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Hezbollah is a significant power in Lebanon that operates as a Shiite political party and militant group. With Iranian support, Hezbollah has created a so-called resistance society from the Shiites neglected by the government that is based on three pillars: military infrastructure, a large-scale network of civilian institutions with the aim of improvement of the well-being of the Shiite population, and a media empire that has an essential role in disseminating the political messages and ideology of Hezbollah and Iran in Lebanon, the Middle East, and other parts of the world, using the full spectrum of media and new technologies, including Internet presence, to shape public opinion, gain supporters and sympathizers, fundraise, and wage information warfare against Israel and the Western World. This article sheds light on Hezbollah's Internet activity and demonstrates Hezbollah's cyberespionage campaign through two examples, describing its "Fake News" media camps and the possible connection between Hezbollah and money counterfeiting and selling on the Dark Web. [ABSTRACT FROM AUTHOR]

Aims: For smokers unmotivated to quit, we assessed the effectiveness and cost‐effectiveness of behavioural support to reduce smoking and increase physical activity on prolonged abstinence and related outcomes. Design: A multi‐centred pragmatic two‐arm parallel randomised controlled trial. Setting: Primary care and the community across four United Kingdom sites. Participants: Nine hundred and fifteen adult smokers (55% female, 85% White), recruited via primary and secondary care and the community, who wished to reduce their smoking but not quit. Interventions: Participants were randomised to support as usual (SAU) (n = 458) versus multi‐component community‐based behavioural support (n = 457), involving up to eight weekly person‐centred face‐to‐face or phone sessions with additional 6‐week support for those wishing to quit. Measurements Ideally, cessation follows smoking reduction so the primary pre‐defined outcome was biochemically verified 6‐month prolonged abstinence (from 3–9 months, with a secondary endpoint also considering abstinence between 9 and 15 months). Secondary outcomes included biochemically verified 12‐month prolonged abstinence and point prevalent biochemically verified and self‐reported abstinence, quit attempts, number of cigarettes smoked, pharmacological aids used, SF12, EQ‐5D and moderate‐to‐vigorous physical activity (MVPA) at 3 and 9 months. Intervention costs were assessed for a cost‐effectiveness analysis. Findings Assuming missing data at follow‐up implied continued smoking, nine (2.0%) intervention participants and four (0.9%) SAU participants achieved the primary outcome (adjusted odds ratio, 2.30; 95% confidence interval [CI] = 0.70–7.56, P = 0.169). At 3 and 9 months, the proportions self‐reporting reducing cigarettes smoked from baseline by ≥50%, for intervention versus SAU, were 18.9% versus 10.5% (P = 0.009) and 14.4% versus 10% (P = 0.044), respectively. Mean difference in weekly MVPA at 3 months was 81.6 minutes in favour of the intervention group (95% CI = 28.75, 134.47: P = 0.003), but there was no significant difference at 9 months (23.70, 95% CI = −33.07, 80.47: P = 0.143). Changes in MVPA did not mediate changes in smoking outcomes. The intervention cost was £239.18 per person, with no evidence of cost‐effectiveness. Conclusions: For United Kingdom smokers wanting to reduce but not quit smoking, behavioural support to reduce smoking and increase physical activity improved some short‐term smoking cessation and reduction outcomes and moderate‐to‐vigorous physical activity, but had no long‐term effects on smoking cessation or physical activity. [ABSTRACT FROM AUTHOR]

Research demonstrates that simulations encourage students to apply their understanding of theories and content, navigate problem-solving processes with peers, support student motivation for learning, and reflect afterward to enrich their comprehension of course materials. Peacebuilding and international relations scholars have implemented simulations to improve student learning and understanding about complex dilemmas, such as collective action, structural inequality, post-conflict reconstruction, climate change, disaster management, and terrorism. However, studies of real-life-based simulations also indicate that they may entrench, rather than subvert, students' extant bias, perpetuate cultural misrepresentation, and pose logistical challenges for instructors and students. We thus add to scholarly debates about the utility of role-play simulations in internationalized pedagogy settings by asking and answering: Do adult learners perceive fantastical role-play simulations as effective teaching and learning tools for cross-cultural negotiation? We bridge disparate literature on (1) simulations as active learning tools, (2) real-life simulation approaches for teaching cross-cultural studies, and (3) creative play pedagogy to investigate the utility of fantastical simulation as a pedagogical approach for teaching cross-cultural negotiation theories. While we examined the perceived effectiveness of fantastical simulations for adult learners in a graduate-level course, more research is needed to understand their utility in other classrooms and disciplines. [ABSTRACT FROM AUTHOR]

