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IntroductionPreventable adverse effects of medicines often pass unnoticed, but lead to real harm.InterventionNurse-led monitoring using the structured Adverse Drug Reaction (ADRe) Profile identifies and addresses adverse effects of mental health medicines.ObjectivesThis study investigated the implementation and clinical impact of ADRe, and barriers to and facilitators of sustained utilisation in routine practice.MethodsAdministration of ADRe was observed for 30 residents prescribed mental health medicines in ten care homes. The study pharmacist reviewed completed ADRes against medication records. Policy context was explored in 30 interviews with service users, nurse managers and strategic leads in Wales.ResultsResidents were aged 60-95, and prescribed 1-17 (median 9 [interquartile range (IQR) 7-13]) medicines. ADRe identified a median of 18 [IQR 11.5-23] problems per resident and nurses made 2 [1-2] changes to care per resident. For example: falls were reported for 9 residents, and care was modified for 5; pain was identified in 8 residents, and alleviated for 7; all 6 residents recognised as dyspnoeic were referred to prescribers. Nurses referred 17 of 30 residents to prescribers. Pharmacists recommended review for all 30. Doubts about administering ADRe, sometimes expressed by people who had not yet used it, diminished as it became familiar. ADRe was needed to bridge communication between resident, nurses and prescribers. When barriers of time, complacency, and doctors' non-availability were overcome, reporting with ADRe made prescribers more likely to heed nurses' concerns regarding residents' welfare. Clinical gains were facilitated by one-to-one time, staff-resident relationships, and unification of documentation.ImplicationsTo our knowledge, ADRe is the only instrument that brings a full account of patients' problems to medication reviews. This juxtaposition of signs and symptoms against prescriptions facilitates dose adjustments and de-prescribing and leads to: reduced pain and sedation; early identification of problems linked to ADRs, such as falls; and timely medication reviews e.g. for dyspnoea.

Background: As an umbrella term, social prescribing offers varied routes into society which promise to support, enhance, and empower individual citizens to take control of their own health and wellbeing. Globally healthcare systems are struggling to cope with the increasing demands of an ageing population and the NHS (UK) is no exception. Social prescribing is heralded as a means to relieve the burden on primary care and provide support for the 20% of patients whose needs are non-medical. As such an increasing array of schemes are available, spanning five sub-sets: creative or nature-based referrals, welfare services, exercise referrals, education programmes or befriending support. Green social prescription offers significant potential to promote wellbeing and improve health outcomes. However limited research has explored this emergent sub-set., Aim: Explore and interrogate the concept of social prescribing to understand how it is conceptualised, perceived, and experienced by different stakeholders involved in its coordination, delivery, and provision; At a time when it is being formalised in Wales, UK., Methods: Using qualitative enquiry, from a social constructivist paradigm, stakeholder perspectives pertaining to current social prescribing models, pathways and actions in Wales were explored. Three multi-discipline research workshops and ten semi-structured, one-to-one interviews were conducted either in person or via zoom. Qualitative data were analysed thematically., Results: 39 different stakeholders contributed. These included social prescribers, community connectors, service coordinators, third sector and voluntary organisation representatives, a general practitioner, occupational therapist, social enterprisers, academics and local area coordinators. Five themes were identified which revolved around stakeholders discussions of critical challenges pertaining to the delivery, provision, and evaluation of green social prescribing schemes in south Wales, UK. Tension between varying stakeholders was also evident, often preceded, or complicated by funding discrepancies, competition, and uncertainty. Stakeholders demanded clarity regarding evaluation outcomes and benchmarking across the sector., Conclusions: To ensure the continued provision of social prescribing schemes which are highly valued by service users, voluntary and third sector organisations require funding security and stability. The delivery of green, nature-based, schemes require maintenance of trusting, long-term relationships with local service co-ordinators and referrers, secure equitable funding models and agreement over conceptual basis of social prescribing itself, particularly in relation to 'where' social prescribing is located within health and social care models. Without resolution and positive progress across these areas the continuation of local green schemes within local communities, which build resilience and support positive change for service users' health and wellbeing, is questionable., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Brown, Aylett. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Aquaporin 1 (AQP1) is a key channel for water transport in peritoneal dialysis. Inhibition of AQP1 could therefore impair water transport during peritoneal dialysis. It is not known whether inhibition of AQP1 occurs unintentionally due to off-target interactions of administered medications. A high-throughput virtual screening study has been performed to investigate the possible binding of licensed medications to the water pore of human AQP1. A complete model of human AQP1 based on its canonical sequence was assembled using I-TASSER and MODELLER. The model was refined via the incorporation of pore water molecules from a high-resolution yeast aquaporin structure. Docking studies were conducted for the cytoplasmic domain of the AQP1 monomer against a library of all compounds listed in the British National Formulary (BNF), using the PLANTS software with the ChemPLP scoring function. The stability of the best docked conformations within the intrinsic water pore was assessed via short 15 nanosecond molecular dynamics (MD) simulations using the GROMACS-on-Colab utility. Of the 1512 compounds tested, 1002 docking results were obtained, and 198 of these conformations occupied a position within the intrinsic water pore. 30 compounds with promising docking scores were assessed by MD. The docked conformations for dopamine, gabapentin, pregabalin, and methyldopa were stable in these short MD studies. For furosemide and pravastatin, the MD trajectory suggested a binding mode different to the docking result. A small set of compounds which could impede water transport through human AQP1 have been identified in this computational screening study., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 Lloyd et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Self-reported height and weight is widely used to calculate Body Mass Index (BMI) and yet little is known about factors that affect accuracy. This study investigated the motivational characteristics-narcissism and social desirability-that influence the accuracy of self-reported weight and how they interact with accountability (telling participants that their weight will be verified). A two-way between-subjects design was used (accountable vs not accountable) with motivational moderators (narcissism and social desirability). Participants (N = 80; Mean Age = 34.63; 58.8% Female) were randomly allocated to accountable (told that their weight would be verified in a follow-up lab session) or not-accountable (no information given) conditions. In Session 1, participants self-reported motivational (social desirability and narcissism) and anthropometric (height and weight) measures online. In Session 2 (24 hours later), objective measures of height and weight were taken in the lab. There was a significant interaction between condition and maladaptive narcissism level. Being told that weight would be later verified improved accuracy of self-reported weight, but only for those low in maladaptive narcissism. Accountability improves the accuracy of self-report weight data, but not for individuals high in narcissism. Though based on a modest sample, these findings suggest that the under-estimation of self- report weight serves a self-protective function and maladaptive narcissism may be a useful covariate to include in research using self-report weight estimates., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Price et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Pop-out effects occur when a novel or different stimulus is presented in the context of an array of otherwise familiar or similar stimuli. The effect has been studied using words extensively, but little evidence exists for humans relating to nonverbal stimuli. Although the finding has implications for understanding features of stimuli that capture attention, contradictory findings exist, and previous paradigms have limited applicability to real world situations. Given this, an experiment employed a novel procedure to investigate whether category pop-out effects, where one item is drawn from a different category to the others, could be obtained with pictorial stimulus array. It also investigated whether pop-out effects could be generated with a single continuous pre-exposure procedure, as would be experienced in a naturalistic setting, or whether they were the results of biases introduced by the repetitive pre-exposure procedures, typically used in such studies. The latter finding would undermine the use of such findings to support ecologically-valid models of attention. Both of these questions were answered in the affirmative: category pop-out effects were obtained using picture stimuli; and such effects were obtained with a single continuous pre-exposure. Further development this novel procedure may allow exploration of evolutionary and neurological aspects of selective attention effects., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 McCarthy, Reed. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: Tobacco consumption is associated with an increased risk of morbidity and mortality. India is one of the largest consumers of tobacco worldwide. We assessed the trend of tobacco use among Indian males over a period of 20 years using data obtained from four rounds of the National Family Health Survey (NFHS)., Methods: Data on tobacco usage and relevant socioeconomic variables obtained from NFHS rounds 2 to 5 over the period 1998-2021, was used for analysis. Specifically, data were available for 138,951 males from NFHS-2, 74,369 males from NFHS-3, 112,222 males from NFHS-4, and 101,839 males from NFHS-5. Significance of association between various socio-economic factors and tobacco usage was ascertained using a multicategory logistic regression model., Results: Among all the forms of tobacco, smokeless tobacco was predominantly used by Indian males. The proportion of smokers and those using both smoke and smokeless forms peaked during NFHS-3, followed by a consistent dip; however, the use of smokeless tobacco plateaued from NFHS-4 to NFHS-5. NFHS-5 shows that 19.2% of Indian males smoked, 27.0% used smokeless tobacco, and 6.3% used both. Tobacco use has declined significantly over the last two decades. Tobacco usage is noticeably higher among the elderly, Muslims, and those from the backward classes, while it was considerably lower for individuals belonging to the educated and wealthier segment., Conclusion: There has been a steady decline in tobacco use in India over the past 22 years, specifically in the smoke-form category. However, smokeless tobacco use remains nearly unaffected. The outcome of this study might aid policymakers in devising targeted tobacco control policies and improving existing ones., Competing Interests: The authors have no relevant financial or non-financial interests to disclose., (Copyright: © 2024 Gupta et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Active travel offers many societal benefits, including improving people's mental and physical health