Search

As the attention for climate change has grown in recent years, the topic of biodiversity loss has become increasingly relevant. The importance of biodiversity is reflected in the requirements stated in the Corporate Sustainability Reporting Directive (2022). 2024 is the year in which CSRD and ESRS are effective, implying that the first reports that must be compliant (by large listed companies) will be published in 2025. This article reflects on how and to what extent Dutch large listed companies already address the topic of biodiversity in their annual reports one year before they must comply with the CSRD (2024). Our research shows that many companies are aware of biodiversity issues. However, many companies have to further specify their policy, strategy, actions and targets by next year.

Abstract Assessment of immune correlates of severe COVID-19 has been hampered by the low numbers of severe cases in COVID-19 vaccine efficacy (VE) trials. We assess neutralizing and binding antibody levels at 4 weeks post-Ad26.COV2.S vaccination as correlates of risk and of protection against severe-critical COVID-19 through 220 days post-vaccination in the ENSEMBLE trial (NCT04505722), constituting ~4.5 months longer follow-up than our previous correlates analysis and enabling inclusion of 42 severe-critical vaccine-breakthrough cases. Neutralizing antibody titer is a strong inverse correlate of severe-critical COVID-19, with estimated hazard ratio (HR) per 10-fold increase 0.35 (95% CI: 0.13, 0.90). In a multivariable model, HRs are 0.31 (0.11, 0.89) for neutralizing antibody titer and 1.22 (0.49, 3.02) for anti-Spike binding antibody concentration. VE against severe-critical COVID-19 rises with neutralizing antibody titer: 63.1% (95% CI: 40.0%, 77.3%) at unquantifiable [

Abstract Background Sacituzumab govitecan is an antibody-drug conjugate that is FDA approved for refractory metastatic triple-negative breast cancer. It targets the human trophoblastic cell-surface antigen 2 (Trop-2) with SN-38, a topoisomerase I inhibitor, attached to the antibody [1]. SN-38 breaks DNA strands and induces tumor apoptosis [2]. Acute kidney injury (AKI) is one of its adverse effects mainly prerenal due to gastrointestinal toxicity, but it has not been reported to cause acute tubulointerstitial nephritis (ATIN). Case Presentation This report describes a rare adverse effect of sacituzumab govitecan, the approach to diagnosing the etiology of the patient’s AKI, and the mechanism by which sacituzumab govitecan causes ATIN. A woman with metastatic ER positive, PR positive, HER2 negative breast cancer who was initiated on sacituzumab govitecan presents with vomiting and diarrhea, and findings of nephrotic-range proteinuria, negative anti-PLA2R antibody, and severe AKI requiring hemodialysis. She underwent kidney biopsy and pathology showed ATIN characterized by patchy interstitial inflammation alongside tubular injury without glomerular and vascular involvement. With intermittent renal replacement therapy, furosemide challenge, and a course of prednisone, the patient’s kidney function recovered. Conclusions Sacituzumab has a high affinity for Trop-2 protein which is also expressed within the collecting ducts, and to a lesser extent, the proximal tubule. Individuals, such as this patient, who express a homozygous genotype for UGT1A1*28 allele are at increased risk for AKI from sacituzumab govitecan due to decreased glucuronidation of SN-38.

Abstract In this study, we focused on calcification and diffusion restriction, which sometimes appear around the resection cavity or periventricular white matter in patients with high-grade glioma (HGG) treated with bevacizumab (BVZ), as candidate imaging biomarkers for BVZ treatment efficacy. We investigated the timing of the appearance of diffusion restriction and calcification using magnetic resonance imaging and computed tomography in 35 patients with newly diagnosed or recurrent HGG treated with BVZ. In 17 (48.6%) patients, calcification was identified around the resection cavity or periventricular white matter at a median of 12 months after the initiation of BVZ treatment. Patients with calcification had significantly longer progression-free survival (16 vs. 7 months; p = 0.0023) and overall survival (36 vs. 12 months; p = 0.0006) than those without calcification. Histopathological examination revealed the presence of scattered microcalcifications within areas of necrosis, which suggested dystrophic calcification induced by BVZ. Diffusion-restricted lesions that appeared in patients with calcification had significantly lower apparent diffusion coefficients than those in patients without calcifications, indicating the presence of treatment-related necrosis but not hypercellularity. In conclusion, the radiological finding of diffusion restriction followed by calcification could be a potential imaging biomarker for favorable clinical course in patients with HGG treated with BVZ.

We recently expanded the viral genomic surveillance program in Minnesota, USA, to include human respiratory syncytial virus. We performed whole-genome sequencing of 575 specimens collected at Minnesota healthcare facilities during July 2023–February 2024. Subgroups A and B differed in their genomic landscapes, and we identified 23 clusters of genetically identical genomes.

Abstract Genetic testing for Parkinson’s disease (PD) is infrequently performed due to perceptions of low utility. We investigated the personal utility in PD GENEration and how results lead to enrollment in additional research studies. Participants (n = 972) underwent genetic testing, results disclosure, genetic counseling, and completed a survey examining the perceived personal utility of their results and interest in participating in additional studies. Most participants found their genetic test results useful, including satisfying curiosity (81%), feeling good about helping the medical community (80%), and having information to share with family (77%). There were no significant differences in responses based on result type. Forty-five percent of participants expressed interest in participating in research studies; whereas 16% of participants confirmed enrollment. Our results suggest that participants find personal utility in genetic testing regardless of results. Although participants may be interested in enrolling in additional research, they may need support and resources.

Abstract Metabolic dysfunction-associated steatohepatitis (MASH) is a rising global disease signaling the urgent need for non-invasive tests (NITs). Recent work demonstrated that dynamic 18F-fluorodeoxyglucose (FDG) positron emission tomography (PET)/computed tomography (CT) imaging can identify MASH by measuring liver glucose transport rate, K1, and liver CT attenuation. By combining dynamic PET/CT with the serum-based fibrosis-4 (FIB-4) test, we were able to better distinguish clinical MASH from fibrotic subtypes, enabling determination of the core tenets of MASH: steatosis, inflammation, and fibrosis. Future studies using FDG-PET technology can further enable concomitant prediction of MASH severity and extrahepatic comorbidities such as cardiovascular disease.

Abstract In the phase 3 Coronavirus Efficacy (COVE) trial (NCT04470427), post-dose two Ancestral Spike-specific binding (bAb) and neutralizing (nAb) antibodies were shown to be correlates of risk (CoR) and of protection against Ancestral-lineage COVID-19 in SARS-CoV-2 naive participants. In the SARS-CoV-2 Omicron era, Omicron subvariants with varying degrees of immune escape now dominate, seropositivity rates are high, and booster doses are administered, raising questions on whether and how these developments affect the bAb and nAb correlates. To address these questions, we assess post-boost BA.1 Spike-specific bAbs and nAbs as CoRs and as correlates of booster efficacy in COVE. For naive individuals, bAbs and nAbs inversely correlate with Omicron COVID-19: hazard ratios (HR) per 10-fold marker increase (95% confidence interval) are 0.16 (0.03, 0.79) and 0.31 (0.10, 0.96), respectively. In non-naive individuals the analogous results are similar: 0.15 (0.04, 0.63) and 0.28 (0.07, 1.08). For naive individuals, three vs two-dose booster efficacy correlates with predicted nAb titer at exposure, with estimates -8% (-126%, 48%), 50% (25%, 67%), and 74% (49%, 87%), at 56, 251, and 891 Arbitrary Units/ml. These results support the continued use of antibody as a surrogate endpoint.

Abstract Background In Australia, university clinical programs rely heavily on external healthcare professionals to provide a range of authentic clinical training and professional development opportunities for students. There is, however, a limited understanding of the factors that motivate these professionals to be educators and whether this varies across different healthcare disciplines within Australia. As the demand for clinical placements continues to increase, it is critical for the ongoing success of these programs that universities identify both the barriers associated with teaching and the benefits that enhance job satisfaction. Methods A two-part questionnaire was emailed to 849 external healthcare educators teaching predominantly in Medicine, Medical Imaging, and Optometry programs at Deakin University. Part-one surveyed the socio-demographics, perceived benefits, and barriers to teaching, plus the utilisation of entitlements offered by the university. Part-two was modelled on Dybowski and Harendza’s validated Physician Teaching Motivation Questionnaire (PTMQ) and adapted to an Australian audience. Results Overall, 776 out of the 849 questionnaires were considered in the final participant pool. The response rate for part-one was 19.7% (n = 153/776) and 18.3% (n = 142/776) for part-two. Across all professions, altruism was the primary source of motivation for teaching in Deakin University’s healthcare programs. Medical Imaging educators placed a higher value on career-related teaching aspects compared to those in Medicine and Optometry (p

Abstract Background Interprofessional education (IPE) has the potential to shape students’ collaboration perception and interprofessional identity but remains understudied. This study aims to understand the effects of the IPE program as a contextual trigger to promote collaboration perception change and interprofessional identity formation among healthcare professional students. Methods Using concurrent triangulation mixed-methods, we examined the relationship between collaboration perception and interprofessional identity change among health profession students (N = 263), and explored their perspectives on how their IPE experiences influenced their perception and identity. Participants completed the Interdisciplinary Education Perception Scale and Extended Professional Identity Scale and responded to open-ended questions before and after the IPE intervention. Pearson’s correlation, t-tests, regression (quantitative), and thematic analysis (qualitative) were conducted. Results Teams with initially lower collaboration perception (M = 3.59) and lower interprofessional identity (M = 3.59) showed a significant increase in collaboration perception (M = 3.76, t = 2.63; p = .02) and interprofessional identity (M = 3.97, t = 4.86; p

El objetivo del artículo es explorar la interacción entre la pandemia y las manifestaciones culturales, utilizando un enfoque cualitativo de los datos bibliográficos. El marco analítico se basa en suposiciones metodológicasde Marc Bloch (2001) para apoyar el análisis bibliográfico de las manifestaciones culturales y el impacto pan-démico de Covid-19. La globalización se analiza como un factor que intensifica el mercado de la información y tiene un gran impacto en las identidades culturales. Bauman (2007) reflexiona sobre la sociedad contempo-ránea y sus características fluidas y efímeras, que influyen en las manifestaciones culturales. El tema de la into-lerancia religiosa (Nogueira, 2020) también se aborda en el contexto de la pandemia, destacando los cambios en las formas de manifestación a lo largo de la historia. La investigación analiza las manifestaciones culturales como una forma de resistencia (Bhabha, 2007), donde aún con el impacto directo de la pandemia, se buscaron alternativas para continuar con sus festividades, y cómo estos elementos interculturales (Candau, 2016) abar-can la identidad de un pueblo, además de romper fronteras simbólicas impuestas por no aceptar al "otro".

