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Evidence shows that people with strong physical activity habits tend to engage in more physical activity than those with weaker habits, but little is known about how habit influences specific types of physical activity. This study aimed to test whether mean level of habit strength and magnitude of the habit strength – behaviour association differed as a function of physical activity modality. Participants (N = 120; M age = 25 years, 75% female) who reported engaging in organised sport separately reported their habit strength for organised sport and leisure time physical activity as well as the time they spent engaging in these physical activity behaviours. Means comparisons and multilevel modelling revealed that people had significantly stronger habit for organised sport than for leisure time physical activity. Crucially, no significant difference was found in the magnitude of the sport-habit and leisure-habit link. Post-hoc analyses revealed that habit was stronger for team sport compared to individual sport, but that there was no significant difference in sport-habit association between team and individual sports. Research should therefore focus on identifying the characteristics of team sports-based activity that are particularly conducive to habit formation as a precursor to developing interventions to promote performance of leisure time activity in a way that would attain such characteristics.

Objective: Leadership development assessments are a critical component of student pharmacists' understanding and development of effective team strategies., Methods: The 5 Voices tool, developed by GiANT Worldwide, was incorporated into the leadership curriculum across 2 colleges of pharmacies for second-year Doctor of Pharmacy (PharmD) students. One public land-grant institution administers the assessment in the fall semester during a 2-h class session as part of a leadership elective leadership course and a private liberal arts institution distributes the 5 Voices assessment to all students during a 1-h spring semester required course., Results: Responses from 456 PharmD students were included in the analysis, with 159 (34.9%) and 297 (65.1%) coming from the University of Minnesota and Drake University, respectively. Overall, 49.1% of PharmD students had nurturer as their foundational (first) voice. No differences were found in the distribution of first voices between institutions. The PharmD data are higher than the nurturer population-level average (43%)., Conclusion: Introducing students to the 5 Voices assessment provides an opportunity for them to gain a better understanding of what they can contribute to a team. In addition, because nurturer is a dominant voice, this understanding can help provide appreciation for other voices necessary for team development., Competing Interests: Declaration of Competing Interest Dr. Melissa Medina is an Associate Editor for the American Journal of Pharmaceutical Education. The remaining authors have no competing interest to declare., (Published by Elsevier Inc.)

The vortex that forms in the aortic sinus plays a vital role in optimizing blood flow. Disruption of the vortex can result in flow stagnation and activate thrombus formation in the aortic root, especially when aortic valve flow is reduced as during left ventricular assist device (LVAD) support. Our goal in this study was to visualize vortex formation in an experimental model of the aortic root as flow is progressively reduced. A mock circulatory loop that reproduces heart failure hemodynamics was combined with a HeartMate II LVAD and velocity measured in a transparent aortic root with a bioprosthetic valve. The aortic valve sinus vortices are clearly visible as counter-rotating structures in the velocity field at baseline and for all conditions with flow through the aortic valve. As LVAD speed increases, the central jet narrows but the vortices persist, disappearing only when the valve is completely closed. The vortices preserve fluid momentum and generate shear stress along the tissue surfaces which disrupts flow stasis. These features underscore the importance of maintaining "intermittent" aortic valve opening, as recommended for LVAD patients. This study is the first to report vortex formation in the aortic root during LVAD support, providing a motivation for further evaluation., Competing Interests: Disclosure: The authors have no conflicts of interest to report., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the ASAIO.)

