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Introduction: Mutation-specific disease modifying drugs such as the triple combination Elexacaftor/Tezacaftor/Ivacaftor (ETI), are associated with significant improvements in physical health. Reproductive health and a pursuit of parenthood are of increased relevance; a dramatic increase in childbirth rates for females with CF has already been observed. Areas covered: Fertility in males and females with CF, and any subsequent impact of CFTR modulator therapy, is reviewed. The potential impacts of maternal use of CFTR modulator drugs on offspring health are considered, as constituent components have been found in fetal circulation in animals and humans, and the implications for maternal continuation or cessation of treatment. Clinical data are reassuring, although cases of lens opacities, and missed CF diagnoses due to false negative newborn screening results have been reported. Expert opinion: More research and high-quality evidence are needed to characterize maternal, fetal and long-term offspring outcomes following CFTR modulator therapy use during pregnancy and breastfeeding. There is a potential therapeutic impact of targeting CFTR-related organ dysfunction in CF-fetuses via maternal-administration of CFTR modulators. Additionally, any consequences of CFTR-modulation in heterozygote carrier infant warrants urgent and collective consensus regarding ethical and clinical research programs to evaluate this discrete population. [ABSTRACT FROM AUTHOR]

Background: CFAP410 (Cilia and Flagella Associated Protein 410) encodes a protein that has an important role in the development and function of cilia. In ophthalmology, pathogenic variants in CFAP410 have been described in association with cone rod dystrophy, retinitis pigmentosa, with or without macular staphyloma, or with systemic abnormalities such as skeletal dysplasia and amyotrophic lateral sclerosis. Herein, we report a consanguineous family with a novel homozygous CFAP410 c.335_346del variant with cone only degeneration and no systemic features. Methods: A retrospective analysis of ophthalmic history, examination, retinal imaging, electrophysiology and microperimetry was performed as well as genetic testing with in silico pathogenicity predictions and a literature review. Results: A systemically well 28-year-old female of Pakistani ethnicity with parental consanguinity and no relevant family history, presented with childhood-onset poor central vision and photophobia. Best-corrected visual acuity and colour vision were reduced (0.5 LogMAR, 6/17 Ishihara plates (right) and 0.6 LogMAR, 3/17 Ishihara plates (left). Fundus examination showed no pigmentary retinopathy, no macular staphyloma and autofluorescence was unremarkable. Optical coherence tomography showed subtle signs of intermittent disruption of the ellipsoid zone. Microperimetry demonstrated a reduction in central retinal sensitivity. Electrodiagnostic testing confirmed a reduction in cone-driven responses. Whole-genome sequencing identified an in-frame homozygous deletion of 12 base pairs at c.335_346del in CFAP410. Conclusions: The non-syndromic cone dystrophy phenotype reported herein expands the genotypic and phenotypic spectra of CFAP410-associated ciliopathies and highlights the need for light of potential future genetic therapies. [ABSTRACT FROM AUTHOR]

Many people who are homeless own a companion animal (a "pet"). For people who are homeless, pet ownership has a range of benefits. However, it may also limit a person's access to services and interventions, and so complicate or even prolong their homelessness. "Pet-friendly" services/interventions – which preserve the relationship between people who are homeless and their pets, whilst also meeting their unique needs – are important. Currently, however, there is limited knowledge about what services/interventions exist for people who are homeless with pets, the impact of these, and how they can be implemented in practice. This systematic review was undertaken to address these gaps. It was conducted according to the PRISMA guidelines. Eleven academic journal articles were selected for inclusion. The review identified four key services/interventions which may benefit people who are homeless with pets – pet-friendly accommodation, free veterinary care, free pet food, and foster care/ boarding – in addition to a number of "other" related services/interventions. It identified multiple challenges associated with delivering these services/interventions in practice. None of the studies offered rigorous evaluations – and, therefore, evidence – about "what works." Further research is essential to identify the most effective and cost-effective approaches. [ABSTRACT FROM AUTHOR]

Forest Schools emerged in the UK in the early 1990s after a group of practitioners developed the Forest School programme following a visit to Denmark. In our recent systematic review of forest school literature in England (Garden and Downes 2021), we proposed that a focus on space in future research to generate new complexities around the broader concepts that allow us to explore hybrid spaces constituted by both classrooms and Forest Schools. This means an examination of the various interactions between children, adults and artefacts that come together to generate existing and new spaces. There is the opportunity to re-conceptualise ideas around the Forest School space through the framing of Massey's (2005) proposition that space is a product of relations-between and that space is always in the process of being made. Thus, children create and 'own' the Forest School space through their inhabitation of it. This paper provides a key contribution to existing knowledge around Forest Schools within outdoor education by examining ways in which new educational spaces can be formed, contested and colonised beyond the classroom. [ABSTRACT FROM AUTHOR]

This commentary discusses the advantages and benefits of Pillar 2 of the Australia-United Kingdom-United States of America Arrangement for small states such as New Zealand. The commentary focuses on four issues: (1) the potential vision for a future Pillar 2; (2) the advantages of early membership of Pillar 2; (3) implications of commercially-driven emerging technologies and products; (4) the push factor of China's technology dominance strategy. [ABSTRACT FROM AUTHOR]