and minimising our impacts on the environment. Increasing active travel is particularly important amongst children and young people (CYP), who are building habits which they will carry into adulthood. Studies on active travel amongst CYP are limited, however, with most research focusing on adult participants or on adult perceptions of children. This study sought to understand CYP's interactions with the built and natural environment-and therefore their access to active travel-through the Capability, Opportunity, Motivation, Behaviour (COM-B) model. With a stakeholder group representing local government, youth organisations and active travel organisations, we co-created two bilingual questionnaires-one for young people aged 12-16 years living in Wales and the other for parents of young people aged 12-16 years living in Wales. Both questionnaires collected information on behaviour and perceived capability, opportunity and motivation of CYP to engage with their natural and built environments. The questionnaires included a discrete choice experiment (DCE), which proposed a series of binary choice questions indicating preferences based on landscape, journey time and type of travel. A total of 124 questionnaires (38 young people and 86 parents) were returned for analysis. These data indicate that CYP's time spent outdoors is not dependent upon geography (rural/urban/suburban), season, or school holidays. There was a significant difference in capability, opportunity and motivation between parents and CYP, with parents over-estimating the psychological capability of CYP to engage outdoors. The preference data indicate that active travel is the favoured mode of transport, with both CYP and parents stating that they would increase travel time in order to travel actively. While this response is not consistent with respondent's day-to-day travel choices, it suggests that the limitations to active travel may be psychological capability and automatic motivation, rather than a lack of opportunity., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Holmes et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Exposure to adverse childhood experiences (ACEs) is recognised globally as a risk factor for health problems in later life. Awareness of ACEs and associated trauma is increasing within schools and educational settings, as well as the demand for supportive services to address needs. However, there is a lack of clear evidence for effective interventions which can be delivered by non-clinicians (e.g., the school staff themselves). Thus, we undertook a systematic review to answer the question: What evidence exists for the efficacy of non-clinician delivered trauma-based interventions for improving mental health in school-age youth (4-18 years) who have experienced ACEs? The protocol for the review is registered in the PROSPERO International Prospective Register of Systematic Reviews (ID: CRD42023417286). We conducted a search across five electronic databases for studies published between January 2013 and April 2023 that reported on interventions suitable for non-clinician delivery, were published in English in the last 10 years, and involved participants aged 4-18 years (school-age) that had exposure to ACEs. Of the 4097 studies identified through the search, 326 were retrieved for full text screening, and 25 were included in the final review. Data were extracted from included articles for analysis and selected studies were quality assessed using validated assessment tools. Data were analysed through narrative synthesis. There was considerable heterogeneity in study design, outcome measures, and the interventions being studied. Interventions included CBT, mindfulness and art-based programs. A key finding was that there is a lack of high-quality research evidence to inform non-clinician delivered trauma-informed interventions. Many included studies were weak quality due to convenience sampling of participants and potential bias. Cognitive Behavioural Therapy (CBT)-based approaches are tentatively suggested as a suitable target for future rigorous evaluations of interventions addressing ACE-related trauma recovery and mental health improvement in school-age youth., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Avery et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Development of resistance and tolerance to antifungal drugs in Candida albicans can compromise treatment of infections caused by this pathogenic yeast species. The uniquely expanded C. albicans TLO gene family is comprised of 14 paralogous genes which encode Med2, a subunit of the multiprotein Mediator complex which is involved in the global control of transcription. This study investigates the acquisition of fluconazole tolerance in a mutant in which the entire TLO gene family has been deleted. This phenotype was reversed to varying degrees upon reintroduction of representative members of the alpha- and beta-TLO clades (i.e. TLO1 and TLO2), but not by TLO11, a gamma-clade representative. Comparative RNA sequencing analysis revealed changes in the expression of genes involved in a range of cellular functions, including ergosterol biosynthesis, mitochondrial function, and redox homeostasis. This was supported by the results of mass spectrometry analysis, which revealed alterations in sterol composition of the mutant cell membrane. Our data suggest that members of the C. albicans TLO gene family are involved in the control of ergosterol biosynthesis and mitochondrial function and may play a role in the responses of C. albicans to azole antifungal agents., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 O’Connor-Moneley et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Both diabetes mellitus (DM) and hypertension (HTN) have been on the rise in recent decades all over the world more remarkably in developing countries like India. We intend to measure the prevalence of DM and HTN in the Indian population and to compare the trends and various correlates of these diseases in NFHS (National Family Health Survey)-4 and 5. Data of NFHS-4 and 5 were accessed from dhs program website. All statistical analyses were done in SAS (version 9.4). Mixed effects survey logistic regression models were used for estimating odds ratio (OR).p-values <0.05 were considered significant .1,637,762 individual case entries were evaluated. Both the diseases showed an increasing trend as per the advancing age in both sexes. The highest prevalence of DM is seen in the age group of 45-49 years (7.8%) in females and > 50 years (11.9%) in males as per NFHS-5. Similarly, the highest prevalence of HTN was seen in the age group of45-49 years (31.2%) in females and > 50 years (41.4%) in males as per NFHS-5. The OR (95% CI) of prevalence of DM, HTN and both the diseases in age group >50 years was 14.46 (13.14-15.7), 16.65 (15.78-17.6), 79.5 (64.76-97.73) respectively when compared to reference age group15-19 years. Highest odds for having both DM, HTN concurrently was in age >50 years with aOR(95% CI) 65.32 (52.26-72.63) in NFHS 4 and 35.57 (97.47-45.53) in NFHS 5.Rise in prevalence of DM, HTN and concurrent presence is noted with an apparent increase in cases., Competing Interests: No conflicting interest., (Copyright: © 2024 Rana et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

This study aimed to evaluate the effect of discrete passages of play on locomotor demands of international men's and women's rugby sevens matches and their relationship with winning or losing. Thirteen men's and thirteen women's international rugby sevens players wore 10 Hz Global Positioning Systems during twelve Tokyo Olympic games matches (966 observations; 507 for men, 459 for women). Discrete ball-in-play periods were categorised as: 'Single-phase defence', 'single-phase attack', 'multi-phase defence', 'multi-phase attack', 'multi-phase defence to attack', or 'multi-phase attack to defence'. Relative total distance, alongside high-speed (>5.0 m∙s-1), acceleration (>3 m∙s-2), and deceleration (>3 m∙s-2) distances were recorded for each passage. Separately for men and women, linear mixed models examined the effect of passage type and match outcome (win or loss) on locomotor demands, whilst controlling for opposition ranking. In men, relative total distance ranged from 137 m∙min-1 to 174 m∙min-1 for 'multi-phase defence to attack' and 'multi-phase attack', respectively. In women, 'multi-phase attack' elicited the lowest relative total distance (118 m∙min-1), whereas the greatest values (186 m∙min-1) were recorded for 'single-phase defence'. For men, there were significant interactions between match outcome and passage type for relative total (p<0.001) and high-speed (p = 0.006) distance. During 'multi-phase attack', relative total distance was greater for wins versus losses (174 vs 138 m.min-1, p = 0.024). However, for 'single-phase defence', relative total distance was lower for wins (128 vs 164 m.min-1, p<0.001). For women, there were significant interactions between match outcome and passage type for relative total (p = 0.036), high-speed (p = 0.003), and deceleration (p = 0.015) distances. Locomotor responses were influenced by passage type and match result for men and women. Knowing the demands of each passage type may inform training drills targeted at developing match-play-specific physical, technical, and tactical adaptations. Understanding how passages differ between matches won and lost could also inform team technical/tactical preparation including selection., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Hills et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Skin cancer comprises half of all cancers in England and Wales. Most skin cancers can be prevented with safer sun exposure. As over exposure as a child can greatly increase future skin cancer risk, early and accessible sun safety education and promotion of sun safe behaviours is critical. Scientists agree there is no such thing as a 'safe tan', yet the public, including children, often have positive perceptions of tanned skin. To protect against future skin cancer, it is important to understand and address these misconceptions. The Curriculum for Wales with its area for Health and Well-being, and autonomy for schools in designing curriculum content, presents an ideal way to facilitate this exploration., Aims: Gather data regarding perceptions towards tanning to explore the perceived effects of a tan on health.Inform the development and testing of an educational toolkit for integration within the Curriculum for Wales to encourage positive health behaviours and attitudes of school children towards tanning and sun exposure., Methods: SunChat is a mixed methods exploratory study comprising three work streams: Workshops with school children to understand their perceptions on tanning.An online multiple-choice survey with parents/carers to understand perceptions, attitudes and behaviours towards tanning both for themselves and their children.An informal focus group with primary school educators to explore challenges in engaging with the school community around the Health and Well-being Area in the Curriculum for Wales., Discussion: To date, there has been no work in Wales exploring children's, parents/carers', and educators' perceptions of tanning and how healthier attitudes can be encouraged. This study will engage with participants to scope current perceptions on tanning and the perceived effects tanning has on health. Findings will feed into future toolkit and curriculum development for health in schools in Wales and beyond., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Tur Porres et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Autistic people are more likely to experience stigma, communication barriers and anxiety during healthcare. Autism Health Passports (AHPs) are a communication tool that aim to provide information about healthcare needs in a standardised way. They are recommended in research and policy to improve healthcare quality., Aim: To explore views and experiences of AHPs among Autistic people from the UK who have been pregnant., Methods: We developed an online survey using a combination of open and closed questions focused on healthcare impairments and views and experiences of AHPs. Data were anlaysed using