Abstract: Sax van der Weyden, M, Merrigan, JJ, Newman, K, Hahn, J, and Martin, J. Army Combat Fitness Test scores moderate cognitive function improvements after a ruck march: A hierarchical linear model approach. J Strength Cond Res 38(7): 1314-1320, 2024-Heavy load carriage is a common task for military personnel and can lead to undue physical and mental fatigue. The purpose of this study was to assess effects of load carriage on cognitive function (CF) and the role individual characteristics play in CF responses. Anthropometrics/body composition, demographics, and Army Combat Fitness Test (ACFT) scores were gathered from 47 Reserve Officers' Training Corps cadets. Cadets' CF was assessed through the concentration task grid (CTG) before (preruck), immediately after (postruck), and 3 weeks after (follow-up) a 16.09- to 19.31-km ruck march. Hierarchical linear modeling was used, with α < 0.05. The final model revealed growth, or improvement, in CF from preruck to postruck with growth decelerating, but still improved, at follow-up. The load carriage bout improved CF in most cadets, with average growth from 5.67- to 7.20-grid squares found. However, postruck CF did not return to the same level as a controlled follow-up (9.69). Sex (2.46, female), familiarity with the CTG (1.99), ACFT total scores (0.009), and relative ruck mass (-0.09) were all significant predictors of postruck CF. Army Combat Fitness Test scores (0.008) were also significant predictors of the slope between preruck and postruck, such that an ACFT score 59 points above average would result in a 1-grid square greater improvement in CF postruck. The significance of ACFT scores, lower relative ruck mass, and familiarization highlights the importance physical and mental preparation for desirable CF outcomes after occupational tasks., (Copyright © 2024 National Strength and Conditioning Association.)

Flaviviruses pose a significant threat to public health due to their ability to infect the central nervous system (CNS) and cause severe neurologic disease. Astrocytes play a crucial role in the pathogenesis of flavivirus encephalitis through their maintenance of blood-brain barrier (BBB) integrity and their modulation of immune cell recruitment and activation within the CNS. We have previously shown that receptor interacting protein kinase-3 (RIPK3) is a central coordinator of neuroinflammation during CNS viral infection, a function that occurs independently of its canonical function in inducing necroptotic cell death. To date, however, roles for necroptosis-independent RIPK3 signaling in astrocytes are poorly understood. Here, we use mouse genetic tools to induce astrocyte-specific deletion, overexpression, and chemogenetic activation of RIPK3 to demonstrate an unexpected anti-inflammatory function for astrocytic RIPK3. RIPK3 activation in astrocytes was required for host survival in multiple models of flavivirus encephalitis, where it restricted neuropathogenesis by limiting immune cell recruitment to the CNS. Transcriptomic analysis revealed that, despite inducing a traditional pro-inflammatory transcriptional program, astrocytic RIPK3 paradoxically promoted neuroprotection through the upregulation of serpins, endogenous protease inhibitors with broad immunomodulatory activity. Notably, intracerebroventricular administration of SerpinA3N in infected mice preserved BBB integrity, reduced leukocyte infiltration, and improved survival outcomes in mice lacking astrocytic RIPK3. These findings highlight a previously unappreciated role for astrocytic RIPK3 in suppressing pathologic neuroinflammation and suggests new therapeutic targets for the treatment of flavivirus encephalitis., Competing Interests: Declaration of Interests The authors declare no competing interests.

Non-neutralizing functions of antibodies, including phagocytosis, may play a role in Chlamydia trachomatis (CT) infection, but these functions have not been studied and assays are lacking. We utilized a flow-cytometry-based assay to determine whether serum samples from a well-characterized cohort of CT-infected and naïve control individuals enhanced phagocytosis via Fc-receptor-expressing THP-1 cells, and whether this activity correlated with antibody titers. Fc-receptor-mediated phagocytosis was detected only in CT+ donors. Phagocytosis generally did not correlate well with antibody titer. In addition, we found that complement from both CT+ and negative individuals enhanced phagocytosis of CT into primary neutrophils. These results suggest that anti-CT antibodies can have functions that are not reflected by titer. This method could be used to quantitively measure Fc-receptor-mediated function of anti-CT antibodies or complement activity and could reveal new immune correlates of protection., Competing Interests: N.R.M. and K.N. report receiving research funding under the Merck Investigator Sponsored Program. The other authors report no conflict of interest.