Abstract Background In 2015, the results of the ‘Small bites versus large bites for closure of abdominal midline incisions (STITCH) Trial’ were published in The Lancet. This demonstrated the superiority of small bite laparotomy closure over mass closure for the reduction of incisional hernias; despite this most surgeons have not changed their practice. Previous research has shown the time taken for the implementation of evidenced based practise within medicine takes an average of 17 years. This study aims to understand the reasons why surgeons have and have not changed their practice with regards to closure of midline laparotomy. Methods Semi-structured interviews were completed with surgical consultants and registrars at a single institution in South West England. The interview topic guide was informed by a review of the published literature, which identified barriers to adopting evidence into surgical practice. Interview transcripts underwent thematic analysis with themes identified following discussions within the research team, exploring views on published data and clinical practise. Results Nine interviews with general surgical and urological consultants as well as registrars in training were performed. Three themes were identified; ‘Trusting the Evidence & Critical Appraisal’, ‘Surgical Attitude to Risk’ and ‘Adopting Evidence in Practise’, that reflected barriers to the introduction of evidenced based practise to clinical work. Conclusion Identification of the themes highlights possible areas for intervention to decrease the adoption time for evidence, for example from randomised controlled trials. The continued updating of clinical practise allows clinicians to provide best evidenced based care for patients and improve their outcomes.

Abstract This study aimed to assess retinal alterations following membrane peeling procedures using novel ILM Forceps with laser ablated surface with the help of intraoperative optical coherence tomography (iOCT). A post-hoc analysis was performed to evaluate iOCT findings in eyes that underwent membrane peeling procedures with the novel ILM Forceps. Pre-peel and post-peel iOCT videos and images were evaluated for each eye to assess for post-peel anatomic alterations. Surgical video/iOCT scan correlation was conducted to evaluate the etiology of anatomic alterations. Thirty-two eyes were included in the analysis. Three eyes (9%) had focal full thickness retinal elevations identified on iOCT following tissue-instrument interaction with the ILM Forceps. Two eyes (6%) had focal inner retinal elevations and one eye (3%) had a full-thickness retinal elevation that were not related to direct tissue-instrument interaction but rather indirect peeling forces. iOCT-identified architectural alterations related to direct-tissue instrument interaction were relatively infrequent (

Abstract The diversity in genome resources is fundamental to designing genomic strategies for local breed improvement and utilisation. These resources also support gene discovery and enhance our understanding of the mechanisms of resilience with applications beyond local breeds. Here, we report the genome sequences of 555 cattle (208 of which comprise new data) and high-density (HD) array genotyping of 1,082 samples (537 new samples) from indigenous African cattle populations. The new sequences have an average genome coverage of ~30X, three times higher than the average (~10X) of the over 300 sequences already in the public domain. Following variant quality checks, we identified approximately 32.3 million sequence variants and 661,943 HD autosomal variants mapped to the Bos taurus reference genome (ARS-UCD1.2). The new datasets were generated as part of the Centre for Tropical Livestock Genetics and Health (CTLGH) Genomic Reference Resource for African Cattle (GRRFAC) initiative, which aspires to facilitate the generation of this livestock resource and hopes for its utilisation for complete indigenous breed characterisation and sustainable global livestock improvement.

Background: Rural US regions experience lower naloxone dispensing rates compared to urban counterparts, particularly in Alabama. In light of this, strategies to enhance opioid counseling and naloxone services (OCN) in rural community pharmacies are critical. However, organizational readiness to implement OCN in rural versus urban contexts where resource networks may differ is not well understood. Objectives: The purpose of this study was to explore organizational readiness and identify factors associated with implementation of OCN in rural versus urban Alabama community pharmacies. Methods: Alabama community pharmacists and technicians were recruited to participate in an anonymous online cross-sectional survey via email. The survey instrument was adapted from the Organizational Readiness to Change Assessment (ORCA). Primary outcome measures included 3 overarching ORCA domains (Evidence, Context, and Facilitation) with 19 subscales regarding OCN implementation readiness, measured via 5-point Likert-type scales (1 = strongly disagree, 5 = strongly agree). Secondarily, pharmacy OCN implementation status (implementer, non-implementer, or in-development) was measured via multiple-choice (1-item). Differences in mean domain and subscale scores between rural and urban pharmacies were evaluated using Mann-Whitney U tests and influential factors affecting OCN implementation status were assessed via logistic regression (alpha = 0.05). Results: Of 171 respondents, the majority were pharmacists (78.6 %) in urban locations (57.1 %). Mean[SD] clinical experience evidence (Evidence) (3.98[0.69] vs 3.74[0.71]; p = 0.029), staff culture (Context) (4.04[0.66] vs 3.85[0.76]; p = 0.047), service measurement goals (Context) (3.92[0.77] vs 3.66[0.79]; p = 0.034), and senior management characteristics (Facilitation) (3.87[0.72] vs 3.71[0.66]; p = 0.045) subscales were higher in urban versus rural pharmacies. Notably, 66.7 % of pharmacies were current OCN implementers, and pharmacies with higher ORCA context domain scores had 3.230 greater odds of implementing or being in the process of developing OCN (95 % CI = 1.116–9.350; p = 0.031). Conclusion: Organizational readiness to implement OCN was higher among urban versus rural pharmacies in terms of perceived strength of clinical evidence, staff culture, service measurement goals, and senior management characteristics. Future research may leverage key contextual factors to enhance OCN implementation.

Summary: Background: Adolescent pregnancies pose a risk to young mothers and their babies. In Zambia, one third of 18-year-old girls have given birth. Poverty, low secondary school enrolment, misinformation, and community norms contribute to early childbearing. We assessed the effectiveness of economic support alone and combined with comprehensive sexuality education (CSE) and community dialogue on childbearing and sitting for grade nine exams among girls. Methods: This cluster randomised trial had one control and two intervention arms. In 2016, 157 rural schools (units of randomisation) were included, and girls in grade seven were eligible. After recruitment, schools were stratified by district and randomised (ratio 31:63:63). In one arm, girls and their guardians were offered economic support. Another arm combined CSE and community dialogues with the economic support. The interventions were implemented for 27 months, and the participants were followed for another 2 years. The primary outcomes were birth within 8 months of the end of the intervention period, birth before the 18th birthday, and sitting for grade nine exams. The trial is registered with ISRCTN (ISRCTN12727868). Findings: Between 3rd March and 15th July 2016, 4922 girls were recruited, with 999 randomised to the control, 2004 to the economic and 1919 to the combined arm. The combined support gave a moderate reduction in the incidence of birth within eight months of the intervention period's end (risk difference (RD) −0.042 (95% CI −0.084, −0.0003), possibly a minimal reduction in birth before the 18th birthday (RD −0.010 (95% CI −0.053, 0.032), and a substantial increase in sitting for grade nine exams (RD 0.17 (95% CI 0.11, 0.22). The economic support alone tended to give slightly smaller effects. Interpretation: Our findings suggest that a combination of economic support, CSE and community dialogue may give small reductions in adolescent childbearing. The same interventions can increase completion of basic education. Funding: The Research Council of Norway, the University of Bergen and the Swedish International Development Cooperation Agency (SIDA).

Aim: This study aimed to conduct a global assessment of swallow function (GASF) using a range of swallow outcome tools, in a cohort of patients pre- and post-treatment with image-guided volumetric modulated arc therapy (VMAT) radiotherapy. Materials and methods: All patients receiving radical (chemo)radiation for SCC of the larynx, oro-, hypo- or nasopharynx between October 2016 – 2021 were eligible for inclusion.Patients were treated with VMAT radiotherapy according to institutional and national protocols.Patients underwent GASF pre- and 6 months post-treatment. Data were collated from the MD Anderson Dysphagia Inventory (MDADI), the Functional Oral Intake Scale (FOIS), the Performance Status Scale-Head and Neck: Normalcy of Diet scale (PSS-NoD), the 100 ml water swallow test (WST) for capacity and maximal interincisal opening (MIO). Results: One hundred and seventy-five patients were included. 55.2 % of patients experienced a fall in MDADI-Composite score greater than the published meaningful clinical important difference (MCID).A trend for a decrease in FOIS score reflects a decrease in range of diet textures and increase in reliance on enteral feeding at 6 months post-treatment.Mean PSS-NoD score decreased reflecting increased restriction in diet textures.20 patients’ WST capacity improved by the minimal clinically important difference of > 4mls whilst 37 % of patients experienced a decrease in WST capacity of 4mls or more. 12.6 % of patients developed trismus following radiotherapy. Conclusions: This paper adds new detail to the understanding of the decline in measured eating, drinking and swallowing function that patients treated with VMAT radiotherapyexperience at 6 months post treatment. However, gaps are highlighted in the evidence base in terms of interpretation of swallow outcomes tool scores; future research in HNC should include ongoing discussion and development around robust outcomes tools and data collection.

