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BackgroundChronic pain and opioid use disorder (OUD) individually represent a risk to health and well-being. Concerningly, there is evidence that they are frequently co-morbid. While few treatments exist that simultaneously target both conditions, preliminary work has supported the feasibility of an integrated behavioral treatment targeting pain interference and opioid misuse. This treatment combined Acceptance and Commitment Therapy (ACT) and Mindfulness-Based Relapse Prevention (ACT+MBRP). This paper describes the protocol for the adequately powered efficacy study of this integrated treatment.MethodsA multisite randomized controlled trial will examine the efficacy of ACT+MBRP in comparison to a parallel education control condition, focusing on opioid safety and pain education. Participants include veterans (n = 160; 21-75 years old) recruited from three Veterans Administration (VA) Healthcare Systems with chronic pain who are on a stable dose of buprenorphine. Both conditions include twelve weekly 90 min group sessions delivered via telehealth. Primary outcomes include pain interference (Patient Reported Outcome Measurement Information System - Pain Interference) and hazardous opioid use (Current Opioid Misuse Measure), which will be examined at the end of the active treatment phase and through 12 months post-intervention. Secondary analyses will evaluate outcomes including pain intensity, depression, pain-related fear, and substance use, as well as treatment mechanisms.ConclusionThis study will determine the efficacy of an integrated behavioral treatment program for pain interference and hazardous opioid use among veterans with chronic pain and OUD who are prescribed buprenorphine, addressing a critical need for more integrated treatments for chronic pain and OUD.Trial registrationClinicalTrials.gov Identifier: NCT04648228.

This article is a rejoinder to Annie Te One and Maria Bargh’s article, published in the previous edition of The Australian Journal of Indigenous Education, exploring whether the political science discipline in Aotearoa New Zealand is keeping pace with change with respect to Māori politics content in university political science programs, the number of Māori employed in the political science profession and the content of New Zealand's Political Science journal. While acknowledging the importance of their case, an assessment of the empirical evidence and further analysis of the data and the methods used by Te One and Bargh refutes their allegations in relation to all three issues. As one of the co-editors of Political Science, I note that, from 2012 to 2022, the acceptance rate of articles on Māori politics was 91.7% and that of Māori authors submitting on a Māori topic was 100%. Recognition and change are underway.

Background/Objectives: Prescription opioid use before adulthood is typically effective for acute pain control and is also associated with adverse short- and long-term consequences. Methods: This study examined pediatric opioid prescribing trends over time across different age groups (early childhood, school age, adolescence, young adult) and sociodemographic subgroups (sex, ethnicity, race, language, payer type) from 2005 to 2016. Results: Utilizing 42,020 first outpatient opioid prescriptions for youth aged 0–21 years from a large US children’s hospital, this research found notable trends and disparities. Prescription rates increased by 35% from 2005–2007 to 2008–2010, then decreased by 14% from 2008–2010 to 2011–2013, and decreased again by 22% from 2011–2013 to 2014–2016. Chi-squared tests indicated significant changes in prescription rates across all sociodemographic subgroups, though only age group, ethnicity, and payer type (i.e., the party responsible for payment for hospital services) had changes with non-negligible effect sizes (Cramer’s V). Specifically, age group showed small to medium effects (V = 0.16), while ethnicity and payer demonstrated small effects (V = 0.10 each). This study highlights variations in opioid prescribing trends, particularly among different age groups, ethnicities, and payer statuses up to 2016. Conclusions: These findings reveal differing trends in pediatric opioid prescribing during the peak of the opioid epidemic, highlighting the importance of considering age and sociodemographic variables for understanding prescribing patterns fully and raising potential concerns about inequities in pain management. Future studies should explore similar trends from 2016 onward.

Arctic ecosystems are warming nearly 4 times faster than the global average, which is resulting in plant community shifts and subsequent changes in biogeochemical processes such as gaseous fluxes. Additionally, herbivores shape plant communities and thereby may alter the magnitude and composition of ecosystem respiration and biogenic volatile organic compound (BVOC) emissions. Here we determine the effect of large mammalian herbivores on ecosystem respiration and BVOC emissions in two southern and two northern sites in Swedish Scandes, encompassing mountain birch (LOMB) and shrub heath (LORI) communities in the south and low-herb meadow (RIGA) and shrub heath (RIRI) communities in the north. Herbivory significantly altered BVOC composition between sites and decreased ecosystem respiration at RIGA. The difference in graminoid cover was found to have a large effect on ecosystem respiration between sites as RIGA, with the highest cover, had 35 % higher emissions than the next highest-emitting site (LOMB). Additionally, LOMB had the highest emissions of terpenes, with the northern sites having significantly lower emissions. Differences between sites were primarily due to differences in exclosure effects and soil temperature and the prevalence of different shrub growth forms. Our results suggest that herbivory has a significant effect on trace gas fluxes in a productive meadow community and that differences between communities may be driven by differences in shrub composition.