Background: Technology has been identified as a potential solution to alleviate resource gaps and augment care delivery in dementia care settings such as hospitals, long-term care, and retirement homes. There has been an increasing interest in using real-time location systems (RTLS) across health care settings for older adults with dementia, specifically related to the ability to track a person's movement and location., Objective: In this study, we aimed to explore the factors that influence the adoption or nonadoption of an RTLS during its implementation in a specialized inpatient dementia unit in a tertiary care rehabilitation hospital., Methods: The study included data from a brief quantitative survey and interviews from a convenience sample of frontline participants. Our deductive analysis of the interview used the 3 categories of the Fit Between Individuals, Task, and Technology framework as follows: individual and task, individual and technology, and task and technology. The purpose of using this framework was to assess the quality of the fit between technology attributes and an individual's self-reported intentions to adopt RTLS technology., Results: A total of 20 health care providers (HCPs) completed the survey, of which 16 (80%) participated in interviews. Coding and subsequent analysis identified 2 conceptual subthemes in the individual-task fit category, including the identification of the task and the perception that participants were missing at-risk patient events. The task-technology fit category consisted of 3 subthemes, including reorganization of the task, personal control in relation to the task, and efficiency or resource allocation. A total of 4 subthemes were identified in the individual-technology fit category, including privacy and personal agency, trust in the technology, user interfaces, and perceptions of increased safety., Conclusions: By the end of the study, most of the unit's HCPs were using the tablet app based on their perception of its usefulness, its alignment with their comfort level with technology, and its ability to help them perform job responsibilities. HCPs perceived that they were able to reduce patient search time dramatically, yet any improvements in care were noted to be implied, as this was not measured. There was limited anecdotal evidence of reduced patient risk or adverse events, but greater reported peace of mind for HCPs overseeing patients' activity levels., (©Lynn Haslam-Larmer, Alisa Grigorovich, Leia Shum, Andria Bianchi, Kristine Newman, Andrea Iaboni, Josephine McMurray. Originally published in JMIR Aging (https://aging.jmir.org), 08.04.2024.)

Indirect Drive Inertial Confinement Fusion Experiments on the National Ignition Facility (NIF) have achieved a burning plasma state with neutron yields exceeding 170 kJ, roughly 3 times the prior record and a necessary stage for igniting plasmas. The results are achieved despite multiple sources of degradations that lead to high variability in performance. Results shown here, for the first time, include an empirical correction factor for mode-2 asymmetry in the burning plasma regime in addition to previously determined corrections for radiative mix and mode-1. Analysis shows that including these three corrections alone accounts for the measured fusion performance variability in the two highest performing experimental campaigns on the NIF to within error. Here we quantify the performance sensitivity to mode-2 symmetry in the burning plasma regime and apply the results, in the form of an empirical correction to a 1D performance model. Furthermore, we find the sensitivity to mode-2 determined through a series of integrated 2D radiation hydrodynamic simulations to be consistent with the experimentally determined sensitivity only when including alpha-heating., (© 2024. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.)

On December 5, 2022, an indirect drive fusion implosion on the National Ignition Facility (NIF) achieved a target gain G&#95;{target} of 1.5. This is the first laboratory demonstration of exceeding "scientific breakeven" (or G&#95;{target}>1) where 2.05 MJ of 351 nm laser light produced 3.1 MJ of total fusion yield, a result which significantly exceeds the Lawson criterion for fusion ignition as reported in a previous NIF implosion [H. Abu-Shawareb et al. (Indirect Drive ICF Collaboration), Phys. Rev. Lett. 129, 075001 (2022)PRLTAO0031-900710.1103/PhysRevLett.129.075001]. This achievement is the culmination of more than five decades of research and gives proof that laboratory fusion, based on fundamental physics principles, is possible. This Letter reports on the target, laser, design, and experimental advancements that led to this result.

