Search

Individual decision-making is often expressed through some combination of return or benefit within a context of risk assessment and assumption. Risk is generally defined as variability or chance of loss. Individuals are typically risk averse, where they require a greater benefit for each unit of risk in a decision. Students apply risk assessment when making financial decisions. This research models if risk aversion in making financial decisions extends to academic decisions. Prior literature discusses each decision category but does not adequately surmise correlation. In a survey of 671 university business students, the findings are that students approach risk differently between financial and academic decisions. In asking students if flipping a coin to decide patterns of paying money versus receiving money when risk is introduced, respondents are less willing to take financial risk when receiving money, but much less willing when paying money. When the question is structured to capture academic decisions, students are more willing to risk a lower grade in a class for higher reward longer-term, such as acquiring greater knowledge or improved employability.

Abstract Criminal justice practitioners’ use of erroneous lie-detection methods contributes to inaccurate convictions and research indicates some Queensland police are using fallible methods. A recent study showed that Queensland universities primarily ignore the topic of lie detection. Thus, criminal justice students entering Queensland universities with fallacious lie detection beliefs are unlikely to have them corrected. It was unknown if Australian criminal justice students hold inaccurate lie detection beliefs. Therefore, this mixed-methods study investigated undergraduate students’ beliefs about lie detection methods, many of whom were enrolled in criminal justice-focused degrees at a Queensland-based university. Sixty undergraduate students responded to open and closed-ended questions regarding their intentions to work in the criminal justice system, their opinion on their lie detection ability, methods used to determine deception, and thoughts about cross-cultural lie detection. The findings revealed a prevalence of false beliefs about cues to deception indicating educational needs for Australian criminal justice-career-focused students.

Abstract Objective Delayed transitions from pediatric to adult primary care leads to gaps in medical care. State all-payer claims data was used to assess multilevel factors associated with timely transition from pediatric to adult primary care. Materials and methods We created a cohort of 4,320 patients aged 17–20 in 2014–2017 continuously enrolled in health insurance 36 months between 2014 and 2019 and attributed to a pediatric provider in months 1–12. We also constructed primary care provider networks identifying links between providers who saw members of the same family. Logistic regression was used to predict adult primary care in months 25–36 on family, provider, and county-level factors. Finally, we modeled the effect of county and network cluster membership on care transitions. Results Male sex, having another family member seeing a pediatrician, and residing in a county with high pediatric care capacity or low adult primary care capacity were associated with lower odds of adult primary care transition. Discussion We investigated factors associated with successful transitions from pediatric to adult primary care. Family ties to a pediatrician and robust county capacity to provide primary care to children were associated with non-transition to adult primary care. Conclusion Multiple level factors contribute to non-transition to adult primary care. Understanding the factors associated with appropriate transition can help inform state and national policy.

Building on the research about assessing teachers' leader identity, we were curious to understand how K-12 school principals perceive teachers as leaders. We used a survey research design to gather quantitative and qualitative data from K-12 school principals. We could not find any extant surveys aligned with our research focus; thus, we designed and validated a survey for our research. We contacted 1042 K-12 principals from the south-central region of the US; 70 responded by completing our survey. Analysis indicated a potential misalignment in principal leadership styles between the ideal attributes of leadership and contextual or practical applications of leadership. Additional analysis revealed considerable overlap between the principals' perceptions of leadership and the roles of teachers; however, those leadership roles aligned with teachers as school-level leaders outside the classroom rather than in their role of teaching students. Findings also revealed an alignment of principals' perceptions of teachers as leaders with principals' efforts to develop teachers as leaders. Overall, our research suggests that principals support teachers' development as leaders. We close with a discussion of the results and implications for research and practice.

Current prognostic biomarkers fall short in stratifying Oestrogen receptor (ER)-negative breast cancer patients regarding tumour progression risk at diagnosis. The role of AIPL1 in activating its tumour suppressor client protein, NEDD8 Ultimate Buster-1 (NUB1) remains unknown in cancer. Our study demonstrated how downregulated AIPL1 results in the deactivated NUB1 protein under hypoxic conditions. We examined the AIPL1-NUB1 pathwayin vitro using cell lines i.e. MCF-7, MDA-MB-231, RCC4 etc. NUB1 expression was assessed using Oncomine, and cBioPortal was performed to assess NUB1′s prognostic significance in human cancers. In the John Radcliffe Hospital cohort (n = 122), immunohistochemistry analysis revealed downregulated AIPL1 (Log2 fold change=-0.28; p < 0.001) and upregulated NUB1 transcripts (Log2 fold change=0.59; p < 0.001) compared to adjacent normal tissues. In severe chronic hypoxia, multimerised AIPL1 localisedin the cytoplasm while NUB1 protein migrated to the nucleus, where the absence of NUB1 nuclear localisation led to cell cycle arrest. Biopsies showed that patients with lower cytoplasmic NUB1 expression (n = 57) had poorer overall survival compared to those with higher cytoplasmic expression (n = 57), HR=1.78; 95 % CI=1.01–3.35, p = 0.048. Low NUB1 protein levels in both normoxic and hypoxic conditions were associated with cell cycle arrest and upregulation ofp21 and p27 in breast cancer cell lines, correlating significantly withpoorer survival outcomes in all breast cancer and ER-negative breast cancer patients.