Background: Healthcare-associated infections (HAIs) are a common, costly, yet largely preventable complication impacting patients in healthcare settings globally. Improving routine cleaning and disinfection of the hospital environment has been shown to reduce the risk of HAI. Contaminated shared medical equipment presents a primary transmission route for infectious pathogens, yet is rarely studied. The CLEEN study will assess how enhanced cleaning and disinfection of shared medical equipment affects the rate of HAIs in a tertiary hospital setting. The initiative is an evidence-based approach combining staff training, auditing and feedback to environmental services staff to enhance cleaning and disinfection practices. Methods: The CLEEN study will use a stepped wedge randomised controlled design in 10 wards of one large Australian hospital over 36 weeks. The intervention will consist of 3 additional hours per weekday for the dedicated cleaning and disinfection of shared medical equipment on each ward. The primary outcome is to demonstrate the effectiveness of improving the quality and frequency of cleaning shared medical equipment in reducing HAIs, as measured by a HAI point prevalence study (PPS). The secondary outcomes include the thoroughness of equipment cleaning assessed using fluorescent marker technology and the cost-effectiveness of the intervention. Discussion: Evidence from the CLEEN study will contribute to future policy and practice guidelines about the cleaning and disinfection of shared medical equipment. It will be used by healthcare leaders and clinicians to inform decision-making and implementation of best-practice infection prevention strategies to reduce HAIs in healthcare facilities. Trial registration: Australia New Zealand Clinical Trial Registry ACTRN12622001143718. [ABSTRACT FROM AUTHOR]

The years 2021 and 2022 saw a warning from communication and disinformation experts about the emergence of an ad hoc alliance with long term effects between supporters of conspiracy theories related to the pandemic and climate change deniers. The war in Ukraine has made things only worse. In August 2021 the first section of the 6th IPCC report ("Code Red for Humanity") had a relatively good visibility. However, the launch of the full report, in April 2022, has gone largely unnoticed. In addition to shifts in attention, the war in Ukraine has generated two opposite communication directions: an ambitious one, calling for the urgent reduction of overall dependence on fossil fuels (not just from Russia), and a conservative one, justifying postponement of decarbonisation plans. The latter has already been used in Romania to adopt laws with a significant environmental impact. Last but not least, there is a convergence both nationally and globally (at the levels of human and financial resources, communications channels, messages) of conservative (justifying the attack of Russia in Ukraine through the prism of the defence of traditional values), conspiratorial (related to the pandemic and the promoters of the progressive discourse) and denialist discourses (in relation to climate change). [ABSTRACT FROM AUTHOR]

Background: The e-coachER trial aimed to determine whether adding web-based behavioural support to exercise referral schemes (ERS) increased long-term device-measured physical activity (PA) for patients with chronic conditions, compared to ERS alone, within a randomised controlled trial. This study explores the mechanisms of action of the e-coachER intervention using measures of the behaviour change processes integral to the intervention's logic model. Methods: Four hundred fifty adults with obesity, diabetes, hypertension, osteoarthritis or history of depression referred to an ERS were recruited in Plymouth, Birmingham and Glasgow. The e-coachER intervention comprising 7-Steps to Health was aligned with Self-Determination Theory and mapped against evidence-based behaviour change techniques (BCTs). Participants completed questionnaires at 0, 4, and 12 months to assess PA and self-reported offline engagement with core BCTs in day-to-day life (including action planning and self-monitoring) and beliefs relating to PA (including perceived importance, confidence, competence, autonomy and support). We compared groups at 4 and 12 months, controlling for baseline measures and other covariates. Mediation analysis using the product of coefficients method was used to determine if changes in process variables mediated intervention effects on moderate to vigorous physical activity (MVPA) recorded by accelerometer and self-report at 4- and 12-months. Results: The internal reliability (Cronbach's alpha) for all multi-item scales was > 0.77. At 4-months, those randomised to e-coachER reported higher levels of PA beliefs relating to importance (1.01, 95% confidence interval (CI): 0.42 to 1.61, p = 0.001), confidence (1.28, 95% CI: 0.57 to 1.98, p < 0.001), competence (1.61, 95% CI:.68 to 2.54, p = 0.001), availability of support (0.77, 95% CI: 0.07 to 1.48, p = 0.031), use of action planning (1.54, 95% CI: 0.23 to 2.85, p = 0.021) and use of self-monitoring (0.76, 95% CI: 0.19 to 1.32, p = 0.009) compared to ERS alone. There were no intervention effects on autonomous beliefs or perceived frequency of support, compared to ERS alone. At the 12-month follow-up, participants belief in the importance of PA was the only process measure to remain significantly higher in the e-coachER group when compared to ERS alone (0.75, 95% CI: 0.05 to 1.45). Intervention effects on perceived importance (2.52, 95% CI: 0.45 to 5.39), action planning (1.56, 95% CI: 0.10 to 3.54) and self-monitoring (1.92, 95% CI: 0.21 to 4.33) at 4-months significantly mediated change in accelerometer measured MVPA at 12-months (recorded in ≥ 10-min bouts). Conclusions: e-coachER led to some short-term changes in most process outcomes. Some of these processes also appeared to mediate e-coachER effects on changes in accelerometer measured MVPA. Further work should be carried out to understand how best to design and implement theoretically underpinned web-based physical activity promotion interventions within ERS. Trial registration: ISRCTN, ISRCTN15644451. Registered 12 February 2015. [ABSTRACT FROM AUTHOR]