Objectives: The UK government made it mandatory for large restaurants and cafes in England to display calorie labels on menus. Existing evidence identifies minimal potential for benefit, but significant potential for harm to those with eating disorders. To date, only one published study has directly explored the impact of this legislation on those with eating disorders. This study explores the impact of calorie labelling on menus on adults with experience of eating disorders in England., Design: A qualitative online survey was designed and distributed, and 399 adults with current or past experience/s of eating disorders completed the survey., Methods: Reflexive thematic analysis was used, informed by a critical realist approach., Results: Six themes were developed: (1) impacts on relationships, (2) exclusion and increased isolation, (3) restricted freedom, (4) dis/embodiment, (5) anger and frustration at the perpetuation of diet culture and (6) we are all responsible for ourselves. Most participants felt calorie labels on menus is detrimental to their eating disorder and/or recovery. People are navigating multiple opposing cultural narratives around health, bodies and eating disorder recovery that can put additional barriers in place to developing a relationship with food and body that they would like., Conclusions: Calorie labelling on menus is likely to adversely impact those with eating disorders. Menus with calories should be available separately but should not be the first or only one provided. People with experience of eating disorders should be directly involved in the development of public health legislation and policy that is likely to affect them., (© 2023 The Authors. British Journal of Health Psychology published by John Wiley & Sons Ltd on behalf of British Psychological Society.)