descriptive statistics, Kruskal-Wallis tests, and content analysis., Findings: Of 193 Autistic respondents (54% diagnosed, 22% undergoing diagnosis and 24% self-identifying), over 80% reported anxiety and masking during healthcare always or most of the time. Some significant differences were identified in healthcare (in)accessibility by diagnostic status. Only 4% of participants knew a lot about AHPs, with 1.5% of participants using one at least half of the time. Almost three quarters of respondents had not previously seen an AHP. Open text responses indicated that the biggest barrier to using an AHP was a belief that health professionals would discriminate against Autistic patients. Additional barriers included staff lack of familiarity with AHPs and respondents expecting a negative response to producing an AHP., Conclusions: Our findings suggest that AHPs are not reducing health inequalities for Autistic adults who have been pregnant. Alternative solutions are needed to reduce health inequalities for Autistic people., Competing Interests: I have read the journal’s policy and the authors of this manuscript have the following competing interests: AG is a non-executive Director of Disability Wales. SS is the research lead for Autistic Doctors International, a peer support and advocacy group which is not a legal entity. KW is a non-executive director for Autistic UK a Community Interest Company. This does not alter our adherence to PLOS ONE policies on sharing data and materials. None of the three individuals receive a salary for these affiliations. The organisations did not have any role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. The remaining authors declare no competing interests., (Copyright: © 2024 Grant et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Research pertaining to the experiences of women in rugby is scarce, which, coupled with the limited visibility of the sport and difficulty accessing resources, suggest that women's rugby remains undervalued. Indeed, evidence of such gender inequalities remains largely anecdotal, with little rigorous research undertaken to understand the perspectives of women in rugby. This study aimed to explore the experiences of a diverse cohort of rugby players in relation to their participation in the sport and their ability to access resources. Twenty UK-based rugby players (10 men, 9 women and 1 non-binary person aged 29.1 ± 8.3 years) from school, university, club, military, and semi-professional environments, volunteered to participate in semi-structured interviews (36 ± 12 minutes) discussing their rugby experiences in relation to their gender and playing level. Interviews were transcribed verbatim, and a reflexive thematic analysis was undertaken. A widespread under-prioritisation of women in rugby was highlighted. Gender biases were apparent in access to changing rooms, pitches, quality coaches, and playing opportunities, and were reportedly propagated at the managerial level. Irrespective of gender, some amateur players reported difficulty accessing a suitable rugby environment. Insufficient player numbers precluded the formation of second teams, often resulting in inexperienced players competing beyond their ability. Women's rugby players experienced considerable gender bias. This exploratory study highlights a need to address such issues to protect player welfare. Interventions to change the culture in rugby clubs and increased representation of women in managerial positions in rugby are recommended to enact meaningful change., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Petrie et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Routine monitoring of Body Mass Index (BMI) in general practice, and via national surveillance programmes, is essential for the identification, prevention, and management of unhealthy childhood weight. We examined and compared the presence and representativeness of children and young people's (CYPs) BMI recorded in two routinely collected administrative datasets: general practice electronic health records (GP-BMI) and the Child Measurement Programme for Wales (CMP-BMI), which measures height and weight in 4-5-year-old school children. We also assessed the feasibility of combining GP-BMI and CMP-BMI data for longitudinal analyses., Methods: We accessed de-identified population-level GP-BMI data for calendar years 2011 to 2019 for 246,817 CYP, and CMP-BMI measures for 222,772 CYP, held within the Secure Anonymised Information Linkage Databank. We examined the proportion of CYP in Wales with at least one GP-BMI record, its distribution by child socio-demographic characteristics, and trends over time. We compared GP-BMI and CMP-BMI distributions. We quantified the proportion of children with a CMP-BMI measure and a follow-up GP-BMI recorded at an older age and explored the representativeness of these measures., Results: We identified a GP-BMI record in 246,817 (41%) CYP, present in a higher proportion of females (54.2%), infants (20.7%) and adolescents. There was no difference in the deprivation profile of those with a GP-BMI measurement. 31,521 CYP with a CMP-BMI had at least one follow-up GP-BMI; those with a CMP-BMI considered underweight or very overweight were 87% and 70% more likely to have at least one follow-up GP-BMI record respectively compared to those with a healthy weight, as were males and CYP living in the most deprived areas of Wales., Conclusions: Records of childhood weight status extracted from general practice are not representative of the population and are biased with respect to weight status. Linkage of information from the national programme to GP records has the potential to enhance discussions around healthy weight at the point of care but does not provide a representative estimate of population level weight trajectories, essential to provide insights into factors determining a healthy weight gain across the early life course. A second CMP measurement is required in Wales., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Griffiths et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Semi-articulated remains of a large chelonioid turtle from the Turonian strata (Upper Cretaceous; ca. 93.9-89.8 Myr) near Sant'Anna d'Alfaedo (Verona province, northeastern Italy) are described for the first time. Together with the skeletal elements, the specimen also preserves pebbles inside the thoracic area which are lithologically distinct from the surrounding matrix. These allochthonous clasts are here interpreted as geo-gastroliths, in-life ingested stones that resided in the digestive tract of the animal. This interpretation marks the first reported evidence of geophagy in a fossil marine turtle. SEM-EDS analysis, together with macroscopic petrological characterization, confirm the presence of both siliceous and carbonatic pebbles. These putative geo-gastroliths have morphometries and size ranges more similar to those of gastroliths in different taxa (fossils and extant) than allochthonous "dropstone" clasts from the same deposit that were carried by floating vegetation A dense pitted pattern of superficial erosion is microscopically recognizable on the carbonatic gastroliths, consistent with surface etching due to gastric acids. The occurrence of a similar pattern was demonstrated by the experimental etching of carbonatic pebbles with synthetic gastric juice. Gut contents of modern green sea turtles (Chelonia mydas) were surveyed for substrate ingestion, providing direct evidence of geophagic behavior in extant chelonioids. Comparison with modern turtle dietary habits may suggests that the pebbles were ingested as a way to supplement calcium after or in preparation for egg deposition, implying that the studied specimen was possibly a gravid female., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Serafini et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Numerous concussion-management protocols have been developed in rugby, though little is known about player's personal experiences of concussion. Specifically, research typically refers to clinical recovery, with social and psychological sequelae post-concussion gaining little attention. This study aimed to explore the experiences of rugby players in relation to being concussed and recovering from concussion. UK-based rugby players (10 men, 9 women and 1 non-binary person) from school, university, club, military and semi-professional teams took part in semi-structured interviews (36 ± 12 minutes). Interviews were transcribed verbatim, and a reflexive thematic analysis was conducted. Players considered pitch-side healthcare a necessity, though amateur players highlighted the difficulty in consistently accessing this resource. In the absence of medical staff, players were reliant on the goodwill of volunteers, but their response to concussion did not always align with current concussion guidance. Players highlighted that concussion recovery could be socially isolating and that current return-to-play programmes did little to restore lost confidence, resulting in retirement from the game in some instances. Participants expressed a desire for more in-person concussion education and for greater coverage of holistic methods to support their recovery. This study highlights a need for further investigation of the post-concussion social and psychological changes that players may experience during their recovery. Greater focus on information relating to concussion recovery and return-to-contact in education programmes would likely benefit player welfare., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Petrie et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Echogenic Intracardiac Foci (EIF) are non-structural markers identified during the routine 18-20-week foetal anomaly ultrasound scan yet their clinical significance on future outcomes for the infant is unclear., Objective: To examine the association between EIF and risk of preterm birth, chromosomal abnormalities, and cardiac abnormalities., Design: A review across four databases to identify English language journal articles of EIF using a cohort study design. All studies were reviewed for quality using the Critical Appraisal Skills Programme (CASP) checklist and data extracted for comparison and analysis., Results: 19 papers from 9 different countries were included. Combining these studies showed 4.6% (95% CI = 4.55-4.65%) of all pregnancies had EIF which was on the left in 86% of cases, on the right in 3% of cases and bilaterally in 10%. There was no evidence that EIF was associated with higher rates of preterm birth. However, it is possible that infants with EIF were more likely to be terminated rather than be born preterm as there was a 2.1% (range 0.3-4.2%) rate of termination or death of the foetus after week 20 among those with EIF. There was no evidence that EIF alone is highly predictive of chromosomal abnormalities. There was evidence that EIF is associated with higher rates of minor cardiac abnormalities (e.g. ventricular septal defect, tricuspid regurgitation or mitral regurgitation)) with 5.1% (224 of 4385) of those with EIF showing cardiac abnormalities (3.08% in retrospective studies and 17.85% in prospective studies). However, the risk of cardiac defects was only higher with right-sided EIF and where the EIF persisted into the third trimester. However, this is a rare event and would be seen in an estimated 4 per 10,000 pregnancies., Conclusion: EIF alone was not associated with adverse outcomes for the infant. Only persistent EIF on the right side showed evidence of carrying a higher risk of cardiac abnormality and would warrant further follow-up., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Jones et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The COVID-19 pandemic caused far-reaching societal changes, including significant educational impacts affecting over 1.6 billion pupils and 100 million education practitioners globally. Senior school leaders were at the forefront and were exposed to particularly high demands during a period of "crisis leadership". This occupation were already reporting high work-related stress and large numbers leaving the profession preceding COVID-19. This cross-sectional descriptive study through the international COVID-Health Literacy network