogaster fruit flies, a single mating triggers a behavioural switch in diet choice towards increased protein intake and total food consumption, which supports offspring production. In contrast, male diet choice appears to be unaffected by a single mating. However, one mating may not fully capture the impact of mating on male feeding behaviour. Males can often mate multiply in natural settings, and the costs of ejaculate production and energetic courtship may be cumulative, such that males might experience increased nutritional demands only after multiple matings. In this study we tested this prediction by measuring the effect of multiple matings on the diet choice of male D. melanogaster fruit flies. Males were assigned to one of three mating treatments, unmated, mated once or mated five times consecutively, and then allowed to feed freely on chemically defined diets of protein and carbohydrate. In contrast to the prediction, we found that males that mated five times did not alter the amount of food, or the proportion of protein and carbohydrate consumed, when compared with unmated or once-mated males. This absence of a feeding response occurred despite substantial ejaculate depletion from multiple matings: males sired fewer offspring in each consecutive mating. These results reveal a lack of plasticity in male feeding behaviour according to mating status, despite substantial potential physiological costs, and highlight the remarkably distinct nutritional ecologies of males versus females. • Female fruit flies show altered diet preference following mating. • However, dietary responses to mating in males are largely unknown. • We tested the impact of realistic mating rates on male fruit fly diet choice. • Males do not alter food intake to recoup depleted ejaculate, despite fertility loss. • These results highlight key sex differences in diet choice following mating. [ABSTRACT FROM AUTHOR]

Guided by transactional stress theory, this study aimed to explore elite U.K. soccer coaches' perceived stressors, the situational properties, appraisals, and coping during the COVID-19 pandemic. This study also aimed to explore any variation in stress experiences across football league standards A total of 13 professional first-team male U.K. association football coaches between 38 and 59 years of age (M = 43.00, SD = 6.94) participated in telephone (n = 5) or online (n = 8) semistructured interviews. Informed by the philosophical position of critical realism, Braun et al.'s six-phase approach to thematic analysis was used to generate competitive, organizational, and personal stressor themes. Deductive thematic analysis generated themes reflective of all situational properties of stressors identified by Lazarus and Folkman and an array of appraisal and coping strategies. Future research and recommendations for supporting coach performance and well-being post-COVID-19 pandemic are offered. [ABSTRACT FROM AUTHOR]

Background: Aboriginal and Torres Strait Islander peoples are disproportionately impacted by type 2 diabetes. Continuous glucose monitoring (CGM) technology (such as Abbott Freestyle Libre 2, previously referred to as Flash Glucose Monitoring) offers real-time glucose monitoring that is convenient and easy to use compared to self-monitoring of blood glucose (SMBG). However, this technology's use is neither widespread nor subsidised for Aboriginal and Torres Strait Islander peoples with type 2 diabetes. Building on existing collaborations with a national network of Aboriginal and Torres Strait Islander communities, this randomised controlled trial aims to assess the effect of CGM compared to SMBG on (i) haemoglobin A1c (HbA1c), (ii) achieving blood glucose targets, (iii) reducing hypoglycaemic episodes and (iv) cost-effective healthcare in an Aboriginal and Torres Strait Islander people health setting. Methods: This is a non-masked, parallel-group, two-arm, individually randomised, controlled trial (ACTRN12621000753853). Aboriginal and Torres Strait Islander adults with type 2 diabetes on injectable therapy and HbA1c ≥ 7.5% (n = 350) will be randomised (1:1) to CGM or SMBG for 6 months. The primary outcome is change in HbA1c level from baseline to 6 months. Secondary outcomes include (i) CGM-derived metrics, (ii) frequency of hypoglycaemic episodes, (iii) health-related quality of life and (iv) incremental cost per quality-adjusted life year gained associated with the CGM compared to SMBG. Clinical trial sites include Aboriginal Community Controlled Organisations, Aboriginal Medical Services, primary care centres and tertiary hospitals across urban, rural, regional and remote Australia. Discussion: The trial will assess the effect of CGM compared to SMBG on HbA1c for Aboriginal and Torres Strait Islander people with type 2 diabetes in Australia. This trial could have long-term benefits in improving diabetes management and providing evidence for funding of CGM in this population. Trial registration: Australian and New Zealand Clinical Trials Registry ACTRN12621000753853. Registered on 15th June 2021. [ABSTRACT FROM AUTHOR]

