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•Population-scale genomics (N = 937 939) allowed assembly of a large FVL/PTGM double-heterozygous cohort while mitigating ascertainment bias.•FVL/PTGM DH appeared to be more common than FVL homozygosity and conferred a similar risk of venous thrombosis.

The presence of disorder substantially influences the behaviour of physical systems. It can give rise to slow or glassy dynamics, or to a complete suppression of transport as in Anderson insulators1, where normally extended wavefunctions such as light fields or electronic Bloch waves become exponentially localized. The combined effect of disorder and interactions is central to the richness of condensed-matter physics2. In bosonic systems, it can also lead to additional quantum states such as the Bose glass3,4—an insulating but compressible state without long-range phase coherence that emerges in disordered bosonic systems and is distinct from the well-known superfluid and Mott insulating ground states of interacting bosons. Here we report the experimental realization of the two-dimensional Bose glass using ultracold atoms in an eight-fold symmetric quasicrystalline optical lattice5. By probing the coherence properties of the system, we observe a Bose-glass-to-superfluid transition and map out the phase diagram in the weakly interacting regime. We furthermore demonstrate that it is not possible to adiabatically traverse the Bose glass on typical experimental timescales by examining the capability to restore coherence and discuss the connection to the expected non-ergodicity of the Bose glass. Our observations are in good agreement with recent quantum Monte Carlo predictions6and pave the way for experimentally testing the connection between the Bose glass, many-body localization and glassy dynamics more generally7,8.

Purpose: Heat adaptation (HA) is a popular strategy to combat the negative effects of thermal stress. The HA literature has expanded since a 2016 meta-analysis, and we provide an updated meta-analysis, incorporating 39 additional studies and advanced analysis. Methods: Following Pubmed searches, full-text original articles using human participants were reviewed using the four-stage PRISMA process. Data were extracted by at least two of the authors. Hedges’ geffect sizes, 95% confidence intervals, and prediction intervals were calculated. Correlations were run where appropriate. Results: One hundred and thirty-five total articles (96 previous, 39 new) were reviewed. Medium-term (8–14 days), active, constant work HA regimens remain the most common despite a recent focus on isothermal, passive, and short-term (≤ 7 days) alternatives. HA still improves subsequent exercise performance and capacity in the heat (g= 0.7), reduces resting core temperature (g= − 0.6) and heart rate (g= − 0.5), and increases sweat rate (g= 0.4) but the effect sizes are lower than previously reported. HA has a moderate or larger effect (g> 0.5) on lowering sweat onset temperature, mean heart rate, sweat sodium and chloride concentrations, resting thermal sensation, and thirst sensation, and increasing resting plasma volume. There is considerable heterogeneity within the data for most variables. Conclusion: HA regimens can reduce physiological and perceptual strain and improve subsequent exercise performance and capacity in the heat. Longer regimens may be more effect than shorter ones, but the data are lacking. Passive HA is a practical, effective alternative to active HA.

We evaluated the effects of a discrimination training procedure for establishing praise as a reinforcer for three children with autism spectrum disorder. After establishing two praise words as discriminative stimuli and two nonsense words as S‐deltas, we evaluated whether the stimuli then functioned as reinforcers by presenting each stimulus as a consequence for a new response. The results demonstrated that previously neutral praise words functioned as reinforcers and nonsense words did not. As in previous studies on establishing reinforcers, the effects were transitory, and praise words did not continue to function as reinforcers after repeated exposure without discrimination training. Recommendations are provided for future research and maintaining reinforcement effects.