aimed to examine the well-being and work-related stress of senior school leaders (n = 323) in Wales (n = 172) and Northern Ireland (n = 151) during COVID-19 (2021-2022). Findings suggest that senior school leaders reported high workloads (54.22±11.30 hours/week), low well-being (65.2% n = 202, mean WHO-5 40.85±21.57), depressive symptoms (WHO-5 34.8% n = 108) and high work-related stress (PSS-10: 29.91±4.92). High exhaustion (BAT: high/very high 89.0% n = 285) and specific psychosomatic complaints (experiencing muscle pain 48.2% n = 151) were also reported, and females had statistically higher outcomes in these areas. School leaders were engaging in self-endangering working behaviours; 74.7% (n = 239) gave up leisure activities in favour of work and 63.4% (n = 202) sacrificed sufficient sleep, which was statistically higher for females. These findings are concerning given that the UK is currently experiencing a "crisis" in educational leadership against a backdrop of pandemic-related pressures. Senior leaders' high attrition rates further exacerbate this, proving costly to educational systems and placing additional financial and other pressures on educational settings and policy response. This has implications for senior leaders and pupil-level outcomes including health, well-being and educational attainment, requiring urgent tailored and targeted support from the education and health sectors. This is particularly pertinent for Wales and Northern Ireland as devolved nations in the UK, who are both implementing or contemplating major education system level reforms, including new statutory national curricula, requiring significant leadership, engagement and ownership from the education profession., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Marchant et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Robust evidence supports the role of physical activity and exercise in increasing longevity, decreasing morbidity and helping older adults maintain the highest quality of life attainable. However, the majority of older adults are not sufficiently physically active and interventions are needed to change their behaviors. Familial or intergenerational contact has been positively linked to health and well-being in older adults. Therefore, this study aimed to i) establish acceptability and test the functionality and useability of a novel technology-driven intergenerational intervention targeting physical activity and age stereotypes, and ii) identify any potential issues with recruitment and retention. Four familial dyads (adult ≥ 65 and child 7-11 years) engaged with the intervention. Working collaboratively during a four-week trial, they combined daily step-counts (acquired via any activity of their choice, using PA trackers) to complete a virtual walk route using online platform World Walking. Thematic analysis of three post-intervention focus groups (one older adult; one child; one additional parental cohort) identified eight subthemes: Engagement; Provision of a Positive Experience; Participant Stimuli; Generated Outcomes; Operationality; Limitations; Mediators; Facilitators, and Perceptions. Participants enjoyed and successfully engaged with the intervention; when designing behaviour change interventions for older adults, flexibility within pre-established routines, individual choice, and avoiding rigidly imposed structures, is important. Strategies to challenge negative perceptions of older adults' engagement with technology and PA should be integrated into recruitment processes., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Knight et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Self-report and device-based measures of physical activity (PA) both have unique strengths and limitations; combining these measures should provide complementary and comprehensive insights to PA behaviours. Therefore, we aim to 1) identify PA clusters and clusters of change in PA based on self-reported daily activities and 2) assess differences in device-based PA between clusters in a lifestyle intervention, the PREVIEW diabetes prevention study. In total, 232 participants with overweight and prediabetes (147 women; 55.9 ± 9.5yrs; BMI ≥25 kg·m-2; impaired fasting glucose and/or impaired glucose tolerance) were clustered using a partitioning around medoids algorithm based on self-reported daily activities before a lifestyle intervention and their changes after 6 and 12 months. Device-assessed PA levels (PAL), sedentary time (SED), light PA (LPA), and moderate-to-vigorous PA (MVPA) were assessed using ActiSleep+ accelerometers and compared between clusters using (multivariate) analyses of covariance. At baseline, the self-reported "walking and housework" cluster had significantly higher PAL, MVPA and LPA, and less SED than the "inactive" cluster. LPA was higher only among the "cycling" cluster. There was no difference in the device-based measures between the "social-sports" and "inactive" clusters. Looking at the changes after 6 months, the "increased walking" cluster showed the greatest increase in PAL while the "increased cycling" cluster accumulated the highest amount of LPA. The "increased housework" and "increased supervised sports" reported least favourable changes in device-based PA. After 12 months, there was only minor change in activities between the "increased walking and cycling", "no change" and "increased supervised sports" clusters, with no significant differences in device-based measures. Combining self-report and device-based measures provides better insights into the behaviours that change during an intervention. Walking and cycling may be suitable activities to increase PA in adults with prediabetes., Competing Interests: Ian MacDonald: Principle investigator of the Nottingham site, conception of the study, editing of the manuscript. International Life Sciences Institute (ILSI) Europe: Member of Dietary Carbohydrates Task Force, Member of expert group on ’Efficacy Markers of Diabetes Risk’. Travel and subsistence paid but no attendance fees. Nature Publishing Group (Springer Nature) - Editor International Journal of Obesity. Travel and accommodation re-imbursed and honorarium paid (Amount received per annum over £5,000: yes). Nestle Research - Scientific Advisory Board. Travel and accommodation reimbursed, and honorarium paid (Amount received per annum over £5,000: yes) Mars Incorporated-Waltham Centre for Pet Nutrition Peer-review of pet nutrition research projects honorarium received (Amount received per annum over £5,000: no); Mars UK/Europe - Member of Nutrition Advisory Board, and Health and Wellbeing Committee travel and subsistence costs reimbursed. Honorarium paid to the University of Nottingham. Mars Incorporated - Member of Mars Scientific Advisory Committee. Honorarium paid to the University of Nottingham. Novozymes - Member of Science Advisory Board. Travel and subsistence costs reimbursed. Honorarium paid to the University of Nottingham. Public Health England - Member of Scientific Advisory Committee on Nutrition. Travel and accommodation re-imbursed and honorarium paid (Amount received per annum over £5,000: no) Jennie Brand-Miller: Principle investigator of the Sydney site and participated in editing of the manuscript. Jennie Brand-Miller is President and Director of the Glycemic Index Foundation and oversees a glycemic index testing service at the University of Sydney. She receives royalties for books about carbohydrates, obesity and diabetes. This does not alter our adherence to PLOS ONE policies on sharing data and materials., (Copyright: © 2024 Klos et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Mosquitoes of the genera Aedes, Anopheles and Culex vector a wide range of pathogens seriously affecting humans and livestock on a global scale. Over-reliance on insecticides and repellents has driven research into alternative, naturally-derived compounds to fulfil the same objectives. Steam distilled extracts of four plants with strong, yet attractive, volatile profiles were initially assessed for repellency in a dual-port olfactometer using Aedes aegypti as the model species. Picea sitchensis was found to be the most repellent, proving comparable to leading products when applied at 100% (p = 1.000). Key components of conifer-derived volatile profiles were then screened via electroantennography before those components eliciting an electrophysiological response were assayed individually in the olfactometer; according to WHO protocol. The most promising 5 were selected for reductive analyses to produce an optimised semiochemical blend. This combination, and a further two variations of the blend, were then progressed to a multi-species analysis using the BG-test whereby bite-attempt frequency on hands was assessed under different repellent treatments; assays were compared between Aedes aegypti, Anopheles gambiae and Culex quinquefasciatus. Efficacy was found against all three species, although it was found that Ae. aegypti was the most susceptible to the repellent, with An. gambiae being the least. Here, a novel, naturally-derived blend is presented with weak spatial repellency, as confirmed in laboratory assays. Further work will be required to assess the full extent of the potential of the products, both in terms of field application and species screening; however, the success of the products developed demonstrate that plant metabolites have great capacity for use in the repellent sector; both to improve upon known compounds and to reduce the usage of toxic products currently on the market., Competing Interests: The authors have declared that no competing interests exist, (Copyright: © 2024 Wood et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objectives: The study aimed to assess if specialised healthcare service interventions in Wales benefit the population equitably in work commissioned by the Welsh Health Specialised Services Committee (WHSSC)., Approach: The study utilised anonymised individual-level, population-scale, routinely collected electronic health record (EHR) data held in the Secure Anonymised Information Linkage (SAIL) Databank to identify patients resident in Wales receiving specialist cardiac interventions. Measurement was undertaken of associated patient outcomes 2-years before and after the intervention (minus a 6-month clearance period on either side) by measuring events in primary care, hospital attendance, outpatient and emergency department. The analysis controlled for comorbidity (Charlson) and deprivation (Welsh Index of Multiple Deprivation), stratified by admission type (elective or emergency) and membership of top 5% post-intervention costs. Costs were estimated by multiplying events by mean person cost estimates., Results: We identified 5,999 percutaneous coronary interventions (PCI) and 1,640 coronary artery bypass graft (CABG) between 2014-06-01 to 2020-02-29. The ratio of emergency to elective interventions was 2.85 for PCI and 1.04 for CABG. In multivariate analysis significant associations were identified for comorbidity (OR = 1.52, CI = (1.01-2.27)), deprivation (OR = 1.34, CI = (1.03-1.76)) and rurality (OR = 0.81, CI = (0.70-0.95)) for PCI interventions, and comorbidity (OR = 1.47, CI = (1.10-1.98)) for CABG. Higher costs post-intervention were associated with increased comorbidity for PCI and CABG in the top 5% cost groups, but for PCI this was not seen outside the top 5%. For PCI, moderate cost increase was associated with increased deprivation, but the picture was more mixed following CABG interventions. For both interventions, lower costs post intervention were seen in rural locations., Conclusion: We identified and compared health outcomes for selected specialist cardiac interventions amongst patients resident in Wales, with these methods and analyses, providing a template for comparing other cardiac interventions., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Davies et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: A COVID-19 hospital guideline was implemented across all 18 acute hospitals in Wales in March 2020, promoting ward management of COVID pneumonitis and data collected across the first 3 Waves of the pandemic (Wave 1 March 1st 2020 to November 1st 2020, Wave 2 November 2st 2020 to February 21st 2021 and Wave 3 