Background: In an era marked by rapid technological advancements, changing demographics, and evolving healthcare needs, the landscape of health services has been undergoing a profound transformation. Innovation has emerged as a central force driving change in the healthcare sector, as stakeholders across the globe strive to enhance the quality, accessibility, and efficiency of healthcare services. Objective: Within this dynamic context, this systematic literature review explored the barriers and driving forces behind successful health service innovation. Methods: A comprehensive systematic literature review was conducted using the Griffith University Library search engine and databases that included PubMed, ProQuest, Web of Science, Scopus, and CINHAL. To achieve the study goal, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and the associated PRISMA checklist guided the review and reporting method. Results: Findings from this review identified a need for a universal definition of health innovation that encompasses the unique complexities and challenges within this context. In our comprehensive analysis of healthcare innovation, we have uncovered pivotal findings that underscore the indispensable nature of a well-structured framework. Conclusions: To succeed in fostering innovation within the health and social care sectors, it is imperative to establish an overarching organisational culture that meticulously addresses the following key components: team challenges; communication and collaboration; governance goals and authentic leadership, environmental engagement; and innovation endurance. Through systematic analysis of existing literature, this review offers a definition of health innovation, covering its conceptual foundations, determinants, and barriers, and provides a framework for creating an innovative culture. [ABSTRACT FROM AUTHOR]

Introduction Methods Findings Conclusion Research on critical reflection (a process of recognising and challenging assumptions that frame health care practice) has demonstrated strong potential for making health care more collaborative and equitable, yet its enactment within team‐based health care remains underexplored. We conducted a narrative review to advance understanding of how critical reflection develops, occurs in and impacts team‐based practice and care.We searched three databases (Medline, CINAHL and Scopus) for articles related to the concepts of critical reflection and/or critically reflective practice in the context of team‐based health care and examined how teams engage with those theoretical concepts, to inform ideas for a new approach to support critically reflective practice.The search identified 974 citations of which nine articles showed elements of critical reflection in team‐based practice. However, since only one of the nine included articles explicitly used the term ‘critical reflection’ in their research, critical reflection as a theoretical concept was found to be largely missing from the current team‐based health care literature. Instead, aspects of critical reflection were evident in terms of challenging power hierarchies and questioning practice assumptions through dialogue, with a goal of collaborative practice. This sharing of knowledge and skills allowed teams to push boundaries and innovate together in practice. The included articles also emphasised the importance of creating a purposeful environment for open dialogue and practice change to occur.To support equitable care through collaborative practices, we suggest dialogue as and for critical reflection should be explicitly developed and researched within team‐based health care. [ABSTRACT FROM AUTHOR]

High throughput screening of small molecules and natural products is costly, requiring significant amounts of time, reagents, and operating space. Although microarrays have proven effective in the miniaturization of screening for certain biochemical assays, such as nucleic acid hybridization or antibody binding, they are not widely used for drug discovery in cell culture due to the need for cells to internalize lipophilic drug candidates. Lipid droplet microarrays are a promising solution to this problem as they are capable of delivering lipophilic drugs to cells at dosages comparable to solution delivery. However, the scalablility of the array fabrication, assay validation, and screening steps has limited the utility of this approach. Here we take several new steps to scale up the process for lipid droplet array fabrication, assay validation in cell culture, and drug screening. A nanointaglio printing process has been adapted for use with a printing press. The arrays are stabilized for immersion into aqueous solution using a vapor coating process. In addition to delivery of lipophilic compounds, we found that we are also able to encapsulate and deliver a water-soluble compound in this way. The arrays can be functionalized by extracellular matrix proteins such as collagen prior to cell culture as the mechanism for uptake is based on direct contact with the lipid delivery vehicles rather than diffusion of the drug out of the microarray spots. We demonstrate this method for delivery to 3 different cell types and the screening of 92 natural product extracts on a microarray covering an area of less than 0.1 cm2. The arrays are suitable for miniaturized screening, for instance in high biosafety level facilities where space is limited and for applications where cell numbers are limited, such as in functional precision medicine. [ABSTRACT FROM AUTHOR]