Background: Nintedanib slows progression of lung function decline in patients with progressive fibrosing (PF) interstitial lung disease (ILD) and was recommended for this indication within the United Kingdom (UK) National Health Service in Scotland in June 2021 and in England, Wales and Northern Ireland in November 2021. To date, there has been no national evaluation of the use of nintedanib for PF-ILD in a real-world setting., Methods: 26 UK centres were invited to take part in a national service evaluation between 17 November 2021 and 30 September 2022. Summary data regarding underlying diagnosis, pulmonary function tests, diagnostic criteria, radiological appearance, concurrent immunosuppressive therapy and drug tolerability were collected via electronic survey., Results: 24 UK prescribing centres responded to the service evaluation invitation. Between 17 November 2021 and 30 September 2022, 1120 patients received a multidisciplinary team recommendation to commence nintedanib for PF-ILD. The most common underlying diagnoses were hypersensitivity pneumonitis (298 out of 1120, 26.6%), connective tissue disease associated ILD (197 out of 1120, 17.6%), rheumatoid arthritis associated ILD (180 out of 1120, 16.0%), idiopathic nonspecific interstitial pneumonia (125 out of 1120, 11.1%) and unclassifiable ILD (100 out of 1120, 8.9%). Of these, 54.4% (609 out of 1120) were receiving concomitant corticosteroids, 355 (31.7%) out of 1120 were receiving concomitant mycophenolate mofetil and 340 (30.3%) out of 1120 were receiving another immunosuppressive/modulatory therapy. Radiological progression of ILD combined with worsening respiratory symptoms was the most common reason for the diagnosis of PF-ILD., Conclusion: We have demonstrated the use of nintedanib for the treatment of PF-ILD across a broad range of underlying conditions. Nintedanib is frequently co-prescribed alongside immunosuppressive and immunomodulatory therapy. The use of nintedanib for the treatment of PF-ILD has demonstrated acceptable tolerability in a real-world setting., Competing Interests: Conflict of interest: A.J. Simpson has received funding to his institution from Boehringer Ingelheim (BI) to undertake an educational meeting. A. West has received support from BI for speaking at or chairing educational events, and attendance and travel to educational meetings; and is part of an advisory board for BI and Avalyn Pharmaceuticals. A. John has received funding from BI to attend an educational event. A.M. Wilson has received grants from Aseptika, Brainomix and BASF, has received speakers’ fees from BI, has received support for attending meetings by Chiesi, and has institutional interests with Celgene Corporation, GSK and Insmed Inc. A. Crawshaw has received speakers’ fees from BI and AstraZeneca (AZ). A.U. Wells has undertaken advisory board activity and consultant work for BI, Roche and Veracyte. C.C. Huntley has received an honorarium for educational content from BI and sponsorship for conference attendance. D. Dosanjh has received a speaker's fee from BI, meeting attendance costs from AZ and is part of the advisory board for AZ, Gilead, BI and Synairgen. E. Renzoni has received institutional funding, honoraria for educational events and funding for conference attendance from BI, and is member of the advisory board for BI and Roche. F. Chua has received consulting fees, honoraria, support for conference attendance and is an advisory board member for BI. G. Saini has received institutional payment for educational presentation from BI. G. Dixon, H. Stone, L.M. Nicol and I.A. Forrest have received support for educational event attendance from BI. J.C.L. Rodrigues has received grant funding from NIHR, consulting fees from NHSx and HeartFlow, honoraria from Sanofi, Aidence and 4-C Research market research, meeting attendance support from Aidence and HeartFlow, leadership role in Heart and Lung Imaging LTD (HLH), stock in Radnet and shares in HLH. K. Tsaneva-Atanasova has financial support from EPSRC grant. M. Naqvi has received a grant from NHS Digital, honoraria from BI, AZ and Roche, support for meeting attendance from BI and advisory board membership for BI, and is ILD Pharmacist Network Chair and ILD-IN Co-chair. M.G. Jones has received grants from Royal Society, BI, NC3Rs, MRC, AAIR Charity and the British Lung Foundation. P.M. George has received an institutional grant from BI, honoraria from BI, Roche, Teva, Cipla and Brainomix, meeting attendance support from BI and Roche and has stock in Brainomix. P. Molyneaux has grant funding from AZ, consulting fees from Roche, BI, AZ, Trevi and Qureight, and honoraria from BI and Roche; and is an associate editor of this journal. P. Rivera-Ortega has received grant funding from MRC, institutional grant funding from BI, Roche, CSL Behring, Fibrogen, Vicore Pharma AB, Gilead Sciences and Galecto, consulting fees from BI and Roche, honoraria from BI, Roche and Respiratory Effectiveness Group (REG), support for meeting attendance from BI and REG, is a chair of the REG and member of the Global Writing Group Committee for REMAP-ILD. R.K. Coker has received honoraria from BI. S. Agnew has received honoraria from BI, support for meeting attendance from BI and is member of the BTS ILD registry advisory board. S.L. Barratt has received consulting fees and honoraria from BI. S. Hart has received research grant from BI, consulting fees from Trevi Therapeutics, honoraria and support for meeting attendance from BI and Chiesi, was Chair of the BTS Standard of Care Committee 2019–2022, and is a Trustee of Action for Pulmonary Fibrosis and an associate editor of this journal. S. Barth received honoraria from BI for educational meeting facilitating. T. Garfoot received support to attend the ILD IN annual conference. T. Gatheral has received speakers’ fees from BI. Conflict of interest: The remaining authors have no competing interests., (Copyright ©The authors 2024.)

Objective: This study aimed to understand pharmacy programs' policies and processes of sharing Advanced Pharmacy Practice Experience (APPE) assessment information among preceptors and to determine the types of grading scales currently being used nationally., Methods: A 14-question survey was utilized to collect information on Experiential Education policies and practices regarding APPE evaluations and assessment data sharing. The survey was administered electronically to Experiential Education Administrators at accredited schools of pharmacy nationally and gathered information on approach to APPE assessment, information sharing with future preceptors and open-ended responses on how struggling student learners are supported. Descriptive statistics were used to analyze quantitative responses, while qualitative open-ended comments were analyzed using thematic analysis., Results: A total of 95 responses were included in the analysis (67.9% response rate). The majority of programs (83.2%) reported not sharing student performance assessments with future preceptors. Themes that emerged from the analysis of open-ended comments included concerns about bias and privacy violations, and the benefits of sharing evaluations for preceptor preparation and longitudinal student growth. The grading approach varied, with 53.7% of programs using traditional tiered letter grades and 45.3% using a pass/fail grading system., Conclusion: Most pharmacy programs do not share APPE assessment information with future preceptors due to concerns about bias and protecting student privacy. However, programs may be looking for alternative processes that address the need to facilitate student growth and to support struggling learners. Examples shared may provide stimulus and insight for Experiential Education Offices to engage in programmatic discussions about the approach to assessment sharing practices., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 American Association of Colleges of Pharmacy. Published by Elsevier Inc. All rights reserved.)