June 1st 2021 to December 14th 2021). The aim of this paper is to compare outcomes for patients by admission setting and type of ventilatory support given, with a particular focus on CPAP therapy., Methods: This is a retrospective observational study of those aged over 18 admitted to hospital with community acquired COVID-19 between March 2020 and December 2021. The outcome of interest was in-hospital mortality. Univariate logistic regression models were used to compare crude outcomes across the waves. Multivariable logistic regression models were used to assess outcomes by different settings and treatments after adjusting for Wave, age, sex, co-morbidity and deprivation., Results: Of the 7,803 records collected, 5,887 (75.4%) met the inclusion criteria. Analysis of those cases identified statistically significant outcome improvements across the waves for all patients combined (Waves 1 to 3: 31.5% to 18.8%, p<0.01), all ward patients (28.9% to 17.7%, p<0.01), and all ICU patients (44.3% to 32.2%, p = 0.03). Sub group analyses identified outcome improvements in ward patients without any oxygen therapy (Waves 1 to 3: 22.2% to 12.7%, p<0.01), with oxygen therapy only (34.0% to 12.9%, p<0.01) and with CPAP only (63.5% to 39.2%, p<0.01). The outcome improvements for ICU patients receiving CPAP only (35.7% to 24.6%, p = 0.31) or invasive ventilation (61.6% to 54.6%, p = 0.43) were not statistically significant though the numbers being admitted to ICU were small. The logistic regression models identified important age and comorbidity effects on outcomes. The multivariable model that took these into account suggested no statistically significantly greater risk of death for those receiving CPAP on the ward compared to those receiving CPAP in ICU (OR 0.89, 95% CI: 0.49 to 1.60)., Conclusions: There were successive reductions in mortality in inpatients over the three Waves reflecting new treatments and better management of complications. Mortality for those requiring CPAP was similar in respiratory wards and ICUs after adjusting for differences in their respective patient populations., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 Barry et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Rates of Multimorbidity (also called Multiple Long Term Conditions, MLTC) are increasing in many developed nations. People with multimorbidity experience poorer outcomes and require more healthcare intervention. Grouping of conditions by health service utilisation is poorly researched. The study population consisted of a cohort of people living in Wales, UK aged 20 years or older in 2000 who were followed up until the end of 2017. Multimorbidity clusters by prevalence and healthcare resource use (HRU) were modelled using hypergraphs, mathematical objects relating diseases via links which can connect any number of diseases, thus capturing information about sets of diseases of any size. The cohort included 2,178,938 people. The most prevalent diseases were hypertension (13.3%), diabetes (6.9%), depression (6.7%) and chronic obstructive pulmonary disease (5.9%). The most important sets of diseases when considering prevalence generally contained a small number of diseases, while the most important sets of diseases when considering HRU were sets containing many diseases. The most important set of diseases taking prevalence and HRU into account was diabetes & hypertension and this combined measure of importance featured hypertension most often in the most important sets of diseases. We have used a single approach to find the most important sets of diseases based on co-occurrence and HRU measures, demonstrating the flexibility of the hypergraph approach. Hypertension, the most important single disease, is silent, underdiagnosed and increases the risk of life threatening co-morbidities. Co-occurrence of endocrine and cardiovascular diseases was common in the most important sets. Combining measures of prevalence with HRU provides insights which would be helpful for those planning and delivering services., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Rafferty et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: School readiness is a measure of a child's cognitive, social, and emotional readiness to begin formal schooling. Children with low school readiness need additional support from schools for learning, developing required social and academic skills, and catching-up with their school-ready peers. This study aims to identify the most significant risk factors associated with low school readiness using linked routine data for children in Wales., Method: This was a longitudinal cohort study using linked data. The cohort comprises of children who completed the Foundation Phase assessment between 2012 and 2018. Individuals were identified by linking Welsh Demographic Service and Pre16 Education Attainment datasets. School readiness was assessed via the binary outcome of the Foundation Phase assessment (achieved/not achieved). This study used multivariable logistic regression model and a decision tree to identify and weight the most important risk factors associated with low school readiness., Results: In order of importance, logistic regression identified maternal learning difficulties (adjusted odds ratio 5.35(95% confidence interval 3.97-7.22)), childhood epilepsy (2.95(2.39-3.66)), very low birth weight (2.24(1.86-2.70), being a boy (2.11(2.04-2.19)), being on free school meals (1.85(1.78-1.93)), living in the most deprived areas (1.67(1.57-1.77)), maternal death (1.47(1.09-1.98)), and maternal diabetes (1.46(1.23-1.78)) as factors associated with low school readiness. Using a decision tree, eligibility for free school meals, being a boy, absence/low attendance at school, being born late in the academic year, being a low birthweight child, and not being breastfed were factors which were associated with low school readiness., Conclusion: This work suggests that public health interventions focusing on children who are: boys, living in deprived areas, have poor early years attendance, have parents with learning difficulties, have parents with an illness or have illnesses themselves, would make the most difference to school readiness in the population., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Bandyopadhyay et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

There is still limited understanding of how chronic conditions co-occur in patients with multimorbidity and what are the consequences for patients and the health care system. Most reported clusters of conditions have not considered the demographic characteristics of these patients during the clustering process. The study used data for all registered patients that were resident in Fife or Tayside, Scotland and aged 25 years or more on 1st January 2000 and who were followed up until 31st December 2018. We used linked demographic information, and secondary care electronic health records from 1st January 2000. Individuals with at least two of the 31 Elixhauser Comorbidity Index conditions were identified as having multimorbidity. Market basket analysis was used to cluster the conditions for the whole population and then repeatedly stratified by age, sex and deprivation. 318,235 individuals were included in the analysis, with 67,728 (21·3%) having multimorbidity. We identified five distinct clusters of conditions in the population with multimorbidity: alcohol misuse, cancer, obesity, renal failure, and heart failure. Clusters of long-term conditions differed by age, sex and socioeconomic deprivation, with some clusters not present for specific strata and others including additional conditions. These findings highlight the importance of considering demographic factors during both clustering analysis and intervention planning for individuals with multiple long-term conditions. By taking these factors into account, the healthcare system may be better equipped to develop tailored interventions that address the needs of complex patients., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Fagbamigbe et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Over 90% of deaf children are born to hearing parents who have limited knowledge about deafness and require comprehensive support and information to support and communicate with their deaf child. However, little is known about the systems that support hearing families with deaf children. We performed a scoping review to provide an overview of current literature on the topic., Methods: The protocol of the scoping review was prepared using the PRISMA statement guidelines for scoping reviews. Relevant search terms were used to identify eligible studies following discussion with the study's steering group. Databases searched were CINAHL, Medline, ProQuest Central and ASSIA, as well as grey literature from relevant journals and online sources. Included were studies published from 2000 to 2021 and available in English., Results: A search of databases identified 1274 articles. After excluding duplicates, screening titles and abstracts and full texts, 65 papers matched the identified inclusion criteria. Results included 1 RCT, 7 comparative studies, 6 literature reviews, 4 PhD theses, and 47 further empirical studies., Conclusion: There is limited quality evidence on what supports hearing parents with deaf children. It is evident that further studies are needed to ensure comprehensive support is accessible and effective for hearing parents of deaf children., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Terry, Rance. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Reconstruction of the outer ear currently requires harvesting of cartilage from the posterior of the auricle or ribs leading to pain and donor site morbidity. An alternative source for auricular reconstruction is in vitro tissue engineered cartilage using stem/progenitor cells. Several candidate cell-types have been studied with tissue-specific auricular cartilage progenitor cells (AuCPC) of particular interest. Whilst chondrogenic differentiation of competent stem cells using growth factor TGFβ1 produces cartilage this tissue is frequently fibrocartilaginous and lacks the morphological features of hyaline cartilage. Recent work has shown that growth factor BMP9 is a potent chondrogenic and morphogenetic factor for articular cartilage progenitor cells, and we hypothesised that this property extends to cartilage-derived progenitors from other tissues. In this study we show monoclonal populations of AuCPCs from immature and mature bovine cartilage cultured with BMP9 produced cartilage pellets have 3-5-fold greater surface area in sections than those grown with TGFβ1. Increased volumetric growth using BMP9 was due to greater sGAG deposition in immature pellets and significantly greater collagen accumulation in both immature and mature progenitor pellets. Polarised light microscopy and immunohistochemical analyses revealed that the organisation of collagen fibrils within pellets is an important factor in the growth of pellets. Additionally, chondrocytes in BMP9 stimulated cell pellets had larger lacunae and were more evenly dispersed throughout the extracellular matrix. Interestingly, BMP9 tended to normalise the response of immature AuCPC monoclonal cell lines to differentiation cues whereas cells exhibited more variation under TGFβ1. In conclusion, BMP9 appears to be a potent inducer of chondrogenesis and volumetric growth for AuCPCs a property that can be exploited for tissue engineering strategies for reconstructive surgery though with the caveat of negligible elastin production following 21-day treatment with either growth factor., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Gardner et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: There are few studies that focus explicitly on the impact of the home environment on older adults' sedentary behaviour (SB) and physical activity (PA) using the socio-ecological model (SEM). This study aims to investigate older adults' PA and SB within the home environment integrating the SEM as a theoretical framework., Methods: A qualitative exploratory research design was employed to conduct 33 in-depth interviews (IDIs) and five focus group (FGs; n = 16) with multi-diverse ethnic older adults (mean age 72±5 years). Using