Cell division is fundamental to all healthy tissue growth, as well as being rate-limiting in the tissue repair response to wounding and during cancer progression. However, the role that cell divisions play in tissue growth is a collective one, requiring the integration of many individual cell division events. It is particularly difficult to accurately detect and quantify multiple features of large numbers of cell divisions (including their spatio-temporal synchronicity and orientation) over extended periods of time. It would thus be advantageous to perform such analyses in an automated fashion, which can naturally be enabled using deep learning. Hence, we develop a pipeline of deep learning models that accurately identify dividing cells in time-lapse movies of epithelial tissues in vivo. Our pipeline also determines their axis of division orientation, as well as their shape changes before and after division. This strategy enables us to analyse the dynamic profile of cell divisions within the Drosophila pupal wing epithelium, both as it undergoes developmental morphogenesis and as it repairs following laser wounding. We show that the division axis is biased according to lines of tissue tension and that wounding triggers a synchronised (but not oriented) burst of cell divisions back from the leading edge.

Background Childhood chronic pain is a widespread public health issue. We need to understand how children with chronic pain and their families experience chronic pain and its management. Objectives To conduct a meta-ethnography on the experiences and perceptions of children with chronic pain and their families of chronic pain, treatments and services. We investigated how children and their families conceptualise and live with chronic pain; what they think of and want from health and social care services; and what they conceptualise as ‘good’ pain management. Design Meta-ethnography with stakeholder and patient and public involvement in the design, search and sampling strategies, analysis and dissemination. Review strategy: comprehensive searches of 12 bibliographic databases and supplementary searches in September 2022, to identify qualitative studies with children aged 3 months to 18 years with chronic non-cancer pain and their families. We included studies with rich explanatory data; appraised methodological limitations using the Critical Appraisal Skills Programme tool; and extracted, analysed and synthesised studies’ findings. We used Grading of Recommendations Assessment, Development and Evaluation-confidence in the evidence from reviews of qualitative research to assess confidence in review findings. We integrated findings with 14 Cochrane treatment effectiveness reviews on children’s chronic non-cancer pain. Results We synthesised 43 studies sampled from 170 eligible studies reported in 182 publications. Studies had minor (n = 24) or moderate (n = 19) methodological limitations. Grading of Recommendations Assessment, Development and Evaluation-confidence in the evidence from reviews of qualitative research assessments of review findings were high (n = 22), moderate (n = 13) or very low confidence (n = 1). Moderate and severe chronic pain had profound adverse impacts on family members’ well-being, autonomy and self-identity; family dynamics; parenting approaches; friendships and socialising; children’s education and parental paid employment. Most children and families sought a biomedical cure for pain. They experienced difficulties seeking and receiving support from health services to manage pain and its impacts. Consequently, some families repeatedly visited health services. Cochrane reviews of intervention effects and trials did not measure some outcomes important to children and families, for example effects of pain on the family and resolution of pain. Reviews have mainly neglected a biopsychosocial approach when considering how interventions work. Limitations There were limited data on common pain conditions like migraine/headache, abdominal pain; some rarer conditions; children with learning disabilities and under-fives; siblings; fathers and experiences of treatments/services. We excluded studies on cancer, end-of-life pain and experiences of healthcare professionals. Conclusions We developed the family-centred theory of children’s chronic pain management, integrating health and social care with community support. Future work Future research should explore families’ experiences of services and treatments, including opioids, and social care services; experiences of children with autism and learning disabilities, under 5 years old and with certain common pain conditions. We need development and testing of family-centred interventions and services. Study registration This study is registered as PROSPERO (CRD42019161455) and Cochrane Pain, Palliative and Supportive Care (623). Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128671) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 17. See the NIHR Funding and Awards website for further award information. Plain language summary Chronic pain lasting 3 months or more affects at least 8% of children in the UK. It causes difficulties with many aspects of children’s lives including relationships, school attendance and use of National Health Services. In the UK, there are few specialist services and a lack of high-quality research for managing children’s chronic pain. Our study aimed to locate and pull together existing research on the experiences and views of children with chronic pain and their families. We wanted to find out how they think about and live with chronic pain, and their views and experiences of services and treatments, and what they want to achieve from them. We conducted this study alongside children with chronic pain and their families, charities, healthcare professionals and academic experts. They helped us to conduct the study and to ensure our findings are relevant to children, families and the National Health Service. We pulled together data from 43 studies that best answered our questions. We found that moderate and severe children’s chronic pain that was not well managed affected the whole family, including their relationships and social lives. Families found it difficult to get help and a diagnosis from health services. Most families wanted a medical cure for pain. Families had long waits for answers and treatment but gradually realised there may be no cure, so they focused on living well with pain or gave up hope. Children and families from ethnic minority groups or with a learning disability experienced discrimination. Few studies focused on children under 5 years old, children with learning disabilities or experiences of services. Families need a pain management approach tailored to the whole family’s needs involving schools, social care and health services. Our findings could improve treatment guidelines, training of health and social care professionals and service design and treatments. Scientific summary Background Chronic pain in childhood is widespread, affecting at least 8% of children and young people (CYP) in the UK. For a sizeable number of children, chronic non-cancer pain has considerable negative impacts on children’s lives and quality of life and leads to increased use of healthcare services and medication. Treating adolescent pain alone has an annual cost of around 4 billion pounds in the UK. Provision of, and access to, services for managing children’s chronic pain is limited. We also do not know which treatment outcomes children and families value. To design and deliver services and treatments, which meet the needs of patients and their families, it is vital that we understand how children with chronic non-cancer pain and their families experience chronic pain, pain treatments and services, and which outcomes are important to them. Qualitative research addressing these urgent, important issues exists but must be synthesised to interpret the body of evidence. Existing qualitative evidence syntheses have focused on either a narrow chronic pain population or topic and none produced a theory. Therefore, we conducted a qualitative evidence synthesis using meta-ethnography, which is ideal for synthesising the diverse contexts of children’s chronic pain research and developing theory. We refer to the meta-ethnography by the acronym ‘CHAMPION’ (Children And young people’s Meta-ethnography on Pain). The meta-ethnography was conceived as a Cochrane review to inform and supplement existing Cochrane reviews of intervention effectiveness for children’s chronic pain. Cochrane requires qualitative evidence syntheses to be integrated with intervention effects reviews to further understanding of patient experiences, acceptability and implementation of interventions, which outcomes are important to children and their families, and inform further intervention development. Aim To conduct a meta-ethnography on the experiences and perceptions of CYP with chronic pain, and their families, of chronic pain, treatments and services to inform the design and delivery of health and social care services, interventions and future research. Review questions How do children with chronic pain and their families conceptualise chronic pain? How do they live with chronic pain? What do they think of how health and social care services respond to and manage their/their child’s chronic pain? What do they conceptualise as ‘good’ chronic pain management and what do they want to achieve from chronic pain management interventions and services? Objectives Conduct comprehensive searches to identify qualitative research literature on the experiences and perceptions of children with chronic pain and their families to address review questions 1–4. Select and synthesise relevant studies using meta-ethnography. Ensure salience of findings via involvement of children with chronic pain and their families in study design, analysis and interpretation. Assess how much confidence can be placed in our synthesised findings using GRADE-CERQual (Grading of Recommendations Assessment, Development and Evaluation-confidence in the evidence from reviews of qualitative research) in order to facilitate use of our findings for NHS decision-making. Identify research gaps regarding review questions 1–4 in order to inform future research directions. Integrate our findings with existing relevant Cochrane treatment effectiveness reviews in order to determine if programme theories and outcomes of interventions match children and their families’ views. Inform the selection and design of patient-reported outcome measures for use in chronic pain studies and interventions and care provision to children and their families. Disseminate findings to academic, clinical, lay and policy audiences to influence childhood chronic pain policy and practice. Methods Design We conducted a meta-ethnography, a seven-phase interpretive methodology, which takes into account the contexts and meanings of the original studies. Patient and public involvement Patient and public involvement (PPI) of children with chronic non-cancer pain and their families was fundamental to all aspects of our meta-ethnography conduct from study inception to dissemination. We also worked with a Project Advisory Group of wider stakeholders. The groups approved the aim and design and search strategy. They participated in workshops to decide study inclusion and sampling criteria decisions, how to group studies for analysis, data interpretation, identification of research gaps and to develop outputs. They also informed and assisted with dissemination of findings. Review strategy We carried out comprehensive searches of 12 bibliographic databases including MEDLINE (medical literature analysis and retrieval system online), CINAHL (Cumulative Index to Nursing and Allied Health Literature), PsycInfo and 9 others, with