A list of articles to appear in future issues of "Journal of Renal Care" is presented. Articles mentioned include "Needle stick injury: a novel intervention to reduce the occupational health and safety risk in the haemodialysis setting," by Josephine Chow, "Implementing the Buttonhole method using the Biohole peg in a busy dialysis unit: a review," by Jennie King, and "Assessing and training patients on Peritoneal Dialysis in their own homes can influence better practice," by Rumeyza Kazancioglu.

Focuses on the success of Millbank Technology, owned by Ian and Jennie King. Creation of a very specialist international niche market for extrusion machines; Technology for soya processing; Concentration on building exports.

The article reports that a Preservation Assistance Grant will be presented to the Jennie King Mellon Library Archives and Special Collections from the National Endowment for the Humanities (NEH); and mentions that the award supports development of a targeted preservation program.

Background: It is essential to evaluate the ways in which practice changes are implemented and received in and across contexts, identifying barriers and enablers, and mechanisms for enhancing success. Aim: To provide insights into the experiences of clinicians in implementing a multifaceted bundled urinary catheter care intervention in four acute care hospitals in New South Wales, Australia. Methods: The catheter care bundle was implemented using a pre‐ and postintervention study design. The intervention was implemented in all adult inpatient wards, emergency departments and operating theatres of four hospitals. The bundle consisted of an integrated set of evidence‐based practices to assist clinicians in making better informed decisions related to catheter insertion, care and removal practices. Focus groups at each participating hospital evaluated the implementation processes from the clinicians' perspective, identifying barriers and enablers to successful implementation. Results: Eight focus groups were held with 35 participants. Four key inter‐related themes were identified: early and sustained engagement with key stakeholders; good planning but remaining flexible; managing the burden of practice change; and adopting and sustaining practice change. These themes capture and highlight the complexity and the challenges associated with implementation of the practice change across contexts and the project timeline. Conclusion: It is imperative to understand the challenges associated with complex practice change and ways in which implementation can be optimised. This study identified barriers and enablers experienced by staff implementing the bundled intervention. The themes encapsulate factors central to success of practice change within the complex, multilayered healthcare environment. Relevance to clinical practice: Key challenges highlight the need for forward planning, strategic engagement of key players, continuing monitoring and feedback together with adequate resourcing tailored to result in sustainable normalisation of the intervention over time. The COREQ checklist for qualitative studies has been used in reporting this study. [ABSTRACT FROM AUTHOR]

Objective To examine the evidence related to the effectiveness of topical analgesic and topical local anesthetic agents for reducing pain associated with chronic leg ulcers. Methods A systematic search and review of the literature were undertaken using key search terms such as leg ulcers, topical anesthetics, topical analgesics, and pain. Six databases were electronically searched for articles published between January 1990 and August 2019. Results A total of 23 articles were identified that met the inclusion criteria. Data were extracted using content analysis. Most of the included studies were randomised controlled trials; however, the reported methodology for most of studies was poor, and so the validity and reliability of the evidence are uncertain. Lidocaine/prilocaine cream, ibuprofen foam, and morphine gel were the most examined topical agents. Lidocaine/prilocaine cream significantly improved woundrelated pain compared with all other studied agents. For topical analgesic agents, ibuprofen foam also reduced chronic leg ulcer pain significantly, whereas morphine gel was ineffective. Conclusions Lidocaine/prilocaine cream and ibuprofen foam are effective agents for reducing wound-related pain associated with chronic leg ulcers. Effective use of topical agents could reduce the need for systemic pain relief agents, mitigating potential adverse effects, while giving clinicians another treatment option to manage wound-related pain associated with chronic leg ulcers. [ABSTRACT FROM AUTHOR]