reflexive thematic analysis themes were generated from the data set and were interpreted using the SEM., Results: The findings indicate that different levels of the SEM had an impact on older adults' PA and SB. These include the 1) Individual level: Attitude, perception and motivation 2) Interpersonal level: Family and Friends: a motive to remain active 3) Organisational level: healthcare institutes, 4) Community level factors: Significance of social groups, 5) Physical Environment: Microenvironment and 6) Policy level factors (lockdown restrictions and healthcare system). This model can be utilised to foster activity within the home by focusing on the facilitators and barriers identified at each of these levels of influence., Conclusion: The study findings suggest that modifying PA and SB in the home environment is complex and is influenced across different levels of the SEM. Therefore, a holistic approach is required that integrates these multiple influences. This understanding can inform the design of interventions that seek to optimize PA and minimize SB within the home environment., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Meghani et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Regular evaluation of caesarean section (CS) is required due to their rising trend and outcomes. Many women recently opt for elective CS, even in resource-constrained settings. Data evaluating the outcomes of CS is however sparse. Hence, this study sought to determine the rate of fetal mortalities and their determinants following CS in the Tatale District Hospital of the Northern Region, Ghana., Methods: A retrospective cross-sectional study was employed to analyze the medical records of 275 women who underwent CS from 2019 to 2021. Data were collected from the hospital's record of CS cases from 2019 to 2021. Descriptive statistics were used to summarize the data and Pearson's chi-square/Fisher's exact test was used to examine the relationship between maternal and obstetric characteristics and fetal mortality. At a 95% confidence interval (95% CI), logistic regression was fitted to assess significant variables and reported the results using odds ratio., Results: Of 1667 deliveries, 16.5% of the mothers gave birth by CS. A fetal mortality rate of 76.4 per 1000 total births was recorded following CS. Babies born with low Appearance, Pulse, Grimace, Activity and Respiration (APGAR) scores (0-3) at fifth-minute had an increased risk of fetal mortality (AOR  =  523.19, 95%CI: 49.24-5559.37, p  =  <0.001). Having a history of previous CS, cephalopelvic disproportion and delayed labour were the major indications for CS., Conclusion: Overall, this study found a high rate of CS based on the World Health Organization's recommended CS rate. Interventions such as reducing the waiting time for surgery and early diagnosis of the need for CS, and ensuring the availability of modern equipment to resuscitate infants with low APGAR scores can significantly improve fetal outcomes following CS., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Sackeya et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Addressing violence related harm is a global public health priority. While violence is primarily managed in the criminal justice system, healthcare supports and manages those injured by violence. Emergency Departments (EDs), the primary destination for those seriously injured, have emerged as a candidate location for violence prevention initiatives. There is limited evaluation of ED-based violence prevention, and a lack of guidance for the implementation and delivery of them. Nurse-led Violence Prevention Teams (VPTs) have been developed and implemented in two EDs in Wales, UK. This protocol describes methods used in the process evaluation of these VPTs., Aim: To understand how VPTs function, how they were implemented, and mechanisms of impact, as well as the exploration of wider contextual factors influencing their function., Methods: Adopting a critical realist approach and informed by the Medical Research Council (MRC) guidance for process evaluations, the process evaluation will employ qualitative methods to collect and analyse data: a scoping review of evidence of effectiveness that considers the causal mechanisms underpinning violence; a documentary analysis to determine operational considerations concerning the development, implementation and delivery of the VPTs; a descriptive analysis of routine ED data to characterise the prevalence of violence-related attendances in each ED; interviews with professional stakeholders (N = 60) from the violence prevention ecologies in which the VPTs are embedded., Discussion: This protocol outlines a process evaluation of a novel, nurse led violence prevention intervention. Findings will be used to inform policy makers' decision making on whether and how VPTs should be used in practice in other EDs across the UK, and the extent that a single operational model should be adjusted to address the local characteristic of violence. To the authors knowledge, this is the first process evaluation of a UK-based, nurse led Emergency Department Violence Prevention Team., Trial Registration: Protocol registration ISRCTN: 15286575. Registered 13th March, 2023., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Van Godwin et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: Supine sleep position is associated with stillbirth, likely secondary to inferior vena cava compression, and a reduction in cardiac output (CO) and uteroplacental perfusion. Evidence for the effects of prone position in pregnancy is less clear. This study aimed to determine the effect maternal prone position on maternal haemodynamics and fetal heart rate, compared with left lateral position., Methods: Twenty-one women >28 weeks' gestation underwent non-invasive CO monitoring (Cheetah) every 5 minutes and continuous fetal heart rate monitoring (MONICA) in left lateral (20 minutes), prone (30 minutes), followed by left lateral (20 minutes). Anxiety and comfort were assessed by questionnaires. Regression analyses (adjusted for time) compared variables between positions. The information derived from the primary study was used in an existing mathematical model of maternal circulation in pregnancy, to determine whether occlusion of the inferior vena cava could account for the observed effects. In addition, a scoping review was performed to identify reported clinical, haemodynamic and fetal effects of maternal prone position; studies were included if they reported clinical outcomes or effects or maternal prone position in pregnancy. Study records were grouped by publication type for ease of data synthesis and critical analysis. Meta-analysis was performed where there were sufficient studies., Results: Maternal blood pressure (BP) and total vascular resistance (TVR) were increased in prone (sBP 109 vs 104 mmHg, p = 0.03; dBP 74 vs 67 mmHg, p = 0.003; TVR 1302 vs 1075 dyne.s-1cm-5, p = 0.03). CO was reduced in prone (5.7 vs 7.1 mL/minute, p = 0.003). Fetal heart rate, variability and decelerations were unaltered. However, fetal accelerations were less common in prone position (86% vs 95%, p = 0.03). Anxiety was reduced after the procedure, compared to beforehand (p = 0.002), despite a marginal decline in comfort (p = 0.04).The model predicted that if occlusion of the inferior vena cava occurred, the sBP, dBP and CO would generally decrease. However, the TVR remained relatively consistent, which implies that the MAP and CO decrease at a similar rate when occlusion occurs. The scoping review found that maternal and fetal outcomes from 47 included case reports of prone positioning during pregnancy were generally favourable. Meta-analysis of three prospective studies investigating maternal haemodynamic effects of prone position found an increase in sBP and maternal heart rate, but no effect on respiratory rate, oxygen saturation or baseline fetal heart rate (though there was significant heterogeneity between studies)., Conclusion: Prone position was associated with a reduction in CO but an uncertain effect on fetal wellbeing. The decline in CO may be due to caval compression, as supported by the computational model. Further work is needed to optimise the safety of prone positioning in pregnancy., Trial Registration: This trial was registered at clinicaltrials.gov (NCT04586283)., Competing Interests: Karli Buchling is the inventor of the Anna Cushion and is the Founder of Natal Comfort who market the cushion. She applied for the research funding with Professor Heazell, but had no part in the conduct of the experiments or analysis of the data. This does not alter our adherence to PLoS One policies on sharing data and materials., (Copyright: © 2023 Ormesher et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Multimorbidity is one of the greatest challenges facing health and social care systems globally. It is associated with high rates of health service use, adverse healthcare events, and premature death. Despite its importance, little is known about the effects of contextual determinants such as household and area characteristics on health and care outcomes for people with multimorbidity. This study protocol presents a plan for the examination of associations between individual, household, and area characteristics with important health and social care outcomes., Methods: The study will use a cross-section of data from the SAIL Databank on 01 January 2019 and include all people alive and registered with a Welsh GP. The cohort will be stratified according to the presence or absence of multimorbidity, defined as two or more long-term conditions. Multilevel models will be used to examine covariates measured for individuals, households, and areas to account for social processes operating at different levels. The intra-class correlation coefficient will be calculated to determine the strength of association at each level of the hierarchy. Model outcomes will be any emergency department attendance, emergency hospital or care home admission, or mortality, within the study follow-up period., Discussion: Household and area characteristics might act as protective or risk factors for health and care outcomes for people with multimorbidity, in which case results of the analyses can be used to guide clinical and policy responses for effective targeting of limited resources., Competing Interests: None, (Copyright: © 2023 MacRae et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Autism is a normal part of cognitive diversity, resulting in communication and sensory processing differences, which can become disabling in a neurotypical world. Autistic people have an increased likelihood of physical and mental co-occurring conditions and die earlier than neurotypical peers. Inaccessible healthcare may contribute to this. Autism Health Passports (AHPs) are paper-based or digital tools which can be used to describe healthcare accessibility needs; they are recommended in UK clinical guidance. However, questions remained as to the theoretical underpinnings and effectiveness of AHPs., Methods: We undertook a systematic literature search identifying studies focused on AHPs for adults (aged over 16 years) from five databases. Included literature was subjected to realist evaluation. Data were extracted using a standardised form, developed by the research team, which considered research design, study quality for realist review and the Context, Mechanisms and Outcomes (CMOs) associated with each AHP tool., Findings: 162 unique records were identified, and 13 items were included in the review. Only one item was considered high quality. Contextual factors focused on the inaccessibility of healthcare to Autistic patients and staff lack of confidence and training in supporting Autistic needs. Interventions were heterogeneous, with most sources reporting few details as to how they had been developed. The most frequently included contents were communication preferences. Mechanisms were often not stated or were inferred by the reviewers and lacked specificity. Outcomes were included in four studies and were primarily focused on AHP uptake, rather than Outcomes which measured impact., Conclusion: There is insufficient evidence to conclude that AHPs reduce the health inequalities experienced by Autistic people. Using an AHP tool alone in a healthcare Context that does not meet Autistic needs, without the inclusion of the local Autistic community developing the tool, and a wider intervention to reduce known barriers to health inequality, may mean that AHPs do not trigger any Mechanisms, and thus cannot affect Outcomes., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Ellis et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Burn injuries are the fourth most common type of trauma and are associated with substantial morbidity and mortality. The impact of burn injury is clinically significant as burn injuries often give rise to exuberant scarring. Hypertrophic scarring (HTS) is a particular concern as up to 70% of burns patients develop HTS. Laser therapy is used for treating HTS and has shown positive clinical outcomes, although the mechanisms remain unclear limiting approaches to improve its effectiveness. Emerging evidence has shown that fibroblasts and senescent cells are important modifiers of scarring. This study aims to investigate the cellular kinetics in HTS after laser therapy, with a focus on the association of scar reduction with the presence of senescent cells., Methods: We will conduct a multicentre, intra-patient, single-blinded, randomised controlled longitudinal pilot study with parallel assignments to achieve this objective. 