iterative supplementary searches, including citation tracking. We searched for studies that had been published up to September 2022. Selection criteria To identify qualitative research studies with children aged 3 months to 18 years with chronic non-cancer pain, and their families, which focused on their perceptions, experiences and views of chronic pain, services and treatments. The final inclusion criteria were agreed with our PPI group. We included qualitative research studies of any design using recognisable qualitative methods of data collection, in any language, with no date restrictions. We did not include children with chronic pain related to cancer or end of life because they have distinct care pathways; Cochrane reviews of effects also synthesise non-cancer pain separately. Data collection and analysis Eligible studies were purposively sampled to ensure we could conduct an in-depth, synthesis of the data most relevant to answering our review questions. Sampling, organising studies for synthesis and analysis and interpretation involved our PPI group via two workshops and additional communication by teleconference, e-mail and social media. ‘Conceptually rich’ and ‘thick’ studies, that is, those with in-depth explanatory/interpretive findings and contextual details, were included. Sampling was guided by Cochrane Qualitative and Implementation Methods Group Guidance, and our advisory and involvement groups who agreed we should include non-UK studies and studies with moderately rich data to ensure a wider range of pain conditions were represented. We assessed methodological limitations of studies using the Critical Appraisal Skills Programme tool. We extracted data on study aims, focus and characteristics into Microsoft Excel® and findings using NVivo software. We compared these study data to determine how studies related to one another and decided how to order and group them for synthesis. Stakeholders and our PPI group agreed we should group studies by pain condition. We used meta-ethnography to synthesise each group of studies separately before synthesising them all together. Analysis and interpretation of studies involved children with chronic non-cancer pain and their families and has resulted in theory to inform service design and delivery. Our PPI group clarified the meaning of ambiguous study findings and identified and addressed gaps in the data. We used the GRADE-CERQual approach to assess our confidence in each key review finding and used a matrix approach to integrate our findings with 14 existing Cochrane reviews on treatment effectiveness for children’s chronic non-cancer pain. Results One hundred and seventy studies met inclusion criteria. We sampled and synthesised 43 most relevant conceptually rich and thick studies, which had minor (n = 24) or moderate (n = 19) methodological limitations overall. Using GRADE-CERQual, we rated 36 descriptive-level review findings as high (n = 22) or moderate (n = 13) confidence with only one very low confidence. Twenty-three included studies were conducted in the UK, 17 in other high-income countries and 4 in low- to middle-income countries (there is a three-country study, so the total does not add to 43 studies). Included studies involved 325 CYP with chronic pain, most aged 10 years or older, and 308 family members, mostly mothers. The studies covered chronic pain conditions including complex regional pain syndrome, juvenile idiopathic arthritis, sickle cell disease, headache, migraine, abdominal pain, musculoskeletal pain, epidermolysis bullosa, dysmenorrhoea, neurological conditions such as cerebral palsy, unspecified chronic pain or a mix of conditions. Moderate and severe children’s chronic pain had profound adverse impacts on the whole family, family life and their wider social connections. Pain affected all aspects of an individual’s and a family’s functioning: family dynamics and relationships; family members’ emotions, well-being, autonomy and a sense of self-identity; parenting strategies; friendships and socialising; children’s education and future employment prospects; and parental employment. Families experienced difficulties in seeking and getting help and support from health services to manage their child’s pain and its impacts. Most pain management occurred outside of health services supervised by parents, especially mothers who were usually the main caregivers. Children and young people and their families were aware of the biopsychosocial (physical/biological, psychological and social) impacts of chronic pain on their lives. However, most CYP and parents understood the cause of chronic pain as having solely an underlying biological cause. This influenced their expectations of, and interactions with, health services. However, families’ conceptualisations of pain were dynamic and could change over time influenced by experiences of treatments, services and interactions with healthcare professionals. Interactions with healthcare professionals were frequently negative and stressful. CYP and parents, particularly mothers, felt they were not listened to and believed, and thus felt unsupported. For instance, CYP’s experiences of living with pain were ignored or their pain was disbelieved, and mothers felt blamed for their child’s pain. Parents of younger children and of children with communication difficulties, in particular, perceived that healthcare professionals did not always recognise their expertise in assessing their child’s pain. A key challenge for children and their families was that they found health services fragmented and very difficult to navigate. Consequently, it was difficult to achieve satisfactory pain management. Families often entered a lengthy cycle, which could last many years, of attending then reattending health services, and awaiting referral. In addition to these navigation challenges, CYP and their families, particularly CYP with sickle cell disease and those with chronic pain and learning disabilities, such as Down syndrome, experienced prejudice and discrimination in health services. We created a model of how families navigate chronic management with two key routes labelled Path A and B. On Path A, families seek a cure from services but often repeatedly seek services without pain resolution. When their expectations of services are not met, they try to deal with pain alone, often unsuccessfully, which can dominate family life. Psychological treatments are only used as a last option. Path B depicts effective communication and expectation management by healthcare professionals which can help families to shift their focus from a cure to trying to live well despite the pain. Families might also realise independently over time that a cure is unlikely. Families on Path B tend to be more receptive to biopsychosocial approaches for pain management, due to lack of other options. Families can move between the paths depending on input from services and if pain worsens. We developed new interpretive findings resulting in the family-centred theory of children’s chronic pain and its management, which incorporates how children and families conceptualise pain, their experiences of living with pain and of pain management services, and defines ‘good’ pain management and services. Our mid-range theory describes good pain management and services as holistic, biopsychosocial, family-centred pain management which acknowledges the impact of CYP’s chronic pain on all aspects of family life and their social relationships. In the theory, pain management strategies are tailored to the family’s needs. Schools, social services, social care and healthcare services function as inter-related aspects in a whole system approach. This approach aims to reduce service fragmentation making services more intuitive for families. Empathetic communication is a core component of this approach, and it is fundamental for building trust between families and services. The theory includes assessment of chronic pain and of families’ psychosocial needs to enable effective triage and trigger appropriate actions from/referrals to different services (schools, social care and health services). Cochrane systematic reviews of intervention effects and trials did not measure some outcomes important to children and families, including effects of chronic pain on the family and resolution of pain. Reviews have mainly neglected a biopsychosocial approach when considering how interventions work. Limitations There were few conceptually rich qualitative studies focusing on common pain conditions like migraine, headache, abdominal pain; some rarer conditions; children with learning disabilities and under 5 years old; siblings; boys with chronic pain; fathers; and experiences of treatments/services for chronic pain. Our findings may not well represent the experiences and perceptions of the poorly represented groups and there were gaps in the evidence regarding experiences and perceptions of treatments/services. Three per cent (n = 1) of our findings were assessed as very low confidence, none were low confidence and 36% (n = 13) were moderate confidence, using GRADE-CERQual. Additional evidence could increase our confidence in those findings. We excluded studies focusing on chronic cancer pain, end-of-life pain management and experiences of healthcare professionals. Conclusions Currently, children’s chronic pain management does not involve holistic, biopsychosocial health and social care tailored for children and integrated with support in the community, which considers the needs of the entire family and the impact on the family life. The theory and findings developed in this meta-ethnography have the potential to contribute to the development and updating of existing clinical guidelines on children’s chronic non-cancer pain; inform training of health and social care professionals regarding children’s chronic pain management; and inform service, treatment and intervention design and delivery. Ultimately, this could improve the care provided and thus the health and quality of life of children with chronic non-cancer pain and their families, which in turn could reduce the burden on health and social care services. Findings are being disseminated widely to academic, lay, clinical and policy audiences. Outputs include a short, animated film on YouTube for children (https://youtu.be/Oz5I7xKYf5o), academic journal articles, a webinar, a lay podcast, an infographic, a policy briefing and other social media outputs. In addition, we have delivered eight conference presentations. Future work Family-centred outcomes should be included in future trials of chronic pain interventions. Conceptually rich, primary qualitative studies are needed to explore families’ experiences of services and treatments, including pain management plans, pain assessment, opioid use in children and social care services; experiences of children with autism and learning disabilities, under 5 years old, and with certain common pain conditions, such as headache, migraine and abdominal pain and with some rarer conditions such as Ehlers–Danlos syndrome; experiences of siblings and fathers of children with chronic pain; and healthcare professionals’ experiences and perceptions of chronic pain management. A qualitative evidence synthesis on chronic pain management for children with cancer is needed. Development and testing of family-centred children’s chronic pain interventions, services and treatments are needed. Study registration This study is registered as PROSPERO, the International Prospective Register of Systematic Reviews (reference: CRD42019161455) and Cochrane Pain, Palliative and Supportive Care (review number 623). Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128671) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 17. See the NIHR Funding and Awards website for further award information.