Introduction Routine collection of patient-reported outcome measures (PROMs) has the potential to inform and improve cancer care. It is now feasible for patients to complete PROMs electronically (ePROMs) providing information about their current levels of symptoms, side effects of treatment and other concerns. PROM scores can be tracked over time allowing more timely identification of problems and more appropriate intervention. Studies have reported clear benefits in patient–clinician communication when PROMs are used and trials in the USA and France found patients randomised to complete regular ePROMs reported better health-related quality of life, had fewer unplanned hospital visits and, importantly, significantly better survival than those randomised to usual care. However, information about the effects on health outcomes and, particularly, the cost-effectiveness of incorporating this information into practice is limited.Methods and analysis PROMISE (Patient Reported Outcome Measures in cancer care: a hybrid effectiveness-Implementation trial to optimise Symptom control and health service Experience) is a multicentre, randomised hybrid effectiveness/implementation trial to evaluate the clinical and cost-effectiveness of using ePROMs in routine cancer care to improve patient outcomes. Participants (target sample=572; randomised 1:1 to intervention and control) are adults aged 18 years or older diagnosed with a solid cancer and starting treatment at one of the four study hospitals. The primary outcomes are unplanned hospital presentations and physical/functional well-being at 6 months. We hypothesise that, compared with usual care, patients randomised to use an ePROM tool will have fewer unplanned hospital presentations, report better health-related quality of life and greater satisfaction with their care and that the ePROM tool will be cost-effective. We will also assess implementation and process outcomes consistent with the RE-AIM (Reach Effectiveness Adoption Implementation Maintenance) Framework.Ethics and dissemination This trial has been approved by the Metro South Human Research Ethics Committee (HREC/2020/QMS/67441). Participants provide written informed consent, including consent for record linkage, prior to completing the baseline questionnaire. Study results will be disseminated via peer-reviewed journals and presentations at scientific conferences and clinical meetings.Trial registration number ACTRN12620001290987.

The sudden shift to remote learning during the Covid-19 pandemic has brought much distress to teachers. Since the teachers are considered as the major force that facilitates the learning process, their well-being should be given importance. The study used a survey research design to determine the level of distress among private school teachers in San Pablo City, Philippines, using the Covid-19 Peritraumatic Distress Index (CPDI). It also analyzed the sources of distress and examined the different coping strategies the teachers are using to mitigate the distress related to remote learning. Results show that the majority of the respondents are experiencing distress, with most having mild-moderate distress, followed by severe distress. Preparation of learning materials, internet connectivity problems, limited teacher-student interaction, assessment of student's learning, tracking student's progress, inconducive working environment, and inadequate technical skills were identified as sources of distress. Most respondents prefer coping strategies that would promote their overall wellness and those activities that avoid the source of distress. These findings have implications for school owners and administrators, policymakers, and curriculum developers in addressing the needs of teachers by providing programs that would help them cope with the distress related to remote learning.

As experiências vivenciadas por licenciandos em Física ganham destaque na medida em que se compreende que estes retroalimentarão a educação básica. No entanto, pesquisas têm mostrado pouca ênfase em discussões sobre as aprendizagens de conceitos e fenômenos abordados pela Física Moderna e Contemporânea (FMC). Por isso, implementamos a técnica da Revisão Sistemática de Literatura (RSL) de Kitchenham e Charters (2007), cujo corpus é constituído de teses disponibilizadas no período de 1987 a 2021 no contexto do ensino de Física em cursos de licenciatura, a fim de analisar os caminhos tomados pelos pesquisadores: teorias e avaliação da aprendizagem, recursos didáticos, estratégias de ensino e conteúdos abordados. A partir da leitura das 6 teses selecionadas, concluímos que apesar das práticas apresentarem propostas para melhorias do ensino de FMC nos cursos de licenciatura, suas possibilidades educacionais não foram significativamente exploradas, principalmente nas discussões de transposição didática e dificuldades de aprendizagem.

Abstract Background Globally, the counting of deaths based on gender identity and sexual orientation has been a challenge for health systems. In most cases, non-governmental organizations have dedicated themselves to this work. Despite these efforts in generating information, the scarcity of official data presents significant limitations in policy formulation and actions guided by population needs. Therefore, this manuscript aims to evaluate the accuracy, potential, and limits of probabilistic data relationships to yield information on deaths according to gender identity and sexual orientation in the State of Rio de Janeiro. Methods This study evaluated the accuracy of the probabilistic record linkage to obtain information on deaths according to gender and sexual orientation. Data from two information systems were used from June 15, 2015 to December 31, 2020. We constructed nine probabilistic data relationship strategies and identified the performance and cutoff points of the best strategy. Results The best data blocking strategy was established through logical blocks with the first and last names, birthdate, and mother’s name in the pairing strategy. With a population base of 80,178 records, 1556 deaths were retrieved. With an area under the curve of 0.979, this strategy presented 93.26% accuracy, 98.46% sensitivity, and 90.04% specificity for the cutoff point ≥ 17.9 of the data relationship score. The adoption of the cutoff point optimized the manual review phase, identifying 2259 (90.04%) of the 2509 false pairs and identifying 1532 (98.46%) of the 1556 true pairs. Conclusion With the identification of possible strategies for determining probabilistic data relationships, the retrieval of information on mortality according to sexual and gender markers has become feasible. Based on information from the daily routine of health services, the formulation of public policies that consider the LGBTQ + population more closely reflects the reality experienced by these population groups.

Abstract Background The problem of mental ill-health in doctors is complex, accentuated by the COVID-19 pandemic, and impacts on healthcare provision and broader organisational performance. There are many interventions to address the problem but currently no systematic way to categorise them, which makes it hard to describe and compare interventions. As a result, implementation tends to be unfocussed and fall short of the standards developed for implementing complex healthcare interventions. This study aims to develop: 1) a conceptual typology of workplace mental health and wellbeing interventions and 2) a mapping tool to apply the typology within research and practice. Methods Typology development was based on iterative cycles of analysis of published and in-practice interventions, incorporation of relevant theories and frameworks, and team and stakeholder group discussions. Results The newly developed typology and mapping tool enable interventions to be conceptualised and/or mapped into different categories, for example whether they are designed to be largely preventative (by either improving the workplace or increasing personal resources) or to resolve problems after they have arisen. Interventions may be mapped across more than one category to reflect the nuance and complexity in many mental health and wellbeing interventions. Mapping of interventions indicated that most publications have not clarified their underlying assumptions about what causes outcomes or the theoretical basis for the intervention. Conclusion The conceptual typology and mapping tool aims to raise the quality of future research and promote clear thinking about the nature and purpose of interventions, In doing so it aims to support future research and practice in planning interventions to improve the mental health and wellbeing of doctors.

El agua envasada ―o embotellada― es una fuente vital de hidratación en favor de la salud. Las empresas de agua embotellada gestionan los recursos responsablemente y tienen como gran reto invertir en ciencia, tecnología, innovación e investigación, y prácticas que mejoran la calidad y conservación del agua. En Colombia, el mercado del agua embotellada se lo disputan cerca de 800 compañías, las cuales parten del agua potable, y le suman tratamientos de microfiltración, nanofiltración, ozonización, ósmosis inversa, luz ultravioleta y pasteurización, entre otros. El objetivo del presente estudio fue evaluar la presencia de aerobios mesófilos, coliformes, Pseudomonas aeruginosa y Salmonella spp. en agua potable tratada envasada producida por empresas de San José de Cúcuta, y comercializada en los municipios de Los Patios, Villa del Rosario y Cúcuta, Colombia. Se recolectaron 50 muestras en diez empresas y se analizaron siguiendo metodologías establecidas en las normas técnicas colombianas. Se determinó la presencia de aerobios mesófilos en un 76 % del total de muestras, coliformes totales en 36 %, coliformes fecales en 28 %, Pseudomonas aeruginosa en 12 % y Salmonella spp. en 0 %, resultados que superan los valores permitidos de acuerdo con lo expuesto por el Ministerio de Salud (1991), en la resolución 12186 de 1991, razón por la cual se debe hacer un seguimiento y control exhaustivo en las etapas del procesamiento y distribución del agua potable tratada envasada, a fin de establecer las medidas correctivas necesarias que aseguren la calidad y reduzcan el riesgo potencial para la salud de los consumidores.

Beyond the challenges presented by obesity itself, a considerable portion of the population encounters prejudice and discriminatory behavior based on their weight and size. This phenomenon, termed weight stigma and weight bias, appears to be perpetuated not only by the broader society but also by healthcare providers, leading to distrust and alienation among individuals with obesity, thereby exacerbating a global issue. Recognizing weight stigma as a violation of human rights and its association with declining health outcomes, there is a pressing need to explore evidence-based strategies for mitigating it within healthcare. This is especially crucial at the early stages of professional development. Methodology: A randomized controlled trial employing a 60 min lecture experimental design was conducted to evaluate changes in conceptions, beliefs, and prejudices toward obesity among healthcare undergraduates (n = 242). Results: Semantic network analysis revealed participants’ conceptualization of obesity as a condition closely linked to diet and sedentary habits. Moreover, three out of four healthcare students considered obesity a disease for which the individual is responsible. While individuals with obesity were described as weak, lazy, and having a high affinity for food, these prejudices decreased following the educational intervention. Conclusion: Following an educational intervention based on the multifactorial nature of obesity and weight stigma, it was possible to modify prejudices and conceptions about obesity among future healthcare professionals.

Abstract Background Persistent respiratory symptoms and lung abnormalities post‐COVID‐19 are public health problems. This study evaluated biomarkers to stratify high‐risk patients to the development or persistence of post‐COVID‐19 interstitial lung disease. Methods One hundred eighteen patients discharged with residual lung abnormalities compatible with interstitial lung disease (COVID‐ILD patients) after a severe COVID‐19 were followed for 1 year (post‐COVID‐ILD patients). Physical examination, pulmonary function tests, and chest high‐resolution computed tomography (HRCT) were performed. Soluble forms (s) of PD‐L1, PD‐L2, TIM‐3, and GAL‐9 were evaluated in serum and cell culture supernatant, as well as T‐cells subsets and the transmembrane expression of PD‐L1 and PD‐L2 on the cell surface. Results Eighty percent of the post‐COVID‐ILD patients normalized their lung function at 1‐year follow‐up, 8% presented COVID‐independent ILD, and 12% still showed functional and HRCT alterations. PD‐L2 levels were heterogeneous during acute COVID‐19 (aCOVID); patients who increased (at least 30%) their sPD‐L2 levels at 1 year post‐COVID‐19 and exhibited altered CD4/CD8 ratio showed persistence of chest tomographic and functional alterations. By contrast, patients who decreased sPD‐L2 displayed a complete lung recovery. sPD‐L1, sTIM‐3, and sGAL‐9 increased significantly during aCOVID and decreased in all patients after 1‐year follow‐up. Conclusion Increased sPD‐L2 and an altered CD4/CD8 ratio after 12 months of aCOVID are associated with the persistence of lung lesions, suggesting that they may contribute to lung damage post‐COVID‐19.