60 participants will be recruited to receive 3 interventional ablative fractional CO2 laser treatments over a 12-month period. Each participant will have two scars randomly allocated to receive either laser treatment or standard care. Biopsies will be obtained from laser-treated, scarred-no treatment and non-scarred tissues for immune-histological staining to investigate the longitudinal kinetics of p16INK4A+-senescent cells and fibroblast subpopulations (CD90+/Thy1+ and αSMA+). Combined subjective scar assessments including Modified Vancouver Scar Scale, Patient and Observer Scar Assessment Scale and Brisbane Burn Scar Impact Profile; and objective assessment tools including 3D-Vectra-H1 photography, DermaScan® Cortex, Cutometer® and ColoriMeter®DSMIII will be used to evaluate clinical outcomes. These will then be used to investigate the association between senescent cells and scar reduction after laser therapy. This study will also collect blood samples to explore the systemic biomarkers associated with the response to laser therapy., Discussion: This study will provide an improved understanding of mechanisms potentially mediating scar reduction with laser treatment, which will enable better designs of laser treatment regimens for those living with HTS., Trial Registration: ClinicalTrials.gov: NCT04736251., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Chen et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Linking routinely collected healthcare administrative data is a valuable method for conducting research on morbidity outcomes, but linkage quality and accuracy needs to be assessed for bias as the data were not collected for research. The aim of this study was to describe the rates of linking data on children with and without congenital anomalies to regional or national hospital discharge databases and to evaluate the quality of the matched data. Eleven population-based EUROCAT registries participated in a EUROlinkCAT study linking data on children with a congenital anomaly and children without congenital anomalies (reference children) born between 1995 and 2014 to administrative databases including hospital discharge records. Odds ratios (OR), adjusted by region, were estimated to assess the association of maternal and child characteristics on the likelihood of being matched. Data on 102,654 children with congenital anomalies were extracted from 11 EUROCAT registries and 2,199,379 reference children from birth registers in seven regions. Overall, 97% of children with congenital anomalies and 95% of reference children were successfully matched to administrative databases. Information on maternal age, multiple birth status, sex, gestational age and birthweight were >95% complete in the linked datasets for most regions. Compared with children born at term, those born at ≤27 weeks and 28-31 weeks were less likely to be matched (adjusted OR 0.23, 95% CI 0.21-0.25 and adjusted OR 0.75, 95% CI 0.70-0.81 respectively). For children born 32-36 weeks, those with congenital anomalies were less likely to be matched (adjusted OR 0.78, 95% CI 0.71-0.85) while reference children were more likely to be matched (adjusted OR 1.28, 95% CI 1.24-1.32). Children born to teenage mothers and mothers ≥35 years were less likely to be matched compared with mothers aged 20-34 years (adjusted ORs 0.92, 95% CI 0.88-0.96; and 0.87, 95% CI 0.86-0.89 respectively). The accuracy of linkage and the quality of the matched data suggest that these data are suitable for researching morbidity outcomes in most regions/countries. However, children born preterm and those born to mothers aged <20 and ≥35 years are less likely to be matched. While linkage to administrative databases enables identification of a reference group and long-term outcomes to be investigated, efforts are needed to improve linkages to population groups that are less likely to be linked., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Loane et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The proliferation of fake news has severe effects on society and individuals on multiple fronts. With fast-paced online content generation, has come the challenging problem of fake news content. Consequently, automated systems to make a timely judgment of fake news have become the need of the hour. The performance of such systems heavily relies on feature engineering and requires an appropriate feature set to increase performance and robustness. In this context, this study employs two methods for reducing the number of feature dimensions including Chi-square and principal component analysis (PCA). These methods are employed with a hybrid neural network architecture of convolutional neural network (CNN) and long short-term memory (LSTM) model called FakeNET. The use of PCA and Chi-square aims at utilizing appropriate feature vectors for better performance and lower computational complexity. A multi-class dataset is used comprising 'agree', 'disagree', 'discuss', and 'unrelated' classes obtained from the Fake News Challenges (FNC) website. Further contextual features for identifying bogus news are obtained through PCA and Chi-Square, which are given nonlinear characteristics. The purpose of this study is to locate the article's perspective concerning the headline. The proposed approach yields gains of 0.04 in accuracy and 0.20 in the F1 score, respectively. As per the experimental results, PCA achieves a higher accuracy of 0.978 than both Chi-square and state-of-the-art approaches., Competing Interests: The authors declare that there is no conflict of interests., (Copyright: © 2023 Aljrees et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: The number of people living with dementia (PLWD) in Aotearoa New Zealand (NZ) was estimated at 96,713 in 2020 and it is anticipated that this number will increase to 167,483 by 2050, including an estimated 12,039 Māori (indigenous people of NZ) with dementia. Experiencing urinary incontinence (UI) or faecal incontinence (FI) is common for PLWD, particularly at the later stages of the disease. However, there is no robust estimate for either prevalence or incidence of UI or FI for PLWD in NZ. Although caregivers rate independent toilet use as the most important activity of daily living to be preserved, continence care for PLWD in the community is currently not systematised and there is no structured care pathway. The evidence to guide continence practice is limited, and more needs to be known about caregiving and promoting continence and managing incontinence for PLWD in the community. This project will seek to understand the extent of the challenge and current practices of health professionals, PLWD, caregivers and family; identify promising strategies; co-develop culturally appropriate guidelines and support materials to improve outcomes; and identify appropriate quality indicators so that good continence care can be measured in future interventions., Methods and Analysis: A four-phase mixed methods study will be delivered over three years: three phases will run concurrently, followed by a fourth transformative sequential phase. Phase 1 will identify the prevalence and incidence of incontinence for PLWD in the community using a cohort study from standardised home care interRAI assessments. Phase 2 will explore continence management for PLWD in the community through a review of clinical policies and guidance from publicly funded continence services, and qualitative focus group interviews with health professionals. Phase 3 will explore experiences, strategies, impact and consequences of promoting continence and managing incontinence for PLWD in the community through secondary data analysis of an existing carers' study, and collecting new cross-sectional and longitudinal qualitative data from Māori and non-Māori PLWD and their caregivers. In Phase 4, two adapted 3-stage Delphi processes will be used to co-produce clinical guidelines and a core outcome set, while a series of workshops will be used to co-produce caregiver resources., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Burholt et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: At the start of the COVID-19 pandemic there was an urgent need to identify individuals at highest risk of severe outcomes, such as hospitalisation and death following infection. The QCOVID risk prediction algorithms emerged as key tools in facilitating this which were further developed during the second wave of the COVID-19 pandemic to identify groups of people at highest risk of severe COVID-19 related outcomes following one or two doses of vaccine., Objectives: To externally validate the QCOVID3 algorithm based on primary and secondary care records for Wales, UK., Methods: We conducted an observational, prospective cohort based on electronic health care records for 1.66m vaccinated adults living in Wales on 8th December 2020, with follow-up until 15th June 2021. Follow-up started from day 14 post vaccination to allow the full effect of the vaccine., Results: The scores produced by the QCOVID3 risk algorithm showed high levels of discrimination for both COVID-19 related deaths and hospital admissions and good calibration (Harrell C statistic: ≥ 0.828)., Conclusion: This validation of the updated QCOVID3 risk algorithms in the adult vaccinated Welsh population has shown that the algorithms are valid for use in the Welsh population, and applicable on a population independent of the original study, which has not been previously reported. This study provides further evidence that the QCOVID algorithms can help inform public health risk management on the ongoing surveillance and intervention to manage COVID-19 related risks., Competing Interests: KK is Chair of the Ethnicity Subgroup of the UK Scientific Advisory Group for Emergencies (SAGE) and Member of SAGE. AS is a member of the Scottish Government Chief Medical Officer’s COVID-19 Advisory Group, the Scottish Government’s Standing Committee on Pandemic Preparedness, the UK Government’s New and Emerging Respiratory Virus Threats Advisory Group (NERVTAG) Risk Stratification Subgroup, the Department of Health and Social Care’s COVID-19 Therapeutics Modelling Group and was a member of Astra-Zeneca’s COVID-19 Strategic Thrombocytopenia Taskforce. All AS’ roles are unfunded. JHC is a member of SAGE subgroups and chair of the NERVTAG subgroup on risk stratification and several DHSC therapeutics modelling advisory groups. RAL is a member of the Welsh Government COVID-19 Technical Advisory Group., (Copyright: © 2023 Lyons et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