Objectives:. The proposed study aims to assess users’ perceptions of a surgical safety checklist (SSC) reimplementation toolkit and its impact on SSC attitudes and operating room (OR) culture, meaningful checklist use, measures of surgical safety, and OR efficiency at 3 different hospital sites. Background:. The High-Performance Checklist toolkit (toolkit) assists surgical teams in modifying and implementing or reimplementing the World Health Organization’s SSC. Through the explore, prepare, implement, and sustain implementation framework, the toolkit provides a process and set of tools to facilitate surgical teams’ modification, implementation, training on, and evaluation of the SSC. Methods:. A pre–post intervention design will be used to assess the impact of the modified SSC on surgical processes, team culture, patient experience, and safety. This mixed-methods study includes quantitative and qualitative data derived from surveys, semi-structured interviews, patient focus groups, and SSC performance observations. Additionally, patient outcome and OR efficiency data will be collected from the study sites’ health surveillance systems. Data analysis:. Statistical data will be analyzed using Statistical Product and Service Solutions, while qualitative data will be analyzed thematically using NVivo. Furthermore, interview data will be analyzed using the Consolidated Framework for Implementation Research and reach, effectiveness, adoption, implementation, maintenance implementation frameworks. Setting:. The toolkit will be introduced at 3 diverse surgical sites in Alberta, Canada: an urban hospital, university hospital, and small regional hospital. Anticipated impact:. We anticipate the results of this study will optimize SSC usage at the participating surgical sites, help shape and refine the toolkit, and improve its usability and application at future sites.