The study of animal sounds in biology and ecology relies heavily upon time–frequency (TF) visualisation, most commonly using the short‐time Fourier transform (STFT) spectrogram. This method, however, has inherent bias towards either temporal or spectral details that can lead to misinterpretation of complex animal sounds. An ideal TF visualisation should accurately convey the structure of the sound in terms of both frequency and time, however, the STFT often cannot meet this requirement. We evaluate the accuracy of four TF visualisation methods (superlet transform [SLT], continuous wavelet transform [CWT] and two STFTs) using a synthetic test signal. We then apply these methods to visualise sounds of the Chagos blue whale, Asian elephant, southern cassowary, eastern whipbird, mulloway fish and the American crocodile. We show that the SLT visualises the test signal with 18.48%–28.08% less error than the other methods. A comparison between our visualisations of animal sounds and their literature descriptions indicates that the STFT's bias may have caused misinterpretations in describing pygmy blue whale songs and elephant rumbles. We suggest that use of the SLT to visualise low‐frequency animal sounds may prevent such misinterpretations. Finally, we employ the SLT to develop 'BASSA', an open‐source, GUI software application that offers a no‐code, user‐friendly tool for analysing short‐duration recordings of low‐frequency animal sounds for the Windows platform. The SLT visualises low‐frequency animal sounds with improved accuracy, in a user‐friendly format, minimising the risk of misinterpretation while requiring less technical expertise than the STFT. Using this method could propel advances in acoustics‐driven studies of animal communication, vocal production methods, phonation and species identification. [ABSTRACT FROM AUTHOR]

Women are more directly involved in combat operations today than ever before, currently making up 18.6% of officers and 16.8% of enlisted personnel in the United States military. However, women continue to be under-represented in military research. Studies that do consider gender differences in traumatic brain injury (TBI) outcomes have shown that women report significantly more post-concussive symptoms than men. Conclusions for true gender differences related to TBI are hard to make without controlling for non-TBI factors. The effects previously identified in the literature may be an artifact of how men and women differ in their response to injury, unrelated to the neurological recovery process associated with TBI. The objective of this study was to examine the effects of gender specifics on mild TBI (mTBI) sequelae on injured and uninjured control groups, and to investigate the role of post-traumatic stress disorder (PTSD) on symptom reporting. It should be noted that the terms "gender" and "men/women" are used in this article in place of "sex" or "males/females" given that we are not discussing biological attributes. A total of 966 United States military service members and veterans were included in the study. Of the total sample, 455 men and 46 women were in the mTBI group, 285 men and 31 women were in the injured controls group (IC), and 111 men and 38 women in the non-injured controls group (NIC). Post-concussive and quality of life symptoms were compared for men and women while controlling for combat exposure. MTBI and IC groups were also stratified by PTSD presentation. Measures used included the Neurobehavioral Symptom Inventory (NSI), PTSD Checklist (PCL-C), Traumatic Brain Injury Quality of Life (TBI-QOL), and Combat Exposure Scale. In the mTBI group, women had worse scores on NSI total, NSI Somatosensory and Affective clusters, and the TBI-QOL Anxiety, Fatigue, and Headache scales (n2 = 0.018–0.032, small to small-medium effect sizes). When PTSD was present, women had worse scores on the NSI Somatosensory cluster only (n2 = 0.029, small-medium effect size). In contrast, when PTSD was absent, women had worse scores than men on the NSI Somatosensory and Affective clusters, and the TBI-QOL Anxiety and Headache scales (n2 = 0.032–0.063, small to medium effect sizes). In the IC group, women had worse scores on the NSI Cognitive cluster and the TBI-QOL Fatigue and Pain Interference scales (n2 = 0.024–0.042, small to small-medium effect sizes). However, group differences were no longer found when stratified by PTSD sub-groups. In the NIC group, there were no significant group differences for any analyses. We were able to identify symptoms unique to women recovering from mTBI that were not present following other forms of physical injury or in healthy controls. However, the impact of PTSD exacerbates the symptom profile and its comorbidity with mTBI equates to most of the noted gender differences. [ABSTRACT FROM AUTHOR]

Although nursing seems to understand itself and its practice as complex, the literature is less clear about what this actually means. While complexity is discussed as an attribute of nursing, it is also suggested that complexity in nursing remains misunderstood and poorly articulated, is devalued, is not considered as a measure of health outcomes and remains invisible. Despite the overarching lack of a definition, some nurse scholars have conceptualized complexity as a complex intervention. For these authors, complexity becomes a complex intervention defined as that which is composed of component parts interacting in a variety of ways that influence the delivery of and outcomes of health‐related interventions for populations. Conceptualizing complexity as a complex intervention forces nursing to embrace and adopt a received interpretation of complexity as expressed through complexity theory and complexity science. While complexity theory may afford us some tools for thinking about complexity, when we deconstruct nursing complexity to explicitly determinate and quantifiable tasks, this artificially narrowed orientation to complexity reveals an oversimplified explanation of the complexities associated with nursing and serves to blind us to its real qualities. Through a consideration of complexity from a Western philosophical tradition, I demonstrate that when nursing adopts the received interpretation of complexity as a complex intervention, this perspective on complexity contains nursing epistemologically and ontologically. I offer an extended conceptualization of complexity framed upon the consideration that nurses assume complexity and do not reduce it; that nurses have the capacity to not be paralysed by complexity and have developed logics to mobilize it in productive ways. Mobilizing complexity through navigating paradox and contradiction shapes an orientation to complexity that embraces an extended epistemology. This extended epistemology is characterized by a 'yes/and' mindset that expresses the dynamic and generative relationship between forms of knowledge which reflects complexity that characterizes nursing. [ABSTRACT FROM AUTHOR]