To mitigate the morphological and ecological impacts of direct (e.g. dredging) and indirect (e.g. damaged river function) sediment loss, gravel augmentation is commonly practiced in river systems globally. Despite this, the effectiveness of this practice remains poorly understood, especially in less often considered systems such as chalk streams which present uncommon conditions (e.g. low stream power, stable flow) and may respond to interventions in ways that differ from systems more commonly studied. This study quantified immediate (0-1 years) and short-term (1-2 years) physical and ecological responses to gravel augmentation at two English chalk stream restoration sites: Home Stream (HS; River Test) and East Lodge (EL; River Itchen). We quantified habitat (depth, velocity, substrate composition), cover of different macrophytes, and macroinvertebrate (before-after-control-impact) abundance and community structure. Restoration reduced depth and increased gravel cover in both sites and decreased the cover of filamentous green algae in HS. Macroinvertebrate communities became more dominated by silt-intolerant taxa, while abundance [HS only] and taxon richness increased 1-2 years post-restoration. Whilst the responses found were generally positive in light of the restoration goals, the effects varied across sites, post-restoration time periods and ecological groups, emphasising the need for the more holistic monitoring of restoration projects considering community-level responses at different sites and systems over ecologically relevant timescales. This will help inform on the generality and longevity of responses and provide the evidence needed to develop sound restoration practice.

ABSTRACTIn New Zealand, also known by its Indigenous Māori name Aotearoa, voters of Māori descent have the choice between the Māori roll and the General roll. The boundaries of the seven dedicated Māori electoral districts are superimposed over those of the 65 General districts. Every five years, after the census, persons who have reported Māori descent have the option to change between electoral rolls. Choice of the Māori roll indicates a strong sense of Māori identity and a belief that it is important that the Māori seats remain to guarantee Parliamentary representation by Māori MPs, elected only by Māori. Using a unique dataset sampled from the electoral rolls, plus entire electoral rolls, we investigate roll locations and roll shifts of persons claiming Māori descent across age, gender, spatial location and other factors, merging in census local area census data to estimate linguistic contextual effects. We test hypotheses related to generational socialisation, speaking the Māori language, occupational mobility, household context, and the timing of enrolments. We confirm that identity as Māori, expressed most strongly through language context, has strong effects on Māori roll enrolment, but also find that other factors offset its impact on the number of Māori electorates.

IntroductionThere is an emerging need for plant-based, vegan options for patients requiring nutritional support.MethodsTwenty-four adults at risk of malnutrition (age: 59 years (SD 18); Sex: 18 female, 6 male; BMI: 19.0 kg/m2 (SD 3.3); multiple diagnoses) requiring plant-based nutritional support participated in a multi-center, prospective study of a (vegan suitable) multi-nutrient, ready-to-drink, oral nutritional supplement (ONS) [1.5 kcal/mL; 300 kcal, 12 g protein/200 mL bottle, mean prescription 275 mL/day (SD 115)] alongside dietary advice for 28 days. Compliance, anthropometry, malnutrition risk, dietary intake, appetite, acceptability, gastrointestinal (GI) tolerance, nutritional goal(s), and safety were assessed.ResultsPatients required a plant-based ONS due to personal preference/variety (33%), religious/cultural reasons (28%), veganism/reduce animal-derived consumption (17%), environmental/sustainability reasons (17%), and health reasons (5%). Compliance was 94% (SD 16). High risk of malnutrition (‘MUST’ score ≥ 2) reduced from 20 to 16 patients (p = 0.046). Body weight (+0.6 kg (SD 1.2), p = 0.02), BMI (+0.2 kg/m2 (SD 0.5), p = 0.03), total mean energy (+387 kcal/day (SD 416), p 0.06) with no serious adverse events related.DiscussionThis study highlights that plant-based nutrition support using a vegan-suitable plant-based ONS is highly complied with, improving the nutritional outcomes of patients at risk of malnutrition.