The growth of online learning has created a need for instructors who can competently teach online. This literature review explores the research questions, program recommendations, and future research suggestions related to professional development for online instructors. Articles were selected and coded based on date of publication and the context of the professional development. Results indicate that most research questions focused on (a) professional development programs, (b) instructors, and (c) instructors' online courses. Most program recommendations focused on (a) professional development programs, (b) context of professional development, and (c) instructors' activity during professional development. Future recommendations for research topics focused on professional development programs and instructors, while future recommendations for research methods focused on research design and institutional settings. The findings suggest that while professional development for online instructors is important, consistency in both design and delivery is lacking. Future research is needed to provide guidance to programs, instructors, and institutions leading to satisfaction and success for more online students.

To effectively fight against traffic accidents, it is of great importance to analyse and understand the conditions that are linked with accidents. Such an analysis can serve as the basis to (i) develop reactive measures by finding the links between the pre-accident conditions (ii) devise proactive strategies that will prevent the occurrence of accidents by making the vehicles safer. This paper contributes to advancement of both approaches. For (i), one needs to identify the patterns in accidents. For (ii), introduction of Connected and Automated Vehicles (CAVs) is a promising solution. However CAVs need to be tested under numerous traffic scenarios to prove their safety before their deployment on public roads. This necessitates a great demand for high quality test scenarios for CAVs.This paper achieves two goals. First, it analyses the past traffic accidents (UK’s STATS19 database) to identify trends in the heterogeneous accident data and unravel the relationships between pre-accident conditions. This is done using a clustering algorithm (ROCK). Seven distinct large clusters emerge as a result. Each of these clusters are then further analysed for their meaning using the frequency analysis and geometric analysis. Secondly the paper underpins the proactive route (ii) by systematically developing, using the information in each cluster, test-case scenarios for CAVs which reflect the risk-prone conditions of the respective clusters. This is done using a data mining method (Market Basket algorithm) and further geometric interpretation of clusters. This way explicit scenarios are developed carrying the characteristics of the clusters that they come from.

Purpose: Phenomenology has a long tradition as a qualitative research method in the social and health sciences. The application of phenomenological methods to understand lived experiences and subjectivities offers researchers a rich tapestry of methodological approaches, often however, the availability of these methods to researchers is tempered as a result of inflexible ideas regarding their use. This article aims to highlight the uniting features between approaches. Design/methodology/approach: The paper begins by offering a brief overview of the two traditions within phenomenology, the descriptive and interpretive approaches and traces the development of each one. It then presents an overview of the commonalities shared by both approaches in with particular reference to the philosophical and methodological cohesion between them. Findings: Frequently, the literature fails to focus on how these methodologies can be used together, and instead foregrounds the ontological and methodological differences between them. While an overview of some of the more vociferous debates within phenomenology are included and acknowledged, the paper calls for a focus on the shared goals of the phenomenological project. Originality/value: This article aims to illustrate that, while recognising differences, the two phenomenological traditions have more in common that unites them, and argues that once this is applied pragmatically, a multiplicity of phenomenological traditions are available to researchers.

In this study, we explore parent and teacher perceptions of school readiness (SR) among 4-year-olds learning English as a second language (ESL) and native English-speaking 4-year-olds and compare these perceptions to child scores. Child assessments focused on letter and numeral knowledge. These data were collected from 387 children (52% boys), including 28% ESL children. Adult perspectives were collected from 141 parents (who rated one child each) and from 30 teachers (who rated 380 children). Findings indicated (a) children's letter and numeral knowledge did not significantly vary by ESL status; (b) teachers, but not parents, rated ESL children significantly lower on literacy knowledge compared to non-ESL children; (c) teacher and, to a lesser extent, parent perceptions of children's literacy and numeracy knowledge were positively associated with children's scores; and (d) teacher perception of numeracy was significantly more aligned with children's numeral knowledge compared to parent perception. Discussion of these findings is included.