Injury surveillance data indicate that collegiate athletes are at greater risk for lower extremity (LE) injuries following sports‐related concussion (SRC). While the association between SRC and LE injury appears to be clinically relevant up to 1‐year post‐SRC, little evidence has been provided to determine possible mechanistic rationales. Thus, we aimed to compare collegiate athletes with a history of SRC to matched controls on biomechanical and cognitive performance measures associated with LE injury risk. Athletes with a history of SRC (n = 20) and matched controls (n = 20) performed unanticipated bilateral land‐and‐cut tasks and cognitive assessments. Group‐based analyses (ANOVA) and predictive modeling (C5.0 decision tree algorithm) were used to compare group differences on biomechanical and cognitive measures. Collegiate athletes with a history of SRC demonstrated approximately six degrees less peak knee flexion on both dominant (p = 0.03, d = 0.71) and nondominant (p = 0.02, d = 0.78) limbs during the land‐and‐cut tasks compared to controls. Verbal Memory, knee flexion, and Go/No Go total score (C5.0 decision tree algorithm) were identified as the strongest indicators of previous SRC injury history. Reduced knee flexion during sport‐specific land‐and‐cut tasks may be a mechanism for increased LE injury risk in athletes with a history of SRC. There appears to be multiple biomechanical and cognitive predictors for identifying previous SRC in collegiate athletes, providing evidence to support a multifactorial SRC management strategy to reduce future injury risk. [ABSTRACT FROM AUTHOR]

Objectives We compared tacrolimus concentrations obtained by the more recently US Food and Drug Administration–approved tacrolimus assay (CMIA) on the Alinity i analyzer (Abbott Laboratories) with a liquid chromatography/tandem mass spectrometry (LC-MS/MS)–based method from 2 reference laboratories. We also investigated the correlation between the CMIA tacrolimus and Elecsys tacrolimus assays. Methods Tacrolimus concentrations were measured in EDTA whole blood by the chemiluminescent microparticle immunoassay (CMIA) using the Alinity i analyzer, and then 2 aliquots were sent to 2 reference laboratories, both using ascomycin as the internal standard for the LC-MS/MS method. Results The total precision of the CMIA tacrolimus assay was excellent. When tacrolimus concentrations obtained by the LC-MS/MS method from reference laboratory A were plotted on the x-axis and corresponding CMIA values were plotted on the y-axis, the following regression equation was observed: y = 0.9721x + 1.005 (r = 0.95), indicating no significant bias with the CMIA. However, when tacrolimus values obtained from reference laboratory B were used for comparison, the regression equation was y = 0.7664x + 1.775 (r = 0.93), indicating significant negative bias with the CMIA. When we compared tacrolimus concentrations obtained by reference laboratories A and B, we observed positive bias with tacrolimus concentrations obtained by reference laboratory B. However, tacrolimus concentrations obtained by both CMIA and Elecsys immunoassays were comparable. Conclusions Because of good correlation of tacrolimus concentrations using the CMIA and LC-MS/MS from reference laboratory A, our long-term reference laboratory for drug analysis, we concluded that the CMIA on the Alinity i can be used for therapeutic drug monitoring of tacrolimus. [ABSTRACT FROM AUTHOR]

Kim Kardashian is a White female celebrity influencer who also blackfishes. Blackfishing refers to altering one's appearance to appear Black, mixed-race, or racially ambiguous to appeal to a broader audience. In our case study, we examined blackfishing through the lens of celebrity and influencer, Kim Kardashian. We argue that blackfishers like Kardashian cosplay what they believe is Black womanhood for profit and fame at the expense of Black women. Using image repair theory and critical technocultural discourse analysis as our methodological approach, we explore how Kardashian uses social media to create and manage her image. Our study extends the concept of image repair theory by connecting the role social media with image repair, specifically through affordances and the "non-apology" apology. Our study shows the limits of image repair theory because there is little sanctioning of micro/celebrities due to their followers. [ABSTRACT FROM AUTHOR]