Introduction One in five pregnant women has multiple pre-existing long-term conditions in the UK. Studies have shown that maternal multiple long-term conditions are associated with adverse outcomes. This observational study aims to compare maternal and child outcomes for pregnant women with multiple long-term conditions to those without multiple long-term conditions (0 or 1 long-term conditions).Methods and analysis Pregnant women aged 15–49 years old with a conception date between 2000 and 2019 in the UK will be included with follow-up till 2019. The data source will be routine health records from all four UK nations (Clinical Practice Research Datalink (England), Secure Anonymised Information Linkage (Wales), Scotland routine health records and Northern Ireland Maternity System) and the Born in Bradford birth cohort. The exposure of two or more pre-existing, long-term physical or mental health conditions will be defined from a list of health conditions predetermined by women and clinicians. The association of maternal multiple long-term conditions with (a) antenatal, (b) peripartum, (c) postnatal and long-term and (d) mental health outcomes, for both women and their children will be examined. Outcomes of interest will be guided by a core outcome set. Comparisons will be made between pregnant women with and without multiple long-term conditions using modified Poisson and Cox regression. Generalised estimating equation will account for the clustering effect of women who had more than one pregnancy episode. Where appropriate, multiple imputation with chained equation will be used for missing data. Federated analysis will be conducted for each dataset and results will be pooled using random-effects meta-analyses.Ethics and dissemination Approval has been obtained from the respective data sources in each UK nation. Study findings will be submitted for publications in peer-reviewed journals and presented at key conferences.

The strong association with visual cues exhibited by fish that prefer to inhabit flowing water (rheophilic species) may help reduce the energetic costs of maintaining position due to the provision of spatial points of reference. If this "Station Holding Hypothesis" is true, a positive relationship between the association with visual cues and flow velocity is expected. This hypothesis was tested experimentally by quantifying the response of common minnow (Phoxinus phoxinus) and brown trout (Salmo trutta) to visual cues under three flow velocities. In contradiction to the prediction, there was no evidence that the association with strong visual cues was positively related to flow velocity when fish were presented with vertical black stripes in an open channel flume, although interspecific variation in response was observed. The association with visual cues was relatively weak in trout, compared to minnow that spent 660% more time associated with the zone in which visual cues were present during the treatment, than the control when visual cues were absent. Trout tended to be more exploratory and made short visits to the area where visual cues were present, whereas minnow associated with the cues for longer. The strong association with visual cues independent of flow velocity exhibited by minnow and the weak association across all velocities by trout suggest that this behaviour is unlikely to reflect a strategy to minimise the energetic cost of maintaining position in flowing water. Minnow may have used the visual cues as a proxy indicator of physical structure that provides alternative benefits, such as refuge from predators. Trout may have employed alternative cues (e.g. mechanosensory) to seek more energetically favourable regions of the experimental area, reducing the importance of stationary visual stimuli.

Engaging women affected by Obstetric Fistula as advocates has been proposed as an effective strategy to raise awareness of the condition. Limited literature exists on the experience of those who become advocates. A model of community education, in Sierra Leone, trained women affected by Obstetric Fistula to become volunteer Fistula Advocates. This study explored Advocates’ perception of their role and its influence on their recovery and reintegration. This was a qualitative study, undertaken in Sierra Leone, collecting data from 7 Fistula Advocates and 3 Key Informants (with roles in either clinical or outreach care for women with Obstetric Fistula or training and supervision of Advocates), using semi-structured interviews. Data was subject to a thematic analysis and related to a conceptual framework for mental health recovery. Intrinsic factors motivating Advocates to undertake this role were influenced by psycho-social support received and the possibility for financial independence. Advocates used personal stories in their work to define a new identity, change perceptions and reduce stigma. Benefits associated with the interactions and relationships created through providing and receiving peer support were voiced. Surgical treatment was described as an important factor influencing recovery. The Advocates said economic empowerment helped recovery and reintegration, and the voluntary nature of the Advocate role limited the impact of this. Overall Advocates perceived their role positively, reporting psychological, social, and economic benefits. The complexities of recovery from Obstetric Fistula were highlighted and connections drawn between the treatment of physical symptoms, the socio-cultural context and mental health recovery. They described the role positively influencing existing relationships and initiating supportive, empowering social interactions between women affected by Obstetric Fistula and with Non-Governmental Organisation staff and community members. The study offers insights into the potential for community-based approaches to facilitate access to treatment for sensitive and stigmatising health problems and support recovery.

Background: The coronavirus disease 2019 (COVID-19) pandemic resulted in more than six million deaths in the first two years, a third of the estimated number of cancer-related deaths during this time. It directly impacted radiotherapy training in Africa. Aim: This study evaluated the changes applied to the Access to Care Cape Town Radiotherapy training programme during the pandemic. Setting: The training platform prior to March 2020 was used as a baseline and compared with the programme status in January 2022, representing the emergency teaching model. Methods: Five themes were investigated: computer hardware and software changes; e-Learning resources; programme and curriculum changes; challenges experienced and alignment with modern medical education principles. Results: Reconfiguration of the computer laboratories was required, including additional computer monitors, web cameras and headsets, as well as installation of screen recording and teleconferencing software. The EclipseTM radiotherapy treatment planning laboratory was reconfigured for remote student access, with simultaneous monitoring by local assistants. Online learning was augmented by adding the University of Cape Town VulaTM system as resource, and courses restructured for delivery of short blocks. Five new courses were developed, including collaborations with international training partners, showing good alignment with the principles of modern medical education. Conclusion: Reconfiguration was performed at a manageable cost but required a high level of information technology support. Connectivity and bandwidth issues remain a challenge, as well as online engagement. Contribution: Despite these challenges, the virtualisation allowed for continued training between March 2020 and December 2021, with 18 departments attending remote teaching courses.