Introducción: Existe poca información sobre la propagación vegetativa de tacaco (Sechium tacaco). Objetivo: Evaluar el efecto de la longitud del esqueje sobre la propagación asexual de tacaco. Métodos: El ensayo lo realizamos en Ujarrás, Cartago, Costa Rica. Utilizamos 36 esquejes de brotes secundarios, de tres longitudes diferentes (larga, mediana y corta; 12 esquejes de cada longitud). Tratamos los esquejes con 10 000ppm de AIB, y los mantuvimos bajo condiciones de invernadero durante 41 días. Luego los trasplantamos a bolsas plásticas, y los mantuvimos bajo casa sombra por 27 días. Evaluamos las siguientes variables: peso seco de raíz, peso seco de parte aérea, relación peso seco de parte aérea/peso seco de raíz, cambio de altura, cambio de número de nudos, cambio de número de brotes, y cambio de grosor de tallo. Resultados: No hallamos diferencias significativas entre tratamientos para ninguna de las variables evaluadas. Conclusión: La longitud del esqueje no influyó significativamente sobre la propagación vegetativa de tacaco.

Background: Studies report patient race, income, and education influence spinal fusion outcomes; fewer studies, however, examine the influence of provider factors such as exposure to diversity or cultural sensitivity. Objective: To examine how providers’ experience with diverse patient populations affects spinal fusion outcomes. Methods: Retrospective review of 39,680 patients undergoing lumbar and cervical fusions, 2003–2021, in Clinformatics® Data Mart national database. We used the provider patient racial diversity index (pRDI)—a published metric of physician exposure to diverse patients—to divide patients into groups based their provider's category (I, II, III) where patients treated by category III providers had surgeons with the most diverse patient populations. Multivariate regression models on propensity score-matched cohorts examined the association between patient SES and provider category on post-operative outcomes. Results: Black patients had decreased discharge home (OR 0.67; 95% CI 0.54–0.83) compared to white patients. Patients treated by category III providers had increased length of stay (Coeff. 0.62; 95% CI 0.43–0.81), charge (Coeff. 36800; 95% CI 29,200–44,400), and decreased discharge home (OR 0.90; 95% CI 0.83–0.97) compared to patients treated by category I providers. Asian patients treated by category II providers had decreased readmission (OR 0.38; 95% CI 0.14–0.96), and Black patients treated by category III providers had increased discharge home (OR 1.41; 95% CI 1.1–1.9) compared to those treated by category I providers. Conclusion: While our study found two specific instances of improved spine surgery outcomes for minority patients treated by providers serving diverse patient populations, we present mixed findings overall. This study serves as the foundation for future research to better understand how provider pRDI affects outcomes in patients undergoing lumbar and cervical spine surgery.

Abstract Background Peer support for mental health is recommended across international policy guidance and provision. Our systematic umbrella review summarises evidence on the effectiveness, implementation, and experiences of paid peer support approaches for mental health. Methods We searched MEDLINE, EMBASE, PsycINFO, The Campbell Collaboration, and The Cochrane Database of Systematic Reviews (2012–2022) for reviews of paid peer support interventions for mental health. The AMSTAR2 assessed quality. Results were synthesised narratively, with implementation reported using the CFIR (Consolidated Framework for Implementation Research). The protocol was registered with PROSPERO (registration number: CRD42022362099). Results We included 35 reviews (426 primary studies, n = 95–40,927 participants): systematic reviews with (n = 13) or without (n = 13) meta-analysis, or with qualitative synthesis (n = 3), scoping reviews (n = 6). Most reviews were low or critically low (97%) quality, one review was high quality. Effectiveness was investigated in 23 reviews. Results were mixed; there was some evidence from meta-analyses that peer support may improve depression symptoms (particularly perinatal depression), self-efficacy, and recovery. Factors promoting successful implementation, investigated in 9 reviews, included adequate training and supervision, a recovery-oriented workplace, strong leadership, and a supportive and trusting workplace culture with effective collaboration. Barriers included lack of time, resources and funding, and lack of recognised peer support worker (PSW) certification. Experiences of peer support were explored in 11 reviews, with 3 overarching themes: (i) what the PSW role can bring, including recovery and improved wellbeing for service users and PSWs; (ii) confusion over the PSW role, including role ambiguity and unclear boundaries; and (iii) organisational challenges and impact, including low pay, negative non-peer staff attitudes, and lack of support and training. Conclusions Peer support may be effective at improving some clinical outcomes, self-efficacy, and recovery. Certain populations, e.g. perinatal populations, may especially benefit from peer support. Potential strategies to successfully implement PSWs include co-production, clearly defined PSW roles, a receptive hierarchical structure and staff, appropriate PSW and staff training with clinical and/or peer supervision alongside safeguarding. Services could benefit from clear, coproduced, setting specific implementation guidelines for PSW. PSW roles tend to be poorly defined and associations between PSW intervention content and impacts need further investigation. Future research should reflect the priorities of providers/service users involved in peer support.

Reading comprehension enables each child to make meaning of the world. Therefore, it is important to develop this during the child’s primary years in school. Using ex post facto design, this study investigated the effects of reading methods on English reading comprehension of randomly selected 75 Grade 2 pupils in a private school in the Philippines. The scores of pupils who read two comparable narrative passages in oral and silent were compared. Paired t-test results revealed a significant difference between oral reading and silent reading. Silent reading had a greater positive effect on the comprehension of the pupils. Likewise, it was the most preferred reading method among the respondents. Focus group discussion with English teachers' results suggested that silent reading was preferred specifically because it helps in understanding the story better, remembering words, and concentrating given its quiet and peaceful nature. It is recommended that teachers employ sustained silent reading classroom practices such as Silent Reading Activity (SRA) Reading Laboratory, Genuine Love for Reading activities through the Four-pronged approach, and Drop Everything and Read time. These methods will help to support the reading needs and preference of the generation alpha pupils and to further strengthen the positive effects of silent reading on improving their reading comprehension.

La tarjeta de crédito facilita la vida a los ciudadanos, a través del financiamiento, cuando las personas no cuentan con el dinero suficiente para solventar todos sus gastos de consumo, al incrementarse la inflación. Por tal motivo, el presente estudio de investigación tiene como propósito principal evaluar la relación del consumo con tarjeta de crédito y la inflación durante el periodo 2015 – 2021 en el Ecuador. Se usó bases de datos de fuentes secundarias, proporcionadas por INEC y DataLab Asobanca. La metodología utilizada para el desarrollo del trabajo de investigación es a través de dos estudios descriptivos y un correlacional mediante el modelo de vectores autorregresivos VAR Bivariado, para evaluar la relación entre el consumo con tarjeta de crédito y la inflación a través del índice de precios al consumidor. Los resultados más destacables muestran que las transacciones de consumo con tarjeta de crédito poseen buena aceptación por parte de los ciudadanos, siendo el crédito diferido el más usado a partir de la pandemia. Por otra parte, la inflación presentó un repunte en los precios al inicio del Covid-19, y meses después los precios disminuyeron. Finalmente, se determinó que posee una correlación directa en un 56,35 por ciento, por lo tanto, a medida que aumenta la inflación, el consumo con tarjeta de crédito aumentará, además, existe una relación unidireccional, en donde la inflación causa a las tarjetas de crédito en el sentido de Granger, pero las tarjetas de crédito no causan a la inflación.

Abstract Background Health and care workers (HCW) faced the double burden of the SARS-CoV-2 pandemic: as members of a society affected by a public health emergency and as HWC who experienced fear of becoming infected and of infecting others, stigma, violence, increased workloads, changes in scope of practice, among others. To understand the short and long-term impacts in terms of the COVID-19 pandemic and other public health emergencies of international concern (PHEICs) on HCW and relevant interventions to address them, we designed and conducted a living systematic review (LSR). Methods We reviewed literature retrieved from MEDLINE—PubMed, Embase, SCOPUS, LILACS, the World Health Organization COVID-19 database, the ClinicalTrials.org and the ILO database, published from January 2000 until December 2021. We included quantitative observational studies, experimental studies, quasi-experimental, mixed methods or qualitative studies; addressing mental, physical health and well-being and quality of life. The review targeted HCW; and interventions and exposures, implemented during the COVID-19 pandemic or other PHEICs. To assess the risk of bias of included studies, we used the Johanna Briggs Institute (JBI) Critical Appraisal Tools. Data were qualitatively synthetized using meta-aggregation and meta-analysis was performed to estimate pooled prevalence of some of the outcomes. Results The 1013 studies included in the review were mainly quantitative research, cross-sectional, with medium risk of bias/quality, addressing at least one of the following: mental health issue, violence, physical health and well-being, and quality of life. Additionally, interventions to address short- and long-term impact of PHEICs on HCW included in the review, although scarce, were mainly behavioral and individual oriented, aimed at improving mental health through the development of individual interventions. A lack of interventions addressing organizational or systemic bottlenecks was noted. Discussion PHEICs impacted the mental and physical health of HCW with the greatest toll on mental health. The impact PHEICs are intricate and complex. The review revealed the consequences for health and care service delivery, with increased unplanned absenteeism, service disruption and occupation turnover that subvert the capacity to answer to the PHEICs, specifically challenging the resilience of health systems.