We systematically examined comparative gout flare risk after initiation or escalation of different urate‐lowering therapies (ULTs), comparative flare risk with and without concomitant flare prophylaxis, adverse event rates associated with flare prophylaxis, and optimal duration of flare prophylaxis. We searched the Medline, Embase, Web of Science, and Cochrane databases and clinical trial registries from inception to November 2021 for trials investigating adults with gout initiating or escalating ULT. We performed random effects network meta‐analyses and calculated risk ratios (RRs) between treatments. Bias was assessed using the revised Cochrane risk‐of‐bias tool. We identified 3,775 records, of which 29 publications (27 trials) were included. When compared to placebo plus prophylaxis, the RR of flares ranged from 1.08 (95% confidence interval [CI] 0.87–1.33) for febuxostat 40 mg plus prophylaxis to RR 2.65 [95% CI 1.58–4.45] for febuxostat 80 mg plus lesinurad 400 mg plus prophylaxis. Compared to ULT alone, the RR of flares was lower for ULT plus rilonacept 160 mg (RR 0.35 [95% CI 0.25–0.50]), ULT plus rilonacept 80 mg (RR 0.43 [95% CI 0.31–0.60]) and ULT plus colchicine (RR 0.50 [95% CI 0.35–0.72]). There was limited evidence for other flare prophylaxis and on prophylaxis harms and optimal duration. Primarily because of missing outcome data and bias in the selection of reported results, 71.4% and 63.4% of studies were assessed as high risk of bias for flares and adverse events, respectively. The RR of flares when introducing ULT varies depending on ULT drug and dosing strategies. There were limited data on ULT escalation. Flare prophylaxis with colchicine and rilonacept reduces flare incidence. More research is required on the harms and optimal duration of prophylaxis.

ABSTRACTIn a recent study, Gallant et al. (2021) found that both match-to-sample (MTS) and the stimulus-pairing yes/no procedure (SPYN) resulted in a high likelihood of equivalence class formation. Due to this ceiling effect, however, any potential differential effects of the SPYN and MTS trial formats could not be identified. Thus, the purpose of the present study was to compare the effectiveness and efficiency of MTS and SPYN using procedures that were less likely to result in class formation. A pretest-train-posttest sequence was used. During the pretest and posttest, both MTS and SPYN trials were used to assess all trained and derived relations. Class members consisted of abstract visual stimuli. We also assessed the degree to which class-consistent responding would generalize to a card sorting task. During training of baseline relations, half of the participants were exposed only to MTS or only SPYN trials. Posttest results showed that the trial format used to train the baseline relations had no differential effects on class formation; however, participants exposed to MTS training mastered the baseline relations in fewer trials and required less time than those in the SPYN group. Implications of these results and suggestions for future studies are discussed.

Gestational diabetes mellitus (GDM) is a common metabolic disorder affecting more than 16 million pregnancies annually worldwide1,2. GDM is related to an increased lifetime risk of type 2 diabetes (T2D)1–3, with over a third of women developing T2D within 15 years of their GDM diagnosis. The diseases are hypothesized to share a genetic predisposition1–7, but few studies have sought to uncover the genetic underpinnings of GDM. Most studies have evaluated the impact of T2D loci only8–10, and the three prior genome-wide association studies of GDM11–13have identified only five loci, limiting the power to assess to what extent variants or biological pathways are specific to GDM. We conducted the largest genome-wide association study of GDM to date in 12,332 cases and 131,109 parous female controls in the FinnGen study and identified 13 GDM-associated loci, including nine new loci. Genetic features distinct from T2D were identified both at the locus and genomic scale. Our results suggest that the genetics of GDM risk falls into the following two distinct categories: one part conventional T2D polygenic risk and one part predominantly influencing mechanisms disrupted in pregnancy. Loci with GDM-predominant effects map to genes related to islet cells, central glucose homeostasis, steroidogenesis and placental expression.

The purpose of this study was to use meta-analysis to assess the rates of bullying victimization in the United States (US) before and during the COVID-19 pandemic. Using a systematic search of academic databases and a previous meta-analysis database, we collected studies published between 1995 and 2023. Included studies used US-based data and reported on bullying involvement rates among children/adolescents across at least two data points (years), where 1 year had to be from 2020 to 2023. Data were extracted by type of bullying, gender, race, grade level, as well as numerous study-level features. Analyses included random effects meta-analyses, meta-regressions, and moderator analysis. Findings across the 79 studies and 19,033 effect sizes indicate that reported rates of traditional bullying victimization were significantly lower during the COVID pandemic years of 2020 to 2022 compared to the pre-pandemic years (23% vs 19%). This pattern was reflected across gender, grade, and most racial/ethnic groups examined. Overall, rates of cyberbullying victimization remained similar pre-pandemic vs during COVID (16% vs 17%). However, for boys, American Indian/Alaska Native youth, Asian, multi-racial, and White youth rates of cyberbullying victimization were significantly higher during COVID compared to the pre-pandemic period, while rates were significantly lower for transgender/non-binary youth during COVID (39% vs 25%). In addition, we conducted a moderator analysis and used meta-analysis to calculate pooled rates by year. Findings inform the current state of bullying involvement in the US and have implications for school-based bullying prevention practices and policies.