Adolescents who become pregnant during their secondary education experience a range of challenges that intersect and limit their opportunities to complete schooling and take up university places. One approach to addressing this issue at an Australian regional university is through the Tertiary Preparation Pathway (TPP) which has been delivered within the Supporting Teenagers with Education, Mothering, and Mentoring (STEMM) program, since 2008. The STEMM program offers teen mothers an opportunity to continue or re-engage with education during and beyond pregnancy. Adopting an intersectionality lens, interviews with adolescent mothers identified three key elements underpinning the success of the TPP/STEMM program: recognising the educational aspirations of teen mothers, developing agency and independence and promoting a strong sense of self. This article aims to provide practical implications for educators wishing to establish or develop programs based on this transformative teaching.

The WHO Surgical Safety Checklist (SSC) continues to show inconsistent success in reducing surgical complications in high-income settings. Previous implementation research identified potential barriers and facilitators to success, but it primarily consists of qualitative studies with small sample sizes in limited geographic areas. We conducted a multi-country mixed-methods study of barriers and facilitators to SSC implementation to better inform policies and practices for improving SSC buy-in and use to maximize its impact. This convergent parallel mixed-methods study utilized survey and interview data from surgical team members practicing in five countries. Survey data were analyzed using χ2 analysis or Fisher’s exact test for categorical variables and McNemar’s test to analyze differences between related groups for dichotomous variables. Interview data underwent inductive coding followed by thematic analysis for predominant themes common across the study countries. The study resulted in 2,032 survey responses and 51 interviews. Facilitators to success included having influential multi-disciplinary champions from surgery, anesthesiology, and nursing; using a distributed leadership process to promote ownership across all surgical team members; and providing education on the “why” of the checklist. Practitioners found patient safety metrics (e.g., wrong side surgery) more relevant than clinical outcome measures (e.g., surgical mortality) to assess SSC success. Finally, auditing for process engagement was felt to promote more meaningful use than auditing for checklist completion. Our international examination of barriers and facilitators to successful SSC implementation has identified more specific guidance for high-income settings that integrate people, data, and processes.

This case study explores differences between two online course models by investigating the results of a student end-of-course evaluation survey and teacher communication logs in two online high school courses. The two course models were designed with different types and levels of interaction, one with high levels of student-content interaction, the second with high levels of student-content and student-teacher interaction. The majority of research on interaction in online learning has been conducted with adult learners at the university level. There is far less literature focusing on K-12 online learning while investigating interaction, student satisfaction, and teacher time investment. This case study addresses this gap by exploring the results of 764 student surveys and investigating the teacher time investments of four teachers. In this study the students' perception of their learning experience in both models met the online program's acceptable levels. In some dimensions of the course evaluation, the interactive course had a statistically significant higher rating. The teacher communication logs showed a higher teacher time investment in the more interactive courses, with the highest time investment coming from reaching out to inactive students. Due to the shortage of available literature in K-12 online settings regarding interaction, student satisfaction, and teacher time investment, the author recommends additional research in these areas. By continuing to research and understand better about K-12 online learners, this understanding could influence the development of course interaction standards, assist designers in building better courses, and ultimately lead to higher satisfaction for students.

Abstract TGFβ signaling is associated with non-response to immune checkpoint blockade in patients with advanced cancers, particularly in the immune-excluded phenotype. While previous work demonstrates that converting tumors from excluded to inflamed phenotypes requires attenuation of PD-L1 and TGFβ signaling, the underlying cellular mechanisms remain unclear. Here, we show that TGFβ and PD-L1 restrain intratumoral stem cell-like CD8 T cell (TSCL) expansion and replacement of progenitor-exhausted and dysfunctional CD8 T cells with non-exhausted T effector cells in the EMT6 tumor model in female mice. Upon combined TGFβ/PD-L1 blockade IFNγhi CD8 T effector cells show enhanced motility and accumulate in the tumor. Ensuing IFNγ signaling transforms myeloid, stromal, and tumor niches to yield an immune-supportive ecosystem. Blocking IFNγ abolishes the anti-PD-L1/anti-TGFβ therapy efficacy. Our data suggest that TGFβ works with PD-L1 to prevent TSCL expansion and replacement of exhausted CD8 T cells, thereby maintaining the T cell compartment in a dysfunctional state.

Abstract Background RHAMM is a multifunctional protein that is upregulated in breast tumors, and the presence of strongly RHAMM+ve cancer cell subsets associates with elevated risk of peripheral metastasis. Experimentally, RHAMM impacts cell cycle progression and cell migration. However, the RHAMM functions that contribute to breast cancer metastasis are poorly understood. Methods We interrogated the metastatic functions of RHAMM using a loss-of-function approach by crossing the MMTV-PyMT mouse model of breast cancer susceptibility with Rhamm −/− mice. In vitro analyses of known RHAMM functions were performed using primary tumor cell cultures and MMTV-PyMT cell lines. Somatic mutations were identified using a mouse genotyping array. RNA-seq was performed to identify transcriptome changes resulting from Rhamm-loss, and SiRNA and CRISPR/Cas9 gene editing was used to establish cause and effect of survival mechanisms in vitro. Results Rhamm-loss does not alter initiation or growth of MMTV-PyMT-induced primary tumors but unexpectedly increases lung metastasis. Increased metastatic propensity with Rhamm-loss is not associated with obvious alterations in proliferation, epithelial plasticity, migration, invasion or genomic stability. SNV analyses identify positive selection of Rhamm −/− primary tumor clones that are enriched in lung metastases. Rhamm −/− tumor clones are characterized by an increased ability to survive with ROS-mediated DNA damage, which associates with blunted expression of interferon pathway and target genes, particularly those implicated in DNA damage-resistance. Mechanistic analyses show that ablating RHAMM expression in breast tumor cells by siRNA knockdown or CRISPR-Cas9 gene editing blunts interferon signaling activation by STING agonists and reduces STING agonist-induced apoptosis. The metastasis-specific effect of RHAMM expression-loss is linked to microenvironmental factors unique to tumor-bearing lung tissue, notably high ROS and TGFB levels. These factors promote STING-induced apoptosis of RHAMM+ve tumor cells to a significantly greater extent than RHAMM−ve comparators. As predicted by these results, colony size of Wildtype lung metastases is inversely related to RHAMM expression. Conclusion RHAMM expression-loss blunts STING-IFN signaling, which offers growth advantages under specific microenvironmental conditions of lung tissue. These results provide mechanistic insight into factors controlling clonal survival/expansion of metastatic colonies and has translational potential for RHAMM expression as a marker of sensitivity to interferon therapy.