Immunoglobulin heavy chain variable (IGHV) region mutations, TP53 mutation, fluorescence in situ hybridization (FISH), and cytogenetic analysis are the most important prognostic biomarkers used in chronic lymphocytic leukemia (CLL) patients in our daily practice. In real-life environment, there are scarce studies that analyze the correlation of these factors with outcome, mainly referred to time to first treatment (TTFT) and overall survival (OS). This study aimed to typify IGHV mutation status, family usage, FISH aberrations, and complex karyotype (CK) and to analyze the prognostic impact in TTFT and OS in retrospective study of 375 CLL patients from a Spanish cohort. We found unmutated CLL (U-CLL) was associated with more aggressive disease, shorter TTFT (48 vs. 133 months, p

Background/Objectives: For the development of new treatments, the acute phase of Chagas disease (CD) in experimental models acts as a filter to screen out potentially effective interventions. Therefore, the aim of this study was to evaluate ZnO nanocrystals and Ag-ZnO/AgO nanocomposites containing different proportions of silver (ZnO:5Ag, ZnO:9Ag and ZnO:11Ag) in an experimental model of the acute phase of CD. Methods: C57Bl/6 mice were infected with 1000 forms of the Colombian strain of T. cruzi. The treatment was carried out by gavage with 5 mg/kg/d for 7 consecutive days from the first detection of parasitemia. Weight, parasitemia and survival were assessed during treatment and up to the day of euthanasia. After euthanasia, the cardiac and intestinal parasitism, inflammatory infiltrate, collagen deposition and cytokine dosages were analyzed. Results: It was observed that the nanocomposites ZnO:9Ag and ZnO:11Ag were the most effective in reducing parasitemia and increasing the survival of the infected animals. However, pure ZnO induced the maintenance of parasitemia and reduced their survival. The ZnO:9Ag and ZnO:11Ag nanocomposites were able to reduce the number of cardiac amastigote nests. In addition, they were responsible for reducing TNF-α and IL-6 in situ. ZnO:9Ag and ZnO:11Ag induced a reduction in the intestinal inflammatory infiltrate and neuronal protection in the myenteric plexus, as well as reducing TNF-α in situ. Conclusions: Based on these results, it is suggested that there is an ideal concentration in terms of the proportion of Ag/AgO and ZnO in nanocomposites for use against CD. Thus, ZnO:9Ag or ZnO:11Ag nanomaterials are potential candidates for the development of new biotechnological products for the therapy of CD.

This cross-sectional study explored the moderating effect of religious service attendance on the relationship between discrimination and suicidal behaviors in a community sample of immigrants. A convenience sample of 348 individuals with immigrant experience to the U.S. completed a survey in either English, Portuguese or Spanish. The relationship between discrimination and suicidal behaviors was moderated by religious service attendance, equipping help from religious communities (RCs) and not having experienced discrimination in RCs. Other protections included being born outside the U.S. First-generation immigrants also reported less discrimination, which was a risk factor for suicidal behaviors. Other risk factors were refugee status, higher acculturation, discrimination in RCs, and certain types of help from RCs. Help that equipped them to navigate the U.S. system was associated with lower suicide risk. Community partners and RCs can help immigrants by collaborating to promote immigrant mental health because of the high religious affiliation of immigrants.

Objetivo. Evaluar el efecto del factor genético sobre la propagación de tacaco (Sechium tacaco) por medio de esquejes. Materiales y métodos. El ensayo se desarrolló en Ujarrás, Cartago, Costa Rica. Se utilizaron esquejes de brotes secundarios de cuatro colectas de tacaco. Los esquejes fueron tratados con 11 667 ppm de ácido indol-3-butírico (AIB), y se mantuvieron bajo condiciones de invernadero durante 22 días. Las variables evaluadas fueron: porcentaje de enraizamiento (%), porcentaje de supervivencia (%), peso seco de raíces (mg/esqueje) y cambio de altura del esqueje (cm). El diseño experimental fue irrestricto al azar. Resultados. Se halló un efecto significativo del factor genético del esqueje de tacaco sobre el cambio de altura del esqueje a 22 días después de la siembra; las colectas 1 y 4 mostraron un valor significativamente superior (5.62-6.46 cm) con respecto a la colecta 2 (1.63 cm). Sin embargo, no se presentaron diferencias significativas entre colectas para el porcentaje de enraizamiento del esqueje, el peso seco de la raíz y el porcentaje de supervivencia del esqueje. Conclusión. El factor genético solamente influyó de manera significativa en el proceso de propagación vegetativa de tacaco mediante esquejes en el cambio de altura del esqueje, pero no sobre las otras variables evaluadas.

Yam (Dioscorea spp.) and sweet potato (Ipomeas batata) flours must be treated through modification processes because they have limitations in their physicochemical and structural properties for use in agri-food matrices. This study aimed to evaluate the effect of different proportions of flours on the proximate, structural, morphological, physicochemical, pasting, and in vitro digestibility properties of yam and sweet potato flour blends. Flours were obtained by drying the tubers with hot air at 55 °C, and mixtures were prepared at 25:75, 50:50, and 75:25 w/w sweet potato and yam flour proportions, respectively. The yam starch granules were spherical, oval, irregular, and larger than those of sweet potatoes, which are ovoid and flared. Furthermore, yam and sweet potato granules presented with type-B and type-A diffraction patterns, respectively, which, together with the starch content, amylose, non-starch components, and their molecular interactions, influenced the decrease in the molecular order and degree of crystallinity of the flour blends, without altering the morphological characteristics of the simple flours. Additive and non-additive effects were observed on flour blends’ swelling power and water absorption capacity. Likewise, breakdown and setback viscosity increased, which decreased thermal stability, increased the tendency to retrogradation, and elevated the fractions of rapidly digestible starch and resistant starch. These results suggest the high potential of flour blends in preparing baked products from the Caribbean Region, such as white bread, cookies, and cakes.

The compatibility of forest livestock grazing with timber production is disputed, as livestock can damage young trees through browsing and trampling. At the same time, livestock grazing might reduce the growth of competing vegetation and thereby enhance conifer forest regeneration. We investigated the effects of cattle (Bos taurus) on young spruce (Picea abies) trees in boreal production forest. We compared data from young spruce plantations within and outside of the grazing area, and during and off the cattle grazing season. Overall, stocking rates were 0.01 cows per hectare across the grazing areas. Cattle did not distribute equally, but concentrated their area use to young spruce plantations, leading to locally high densities during periods of the grazing season. Cattle removed vegetation competing with young spruce trees: Within the grazing area, the sward height of the field layer vegetation was lower, and young willow (Salix spec.) and downy birch (Betula pubescens) trees were browsed more than outside the grazing area. The annual height growth of spruce increased once the spruce grew above sward height. Spruce trees surrounded by many competing trees grew slower than those surrounded by few trees. Bent spruce trees grew slower than undamaged spruce trees. Yet, no difference in annual spruce growth was found between inside and outside the cattle grazing area. In contrast, we found a higher spruce mortality risk inside than outside the cattle grazing area. This mortality risk was very low and positively correlated with a given spruce tree's bark being damaged. Cattle did not increase the risk of damaged stem bark. This study did not succeed in pointing out the mechanism by which cattle might increase spruce mortality risk. Interestingly, the probability of being browsed and the probability of being bent were higher after winter than after summer, indicating that wild ungulates and snow might have a stronger effect on young spruce trees than summer grazing cattle at these stocking rates. In conclusion, cattle had minor effects on young spruce trees. This study suggests that at low stocking rates, forestry and livestock production in boreal production systems are compatible.

BackgroundGlobally, approximately 1 in 3 women experience intimate partner violence (IPV) in their lifetime. Brain injury (BI) is a common, yet often unrecognized, consequence of IPV. BIs caused by IPV tend to be mild, occur repetitively over the course of months or years, are remote in time, and result in chronic symptoms. Similar to BI from other causes, therapeutic treatment for women with IPV-caused BI (IPV-BI) is crucial to help resolve any physical or cognitive impairments, enhance the quality of life (QoL), and minimize longer-term neurodegeneration. ObjectiveThis study aims to investigate the feasibility and efficacy of a community support network (CSN) rehabilitation intervention regarding its impact on resiliency, QoL, and neurocognitive function. MethodsIn this pre- and postexperimental design, women (aged 18 to 50 years) who are survivors of IPV and IPV-BI will be recruited from various community organizations serving survivors of IPV. Exclusion criteria will include current pregnancy and any diagnosed neurological disorder known to affect cerebrovascular, neurocognitive, or sensorimotor function. A CSN rehabilitation intervention that includes aerobic exercise, cognitive training, mindfulness meditation, and counseling will be administered. A trauma-informed approach will be integrated into the design and implementation of the program. Furthermore, the program will include a participant navigator who will provide trauma- and violence-informed advocacy and systems navigation support to participants, in addition to facilitating a monthly peer support group. The intervention will be provided for 2.5 hours a day and 2 days a week for 3 months. Participants will complete psychological assessments and provide clinic-demographic information in the first assessment. In the second (before intervention), third (after intervention), and fourth (at follow-up) sessions, they will complete tests of resiliency, QoL, and neurocognition. The estimated sample size is 100. The objective of this study will be accomplished by quantitatively measuring resiliency, QoL, and neurocognition before and immediately after the intervention. A follow-up assessment will occur 3 months after the completion of the intervention to evaluate the maintenance of any improvements in function. One-way ANOVAs will be used to evaluate the intervention outcome across the testing times. Relationships among various variables will be explored using regression analysis. ResultsWe anticipate that the CSN rehabilitation intervention will be effective in improving resiliency, QoL, and neurocognitive function in women who have experienced IPV-BI. Furthermore, we anticipate that this intervention will be feasible in terms of study recruitment, adherence, and retention. ConclusionsThe CSN rehabilitation intervention will have a positive impact on resiliency, QoL, and neurocognitive functions in survivors of IPV-BI. Subsequently, a comparative study will be conducted by recruiting a control group receiving usual care. International Registered Report Identifier (IRRID)PRR1-10.2196/54605

Atlantoceratodus iheringi (Ameghino 1898) from Argentine territory is restudied based on its known tooth plates and newly discovered material, which includes previously unknown skull roof bones and vomerine tooth plates. The latter represent the first records of such elements from the Mesozoic era in South America. The comparative morphological analysis reveals its distinctiveness from other dipnoans, and offers valuable data for future systematic and phylogenetic research. The pterygopalatine tooth plates display narrow-based first denticulations and lack anterior wear facets, with the inner angle positioned at the level of the second denticulation. Similarly, the prearticular tooth plates feature straight mediolingual edges, and a wide-based first denticulation without sinuosities at the tip. Histological sections are performed and analyzed in detail for the first time. A. iheringi presents in this aspect distinctive features such as: large-lumen denteons tending to cluster together, circumdenteonal dentine arranged in a double band (an inner birefringent and an outer monorefringent), and a disordered interdenteonal dentine, with birefringence surrounding denteons and areas with monorefringence. A. iheringi exhibits histological structure closer to Mesozoic and Cenozoic dipnoans than Paleozoic, especially resembling the disposition observed in the Upper Cretaceous Patagonian species Metaceratodus baibianorum. The wide distribution of features designated as diagnostic for Atlantoceratodus is discussed.