Aims and objectives: This study aimed to reduce indwelling urinary catheter (IDC) use and duration through implementation of a multifaceted "bundled" care intervention. Background: Indwelling urinary catheters present a risk for patients through the potential development of catheter‐associated urinary tract infection (CAUTI), with duration of IDC a key risk factor. Catheter‐associated urinary tract infection is considered preventable yet accounts for over a third of all hospital‐acquired infections. The most effective CAUTI reduction strategy is to avoid IDC use where ever possible and to remove the IDC as early as appropriate. Design: A cluster‐controlled pre‐ and poststudy at a facility level with a phased intervention implementation approach. Methods: A multifaceted intervention involving a "No CAUTI" catheter care bundle was implemented, in 4 acute‐care hospitals, 2 in metropolitan and 2 in rural locations, in New South Wales, Australia. Indwelling urinary catheter point prevalence and duration data were collected at the bedside on 1,630 adult inpatients at preintervention and 1,677 and 1,551 at 4 and 9 months postintervention. This study is presented in line with the StaRI checklist (see Appendix S1). Results: A nonsignificant trend towards reduction in IDC prevalence was identified, from 12% preintervention to 10% of all inpatients at 4 and 9 months. Variability in preintervention IDC prevalence existed across hospitals (8%–16%). Variability in reduction was evident across hospitals at 4 months (between −2% and 4%) and 9 months (between 0%–8%). Hospitals with higher preintervention prevalence showed larger decreases, up to 50% when preintervention prevalence was 16%. Indwelling urinary catheter duration increased as more of the short‐term IDC placements were avoided. Conclusions: Implementation of a multifaceted intervention resulted in reduced IDC use in four acute‐care hospitals in Australia. This result was not statistically significant but did reflect a positive trend of reduction. There was a significant reduction in short‐term IDC use at 9 months postintervention. Relevance to clinical practice: Clinical nurse leaders can effectively implement change strategies that influence patient outcomes. Implementation of the evidence‐based "No CAUTI" bundle increased awareness of appropriate indications and provided nurses with the tools to inform decision‐making related to insertion and removal of IDCs in acute inpatient settings. Working in partnership with inpatients and the multidisciplinary team is essential in minimising acute‐care IDC use. [ABSTRACT FROM AUTHOR]

Aims and objectives: To identify the point prevalence of indwelling urinary catheters (IDCs) in adult inpatients in acute care hospitals, and to describe the indications for IDC insertion based on patient age, gender, specialty and hospital. Background: Catheter‐associated urinary tract infections (CAUTIs) are preventable healthcare‐associated infections. IDC duration is the strongest predictor of CAUTI, and little is known about characteristics of patients who receive an IDC. Design: Two single‐day point prevalence surveys collected baseline patient data as part of a larger pre‐post control‐intervention study. Methods: Surveys were conducted at four acute care hospitals in NSW, Australia, for all adult patients. Data collection included IDC presence, insertion details and urine culture collection. Point prevalence data were linked with electronically extracted patient demographic data. This study is presented in line with STROBE checklist (See Supplementary File 1). Result: Data from 1,630 patients were analysed, with 196 patients (12%) identified as having an IDC on the survey dates. IDC prevalence rates were higher in males (13%) than in females (11%). Critical care had the highest rate of patients with IDCs (42%). Urine cultures were collected in 70 patients with an IDC (43%). Conclusions: Findings indicated similar rates of IDC use in males and females, and there was no significant difference in age between patients with or without an IDC. However, indication for IDC varied by patient age and gender. High rates of urine culture collection may represent routine collection. Relevance to clinical practice: IDC use is found across genders, all age groups and specialties. Nurses should be aware that any of their patients may have an IDC and be particularly aware of certain indications based on patient age and gender. Routine urine culture collection is not advised, and instead, nurses should be guided by clinical decision‐making tools. [ABSTRACT FROM AUTHOR]