NASA envisions a future where humans establish a thriving colony on the Moon by 2050. Plants will be essential for this endeavor, but little is known about their adaptation to extraterrestrial bodies. The capacity to grow plants in lunar regolith would represent a major step towards this goal by minimizing the reliance on resources transported from Earth. Recent studies reveal that Arabidopsis thaliana can germinate and grow on genuine lunar regolith as well as on lunar regolith simulant. However, plants arrest in vegetative development and activate a variety of stress response pathways, most notably the oxidative stress response. Telomeres are hotspots for oxidative damage in the genome and a marker of fitness in many organisms. Here we examine A. thaliana growth on a lunar regolith simulant and the impact of this resource on plant physiology and on telomere dynamics, telomerase enzyme activity and genome oxidation. We report that plants successfully set seed and generate a viable second plant generation if the lunar regolith simulant is pre-washed with an antioxidant cocktail. However, plants sustain a higher degree of genome oxidation and decreased biomass relative to conventional Earth soil cultivation. Moreover, telomerase activity substantially declines and telomeres shorten in plants grown in lunar regolith simulant, implying that genome integrity may not be sustainable over the long-term. Overcoming these challenges will be an important goal in ensuring success on the lunar frontier.

Attention-deficit/hyperactivity disorder (ADHD) is a complex behavioral disorder characterized by hyperactivity, impulsivity, inattention, and deficits in working memory and time perception. While animal models have advanced our neurobiological understanding of this condition, there are limited and inconsistent data on working and elapsed time memory function. Inflammatory signaling has been identified as a key factor in memory and cognitive impairments, but its role in ADHD remains unclear. Additionally, the disproportionate investigation of male subjects in ADHD research has contributed to a poor understanding of the disorder in females. This study sought to investigate the potential connections between memory, neuroimmunology, and ADHD in both male and female animals. Specifically, we utilized the spontaneously hypertensive rat (SHR), one of the most extensively studied animal models of ADHD. Compared to their control, the Wistar-Kyoto (WKY) rat, male SHR are reported to exhibit several behavioral phenotypes associated with ADHD, including hyperactivity, impulsivity, and poor sustained attention, along with impairments in learning and memory. As the hippocampus is a key brain region for learning and memory, we examined the behavior of male and female SHR and WKY rats in two hippocampal-dependent memory tasks. Our findings revealed that SHR have delay-dependent working memory deficits that were similar to, albeit less severe than, those seen in hippocampal-lesioned rats. We also observed impairments in elapsed time processing in female SHR, particularly in the discrimination of longer time durations. To investigate the impact of inflammatory signaling on memory in these rats, we analyzed the levels of several cytokines in the dorsal and ventral hippocampus of SHR and WKY. Although we found some sex and genotype differences, concentrations were generally similar between groups. Taken together, our results indicate that SHR exhibit deficits in spatial working memory and memory for elapsed time, as well as some differences in hippocampal cytokine concentrations. These findings contribute to a better understanding of the neurobiological basis of ADHD in both sexes and may inform future research aimed at developing effective treatments for the disorder. Nonetheless, the potential mediating role of neuroinflammation in the memory symptomatology of SHR requires further investigation.

Introduction: Anterior cervical discectomy and fusion (ACDF) is commonly performed with cage and plate constructs to stabilise diseased or injured cervical segments. Despite it being a commonly performed procedure, there are notable rates of associated morbidity reported in the literature. Stand-alone spacers represent a novel form of instrumentation to conventional cage and plate constructs. Research question: Do stand-alone spacers have improved operative characteristics and postoperative outcomes in ACDF cohorts when compared to cage and plate constructs? Methods: A systematic review and meta-analysis was conducted of PubMed/Medline, Embase and Google Scholar databases per the Preferred Reporting Items for Systematic Reviews and Meta-Analyzes guidelines. Studies of interest included cage and plate instrumentation versus anchored stand-alone spacers for patients undergoing ACDF. Pre- and post-operative clinical and radiological outcomes were collated and compared for significance between cohorts. Results: 10 RCTs were identified and included with 779 patients total. Mean age of the entire cohort was 50.1 years. 62% (483/779) of the cohort were male. 384 patients underwent ACDF with stand-alone cage, while 395 had ACDF with conventional cage and plate. Stand-alone spacers significantly outperformed conventional instrumentation in terms of estimated blood loss (p

Abstract Honey bee colony management is critical to mitigating the negative effects of biotic and abiotic stressors. However, there is significant variation in the practices implemented by beekeepers, which results in varying management systems. This longitudinal study incorporated a systems approach to experimentally test the role of three representative beekeeping management systems (conventional, organic, and chemical-free) on the health and productivity of stationary honey-producing colonies over 3 years. We found that the survival rates for colonies in the conventional and organic management systems were equivalent, but around 2.8 times greater than the survival under chemical-free management. Honey production was also similar, with 102% and 119% more honey produced in conventional and organic management systems, respectively, than in the chemical-free management system. We also report significant differences in biomarkers of health including pathogen levels (DWV, IAPV, Vairimorpha apis, Vairimorpha ceranae) and gene expression (def-1, hym, nkd, vg). Our results experimentally demonstrate that beekeeping management practices are key drivers of survival and productivity of managed honey bee colonies. More importantly, we found that the organic management system—which uses organic-approved chemicals for mite control—supports healthy and productive colonies, and can be incorporated as a sustainable approach for stationary honey-producing beekeeping operations.