Objectives It is important that allied health professionals (AHPs) are prepared for clinical practice from the very start of their working lives to provide quality care for patients, for their personal well-being and for retention of the workforce. The aim of this study was to understand how well newly qualified AHPs were prepared for practice in the UK.Design Systematic review.Data sources Embase, MEDLINE, CINAHL, ERIC and BEI were searched from 2012 to 2024. Grey literature searching and citation chasing were also conducted.Eligibility criteria We included primary studies reporting the preparedness for practice of UK graduates across 15 professions; all study types; participants included graduates who were up to 2 years postgraduation, their supervisors, trainers, practice educators and employers; and all outcome measures.Data extraction and synthesis A standardised data extraction form was used. Studies were quality assessed using the Quality Appraisal for Diverse Studies tool. 10% of articles were independently double-screened, extracted and quality assessed; 90% was completed by one researcher.Results 14 reports were included (9 qualitative, 3 mixed-method and 2 quantitative). Six papers focused on radiographers, three on a mixture of professions, two on paramedics, and one each on physiotherapists, clinical psychologists and orthotists. An important finding of the review is the paucity and low-medium quality of research on the topic. The narrative synthesis tentatively suggests that graduates are adequately prepared for practice with different professions having different strengths and weaknesses. Common areas of underpreparedness across the professions were responsibility and decision-making, leadership and research. Graduates were generally well prepared in terms of their knowledge base.Conclusion High-quality in-depth research is urgently needed across AHPs to elucidate the specific roles, their nuances and the areas of underpreparedness. Further work is also needed to understand the transition into early clinical practice, ongoing learning opportunities through work, and the supervision and support structures in place.PROSPERO registration number CRD42022382065.

BackgroundOnline forums are widely used for mental health peer support. However, evidence of their safety and effectiveness is mixed. Further research focused on articulating the contexts in which positive and negative impacts emerge from forum use is required to inform innovations in implementation. ObjectiveThis study aimed to develop a realist program theory to explain the impacts of online mental health peer support forums on users. MethodsWe conducted a realist synthesis of literature published between 2019 and 2023 and 18 stakeholder interviews with forum staff. ResultsSynthesis of 102 evidence sources and 18 interviews produced an overarching program theory comprising 22 context-mechanism-outcome configurations. Findings indicate that users’ perceptions of psychological safety and the personal relevance of forum content are foundational to ongoing engagement. Safe and active forums that provide convenient access to information and advice can lead to improvements in mental health self-efficacy. Within the context of welcoming and nonjudgmental communities, users may benefit from the opportunity to explore personal difficulties with peers, experience reduced isolation and normalization of mental health experiences, and engage in mutual encouragement. The program theory highlights the vital role of moderators in creating facilitative online spaces, stimulating community engagement, and limiting access to distressing content. A key challenge for organizations that host mental health forums lies in balancing forum openness and anonymity with the need to enforce rules, such as restrictions on what users can discuss, to promote community safety. ConclusionsThis is the first realist synthesis of online mental health peer support forums. The novel program theory highlights how successful implementation depends on establishing protocols for enhancing safety and strategies for maintaining user engagement to promote forum sustainability. Trial RegistrationPROSPERO CRD42022352528; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=352528