The Covid-19 pandemic and subsequent national lockdowns resulted in drastic changes to the way that higher education was delivered. A mixed-methods research study was conducted to explore university students' perceptions of online learning during the 2020/21 academic year. Students from across all Welsh higher education institutions were invited to participate. First, a series of focus groups (n = 13) were conducted to explore students' experiences of online learning during the pandemic. Two were conducted in Welsh, the remaining eleven in English. Thematic analysis led researchers to develop eight key themes: Seeking the positives, Facilitators to learning, Barriers to learning, Lost sense of community, Let down by University, Workload, Assessment, and Health and well-being. These themes informed the design of a quantitative survey which was completed by 759 students. It was found that students were largely satisfied with the quality of online learning, however there were specific challenges associated with a lack of community, wellbeing concerns, and challenges with loneliness and isolation. Data from the focus groups and survey informed recommendations for practice in three key categories; teaching practice, institutional level recommendations, and student health and wellbeing considerations., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Brown et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Introduction: Information on the impact of medicines on breastfeeding and the breastfed infant remains scarce. The aims of this review were to identify databases and cohorts holding this information, and pinpoint current information and research deficits., Method: We searched 12 electronic databases, including PubMed/ Medline and Scopus, using a combination of controlled vocabulary (MeSH terms) and free text terms. We included studies reporting data from databases with information on breastfeeding, medicines exposure, and infant outcomes. We excluded studies not reporting all three parameters. Two reviewers independently selected papers and extracted data using a standardised spreadsheet. Risk of bias was assessed. Recruited cohorts with relevant information were tabulated separately. Discrepancies were resolved by discussion., Results: From 752 unique records, 69 studies were identified for full review. Eleven papers reported analyses from ten established databases with information on maternal prescription or non-prescription drugs, breastfeeding and infant outcomes. Twenty-four cohort studies were also identified. No studies reported educational or long-term developmental outcomes. The data are too sparse to warrant any firm conclusions, beyond the need for more data. The overall picture hints at 1) unquantifiable, but probably rare, serious harms to infants exposed to medicines via breastmilk, 2) unknown long-term harms, and 3) a more insidious but more pervasive harm in terms of reduced breastfeeding rates following medicines exposure in late pregnancy and peri-partum., Implications: Analyses of databases reporting on the full population are needed to quantify any adverse effects of medicines and identify dyads at risk of harm from prescribed medicines while breastfeeding. This information is essential to ensure 1) infants are monitored appropriately for any adverse drug reactions 2) inform breastfeeding patients using long-term medicines as to whether the benefits of breastfeeding outweigh exposure to medicines via breastmilk and 3) target additional support to breastfeeding patients whose medicines may affect breastfeeding. The protocol is registered with the Registry of Systematic Reviews, no.994., Competing Interests: Sandra Lopez Leon is an employee of Novartis Pharmaceutical Company; the statements presented in the paper do not necessarily represent the position of the company. SJ and SK have declared that no competing interests exist. This does not alter our adherence to PLOS ONE policies on sharing data and materials., (Copyright: © 2023 Jordan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Understanding the day-to-day lived experiences of individuals who have had or are still recovering from Coronavirus Disease-19 (COVID-19), whilst a complex challenge, presents the opportunity to listen and learn. Composite vignettes provide a novel approach to explore and present descriptive portrayals of the most commonly derived experiences and recovery journeys. The thematic analysis of 47 shared accounts (semi-structured interviews with adults aged ≥18 years; 40 females; 6-11 months post-COVID-19 infection) produced a series of four intricate character stories written through the lens of a single individual. Each vignette gives a voice to and captures a different experience trajectory. From the point of initial symptom development onwards, the vignettes depict how COVID-19 has affected everyday lives, focusing on the secondary non-biological socio-psychological effects and implications. The vignettes highlight in participants' own words: i) the potential negative implications of not addressing the psychological effects of COVID-19; ii) the lack of symptom and recovery linearity; iii) the ongoing 'lottery' of access to healthcare services; and iv) the highly variable, yet generally devastating, impacts that COVID-19 and consequent long-COVID has had across multiple facets of daily living., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Knight et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Childbirth has become increasingly medicalised, which may impact on the mother's birth experience and her newborn infant's physiology and behaviour. Although associations have been found between a mother's subjective birth experience and her baby's temperament, there is limited qualitative evidence around how and why this may occur., Objectives: This qualitative study aimed to explore mothers' childbirth and postnatal experiences, perceptions of their baby's early behavioural style, and whether they saw these as related., Methods: A qualitative semi-structured interview schedule collected rich in-depth data. Twenty-two healthy mothers over 18 years of age and with healthy infants aged 0-12 months born at term, were recruited from Southwest regions of England and Wales. Thematic analysis was performed on the data., Results: Mothers experienced childbirth as a momentous physical and psychological process. However, they did not necessarily perceive the birth as affecting their baby's early behaviour or temperament. While some mothers drew a direct relationship, such as linking a straightforward birth to a calm infant, others did not make an explicit connection, especially those who experienced a challenging birth and postnatal period. Nevertheless, mothers who had a difficult or medicalised birth sometimes reported unsettled infant behaviour. It is possible that mothers who feel anxious or depressed after a challenging birth, or those without a good support network, may simply perceive their infant as more unsettled. Equally, mothers who have been well-supported and experienced an easier birth could be more likely to perceive their baby as easier to care for., Conclusions: Childbirth is a physical and psychological event that may affect mother-infant wellbeing and influence maternal perceptions of early infant temperament. The present findings add to prior evidence, reinforcing the importance of providing good physical and emotional support during and after childbirth to encourage positive mother-infant outcomes., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Power et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Ankylosing spondylitis is the second most common cause of inflammatory arthritis. However, a successful diagnosis can take a decade to confirm from symptom onset (via x-rays). The aim of this study was to use machine learning methods to develop a profile of the characteristics of people who are likely to be given a diagnosis of AS in future. The Secure Anonymised Information Linkage databank was used. Patients with ankylosing spondylitis were identified using their routine data and matched with controls who had no record of a diagnosis of ankylosing spondylitis or axial spondyloarthritis. Data was analysed separately for men and women. The model was developed using feature/variable selection and principal component analysis to develop decision trees. The decision tree with the highest average F value was selected and validated with a test dataset. The model for men indicated that lower back pain, uveitis, and NSAID use under age 20 is associated with AS development. The model for women showed an older age of symptom presentation compared to men with back pain and multiple pain relief medications. The models showed good prediction (positive predictive value 70%-80%) in test data but in the general population where prevalence is very low (0.09% of the population in this dataset) the positive predictive value would be very low (0.33%-0.25%). Machine learning can be used to help profile and understand the characteristics of people who will develop AS, and in test datasets with artificially high prevalence, will perform well. However, when applied to a general population with low prevalence rates, such as that in primary care, the positive predictive value for even the best model would be 1.4%. Multiple models may be needed to narrow down the population over time to improve the predictive value and therefore reduce the time to diagnosis of ankylosing spondylitis., Competing Interests: JK, SB reports grants from UCB Pharma, during the conduct of the study; and involved in (but not directly funded by) grants from Biogen, Sanofi and Novartis. RC reports grants from Pfizer, during the conduct of the study;. EC reports grants from UCB, during the conduct of the study; grants and personal fees from Pfizer, grants and personal fees from UCB, grants from BioCancer, grants from Biogen, grants and personal fees from Novartis, grants and personal fees from Roche, personal fees from Amgen, personal fees from Chugai Pharma, personal fees from Eli Lilly, grants and personal fees from Sanofi, personal fees from Abbvie, personal fees from Janssen, personal fees from Gilead, personal fees from Bristol Myer Squibbs, outside the submitted work; In addition, Dr. Choy has a patent null pending. SS reports grants and personal fees from AbbVie, grants and personal fees from UCB, grants and personal fees from Novartis, grants and personal fees from Janssen, grants and personal fees from Pfizer, grants from Bristol Myers Squibb, from Boehringer-Ingelheim, outside the submitted work; This does not alter our adherence to PLOS ONE policies on sharing data and materials., (Copyright: © 2023 Kennedy et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Lumpfish (Cyclopterus lumpus) is a transatlantic marine fish displaying large population sizes and a high potential for dispersal and gene-flow. These features are expected to result in weak population structure. Here, we investigated population genetic structure of lumpfish throughout its natural distribution in the North Atlantic using two approaches: I) 4,393 genome wide SNPs and 95 individuals from 10 locations, and II) 139 discriminatory SNPs and 1,669 individuals from 40 locations. Both approaches identified extensive population genetic structuring with a major split between the East and West Atlantic and a distinct Baltic Sea population, as well as further differentiation of lumpfish from the English Channel, Iceland, and Greenland. The discriminatory loci displayed ~2-5 times higher divergence than the genome wide approach, revealing further evidence of local population substructures. Lumpfish from Isfjorden in Svalbard were highly distinct but resembled most fish from Greenland. The Kattegat area in the Baltic transition zone, formed a previously undescribed distinct genetic group. Also, further subdivision was detected within North America, Iceland, West Greenland, Barents Sea, and Norway. Although lumpfish have considerable potential for dispersal and gene-flow, the observed high levels of population structuring throughout the Atlantic suggests that this species may have a natal homing behavior and local populations with adaptive differences. This fine-scale population structure calls for consideration when defining management units for exploitation of lumpfish stocks and in decisions related to sourcing and moving lumpfish for cleaner fish use in salmonid aquaculture., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2023 Jansson et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)