Summary: Polygenic risk scores (PRSs) developed from multi-ancestry genome-wide association studies (GWASs), PRSmulti, hold promise for improving PRS accuracy and generalizability across populations. To establish best practices for leveraging the increasing diversity of genomic studies, we investigated how various factors affect the performance of PRSmulti compared with PRSs constructed from single-ancestry GWASs (PRSsingle). Through extensive simulations and empirical analyses, we showed that PRSmulti overall outperformed PRSsingle in understudied populations, except when the understudied population represented a small proportion of the multi-ancestry GWAS. Furthermore, integrating PRSs based on local ancestry-informed GWASs and large-scale, European-based PRSs improved predictive performance in understudied African populations, especially for less polygenic traits with large-effect ancestry-enriched variants. Our work highlights the importance of diversifying genomic studies to achieve equitable PRS performance across ancestral populations and provides guidance for developing PRSs from multiple studies.

Summary: Background: While vaccines have established utility against COVID-19, phase 3 efficacy studies have generally not comprehensively evaluated protection provided by previous infection or hybrid immunity (previous infection plus vaccination). Individual patient data from US government-supported harmonized vaccine trials provide an unprecedented sample population to address this issue. We characterized the protective efficacy of previous SARS-CoV-2 infection and hybrid immunity against COVID-19 early in the pandemic over three-to six-month follow-up and compared with vaccine-associated protection. Methods: In this post-hoc cross-protocol analysis of the Moderna, AstraZeneca, Janssen, and Novavax COVID-19 vaccine clinical trials, we allocated participants into four groups based on previous-infection status at enrolment and treatment: no previous infection/placebo; previous infection/placebo; no previous infection/vaccine; and previous infection/vaccine. The main outcome was RT-PCR-confirmed COVID-19 >7–15 days (per original protocols) after final study injection. We calculated crude and adjusted efficacy measures. Findings: Previous infection/placebo participants had a 92% decreased risk of future COVID-19 compared to no previous infection/placebo participants (overall hazard ratio [HR] ratio: 0.08; 95% CI: 0.05–0.13). Among single-dose Janssen participants, hybrid immunity conferred greater protection than vaccine alone (HR: 0.03; 95% CI: 0.01–0.10). Too few infections were observed to draw statistical inferences comparing hybrid immunity to vaccine alone for other trials. Vaccination, previous infection, and hybrid immunity all provided near-complete protection against severe disease. Interpretation: Previous infection, any hybrid immunity, and two-dose vaccination all provided substantial protection against symptomatic and severe COVID-19 through the early Delta period. Thus, as a surrogate for natural infection, vaccination remains the safest approach to protection. Funding: National Institutes of Health.

Background: Open tibial shaft fractures comprise almost 45% of all open fractures and are frequently the result of high-energy trauma. Due to contamination, limited soft tissue coverage of the tibial shaft and poor tibial blood supply, open tibial shaft fractures are associated with high rates of complication including malunion, non-union and infection. Intramedullary nailing (IMN) is a mainstay of treatment. This study aims to determine the frequency of the various complications in this cohort. Methods: A systematic review of papers published on Embase, PubMed and Cochrane databases pertaining to the use of IMN to fix open tibial shaft fractures were included. The available evidence was collated in regard to the incidence of union, malunion, non-union and infection seen in this cohort. Results: A total of 2767 citations were reviewed, and 17 studies comprising 1850 patients were included in the analysis. There was a delayed union rate of 22.4%, malunion rate of 8.3%, non-union rate of 9.7% and infection rate of 8.1% (95% CI: 5.7%–10.8%) in this patient cohort. Subgroup analysis showed a 3-fold increase in non-union and a 2-fold increase in deep infection among Gustilo III injuries compared to Gustilo I and II. Conclusions: IMN for open tibial shaft fractures results in high rates of union and low rates of infection, comparable to figures seen in closed injuries and superior to those seen with alternative methods of fixation. There is a substantially increased risk of complication associated with Gustilo III injuries, reinforcing the significance of the soft tissue injury in these patients.

Property taxes are common in countries around the world. Until recently, Ireland was an exception as there was no annual tax on residential property. This paper is a review of the Local Property Tax (LPT) system that was introduced in 2013 and had its first property revaluations in 2021. Using the lens of municipal finance and tax assignment, the rationale, history, features and administration of this new residential property tax are outlined. While recognising country-specific circumstances, lessons, opportunities and challenges are explored with a view to future improvements in the design and implementation of the LPT. Lessons from the LPT experience are the importance of tax administration and the role of the central tax collection agency, and, in terms of design, the need for a tailored approach to suit local circumstances. Challenges include the rates/LPT mix and the relative tax burdens on non-residential and residential properties, the long-term sustainability of the LPT arising from design issues, the current low tax rate and future revaluations, and, finally, the need for regular property tax reform because of political and taxpayers’ opposition to a highly visible, unpopular but good local tax.