Graphing is an important skill that is used across various career fields. Behavior analysts have examined various methods for training individuals to use various graphing software packages (e.g., GraphPad Prism, Microsoft Excel) to manually create graphs. Behavior-analytic techniques, however, have been underused in fields outside of behavior analysis. Therefore, the purpose of the current study was to use the graphing tools developed by Lehardy et al. (2021) to create a treatment package featuring the graphing workbook, video tutorials, an itemized graphing checklist, and corrective feedback to train college students to create AB graphs in Microsoft Excel. The current study addressed some of the limitations and comments in the social validity survey of Lehardy et al. by providing the itemized checklist concurrently with the video tutorials. Graphing behavior increased to near 100% levels for all participants with an average session time of 43.58 min. Therefore, the results indicate that this procedure may be effective in increasing graphing skills in less than an hour with students across fields and levels. This study provides further evidence that behavior-analytic techniques are useful in a plethora of scenarios, and we should aim to disseminate these techniques within these various areas.

PDMATLAB2D is a meshfree peridynamics implementation in MATLAB suitable for simulation of two-dimensional fracture problems. The purpose of this code is twofold. First, it provides an entry-level peridynamics computational tool for educational and training purposes. Second, it serves as an accessible and easily modifiable computational tool for peridynamics researchers who would like to adapt the code for a multitude of peridynamics simulation scenarios. The current version of the code implements a bond-based brittle elastic peridynamic model and a critical stretch criterion for bond breaking. However, the code is designed to be extendable for other peridynamic models and computational features. In this paper, we provide an overview of the code structure and functions with illustrative examples. Due to the integrated computation and postprocessing MATLAB capabilities, PDMATLAB2D can serve as an effective testbed for testing new constitutive models and advanced numerical features for peridynamics computations.

Despite tremendous efforts in the past decades, relationships among main avian lineages remain heavily debated without a clear resolution. Discrepancies have been attributed to diversity of species sampled, phylogenetic method and the choice of genomic regions1–3. Here we address these issues by analysing the genomes of 363 bird species4(218 taxonomic families, 92% of total). Using intergenic regions and coalescent methods, we present a well-supported tree but also a marked degree of discordance. The tree confirms that Neoaves experienced rapid radiation at or near the Cretaceous–Palaeogene boundary. Sufficient loci rather than extensive taxon sampling were more effective in resolving difficult nodes. Remaining recalcitrant nodes involve species that are a challenge to model due to either extreme DNA composition, variable substitution rates, incomplete lineage sorting or complex evolutionary events such as ancient hybridization. Assessment of the effects of different genomic partitions showed high heterogeneity across the genome. We discovered sharp increases in effective population size, substitution rates and relative brain size following the Cretaceous–Palaeogene extinction event, supporting the hypothesis that emerging ecological opportunities catalysed the diversification of modern birds. The resulting phylogenetic estimate offers fresh insights into the rapid radiation of modern birds and provides a taxon-rich backbone tree for future comparative studies.