We investigated the predictive value of polygenic risk scores (PRS) derived from the schizophrenia GWAS (Trubetskoy et al., 2022) (SCZ3) for phenotypic traits of bipolar disorder type-I (BP-I) in 1878 BP-I cases and 2751 controls from Romania and UK. We used PRSice-v2.3.3 and PRS-CS for computing SCZ3-PRS for testing the predictive power of SCZ3-PRS alone and in combination with clinical variables for several BP-I subphenotypes and for pathway analysis. Non-linear predictive models were also used. SCZ3-PRS significantly predicted psychosis, incongruent and congruent psychosis, general age-of-onset (AO) of BP-I, AO-depression, AO-Mania, rapid cycling in univariate regressions. A negative correlation between the number of depressive episodes and psychosis, mainly incongruent and an inverse relationship between increased SCZ3-SNP loading and BP-I-rapid cycling were observed. In random forest models comparing the predictive power of SCZ3-PRS alone and in combination with nine clinical variables, the best predictions were provided by combinations of SCZ3-PRS-CS and clinical variables closely followed by models containing only clinical variables. SCZ3-PRS performed worst. Twenty-two significant pathways underlying psychosis were identified. The combined RO-UK sample had a certain degree of heterogeneity of the BP-I severity: only the RO sample and partially the UK sample included hospitalized BP-I cases. The hospitalization is an indicator of illness severity. Not all UK subjects had complete subphenotype information. Our study shows that the SCZ3-PRS have a modest clinical value for predicting phenotypic traits of BP-I. For clinical use their best performance is in combination with clinical variables. • Polygenic risk score based on Schizophrenia GWAS (Trubetskoy et al., 2022) (SCZ3-PRS) were computed using two PRS methods. • BP-I age of onset (AO), AO-mania, AO-depression, and rapid cycling had an inverse relationship with the SCZ3-SNP loading. • A negative correlation between the number of depressive episodes and psychosis, mainly incongruent psychosis was found. • The best predictions of BP-I traits were provided by combinations of SCZ3-PRS-CS and clinical variables. • SCZ3-PRS alone generated the worst predictions in machine learning models. • Psychosis pathway analysis in BP-I identified 22 genetic pathways; best associated were ZNF318 , Apoptosis , Mitochondrion . [ABSTRACT FROM AUTHOR]

Widespread political polarization throughout the United States is a threat to the time‐honored democratic tradition of utilizing civil discussion and respectful debate to express divergent views and strive for common ground. The political differences that divide us now are so deep and rife with toxic emotion that they threaten to undermine our social well‐being at both the micro and macro levels. While family therapists are trained to work with relational tensions and to help family members to constructively negotiate their differences, the severity of the hostility and resentment tied to divergent political orientations has made this work increasingly difficult to achieve. This article explores how family therapy training programs can help trainees deepen their capacity for constructive political dialoguing that includes learning how to effectively manage their reactivity to those whose values and views may be dramatically different from their own so that they can support clients in doing the same. [ABSTRACT FROM AUTHOR]

Issue Addressed Methods Results So What? Health‐related information can often be overwhelming for consumers, frequently infused with complex medical terminology that is difficult to understand and apply. Historically empathic connection, art and narratives have played key roles in communicating with diverse populations however collectively have received little recognition as a modality to improve health literacy. This study aimed to investigate the empathetic connection between art and patient narratives with a view to improve health literacy in the wider community.Nine recently discharged patients and one carer from a regional hospital were paired with 10 tertiary visual arts students for interview. Each narrative was transformed into visual art and exhibited at a community art gallery. The Empathy Quotient (EQ), Medical Outcomes Study 36‐item Short Form Health Survey (SF‐36) and self‐completed questionnaires assessed empathy and functional well‐being. Health literacy was evaluated through community response surveys post‐exhibition exposure.Student artist participants' EQ Cognitive Empathy (EQ‐CE) scores were associated with ‘Emotional Reactivity’ (EQ‐ER) (p = .038). SF‐36 scores revealed that role limitations due to physical health and emotional problems had the greatest impact on patient/carer participant's life at the time. The SF‐36 General Health domain was associated with the EQ‐ER total score (p = .044). Exhibition surveys revealed that 96.9% of observers had learnt something new about illness or injury.Although a relatively small study, our findings suggest patient/carer narratives and visual art is a simple yet effective modality for health service organisations to facilitate affective learning and improve health literacy when engaging with consumers. [ABSTRACT FROM AUTHOR]