Objectives: Despite young carers (YCs) providing regular and significant care that exceeds what would normally be associated with an adult caregiver, we need to learn more about their experience interacting with the healthcare system. The primary study aims were to (1) describe YC experiences in interacting with the healthcare system and (2) identify types of support YC recognise as potentially helpful to their caring role., Design and Setting: A mixed-methods qualitative study was conducted between March 2022 and August 2022, comprising two phases of (1) semi-structured interviews and focus groups with YCs living in the community to confirm and expand earlier research findings, and (2) a co-design workshop informed by a generative research approach. We used findings from the interviews and focus groups to inform the brainstorming process for identifying potential solutions., Results: Eight YCs completed either a focus group or an interview, and four continued the study and participated in the co-design activity with 12 participants. Phase 1 resulted in three overarching themes: (1) navigating the YC role within the healthcare system; (2) being kept out of the loop; and (3) normalising the transition into caregiving. Phase 2 identified two categories: (1) YC-focused supports and (2) raising awareness and building capacity in the healthcare system., Conclusion: Study findings revealed the critical role that YCs play when supporting their families during pivotal interactions in the healthcare system. Like their older caregiver counterparts, YCs struggle to navigate, coordinate and advocate for their family members while juggling their needs as they transition from adolescence to adulthood. This study provides important preliminary insights into YCs encountering professionals, which can be used to design and implement national support structures., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Obstruction of the LVAD flow path can occur when blood clots or tissue overgrowth form within the inflow cannula, pump body, or outflow graft, and it can lead to thrombus, embolism, and stroke. The goal of this study was to measure the impact of progressive pump inflow obstruction on the pressure and flow dynamics of the LVAD-supported heart using a mock circulatory loop. Pump obstruction (PO) was produced by progressively blocking a fraction of the LVAD inlet area. Pressures, flows, and the midplane velocity field of the LV were measured for three LVAD speeds and six PO levels. Pressure and flow decreased with PO, shifting more of the flow through the aortic valve such that the total flow decreased by 6-11% and decreased the efficiency of the work of the native heart up to 60%. PO restricts diastolic flow through the LVAD, which reduces mitral inflow and decreases the strength and energy of the intraventricular vortices. The changes in flow architecture produced by PO include flow stasis and increased shear, which predispose the system to thromboembolic risk. Analysis of the contributions to external work may enable early detection, which allows time for therapeutic intervention, reducing the likelihood of pump replacement and the risk of complications.

Objective: To understand the process of the promotion and tenure (P&T) as experienced by faculty members in experiential education (EE)., Methods: A quantitative survey of EE faculty at any academic rank investigated the general landscape of experiences in P&T. Phenomenological qualitative interviews with faculty who currently work in EE and who achieved promotion to full professor while working within EE provided additional context. Analysis was completed using a mixed-methods approach. Incomplete survey responses were excluded., Results: Survey respondents indicated feeling different from other clinical faculty, particularly in the need to justify their work to the P&T committee (26/38; 68%). Respondents noted how challenging the P&T process was and perceived a lack of understanding of EE work among P&T committee members, chairs, and/or colleagues. In qualitative interviews, 3 themes emerged, which were characterizing a misunderstood role; navigating an unclear process with creativity and courage; and seeking outside-of-the-box mentoring., Conclusion: Experiential education faculty may require specific guidance and a thoughtful approach in tailoring their dossier for the P&T process, especially in accounting for administrative work and other unique aspects of the role. To promote inclusivity and retention of EE faculty, greater understanding of the EE role is needed as it applies to guidelines for P&T. Furthermore, EE faculty and others with unique roles should receive guidance to meaningfully apply P&T guidelines in a manner that best represents their role., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 American Association of Colleges of Pharmacy. Published by Elsevier Inc. All rights reserved.)