Background: In 2006, a concept paper (ICH S2(R1)) describing the need for revision of the ICH guidelines on genotoxicity testing for new “small molecule” pharmaceuticals (then ICH S2A and ICH S2B) was finalised. As a result, testing strategy has changed, and flexibility has been introduced in the form of two “equally suitable” options for completing the battery of genotoxicity studies required to support clinical development and marketing of new products. Methods: The TIBCO Spotfire®platform was used to create a specific view of available in-house data on genotoxicity studies conducted to support pharmaceutical product development over a period of approximately 12 years. The available in-house dataset comprised all reportable non-clinical data from Good Laboratory Practice (GLP) compliant and non-GLP/screening studies on regulated products (including pharmaceuticals, industrial chemicals, agrochemicals, and medical devices) across multiple testing sites, in different geographical locations. Results: The analysis showed clear trends in the numbers and types of genotoxicity studies conducted on small molecule pharmaceutical products during development, which correlated with the changes in the available regulatory guidance over time. More interestingly, where two “equally suitable” options for genotoxicity testing are described in the international guidance, there is a clear preference for ICH S2(R1) Option 1 (70–80% of testing) compared to Option 2 (20–30%). Conclusion: Use of ‘Big Data’ identified trends in the newer approach to genotoxicity testing by industry in the light of the updated regulatory guidance.

Being familiar with world religions and their diverse practices is referred to as religious literacy. The present study compared the effects of stimulus equivalence-based instruction (EBI) and video lecture (VL) to increase religious literacy in middle-school students; 10 participants were assigned to either the EBI or the VL group. Participants in the EBI group were taught five 6-member equivalence classes using match-to-sample (MTS) software on a computer. Within each class of (1) Judaism, (2) Islam, (3) Christianity, (4) Hinduism, and (5) Buddhism, the visual stimulus members were (A) name of the religion, (B) major religious symbol, (C) sacred text, (D) notable religious figure, (E) name of religious service leader, and (F) notable celebrated holiday. The VL participants were given an opportunity to complete a fill-in written worksheet while viewing a video lecture about the 5 religions using the same stimuli as the EBI group. Participant responding in each group was compared across worksheet, oral, and MTS pretests and posttests. The results showed that 5 of 5 participants in the EBI group formed equivalence classes but only 1of 5 did so in the VL group. Class-consistent responding generalized to oral vignettes to a greater degree for the EBI participants than for the VL participants. In addition, at an approximately 2-week follow-up, EBI participants maintained class-consistent responding to a greater degree than VL participants did. Duration measures showed that even though EBI was more effective, EBI training did require more time than the VL did. Although not explicitly programmed for, social distance survey scores showed that participants improved equally in their ratings of the acceptability of people from other faiths following training, regardless of training type. Thus, EBI may be an effective method to teach schoolchildren about religious literacy.

Extreme temperature-related events like heat waves or cold snaps can significantly stress the power distribution grid as electricity demand spikes leading to brownouts or blackouts if not managed properly. In addition, such extreme events can exacerbate inequity, with vulnerable populations (for example, houses with poor insulation, located in non-critical zones, and lack of local resources) at greater risk. There is a growing deployment of distribution systems automation technologies such as advanced metering infrastructure, sensors, and automated control systems to enhance the visibility of the entire distribution grid while meeting resilience objectives. This paper proposes a framework for investigating how automation can improve the distribution system's resilience and ensure customers' health and safety during such extremes. The proposed framework's efficacy will be demonstrated for the Electricity Reliability Council of Texas (ERCOT) during winter storm Uri with varying levels of distribution automation technologies such as feeder isolation using smart switches, remote outage signals using advanced meters, and comfort-aware outage using advanced analytics and communication. Simulation results show that an outage strategy involving advanced grid technology and communication can reduce the occupant exposure to severe cold by 93% and, simultaneously, reduce expected energy not served by 73.2% when compared against feeder isolation.

Teachers’ motivational strategies can be categorised into two types of motivating styles—autonomy-supportive style versus controlling style (Reeve in Educ Psychol 44:159–175, 2009). Several factors can affect the teachers’ use of motivational strategies, and student-related factors are some influential reasons. In this study, we focussed on identifying the student-related reasons that could affect the teachers’ motivating styles through 56 teacher interviews from 17 secondary schools across Singapore. From the teachers’ accounts, we identified “student profiles”, “students’ behaviours”, “students’ engagements”, and “students’ feedback” as the student-related factors that could affect the teachers’ motivating styles. By identifying these factors, we hope to raise awareness amongst the teachers (at the personal level) and their social environments (at the contextual level) on what can facilitate or thwart the expression of autonomy-supportive teaching. We also hope to provide useful information on what the social environments can do to support teachers in autonomy-supportive teaching.