Background Nurses, midwives and paramedics are the largest collective group of clinical staff in the National Health Service and have some of the highest prevalence of psychological ill-health. Existing literature tends to be profession-specific and focused on individual interventions that place responsibility for good psychological health with nurses, midwives and paramedics themselves. Aim To improve understanding of how, why and in what contexts nurses, midwives and paramedics experience work-related psychological ill-health; and determine which high-quality interventions can be implemented to minimise psychological ill-health in these professions. Methods Realist synthesis methodology consistent with realist and meta-narrative evidence syntheses: evolving standards’ reporting guidelines. Data sources First round database searching in Medical Literature Analysis and Retrieval System Online Database ALL (via Ovid), cumulative index to nursing and allied health literature database (via EBSCO) and health management information consortium database (via Ovid), was undertaken between February and March 2021, followed by supplementary searching strategies (e.g. hand searching, expert solicitation of key papers). Reverse chronology screening was applied, aimed at retaining 30 relevant papers in each profession. Round two database searches (December 2021) targeted COVID-19-specific literature and literature reviews. No date limits were applied. Results We built on seven key reports and included 75 papers in the first round (26 nursing, 26 midwifery, 23 paramedic) plus 44 expert solicitation papers, 29 literature reviews and 49 COVID-19 focused articles in the second round. Through the realist synthesis we surfaced 14 key tensions in the literature and identified five key findings, supported by 26 context mechanism and outcome configurations. The key findings identified the following: (1) interventions are fragmented, individual-focused and insufficiently recognise cumulative chronic stressors; (2) it is difficult to promote staff psychological wellness where there is a blame culture; (3) the needs of the system often override staff well-being at work (‘serve and sacrifice’); (4) there are unintended personal costs of upholding and implementing values at work; and (5) it is challenging to design, identify and implement interventions to work optimally for diverse staff groups with diverse and interacting stressors. Conclusions Our realist synthesis strongly suggests the need to improve the systemic working conditions and the working lives of nurses, midwives and paramedics to improve their psychological well-being. Individual, one-off psychological interventions are unlikely to succeed alone. Psychological ill-health is highly prevalent in these staff groups (and can be chronic and cumulative as well as acute) and should be anticipated and prepared for, indeed normalised and expected. Healthcare organisations need to (1) rebalance the working environment to enable healthcare professionals to recover and thrive; (2) invest in multi-level system approaches to promote staff psychological well-being; and use an organisational diagnostic framework, such as the NHS England and NHS Improvement Health and Wellbeing framework, to self-assess and implement a systems approach to staff well-being. Future work Future research should implement, refine and evaluate systemic interventional strategies. Interventions and evaluations should be co-designed with front-line staff and staff experts by experience, and tailored where possible to local, organisational and workforce needs. Limitations The literature was not equivalent in size and quality across the three professions and we did not carry out citation searches using hand searching and stakeholder/expert suggestions to augment our sample. Study registration This study is registered as PROSPERO CRD42020172420. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020172420. 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: NIHR129528) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 9. See the NIHR Funding and Awards website for further award information. Plain language summary The National Health Service needs healthy, motivated staff to provide high-quality patient care. Nurses, midwives and paramedics experience poor psychological health (e.g. stress/anxiety) because of pressured environments and the difficulties of healthcare work. This study planned to better understand the causes of poor psychological ill-health in nurses, midwives and paramedics and find which interventions might help and why. We analysed the literature using a method called ‘realist review’ to understand how interventions work (or not), why, and for who. We tested our findings with patients, the public, nurses, midwives and paramedics in our stakeholder group. We reviewed over 200 papers/reports and identified five main findings: (1) existing solutions (interventions) are disjointed, focus mainly on the individual (not the system) and do not recognise enduring stressors enough; (2) when there is a blame culture it is difficult to encourage staff psychological well-being; (3) the needs of the system often override staff psychological well-being at work; (4) upholding and implementing personal and professional values at work can have negative personal costs; and (5) it is difficult to design, identify and implement solutions that work well for staff groups in different circumstances with varied causes of poor psychological health. Healthcare organisations should consider: (1) changing (rebalancing) the working environment to help healthcare professionals rest, recover and thrive; (2) investing in multiple-level system (not just individual) approaches to staff psychological well-being; (3) continuing to reduce stigma; (4) ensuring the essential needs of staff are prioritised (rest-breaks/hydration/hot food) as building blocks for other solutions; (5) addressing the blame culture, assuming staff are doing their best in difficult conditions; (6) prioritising staff needs, as well as patient needs. We will provide guidance and recommendations to policy-makers and organisational leaders to improve work cultures that tackle psychological ill-health and suggest new areas for research. Scientific summary Background The National Health Service (NHS) is the biggest employer in Europe and the world’s largest employer of highly skilled professionals with 1.6 million people. The NHS needs healthy, motivated staff to provide high-quality patient care; however, in recent years increasing workload, due to societal demand for healthcare services, combined with increasing external scrutiny of their work, has been associated with a high prevalence of psychological ill-health amongst staff. Due to budget constraints and staff shortages, pressure is building in the health and care system and this is taking its toll on staff and patients. In 2018, commentators described staff as ‘running on empty’ and the COVID-19 pandemic has only added to these pressures. The 2021 NHS staff survey reports that 47% of staff felt unwell because of work-related stress in the last 12 months, 55% went into work despite not feeling well enough to perform their duties in the last 3 months, 77% often felt they had unrealistic time pressures, 73% felt there were not enough staff to enable them to do their job properly and only 68% were happy with the standard of care provided by their organisation. Nurses, midwives and paramedics are the largest collective group of clinical staff in the NHS, comprising 29.3% of the NHS workforce and over 56% of the clinical workforce. Although there is a large body of literature on interventions that offer prevention, support or treatment to nurses, midwives and paramedics experiencing poor psychological health, this literature tends to be profession-specific and focused on individual interventions that place responsibility for good psychological health with nurses, midwives and paramedics themselves. There is a need for research that is sensitive to the complexities of psychological ill-health in nurses, midwives and paramedics and provides an understanding of the causes of poor psychological health in these three groups, thus identifying what is unique to each group or setting. Through this understanding, we will be able to design context-sensitive interventions that are more likely to address the pressing workforce problems faced by the NHS. Aims The overall aim of this research was to improve understanding of how, why and in what contexts nurses, midwives and paramedics experience work-related psychological ill-health; and determine which high-quality interventions can be implemented to minimise psychological ill-health in nurses, midwives and paramedics. Our specific aims were to (A1) understand when and why nurses, midwives, and paramedics develop psychological ill-health at work and provide examples of where and how it is most experienced; (A2) identify which strategies/interventions to reduce psychological ill-health work best for these staff groups, find out how they work and in what circumstances these are most helpful; (A3) design and develop resources for NHS managers/leaders so that they can understand how work affects the psychological health of nurses, midwives and paramedics; and what they can do to improve their psychological health in the workplace. Methods A realist synthesis methodology based on the realist and meta-narrative evidence syntheses: evolving standards’ reporting guidelines was adopted to search, identify, appraise and synthesise the literature (including primary and secondary empirical research, as well as editorials, theoretical and discussion papers, and key reports) to reach an ontologically deep understanding of causes and interventions to mitigate psychological ill-health in nurses, midwives and paramedics. A stakeholder group supported the project, meeting four times over the course of the project to confirm that our developing analysis was resonating with stakeholders and to make suggestions regarding important areas for improving understanding. The realist approach allowed us to synthesise evidence on organisational and structural contexts (e.g. community or hospital work) and profession-specific working practices (e.g. types of shift work, team or lone-working) within each of these three professional groups, but also differences and similarities between the groups (e.g. by specialty, setting). By illuminating differences in organisational factors, context and working practices (service architecture), we anticipated how these might influence the development of psychological ill-health and the uptake and success or otherwise of interventions aimed at supporting psychological wellness within and between these staff groups. This feature of the approach is particularly appealing because the causes and solutions to workplace psychological ill-health are complex and multifactorial. Due to the broad mandate, and the potential for locating insights across a diversity of literature in nursing, midwifery and paramedic professions, in February–March 2021, we undertook a broad first round of database searching using Medical Literature Analysis and Retrieval System Online Database ALL (via Ovid), cumulative index to nursing and allied health literature database (via EBSCO) and health management information consortium database (via Ovid), followed by more specific supplementary searching strategies (e.g. hand searching journals, expert solicitation of key papers). Subsequent database searches in December 2021 targeted COVID-19-specific literature, as well as literature reviews, to supplement that found in the first database search. We used reverse chronology quota screening to include a manageable, recent set of papers relating to each profession, and excluded literature focussing on physical health, students and patient well-being. All included papers were read multiple times and we extracted key information, including causes and interventions. We used an appraisal journaling technique to enable the multidisciplinary team to extract key insights, built on existing knowledge of the research literature and the NHS, and use these insights to formulate context-mechanism-outcome configurations (CMOcs). Multiple rounds of analysis in consultation with stakeholders allowed us to crystallise the key findings, and generate insights into the tensions facing nurses, midwives and paramedics, as well as a range of interventions that might support their workplace psychological ill-health and wellness. Results We built on seven key reports and included 75 papers in the first round (26 nursing, 26 midwifery, 23 paramedic) plus 44 expert solicitation papers, 29 literature reviews and 49 COVID-19 focused articles in the second round. We found that overall there are more similarities than differences in causes of psychological ill-health among nurses, midwives and paramedics; and very few interventions were profession-specific. Some causes may be more prevalent or exacerbated in certain professions, or roles within professions (rather than being profession-specific). In most cases it is the service architecture (organisational factors, context and working practices), that can increase risk rather than the profession itself. Our findings suggest that staff come into health care with high ideals, strong values and the desire to do a good job every day, yet many develop psychological ill-health as a result of their work. Through the realist synthesis and by surfacing 14 key tensions in the literature, we identified five key findings, supported by 26 CMOcs. The key findings (and 14 key tensions) were as follows: Interventions are fragmented, individual-focused and insufficiently recognise cumulative chronic stressors, with tensions between the below: T1: a focus on individuals versus a focus on systemic issues T2: a focus on acute episodes of trauma versus recognising and supporting chronic cumulative stressors. It is difficult to promote staff psychological wellness where there is a blame culture, with tensions between the below: T3: a lack of collective accountability, which blames individual staff for errors, versus a team/system-based approach T4: needing to raise concerns to improve conditions and patient safety versus fitness-to-practice processes becoming an oppressive force T5: encouraging staff to speak up versus the ‘deaf effect’ response from managers and hearers. The needs of the system often override staff well-being at work (‘serve and sacrifice’), with tensions between the below: T6: a professional culture that promotes a ‘serve and sacrifice’ ethos, which persuades staff to prioritise institutional needs, versus a culture that promotes self-care T7: supporting existing staff in the context of staff shortages versus perceived coercion to fill vacant shifts beyond contracted hours T8: the lived reality of staff shortages versus the wish to deliver high-quality patient care, which can result in moral distress (MD). There are unintended personal costs of upholding and implementing values at work and tensions between the below: T9: the reality of healthcare delivery versus the taught theory and values, which can lead to guilt and moral and emotional distress T10: the benefits of staff empathy to patients (ensuring quality care) versus the harms of staff empathy to staff (increasing risk of vicarious trauma or unhealthy/negative coping strategies). T11: the excessive requirements for emotional labour inherent in healthcare practice versus the need to improve workplace psychological ill-health. It is challenging to design, identify and implement interventions to work optimally for diverse staff groups with diverse and interacting stressors, with tensions between the below: T12: making staff wellness interventions mandatory versus voluntary T13: the need for spaces to debrief with managers/leaders so they hear and can thereby offer support versus the need for peer-led spaces for debriefing T14: the need to act and offer support versus providing interventions that are ineffective because they are too soon, reactive and/or single time point. Importantly, we identified that a multi-layered systems approach to psychological well-being is required; not a one-size-fits-all approach, but individualised, where everyday events as well as acute events, are acknowledged as impacting on staff psychological wellness. A psychologically safe culture, where good visible leaders enable and support staff to speak up and take accountability is needed to change the status quo. Initiatives such as the ‘Freedom to Speak up Guardians’ are promising but need adequate resources to learn from data, change culture and respond to concerns raised. Through the analysis, we learned that healthcare delivery and staff psychological health is a balancing act, with different considerations needing to be held in productive tension, such as needs of staff and the needs of patients. Our findings showed that nurses, midwives and paramedics tend to put patients first, often putting their own needs second, which can erode well-being in the face of intense and potentially traumatic work, and (counterintuitively) actually serve to compromise high-quality patient care. We identified that healthcare staff are selected and trained to hold strong professional values and codes of conduct. Yet, compassion and empathy can come at a high price for staff in terms of their own psychological health and not being able to deliver care in line with their values can cause guilt and MD or moral injury. We also identified the significant challenges of designing and embedding complex interventions within large organisations that meet the dynamic needs of diverse groups of healthcare staff, for example, considering who, when and how interventions are delivered, not just what they are. This implementation gap needs significant future attention in practice and research. Finally, the analysis of COVID-19 literature revealed that the pandemic had significantly impacted the psychological health of staff, in an almost entirely negative way, exacerbating and accelerating staff mental distress from already difficult pre-pandemic conditions. One of the few benefits that the pandemic offered was the focus on staff health and psychological well-being and adaptation and innovation of interventions to support staff, but many interventions had unintended negative consequences. Unfortunately, while most editorials and commentaries tended to call for multi-level, systems approaches, most empirical papers focused on single interventions, perhaps because these interventions are easier to design or evaluate. In other words, the practice and research effort seem to be focusing on what is easiest currently, rather than what is likely to be most effective. Therefore, in the future, more attention needs to be paid to how the primary, secondary and tertiary levels can work together to provide a systems approach to preventing, mitigating and treating psychological ill-health in staff. There is a focus on the traumatised (tip of the iceberg), rather than the essential needs of the majority and organisational prevention is under-represented. Some individual characteristics (e.g. ethnicity, sexual orientation and/or gender identity, and disability) deserve greater focus to improve understanding of causes and interventions. Our profession-specific analysis revealed a need for targeted interventions to support particular staff groups, especially minority groups and newly qualified staff, and at specific times when they may be at greater risk of psychological ill-health. Encouragingly, we also identified many ‘informal’ interventions, perhaps developed by front-line staff to plug gaps in current provision, some of which could be formalised. The strengths of our study were the use of realist methodology that uncovered rich insights, the cross-professional analysis, which provided unique perspectives, and the expertise offered by the multidisciplinary research team, advisory group and stakeholder group. In terms of limitations, the literature was not equivalent in size and quality across the three professions, the literature synthesised was not comprehensive, although it was appropriate to the methodology, and we did not carry out citation searches since hand searching and stakeholder/expert suggestions had proved an efficient way to identify papers. Conclusions Unequivocally our realist synthesis suggests the need to improve the systemic working conditions and the working lives of nurses, midwives and paramedics to improve their psychological well-being. Individual, one-off psychological interventions are unlikely to succeed alone. Psychological ill-health is highly prevalent in these staff groups (and can be chronic and cumulative as well as acute) and should be anticipated and prepared for, indeed normalised and expected. Our research has resulted in eight implications for healthcare practice suggesting a need for healthcare organisations to the following: rebalance the working environment to enable healthcare professionals to recover and thrive; invest in multi-level systems approaches to promote staff psychological well-being; continue to reduce stigma by implementing long-term plans and investment; focus on staff essential needs in order of priority; assume that staff are doing the best job they can in difficult circumstances, to counteract a blame culture; enable the needs of staff to be prioritised, to challenge a ‘serve and sacrifice’ ethos; identify and nurture future compassionate leaders; and use an evidence-based framework to self-assess and implement a systems approach to staff well-being, for example, the NHSE/I Health and Wellbeing Framework. Future research examining psychological ill-health in nurses, midwives and paramedics should build on our synthesis and seek to implement, refine and evaluate systemic interventional strategies. We recommend that interventions and evaluations are co-designed with front-line staff and staff experts by experience and tailored where possible to local organisational and workforce needs. Future interventions and research should focus on what is most needed, rather than what is easy to implement or evaluate, and significant attention should be paid to the implementation design and process. Study registration This study is registered as PROSPERO CRD42020172420. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42020172420. 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: NIHR129528) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 9. See the NIHR Funding and Awards website for further award information.