The characterization of intraventricular flow is critical to evaluate the efficiency of fluid transport and potential thromboembolic risk but challenging to measure directly in advanced heart failure (HF) patients with left ventricular assist device (LVAD) support. The study aims to validate an in-house mock loop (ML) by simulating specific conditions of HF patients with normal and prosthetic mitral valves (MV) and LVAD patients with small and dilated left ventricle volumes, then comparing the flow-related indices result of vortex parameters, residence time (RT), and shear-activation potential (SAP). Patient-specific inputs for the ML studies included heart rate, end-diastolic and end-systolic volumes, ejection fraction, aortic pressure, E/A ratio, and LVAD speed. The ML effectively replicated vortex development and circulation patterns, as well as RT, particularly for HF patient cases. The LVAD velocity fields reflected altered flow paths, in which all or most incoming blood formed a dominant stream directing flow straight from the mitral valve to the apex. RT estimation of patient and ML compared well for all conditions, but SAP was substantially higher in the LVAD cases of the ML. The benchtop system generated comparable and reproducible hemodynamics and fluid dynamics for patient-specific conditions, validating its reliability and clinical relevance. This study demonstrated that ML is a suitable platform to investigate the fluid dynamics of HF and LVAD patients and can be utilized to investigate heart-implant interactions., (Copyright © 2023 by ASME; reuse license CC-BY 4.0.)

Goal: This article describes the development and implementation of a behavior intervention response team (BIRT). Pilot data indicate the successful implementation of BIRT interventions with patients and families and the positive staff response to these interventions., Methods: Patient- and family-disruptive behaviors are increasing in hospitals. Those behaviors arise from stress, financial burdens, and the mental weight of the patient's medical condition on the family. These distressed patients and their families tax an already overwhelmed staff, exacerbating the caregivers' exhaustion, depersonalization, and frustration. We recognized the need to proactively address these disruptions at our children's hospital with an interdisciplinary response. Disciplines engaged in the BIRT development included risk management, behavioral health, child life, service excellence, patient and family services, social work, and chaplaincy. Following multiple brainstorming sessions, we created a comprehensive, clear intervention strategy to engage with a disruptive patient or family. The BIRT was developed to work with both the family and their medical team to intervene at the first signs of potential disruption., Principal Findings: With the BIRT, we were able to reduce disruptive behaviors and limit the subsequent removal of problematic individuals from the facility. Of the families who worked with the BIRT, 75.8% required no postintervention follow-up., Practical Applications: The development of a BIRT can help head off disruptive behaviors and improve family-medical team relationships to support the highest quality and safest healthcare., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2023 Foundation of the American College of Healthcare Executives.)