Introduction With good medical care, most pregnancy complications like pre-eclampsia, gestational diabetes, etc resolve after childbirth. However, pregnancy complications are known to be associated with an increased risk of new long-term health conditions for women later in life, such as cardiovascular disease. These umbrella reviews aim to summarise systematic reviews evaluating the association between pregnancy complications and five groups of long-term health conditions: autoimmune conditions, cancers, functional disorders, mental health conditions and metabolic health conditions (diabetes and hypertension).Methods and analysis We will conduct searches in Medline, Embase and the Cochrane database of systematic reviews without any language restrictions. We will include systematic reviews with or without meta-analyses that studied the association between pregnancy complications and the future risk of the five groups of long-term health conditions in women. Pregnancy complications were identified from existing core outcome sets for pregnancy and after consultation with experts. Two reviewers will independently screen the articles. Data will be synthesised with both narrative and quantitative methods. Where a meta-analysis has been carried out, we will report the combined effect size from individual studies. For binary data, pooled ORs with 95% CIs will be presented. For continuous data, we will use the mean difference with 95% CIs. The findings will be presented in forest plots to assess heterogeneity. The methodological quality of the studies will be evaluated with the AMSTAR 2 tool or the Cochrane risk of bias tool. The corrected covered area method will be used to assess the impact of overlap in reviews. The findings will be used to inform the design of prediction models, which will predict the risk of women developing these five group of health conditions following a pregnancy complication.Ethics and dissemination No ethical approvals required. Findings will be disseminated through publications in peer-reviewed journals and conference presentations.

Macrophages are key target cells of Zika virus (ZIKV) infection, implicated as a viral reservoir seeding sanctuary sites such as the central nervous system and testes. This rests on the apparent ability of macrophages to sustain ZIKV replication without experiencing cytopathic effects. ZIKV infection of macrophages triggers an innate immune response involving type I interferons (IFN-I), key antiviral cytokines that play a complex role in ZIKV pathogenesis in animal models. To investigate the functional role of the IFN-I response we generated human induced pluripotent stem cell (iPSC)-derived macrophages from a patient with complete deficiency of IFNAR2, the high affinity IFN-I receptor subunit. Accompanying the profound defect of IFN-I signalling in IFNAR2 deficient iPS-macrophages we observed significantly enhanced ZIKV replication and cell death, revealing the inherent cytopathicity of ZIKV towards macrophages. These observations were recapitulated by genetic and pharmacological ablation of IFN-I signalling in control iPS-macrophages and extended to a model of iPS-microglia. Thus, the capacity of macrophages to support noncytolytic ZIKV replication depends on an equilibrium set by IFN-I, suggesting that innate antiviral responses might counterintuitively promote ZIKV persistence via the maintenance of tissue viral reservoirs relevant to pathogenesis.

To mitigate the morphological and ecological impacts of direct (e.g. dredging) and indirect (e.g. damaged river function) sediment loss, gravel augmentation is commonly practiced in river systems globally. Despite this, the effectiveness of this practice remains poorly understood, especially in less often considered systems such as chalk streams which present uncommon conditions (e.g. low stream power, stable flow) and may respond to interventions in ways that differ from systems more commonly studied. This study quantified immediate (0–1 years) and short-term (1–2 years) physical and ecological responses to gravel augmentation at two English chalk stream restoration sites: Home Stream (HS; River Test) and East Lodge (EL; River Itchen). We quantified habitat (depth, velocity, substrate composition), cover of different macrophytes, and macroinvertebrate (before-after-control-impact) abundance and community structure. Restoration reduced depth and increased gravel cover in both sites and decreased the cover of filamentous green algae in HS. Macroinvertebrate communities became more dominated by silt-intolerant taxa, while abundance [HS only] and taxon richness increased 1–2 years post-restoration. Whilst the responses found were generally positive in light of the restoration goals, the effects varied across sites, post-restoration time periods and ecological groups, emphasising the need for the more holistic monitoring of restoration projects considering community-level responses at different sites and systems over ecologically relevant timescales. This will help inform on the generality and longevity of responses and provide the evidence needed to develop sound restoration practice. [ABSTRACT FROM AUTHOR]