Introduction: Histological data on muscle fiber size and proportion in (very) young typically developing (TD) children is not well documented and data on capillarization and satellite cell content are also lacking.Aims: This study investigated the microscopic properties of the medial gastrocnemius muscle in growing TD children, grouped according to age and gender to provide normal reference values in healthy children.Methods: Microbiopsies of the medial gastrocnemius (MG) muscle were collected in 46 TD boys and girls aged 2–10 years subdivided into 4 age groups (2–4, 4–6, 6–8 and 8–10 years). Sections were immunostained to assess fiber type cross-sectional area (fCSA) and proportion, the number of satellite cells (SC), capillary to fiber ratio (C/F), capillary density for type I and II fiber (CFD), capillary domain, capillary-to-fiber perimeter exchange index (CFPE) and heterogeneity index. fCSA was normalized to fibula length2 and the coefficient of variation (CV) was calculated to reflect fCSA intrasubject variability.Results: Absolute fCSA of all fibers increased with age (r = 0.72, p < 0.001) but more in boys (+112%, p < 0.05) than in girls (+48%, p > 0.05) Normalized fCSA, CV and fiber proportion did not differ between age groups and gender. C/F was strongly correlated with age in boys (r = 0.83, p < 0.001), and to a lesser extent in girls (r = 0.37, p = 0.115), while other capillary parameters as well as the number of SC remained stable with increasing age in boys and girls.Discussion: This study provides reference values of histological measures in MG according to age in normally growing boys and girls. These data may be used as a reference to determine disease impact and efficacy of therapeutic approach on the muscle.

It is imperative to understand possible protections against suicide because of the steadily climbing U.S. suicide rate. Religion has been associated with fewer suicidal behaviors. This study sought to explore the perspective of congregants experiencing suicidal behaviors (CESBs) on the risks and protections that they experience in their religious communities (RCs) in two separate studies. Study One included a purposive sample of 15 Christian congregants yielding seven codes: routine practices and deliberate suicide prevention efforts were inconsistent both before and during the pandemic lockdown, though RCs continued to operate. Cultures provided participants both protections and risks, while the pandemic amplified deep cultural divides already present before the pandemic. Study Two included a purposive sample of 20 congregants yielding six codes, core protections of a routinely provided worldview and deliberately provided theological teachings, risks of absent protections, aspirational tasks for faith leaders and RCs, inspiring stories of recovery, and some consistency with human flourishing with caution. CESBs in some RCs that have a norm of well-being hide their norm violation and expect rejection. RCs need training in order to provide deliberate suicide prevention protections and CESBs may provide counter-narratives to stigma in RCs and cultures.

OBJECTIVES/GOALS: Culturally Centered Cognitive-Behavioral Therapy (CCCBT) is a therapeutic approach that acknowledges the effect of cultural values, beliefs, and norms on mental health. Study aims to develop a CCCBT for rural community by enhancing engagement, relevance, and outcomes through culturally tailored interventions, and evaluate its implementation. METHODS/STUDY POPULATION: Diverse mixed methods study with participants ages 18-65 from Partial Hospitalization Program in rural community located in Puerto Rico Mountain region. CCCBT intervention will have a span of 9 consecutive bi-weekly sessions. The study consists of 2 phases: 1. Evaluate intervention acceptability through focus groups (n=12) with repeated measures to learn about enhancing mental health outcomes, 2. Measure intervention effectiveness in reducing mild-moderate depression and anxiety symptoms using validated questionnaires (PHQ-9 and GAD-7) with a 100 participants from same region. Descriptive analysis for sociodemographic characteristics will be used to provide overview of participants characteristics. Qualitative analysis of focus groups will be obtained through feedback and content analysis. RESULTS/ANTICIPATED RESULTS: We anticipate high intervention acceptability through positive participant feedback and cultural relevance feedback from focal groups. We expect to find significant reduction in symptoms of depression and anxiety post-intervention, demonstrating the efficacy of CCCBT in Puerto Rican rural communities. These results will support the feasibility of implementing this approach, addressing mental health disparities, and enhancing treatment engagement and outcomes in underserved populations. The study will inform future research to refine and expand this intervention in rural communities of Hispanics and/or other rural underserved populations in the US. DISCUSSION/SIGNIFICANCE: This study’s success will advance culturally tailored mental health care in underserved rural Puerto Rican communities, reducing disparities and enhancing treatment relevance and engagement, with potential implications for improving mental health outcomes in similar populations in the US and worldwide.

This paper aims to present and discuss the issues, challenges, and strategies related to recruitment and retention in clinical trials involving participants with chronic pain. The randomized controlled clinical trial (RCT) is widely regarded as the gold standard for evaluating clinical interventions. However, it is crucial to acknowledge and address the challenges associated with recruiting and retaining participants. To prioritize the experience of the study population, targeted outreach strategies and a patient-centric approach are necessary. Researchers should consider incorporating recruitment and retention strategies during the study design phase. Implementing multi-pronged recruitment methods, leveraging relationships with community providers, and involving representatives of the patient population are helpful approaches. Effective communication and maintaining a professional environment are vital for optimizing engagement and supporting the successful execution of clinical trials involving participants with chronic pain.

Summary: Preeclampsia is a major hypertensive pregnancy disorder with a 50% heritability. The first identified gene involved in the disease is STOX1, a transcription factor, whose variant Y153H predisposes to the disease. Two rare mutations were also identified in Colombian women affected by the hemolysis, elevated liver enzyme, low platelet syndrome, a complication of preeclampsia (T188N and R364X). Here, we explore the effects of these variants in trophoblast cell models (BeWo) where STOX1 was previously invalidated. We firstly showed that STOX1 knockout alters response to oxidative stress, cell proliferation, and fusion capacity. Then, we showed that mutant versions of STOX1 trigger alterations in gene profiles, growth, fusion, and oxidative stress management. The results also reveal alterations of the STOX interaction with DNA when the mutations affected the DNA-binding domain of STOX1 (Y153H and T188N). We also reveal here that a major contributor of these effects appears to be the E2F3 transcription factor.

Summary: Background: Treatment-simplification strategies are important tools for patient-centred management. We evaluated long-term outcomes from a PI monotherapy switch strategy. Methods: Eligible participants attending 43 UK treatment centres had a viral load (VL) below 50 copies/ml for at least 24 weeks on combination ART. Participants were randomised to maintain ongoing triple therapy (OT) or switch to a strategy of physician-selected PI monotherapy (PI-mono) with prompt return to combination therapy if VL rebounded. The primary outcome, previously reported, was loss of future drug options after 3 years, defined as new intermediate/high level resistance to at least one drug to which the participant's virus was considered sensitive at trial entry. Here we report resistance and disease outcomes after further extended follow-up in routine care. The study was registered as ISRCTN04857074. Findings: We randomised 587 participants to OT (291) or PI-mono (296) between Nov 4, 2008, and July 28, 2010 and followed them for a median of more than 8 years (100 months) until 2018. At the end of this follow-up time, one or more future drug options had been lost in 7 participants in the OT group and 6 in the PI-mono group; estimated cumulative risk by 8 years of 2.7% and 2.1% respectively (difference −0.6%, 95% CI −3.2% to 2.0%). Only one PI-mono participant developed resistance to the protease inhibitor they were taking (atazanavir). Serious clinical events (death, serious AIDS, and serious non-AIDS) were infrequent; reported in a total of 12 (4.1%) participants in the OT group and 23 (7.8%) in the PI-mono group (P = 0.08) over the entire follow-up period. Interpretation: A strategy of PI monotherapy, with regular VL monitoring and prompt reintroduction of combination treatment following rebound, preserved future treatment options. Findings confirm the high genetic barrier to resistance of the PI drug class that makes them well suited for creative, patient-centred, treatment-simplification approaches. The possibility of a small excess risk of serious clinical events with the PI monotherapy strategy cannot be excluded. Funding: The National Institute for Health Research Health Technology Assessment programme.

Background Unforeseeable public health emergencies (PHEs) profoundly impact psychological well-being and disrupt mental health care provision in affected regions. To enhance preparedness for future emergencies, it is crucial to understand the effectiveness of mental health services, their underlying mechanisms, the populations they are tailored to, and their appropriateness across distinct emergencies. The aim of this scoping review will be to explore how mental health services have responded to PHEs, focusing on their effectiveness as well as barriers and facilitators to implementation. Methods Following the five-stage Arksey-O'Malley guidance, as updated further by Westphaln and colleagues, this mixed-methods scoping review will search academic and grey literature. Publications related to mental health interventions and supports delivered during PHEs will be considered for inclusion. The interventions and supports are operationally defined as any adaptations to mental health service provision at the international, national, regional or community level as a consequence of PHEs. The “Four Ss” framework will be utilised to provide structure for the evidence synthesis and inform categorisation of interventions and supports delivered during PHEs. Any research methodology will be considered for inclusion. Two reviewers will independently screen titles, abstracts, and full texts of publications against eligibility criteria. The gathered data will be depicted in accordance with the Four Ss” framework through the utilisation of descriptive/analytical statistics and supplemented by narrative exploration of findings. Conclusions Considering the diverse research methodologies and the varied applicability of services in different contexts of PHEs, this review will offer insights into the type, effectiveness, and implementation barriers and facilitators of mental health interventions and supports delivered during PHEs. By employing the “Four Ss” framework, the review will guide decision-making bodies in identifying effective and practical aspects of mental health system operations during emergencies.