Background: Mental health problems affect 1 in 6 workers annually and are one of the leading causes of sickness absence, with stress, anxiety, and depression being responsible for half of all working days lost in the United Kingdom. Primary interventions with a preventative focus are widely acknowledged as the priority for workplace mental health interventions. Line managers hold a primary role in preventing poor mental health within the workplace and, therefore, need to be equipped with the skills and knowledge to effectively carry out this role. However, most previous intervention studies have directly focused on increasing line managers' understanding and awareness of mental health rather than giving them the skills and competencies to take a proactive preventative approach in how they manage and design work. The Managing Minds at Work (MMW) digital training intervention was collaboratively designed to address this gap. The intervention aims to increase line managers' knowledge and confidence in preventing work-related stress and promoting mental health at work. It consists of 5 modules providing evidence-based interactive content on looking after your mental health, designing and managing work to promote mental well-being, management competencies that prevent work-related stress, developing a psychologically safe workplace, and having conversations about mental health at work., Objective: The primary aim of this study is to pilot and feasibility test MMW, a digital training intervention for line managers., Methods: We use a cluster randomized controlled trial design consisting of 2 arms, the intervention arm and a 3-month waitlist control, in this multicenter feasibility pilot study. Line managers in the intervention arm will complete a baseline questionnaire at screening, immediately post intervention (approximately 6 weeks after baseline), and at 3- and 6-month follow-ups. Line managers in the control arm will complete an initial baseline questionnaire, repeated after 3 months on the waitlist. They will then be granted access to the MMW intervention, following which they will complete the questionnaire post intervention. The direct reports of the line managers in both arms of the trial will also be invited to take part by completing questionnaires at baseline and follow-up. As a feasibility pilot study, a formal sample size is not required. A minimum of 8 clusters (randomized into 2 groups of 4) will be sought to inform a future trial from work organizations of different types and sectors., Results: Recruitment for the study closed in January 2022. Overall, 24 organizations and 224 line managers have been recruited. Data analysis was finished in August 2023., Conclusions: The results from this feasibility study will provide insight into the usability and acceptability of the MMW intervention and its potential for improving line manager outcomes and those of their direct reports. These results will inform the development of subsequent trials., Trial Registration: ClinicalTrials.gov NCT05154019; https://clinicaltrials.gov/study/NCT05154019., International Registered Report Identifier (irrid): DERR1-10.2196/48758., (©Louise Thomson, Juliet Hassard, Alexandra Frost, Craig Bartle, Joanna Yarker, Fehmidah Munir, Richard Kneller, Steven Marwaha, Guy Daly, Sean Russell, Caroline Meyer, Benjamin Vaughan, Kristina Newman, Holly Blake. Originally published in JMIR Research Protocols (https://www.researchprotocols.org), 24.10.2023.)

Background: Managing long-term sickness absence is challenging in countries where employers and managers have the main responsibility to provide return to work support, particularly for workers with poor mental health. Whilst long-term sick leave and return to work frameworks and guidance exist for employers, there are currently no structured return to work protocols for employers or for their workers encompassing best practice strategies to support a positive and timely return to work outcome., Purpose: To utilise the intervention mapping (IM) protocol as a framework to develop return to work toolkits that are underpinned by relevant behaviour change theory targeting mental health to promote a positive return to work experiensce for workers on long-term sick leave., Methods: This paper provides a worked example of intervention mapping (IM) to develop an intervention through a six-step process to combine theory and evidence in the development of two toolkits - one designed for managers and one to be used by workers on long-term sick leave. As part of this process, collaborative planning techniques were used to develop the intervention. A planning group was set up, through which researchers would work alongside employer, worker, and mental health professional representatives to develop the toolkits. Additionally, feedback on the toolkits were sought from the target populations of workers and managers and from wider employer stakeholders (e.g., human resource specialists). The implementation and evaluation of the toolkits as a workplace intervention were also planned., Results: Two toolkits were designed following the six steps of intervention mapping. Feedback from the planning group (n = 5; psychologist, psychiatrist, person with previous experience of poor mental health, employer and charity worker) and participants (n = 14; employers = 3, wellbeing director = 1; human resources = 2, managers = 2, employees with previous experience of poor mental health = 5) target populations indicated that the toolkits were acceptable and much needed., Conclusions: Using IM allowed the development of an evidence-based practical intervention, whilst incorporating the views of all the impacted stakeholder groups. The feasibility and acceptability of the toolkits and their supporting intervention components, implementation process and methods of assessment will be evaluated in a feasibility pilot randomised controlled trial., (© 2023. BioMed Central Ltd., part of Springer Nature.)