In this article, I explore the researcher identity of senior women academics in a South African institution of higher education. The aim was to uncover the identity tensions they experience in relation to being a researcher and to understand how they respond to and resolve these tensions. Three focus groups, based on the socioanalytic method of social dream drawing, provided the data. Data were analyzed through hermeneutic phenomenological reflection. Identity theory was applied as a conceptual framework to guide my interpretation of the data. Through their collective reflection on being researchers, the women became cognizant of identity tensions and their engagement with these reflected intrapersonal processing akin to identity work. In the findings, I highlight purposeful, collective identity work as a resource that enabled these women to reconstruct self-defeating gendered conflicts in their researcherhood. By uncovering their identity tensions and related emotions, a sense of researcher self-efficacy emerged. They consequently reframed research success as meaningful self-expression and knowledge dissemination. I propose that collective identity work is a valuable endeavor for women researchers because it facilitates role identity development and a collective voice in responding to the demanding and constantly changing academic work context. [ABSTRACT FROM AUTHOR]

Introduction Physical activity is recommended for improving health among people with common chronic conditions such as obesity, diabetes, hypertension, osteoarthritis and low mood. One approach to promote physical activity is via primary care exercise referral schemes (ERS). However, there is limited support for the effectiveness of ERS for increasing long-term physical activity and additional interventions are needed to help patients overcome barriers to ERS uptake and adherence. This study aims to determine whether augmenting usual ERS with web-based behavioural support, based on the LifeGuide platform, will increase long-term physical activity for patients with chronic physical and mental health conditions, and is cost-effective. Methods and analysis A multicentre parallel two-group randomised controlled trial with 1:1 individual allocation to usual ERS alone (control) or usual ERS plus web-based behavioural support (intervention) with parallel economic and mixed methods process evaluations. Participants are low active adults with obesity, diabetes, hypertension, osteoarthritis or a history of depression, referred to an ERS from primary care in the UK. The primary outcome measure is the number of minutes of moderate-to-vigorous physical activity (MVPA) in ≥10 min bouts measured by accelerometer over 1 week at 12 months. We plan to recruit 413 participants, with 88% power at a two-sided alpha of 5%, assuming 20% attrition, to demonstrate a between-group difference of 36-39 min of MVPA per week at 12 months. An improvement of this magnitude represents an important change in physical activity, particularly for inactive participants with chronic conditions. Ethics and dissemination Approved by North West Preston NHS Research Ethics Committee (15/NW/0347). Dissemination will include publication of findings for the stated outcomes, parallel process evaluation and economic evaluation in peer-reviewed journals. Results will be disseminated to ERS services, primary healthcare providers and trial participants. trial registration number ISRCTN15644451; Pre-results. [ABSTRACT FROM AUTHOR]

This study aimed to evaluate the effect of EMLA 5% cream applied to painful chronic leg ulcers (CLUs) as a primary dressing on wound healing and health-related quality of life (HRQoL). A pilot, parallel-group, nonblinded, randomized controlled trial was conducted in 6 community nursing procedure clinics in New South Wales, Australia. A total of 60 participants with painful CLUs of varied etiology were randomly assigned to the intervention (EMLA daily for 4 weeks as a primary dressing, followed by usual care) or usual care only. Wound size and HRQoL were measured at baseline, end of the intervention period (week 4), and week 12. At baseline, wound sizes were similar for both the intervention and control groups. During the intervention period, there was no significant difference in wound sizes between groups (intervention group: median (cm2) = 2.4, IQR = 1.3-12.7; control group: median (cm2) = 5.0, IQR = 2.5-9.9; P = .05). Mean HRQoL scores for all subscales at baseline and weeks 4 and 12 were similar between groups except for Wellbeing, which was significantly higher in the intervention group at the end of the 4-week intervention period (intervention group: mean = 52.41, SD = 24.50; control group: mean = 38.15, SD = 21.25; P = .03; d = 0.62). The trial findings suggest that daily applications of EMLA as a primary dressing do not inhibit wound healing and may improve patient well-being. Studies with larger samples are required to more comprehensively evaluate the impact of this treatment on wound healing and HRQoL. [ABSTRACT FROM AUTHOR]