Depression is associated with general sleep disturbance and abnormalities in sleep physiology. For example, compared with control subjects, depressed patients exhibit lower sleep efficiency, longer rapid eye movement (REM) sleep duration, and diminished slow-wave activity during non-REM sleep. A separate literature indicates that depression is also associated with many distinguishing memory characteristics, including emotional memory bias, overgeneral autobiographical memory, and impaired memory suppression. The sleep and memory features that hallmark depression may both contribute to the onset and maintenance of the disorder. Despite our rapidly growing understanding of the intimate relationship between sleep and memory, our comprehension of how sleep and memory interact in the aetiology of depression remains poor. In this narrative review, we consider how the sleep signatures of depression could contribute to the accompanying memory characteristics.

Spinal cord stimulation is an effective treatment for those experiencing chronic back and leg pain but requires a temporary evaluation period (SCSeval) before permanent implantation. We present real-world data from 7,000 patients who underwent SCSeval while utilizing a mobile digital health platform for education, feedback, and outcomes collection during their surgical journey. We analyzed preoperative patient demographics, characterized patient pain profiles using the patient-reported outcomes measurement information system-29 surveys, and calculated the rates of conversion from temporary to permanent spinal cord stimulation (SCS) implantation. Between August 1, 2021, and March 2, 2023, 7,000 patients (mean age 59.1, 59.6% female) underwent SCSeval procedures while utilizing a mobile application. Patients commonly experienced aching, sharp, stabbing, tingling, numb, and burning pain. Patients had tried multiple prior therapies and wanted to reduce their use of opioids and pain medications. Overall, 90.1% of the patients had a successful SCSeval, and 80.4% of those converted to permanent implant, with the highest rates among those who underwent SCSeval in a hospital setting. There was a significant improvement in all domains of pain as evaluated by pre and postoperative patient-reported outcomes measurement information system-29 surveys. This study supports the use of digital health technology as part of the SCS journey to improve the patient experience and allow for robust patient-reported outcomes collection. The overall rate of SCSeval to permanent SCS in our study of 72.4% was higher than national rates of 64%, suggesting that an app may allow clinicians to better quantify changes in chronic pain and provide more insight into choosing to implant SCS permanently.

Understanding orchard floor management is critical to organic tree-fruit production systems given its impact on weeds, soil fertility, tree health, and crop yield. Several viable options are available to producers for weed management and promotion of organic fertility, including use of turf and broadleaf alleyway covers and living and nonliving tree-row mulches. While these measures can be effective, little is known about how these strategies influence arthropod pests, which cause fruit injury. Here, we assessed 6 organic orchard floor management strategies for their impact on arthropod abundance and diversity in an organic peach production system in northern Utah from 2010 to 2014, using sweep netting and pitfall collections along with observed peach fruit damage. Generally, we found that alleyway and tree-row treatments had no impact on total arthropod diversity, species richness, or community diversity. However, earwig (Forficula auricularia) abundance was significantly impacted by alleyway and tree-row treatments that resulted in increased fruit injury. Trefoil alleyway treatments consistently increased earwig abundance across life-history stages, while mulch or Alyssum (straw) tree-row treatments harbored more earwigs and, as a result, increased earwig fruit injury. Since earwigs are especially prone to damaging young, developing fruits, it is imperative that more work is done to assess earwig abundances and life-history traits. Our results demonstrate that detrimental arthropods are sensitive to orchard floor management and can further inform integrated pest management approaches that complement sustainability goals.

Here, we discuss the required education and training for the emergent and evolving roles of GPs and other healthcare professionals within Integrated Care Systems (ICSs). We underscore the importance of collaborative skills for all medical specialties, and the need for interprofessional education and leadership development in undergraduate and postgraduate medical training. We also argue for a paradigm shift in medical education, away from traditional siloed approaches and toward comprehensive training that prepares practitioners to excel in integrated and multidisciplinary healthcare environments, within which expert generalists (GPs) and specialists collaborate in individual patient care and concurrently co-develop innovative system pathways for chronic medical conditions, including complexity and frailty. We highlight the need to align workforce development with evolving healthcare systems and the existing obstacles hindering this alignment.