Background and Objectives The coronavirus disease 2019 (COVID-19) pandemic led to many hospital service disruptions and strict visitor restrictions that affected care of older adult populations. This study investigates perceptions of hospital care for persons with dementia during the COVID-19 pandemic as shared on Reddit's social media platform. Research Design and Methods This study combined an Opinion Mining Framework with linguistic processing to conduct a sentiment analysis of word clusters and care-based content in a sample of 1,205 posts shared between February 2020 and March 2023 in Reddit's English-language corpus. Data were classified based on reoccurring contiguous sequences of 2 words from our text sample. Results Hospital dementia care discourse on Reddit advanced 4 negative sentiment themes: (1) fear of poor medication management, hydration, and hygiene, (2) loss of patient advocacy, (3) precipitation of advance directive discussions, and (4) delayed discharge and loss of nursing home bed. One positive sentiment theme also emerged: gratitude toward hospital staff. Discussion and Implications Negative sentiment Reddit posts constituted a larger share of the posts than positive posts regarding hospital care for persons with dementia. People who posted about their experiences shared their concerns about hospital care deficiencies and the importance of including informal caregivers in hospital settings, particularly in the context of a pandemic. Implications exist for dementia training, improved quality of care, advance care planning, and transitions in care policies. [ABSTRACT FROM AUTHOR]

We conducted a narrative literature review to examine contributing factors of disparities in tobacco usage and outcomes affecting Black Americans. We propose potential solutions that can be used to effectively address these disparities. We identified historical factors; socioeconomic factors; targeted marketing/advertising; the influence of racism/discrimination; neighborhood socioeconomic disadvantage; and mass incarceration. We call for more thorough examinations of these factors as a key element of tobacco-focused research and interventions to eliminate the disproportionate burdens faced by Black Americans. We advocate for greater emphases on the impacts of personal and structural racism on tobacco usage and outcomes affecting Black Americans. [ABSTRACT FROM AUTHOR]

Background: Epstein-Barr virus (EBV) is a likely prerequisite for multiple sclerosis (MS) but the underlying mechanisms are unknown. We investigated antibody and T cell responses to EBV in persons with MS (pwMS), healthy EBV-seropositive controls (HC) and post-infectious mononucleosis (POST-IM) individuals up to 6 months after disease resolution. The ability of EBV-specific T cell responses to target antigens from the central nervous system (CNS) was also investigated. Methods: Untreated persons with relapsing-remitting MS, POST-IM individuals and HC were, as far as possible, matched for gender, age and HLA-DRB1*15:01. EBV load was determined by qPCR, and IgG responses to key EBV antigens were determined by ELISA, immunofluorescence and Western blot, and tetanus toxoid antibody responses by multiplex bead array. EBV-specific T cell responses were determined ex vivo by intracellular cytokine staining (ICS) and cross-reactivity of in vitro-expanded responses probed against 9 novel Modified Vaccinia Ankara (MVA) viruses expressing candidate CNS autoantigens. Results: EBV load in peripheral blood mononuclear cells (PBMC) was unchanged in pwMS compared to HC. Serologically, while tetanus toxoid responses were unchanged between groups, IgG responses to EBNA1 and virus capsid antigen (VCA) were significantly elevated (EBNA1 p = 0.0079, VCA p = 0.0298) but, importantly, IgG responses to EBNA2 and the EBNA3 family antigens were also more frequently detected in pwMS (EBNA2 p = 0.042 and EBNA3 p = 0.005). In ex vivo assays, T cell responses to autologous EBV-transformed B cells and to EBNA1 were largely unchanged numerically, but significantly increased IL-2 production was observed in response to certain stimuli in pwMS. EBV-specific polyclonal T cell lines from both MS and HC showed high levels of autoantigen recognition by ICS, and several neuronal proteins emerged as common targets including MOG, MBP, PLP and MOBP. Discussion: Elevated serum EBV-specific antibody responses in the MS group were found to extend beyond EBNA1, suggesting a larger dysregulation of EBV-specific antibody responses than previously recognised. Differences in T cell responses to EBV were more difficult to discern, however stimulating EBV-expanded polyclonal T cell lines with 9 candidate CNS autoantigens revealed a high level of autoreactivity and indicate a far-reaching ability of the virus-induced T cell compartment to damage the CNS. Author summary: Previous infection with Epstein-Barr virus (EBV) is likely required for multiple sclerosis (MS) which occurs when the immune system damages the brain. How EBV contributes to this process is unknown, but some research suggests that immune responses to EBV may react to proteins in the brain that mimic virus proteins. We investigated T-cell and antibody responses to EBV in people with MS (pwMS) and, as controls, people persistently infected with EBV who acquired the virus either silently or symptomatically. pwMS had more frequent antibody responses to several viral proteins, including EBNA1, EBNA2, EBNA3A, EBNA3B and VCA, but their EBV viral load was similar. T cell responses to EBV-transformed B-cells and EBNA1 were only slightly different in pwMS compared to controls. However, T-cell lines from pwMS and healthy individuals, established using each person's own EBV-infected B-cell line, could also respond to multiple brain proteins. T-cell responses to myelin oligodendrocyte glycoprotein (MOG) were particularly common and we isolated T-cells that cross-recognised MOG and EBNA1. Our findings suggest that adaptive immune responses to EBV–which would normally fight EBV infection–are dysregulated in MS and can also target multiple proteins in the brain, indicating their likely involvement in disease. [ABSTRACT FROM AUTHOR]