Purpose The purpose of the study was to gain a better understanding of what severe hypoglycemia means to significant others. Methods Narrative inquiry methodology was utilized. In-depth interviews were conducted with 7 significant others of adults with type 1 diabetes about their experience with severe hypoglycemia. Interviews were recorded, transcribed verbatim, and then developed into narrated core stories through a process of selecting and organizing events and by describing the relationship among these events. This was followed by thematic analysis to reveal the shared narrative of significant others. Results Episodes of severe hypoglycemia were found to turn the participants’ lives upside down. The inability of the individual with diabetes to manage severe hypoglycemia required the significant other to detect and treat these episodes. The theme “managing disruption” captured how the significant others’ role shifted from one of background support to an active, primary role in severe hypoglycemia management. They became (1) the expert by arming themselves with knowledge and skills to assist with the severe hypoglycemia episodes, (2) the sentry by becoming more vigilant and prepared for these episodes, and (3) the protector of the person with diabetes by shielding him or her from the vulnerable position that the severe hypoglycemia episodes placed one in. Conclusions This study highlights the important role that significant others play in the management of severe hypoglycemia. It also emphasizes the need for health care professionals to provide appropriate education and support. [ABSTRACT FROM AUTHOR]

Due to student overreliance on search engines and the time constraints of one-shot instruction sessions, librarians struggle to teach many of the information literacy skills that students need to conduct successful research. Problem-based learning (PBL) provides a way to integrate information literacy naturally into an assignment or course by guiding students through the research process as they work to find a solution to a problem. This article first explains the PBL process, then describes the design and implementation of a PBL project in a required first-year general education course. Finally, it details the Association of College & Research Libraries' (ACRL) Information Literacy Competency Standards for Higher Education addressed by the project, as well as possible future modifications. [ABSTRACT FROM AUTHOR]

Objectives To contextualise and identify the determinants of poor health related quality of life (QOL) among patients with antineutrophil cytoplasm antibody (ANCA) associated vasculitis (AAV). Methods A multicentre AAV case-control study was conducted using two matched groups of population and chronic disease controls. Measures of physical and mental QOL as well as putative bio-psychosocial determinants of QOL impairment were collected. Concurrently, putative clinical QOL determinants were recorded. Conditional logistic regression analyses characterised group differences while multivariable logistic regression identified within-case QOL associations which were further quantified using population attributable risks (PAR). Results Cases (n=410) experienced similar QOL to chronic disease controls (n=318) ( physical QOL: OR 0.7, 95% CI 0.4 to 1.1; mental QOL: OR 1.1, 95% CI 0.8 to 1.6). However, they were substantially more likely to report poor QOL compared to general population controls (n=470) ( physical QOL: OR 7.0, 95% CI 4.4 to 11.1; mental QOL: OR 2.5, 95% CI 1.7 to 3.6). A few clinical, but many more bio-psychosocial factors were independently associated with poor QOL. In population terms, fatigue was found to be of principal importance (physical QOL: PAR 24.6%; mental QOL: PAR 47.4%). Conclusions AAV patients experienced significant QOL impairment compared to the general population, but similar to those with other chronic diseases whose considerable needs are already recognised. Potentially modifiable clinical determinants have been identified; however bio-psychosocial interventions are likely to provide the greater QOL gains in this patient population. [ABSTRACT FROM AUTHOR]

Objectives. To identify the determinants of fatigue among patients with ANCA-associated vasculitis (AAV).Methods. A multicentre cross-sectional study was conducted. Subjects fulfilling the European Medicines Agency criteria for granulomatosis with polyangiitis (Wegener’s), microscopic polyangiitis and eosinophilic granulomatosis with polyangiitis (Churg–Strauss) were approached according to consecutive clinic attendance and invited to complete a questionnaire assessing fatigue and putative biopsychosocial determinants of this symptom. Concurrently, potential clinical determinants were recorded. Independent associations of fatigue were identified using forward stepwise logistic regression modelling and their overall impact expressed as population attributable risk (PAR).Results. The majority (74.8%) of participants (n = 410) reported high levels of fatigue that were found to be significantly associated with numerous biopsychosocial and clinical factors. Sleep disturbance [odds ratio (OR) 5.3, 95% CI 2.7, 10.5] and pain (OR 3.8, 95% CI 2.0, 7.3) were the strongest independent associations of fatigue and, on a population level, each was more than twice as important as any other putative determinant (PAR 18.1% and 16.5%, respectively). Female gender (OR 2.1, 95% 1.1, 4.0), elevated CRP (OR 3.7, 95% CI 1.7, 8.1) and the dysfunctional coping strategies of behavioural disengagement (OR 2.4, 95% CI 1.04, 5.6) and denial (OR 2.4, 95% CI 0.9, 6.7) were also independently associated with fatigue.Conclusion. The data suggest that AAV-related fatigue is multifactorial in origin. Sleep disturbance and pain were found to be most important, although inflammation, as measured by CRP, was also associated. This study has identified potentially modifiable determinants that will inform future interventions aimed at alleviating fatigue. [ABSTRACT FROM AUTHOR]