Methotrexate (MTX) is effective in controlling disease activity in rheumatoid arthritis (RA). Parenteral MTX may have benefits over oral MTX, but it is rarely used in practice. To better understand this low usage rate, it is necessary to explore the barriers and enablers of therapy from the perspective of RA patients. The objectives of this scoping review were to describe RA patients’ perspectives on the barriers and enablers in the use of parenteral MTX and to identify the research gaps in this field. The search was performed in Medline, Embase, Scopus, and Cochrane Library from inception to May 2021. Data synthesis was conducted using the Theoretical Framework of Acceptability. This scoping review included any type of study that explored the use of parenteral MTX by adult RA patients from the patients’ perspective, written in English. Fifteen studies were included; findings related to the constructs “affective attitude,” “burden,” “intervention coherence,” and “self‐efficacy” were explored the most, while some were rarely (“opportunity cost” and “perceived effectiveness”) or not (“ethicality”) reported. RA patients were generally satisfied with MTX injections (“affective attitude”). From the burden construct, the requirement for dexterity for administering MTX by injection was considered a barrier, whereas the lack of significant pain from MTX injection was considered an enabler. The findings suggested that patients generally preferred parenteral MTX formulations with attributes that facilitate self‐administration. However, much of the identified research focused on prefilled pen devices, and significant gaps were identified, such as a lack of qualitative research.

ABSTRACTEquivalence classes are typically established by teaching arbitrary conditional discriminations with discrete single stimuli as samples and comparisons. The current study was the first to use compound stimuli as both samples and comparisons during training of conditional relations. We compared compound-to-compound stimuli MTS training with the more typical single-to-single stimuli training to establish two 4-member arbitrary stimulus classes with adults. A pretest-train-posttest between-groups experimental design was used. Compounds consisted of side-by-side pairs of individual (single) abstract symbols. A pretest and posttest consisting of MTS trials evaluating all single-to-single, single-to-compound, compound-to-single, and compound-to-compound relations were used to compare the effectiveness of the two training procedures. In addition, participants sorted cards depicting all single stimuli into piles both before and after MTS training. Results showed that stimulus classes were established with similar accuracy regardless of the training used. However, the compound-to-compound group participants required significantly fewer trials and training blocks to demonstrate class emergence than participants in the single-to-single group. In addition, the compound-to-compound group participants emitted significantly fewer errors during MTS training. We discuss how these results may inform use of stimulus equivalence procedures in mainstream settings (e.g., teaching academic content).

ABSTRACTTo establish baseline conditional relations during equivalence class formation, an opportunity to immediately respond a second time to the same trial following an error is typically not provided in studies with adults of typical development. Rather, the entire trial block is repeated until a specified mastery criterion is met. The present study is the first to compare immediately repeating a trial to not repeating that specific trial when baseline relations training errors occur. In this study, adults of typical development learned two different sets of two 4-member equivalence classes of abstract stimuli. A within-subjects design was used to compare the effects of immediately repeating or not repeating an incorrect trial. Results showed that equivalence classes were learned with similar accuracy and efficiency regardless of condition. However, maintenance of classes was significantly higher for participants in the repeating a trial condition, and participants strongly preferred this condition. Implications of these findings are discussed.

Marine renewable energy site and resource characterisation, in particular tidal stream energy, require detailed flow measurements which often rely on high-cost in situ instrumentation which is limited in spatial extent. We hypothesise uncrewed aerial vehicles (UAV) offer a low-cost and low-risk data collection method for tidal stream environments, as recently techniques have been developed to derive flow from optical videography. This may benefit tidal and floating renewable energy developments, providing additional insight into flow conditions and complement traditional instrumentation. Benefits to existing data collection methods include capturing flow over a large spatial extent synchronously, which could be used to analyse flow around structures or for site characterisation; however, uncertainty and method application to tidal energy sites is unclear. Here, two algorithms are tested: large-scale particle image velocimetry using PIVlab and dense optical flow. The methods are applied on video data collected at two tidal stream energy sites (Pentland Firth, Scotland, and Ramsey Sound, Wales) for a range of flow and environmental conditions. Although average validation measures were similar (~ 20–30% error), we recommend PIVlab processed velocity data at tidal energy sites because we find bias (underprediction) in optical flow for higher velocities (> 1 m/s).