The classification performance of endogenous electroencephalogram (EEG) brain-computer interfaces (BCIs) can be improved by hybridizing the paradigm through the use of commands from multiple paradigms. Hybrid paradigms using motor imagery (MI) and speech imagery (SI) have shown promise, but there is a lack of research into: i) their effectiveness when compared to pure MI and SI for multiclass problems, and ii) automated command selection. This study investigates multiclass MI and SI hybrid paradigms and compares the results to those obtained using pure MI and SI. Performance was assessed using F1 score and accuracy. The performances of all possible hybrid paradigm designs were assessed. The analysis indicated that hybridization does not always guarantee improved performance when compared to the pure paradigms, and there is inter-subject variation in the best paradigm. This confirmed the need for automated subject-specific hybrid paradigm designs. An automated hybrid paradigm selection technique using successive halving (SH) for expedited computational times was developed and results were compared to those obtained using a standard grid search. The SH approach resulted in an improvement in F1 score of 21.09% and 36.86% compared to MI and SI and led to a reduction in computational times of 82.80% compared to grid search. [ABSTRACT FROM AUTHOR]

Background: Autistic traits are often reported to be elevated in children diagnosed with attention‐deficit/hyperactivity disorder (ADHD). However, the distribution of subclinical autistic traits in children with ADHD has not yet been established; knowing this may have important implications for diagnostic and intervention processes. The present study proposes a preliminary model of the distribution of parent‐reported ADHD and subclinical autistic traits in two independent samples of Australian children with and without an ADHD diagnosis. Methods: Factor mixture modelling was applied to Autism Quotient and Conners' Parent Rating Scale – Revised responses from parents of Australian children aged 6–15 years who participated in one of two independent studies. Results: A 2‐factor, 2‐class factor mixture model with class varying factor variances and intercepts demonstrated the best fit to the data in both discovery and replication samples. The factors corresponded to the latent constructs of 'autism' and 'ADHD', respectively. Class 1 was characterised by low levels of both ADHD and autistic traits. Class 2 was characterised by high levels of ADHD traits and low‐to‐moderate levels of autistic traits. The classes were largely separated along diagnostic boundaries. The largest effect size for differences between classes on the Autism Quotient was on the Social Communication subscale. Conclusions: Our findings support the conceptualisation of ADHD as a continuum, whilst confirming the utility of current categorical diagnostic criteria. Results suggest that subclinical autistic traits, particularly in the social communication domain, are unevenly distributed across children with clinically significant levels of ADHD traits. These traits might be profitably screened for in assessments of children with high ADHD symptoms and may also represent useful targets for intervention. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to evaluate patient outcomes from a 12-month pilot program establishing specialist surgical services in a small rural (Modified Monash Model, MM4) hospital on the south coast of NSW. Methods: Suitable patients for ambulatory surgery were selected based on strict anaesthetic, surgical and social criteria. Skills shortfalls among nursing staff, usually with emergency or inpatient experience, were addressed by appropriate re-training and in-service training in scrub, scout and anaesthetic duties. An anonymous post-operative patient survey was administered during the pilot program, which assessed patient experiences and outcomes. Of 162 patients undergoing surgery during the pilot, 50 consecutive participants completed the survey. Results: Of the 161 procedures during the pilot program, 100 were performed under sedation and locoregional anaesthesia and 62 under general anaesthesia. Half (n = 86, 53.4%) were complex excisions of malignant skin lesions, and of these 63% also required either a skin graft or local flap repair. Survey respondents reported adequate information and pain relief upon discharge (n = 45, 96%) and 100% were satisfied with the care received. No respondents needed to see a doctor following discharge. There were no mortality events or major issues of morbidity during the study period or subsequently, no further overnight admissions or return to theatre and no re-presentations within 48 h of operating. Two superficial surgical site infections were reported. Conclusions: There is merit in drawing on underutilised resources in small rural hospitals in support of initiatives to reduce surgical waitlists. Appropriate outpatient surgeries can be safely performed with high levels of patient satisfaction. What is known about the topic? Waitlist reduction strategies are required to deal with long surgical waitlists. Rural surgical services are declining due to centralisation of these services in larger hospitals. What does this paper add? Significant positive benefits arise from providing an ambulatory, rural surgical service. This paper provides an evidence base for rural hospitals to explore the benefits of re-activating, or increasing utilisation of, existing operating theatre facilities. What are the implications for practitioners? Significant reductions in surgical waitlists within health services can be safely achieved by servicing rural patients at their local hospital for some ambulatory procedures. [ABSTRACT FROM AUTHOR]