Equivalence-based instruction (EBI) involves the teaching of socially relevant material (e.g., academic material) with stimulus equivalence procedures. In the research literature, training and testing of equivalence classes has been almost exclusively conducted on an individual basis. To extend the literature, the present study compared the effects of using EBI with an interdependent group contingency, individualized EBI (no group contingency), and a PowerPoint lecture on class formation with college students. The four equivalence classes taught consisted of information related to positive and negative reinforcement and punishment procedures. The members of each class were the name, definition, an example of the contingency, and the corresponding contingency table diagram. For the two EBI groups, a cloud-based student response system (SRS) application involving personal cell phones was used. To compare the effects of the different teaching protocols, three pretests and posttests were administered: (1) written fill-in, (2) written multiple-choice, and (3) card sorting. Results showed increased class-consistent responding across all three groups following training. However, written multiple-choice tests performances for the two EBI groups were significantly higher than for the lecture group, and the group-contingency EBI was significantly more effective for the fill-in written test than was lecture. Results also maintained at a 1-week follow-up. These results suggest that EBI can be effectively and efficiently implemented in more naturalistic settings, such as a classroom, while using free web-based technology.

Long term opioids are commonly prescribed to manage pain. Dose reduction or discontinuation (deprescribing) can be challenging, even when the potential harms of continuation outweigh the perceived benefits. The Evidence‐based clinical practice guideline for deprescribing opioid analgesicswas developed using robust guideline development processes and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology, and contains deprescribing recommendations for adults prescribed opioids for pain. Eleven recommendations provide advice about when, how and for whom opioid deprescribing should be considered, while noting the need to consider each person's goals, values and preferences. The recommendations aim to achieve: implementation of a deprescribing plan at the point of opioid initiation;initiation of opioid deprescribing for persons with chronic non‐cancer or chronic cancer‐survivor pain if there is a lack of overall and clinically meaningful improvement in function, quality of life or pain, a lack of progress towards meeting agreed therapeutic goals, or the person is experiencing serious or intolerable opioid‐related adverse effects;gradual and individualised deprescribing, with regular monitoring and review;consideration of opioid deprescribing for individuals at high risk of opioid‐related harms;avoidance of opioid deprescribing for persons nearing the end of life unless clinically indicated;avoidance of opioid deprescribing for persons with a severe opioid use disorder, with the initiation of evidence‐based care, such as medication‐assisted treatment of opioid use disorder; anduse of evidence‐based co‐interventions to facilitate deprescribing, including interdisciplinary, multidisciplinary or multimodal care. To our knowledge, these are the first evidence‐based guidelines for opioid deprescribing. The recommendations intend to facilitate safe and effective deprescribing to improve the quality of care for persons taking opioids for pain.

Managing problematic polypharmacy is a complex area of clinical practice and is increasingly recognised as an educational need for newly qualified and experienced GPs. The RCGP curriculum includes this area as a requirement for completion of training, but how this is achieved is devolved to trainers and trainees working in their local training programmes. GPs at all career stages continue to report feeling unconfident in this important, but complex, area of practice. This article aims to address some of these concerns. We will outline the evidence about barriers preventing clinicians from reducing problematic polypharmacy in practice. We will introduce evidence from the Tailor report describing how these barriers can be overcome and focus on the role of trainees and newly qualified GPs in managing problematic polypharmacy. The Tailor report is a recently published synthesis of the evidence surrounding the management of polypharmacy. In particular we will focus on a key output from the report – the DExTruS framework. This has potential applications in GP training and provides a useful structure for developing the skill of deprescribing by AiTs.