Psychological distress is a common response to many conditions physiotherapists treat. It is also common for a person's experience of distress to be associated with multiple stressors. This qualitative study explored physiotherapists' perceptions of the types of patient psychological distress they encountered in their clinical practice. A qualitative research approach was adopted. Twenty-three physiotherapists were recruited through purposive maximum variation sampling. To participate, physiotherapists had to self-report having encountered at least one patient they perceived to be experiencing psychological distress in the last 12 months. Data analysis was completed using Iterative Thematic Inquiry. Five themes were identified in the study: 1) distress extends beyond physical health issues; 2) fear of the future; 3) the emotional toll of loss; 4) trauma is often part of the story; and 5) losing hope. The results of this study highlight that patient psychological distress presents in a variety of forms and appears to be multifaceted and multifactorial in nature. As patients' experiences of psychological distress are relevant to physiotherapy practice, mental health capabilities need to be embedded within physiotherapy training. [ABSTRACT FROM AUTHOR]

Climate change is projected to become the leading cause of adverse health outcomes globally, and the healthcare system is a key contributor. Surgical theatres are three to six times more pollutant than other hospital areas, and produce anywhere from a fifth to a third of total hospital waste. Hospitals are increasingly expected to make operating theatres more sustainable, however guidelines to improve environmental sustainability are lacking, and previous research takes a narrow approach to operative sustainability. This paper presents a narrative review that, following a 'review of reviews' approach, aims to summarize the key recommendations to improve the environmental sustainability of surgical theatres. Key domains of discussion identified across the literature included minimisation of volatile anaesthetics, reduction of operating theatre power consumption, optimisation of surgical approach, re‐use and re‐processing of surgical instruments, waste management, and research, education and leadership. Implementation of individual items in these domains has seen significant reductions in the environmental impact of operative practice. This comprehensive summary of recommendations lays the framework from which providers can assess the sustainability of their practice and for the development of encompassing guidelines to build an environmentally sustainable surgical service. [ABSTRACT FROM AUTHOR]

We aimed to explore the supportive care needs of ovarian cancer patients and their caregivers before and after the first cancer recurrence, the top unmet needs after recurrence, and the relationship between patient and caregiver needs at recurrence. Participants were 288 patients and 140 caregivers from the Australian Ovarian Cancer Study-Quality of Life (AOCS-QoL) cohort. They completed Supportive Care Needs Surveys (patients: SCNS-SF34, caregivers: SCNS-P&C44) every three-to-six months for up to two years. Linear mixed models tracked changes in needs over time. We calculated the percentage reporting moderate-to-high needs after recurrence. LASSO regression analysed patient-caregiver need relationships. Both patients' and caregivers' psychological, health system/service and information needs increased with recurrence along with patients' support and physical needs. These remained stable at nine months after recurrence. Dominant patient needs post-recurrence included 'fear of recurrence' (38%) and 'concerns about the worries of those close' (34%), while caregivers expressed 'concerns about recurrence' (41%) and 'recovery of the patient not turning out as expected' (31%). Among dyads, when patients had 'fears about the cancer spreading' this was associated with caregivers having a need for help with 'reducing stress in the patients' life'; when caregivers had concerns about 'recurrence' this was associated with patients needing help with 'uncertainty about the future' and 'information about things they can do to help themselves'. Recurrent ovarian cancer intensifies disease-related fears and concerns for patients and loved ones. Addressing dyadic concerns through supportive care interventions may enhance cohesion during the challenging journey of recurrent disease. [Display omitted] • Ovarian cancer recurrence imposes enduring psychological, service and information needs for patients and caregivers. • Patients additionally experience an increase in physical and care needs with recurrence. • At recurrence, the most prevalent unmet need for both patients and caregivers revolved around fear of cancer metastasis. • Coupled with this fear is caregivers' desire to alleviate patient stress and patient uncertainty and need for information. • Patients also worry about loved ones, while caregivers struggle with adjusting expectations about patient recovery. [ABSTRACT FROM AUTHOR]