With increasing focus on novel targeted therapies for chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL), this longitudinal claims-based study evaluated real-world CLL/SLL treatment sequences, particularly sequential targeted therapy. Among patients with first-line (1 L) treatment in 2014-2017 (N = 2,612; median follow-up = 3 years), the most common 1 L treatment was chemoimmunotherapy (CIT; 44.6%), followed by CD20 (25.2%) and Bruton's tyrosine kinase inhibitors (BTKi; 21.7%). Among those with 1 L in 2018-2021 (N = 4,534; median follow-up = 1 year), these were BTKi (45.5%), CD20 (20.4%), CIT (17.5%), and B-cell lymphoma 2 inhibitor (8.3%). In 2014-2017, the proportion of patients receiving sequential targeted therapy in the first 2 LOTs was 11.2% (80.2% was BTKi→BTKi); in 2018-2021, this proportion was 34.3% (66.4% was BTKi→BTKi). Over time, there was a substantial increase in targeted therapy use in 1 L and sequential targeted therapy, particularly with BTKi→BTKi. Future studies should assess clinical outcomes to determine optimal sequences for CLL/SLL and reasons for restarting BTKi. [ABSTRACT FROM AUTHOR]

Antivenom is first line treatment for snake envenomation worldwide, despite few placebo controlled clinical trials demonstrating effectiveness. We aimed to investigate whether early antivenom in red-bellied black snake (Pseudechis porphyriacus) bites would prevent systemic myotoxicity. We undertook a multicentre randomized placebo-controlled trial of antivenom for red-bellied black snake bites with patients recruited from the Australian Snakebite Project (July 2014 to June 2020). In addition, we report all patients with red-bellied black snake bites during the same period, comparing the same outcomes. Patients over 2 years of age with definite red-bellied black snake bites and early systemic effects were randomized to receive 50 per cent glucose (placebo) or tiger snake antivenom within 6 hours post-bite, or in the cohort group received antivenom determined by the treating clinician. The primary outcome was the proportion of patients with myotoxicity (peak creatine kinase activity >1,000 U/L). Secondary outcomes were: area under the curve of total creatine kinase elevation over 48 hours, presence of venom post-antivenom, and adverse reactions. We analyzed both the randomized control trial patients and the combination of randomized control trial and cohort patients. Fifteen patients were recruited to the randomized controlled trial, and a cohort of 68 patients who were not randomized were included in the analysis. After treatment, two of seven patients given placebo had a peak creatine kinase activity >1,000 U/L versus none of the eight given antivenom (difference in favour of antivenom; 29 per cent; 95 per cent confidence interval:-18 per cent to +70 per cent; P = 0.2). The median area under the curve of total creatine kinase elevation over 48 hours in patients given placebo was 0 U/L*h (interquartile range: 0–124 U/L*h), which was not significantly different to those given antivenom: 197 U/L*h (interquartile range: 0–66,353 U/L*h; P = 0.26). Venom was not detected post-antivenom in six patients with measured venom concentrations given antivenom. Two patients given antivenom had immediate hypersensitivity reactions, one severe anaphylaxis, and another had serum sickness. Combining randomized and not randomized patients, three of 36 (8 per cent) administered antivenom less than 6 hours post-bite had a peak creatine kinase activity >1,000 U/L versus 17/47 (36 per cent) patients not receiving antivenom less than 6 hours post-bite (difference in favour of antivenom 29 per cent; 95 per cent confidence interval: 8 per cent to 44 per cent; P < 0.004). Overall, 13/36 (36 per cent) patients administered antivenom within 6 hours had hypersensitivity reactions, six severe anaphylaxis (17 per cent). We found that early antivenom was effective in red-bellied black snake bites, and only three patients need to be given antivenom within 6 hours to prevent myotoxicity in one (number needed to treat = 3). However, one in three patients administered antivenom developed a hypersensitivity reaction, and one in six had severe anaphylaxis. The major limitation of this study was the small number of patients recruited to the randomized controlled trial. Administration of antivenom in red-bellied black snake envenomation within 6 hours post-bite appeared to decrease the proportion of patients with myotoxicity, but a third of patients had adverse reactions. [ABSTRACT FROM AUTHOR]

Cost-effective, non-destructive means of estimating wood properties of eucalypts grown in Guangxi, China, were evaluated using near infrared (NIR) spectroscopy and resistance drilling. For this evaluation, wood samples for NIR analysis and resistance drill measurements were collected from 581 trees, representing eight plantation Eucalyptus taxa across five sites. The near infra-red (NIR) spectra collected from the 581 wood samples were analysed using existing calibrations for kraft pulp yield, cellulose content, hot water extractives and Klason lignin. These spectra and calibrations were effective in predicting over 60% of the variance in total carbohydrates and over 80% of the extractives and lignin values from independent laboratory analysis of a subset of 100 samples. Resistance drilling combined with software developed for processing the drill data proved to be a quick, low cost and effective means of quantifying wood density (as amplitude of the drill torque), stem diameter and bark thickness. [ABSTRACT FROM AUTHOR]

Media multitasking is a prevalent phenomenon especially among adolescents and young adults. This study explored the possibility that media multitasking is used as an avoidance coping strategy against stress. If so, media multitasking behaviour could be monitored to detect symptoms of anxiety and depression. Across three experiments, participants completed measures of media multitasking, anxiety, depression, and cognitive behavioural avoidance. In each of the three experiments, participants also completed an attentional bias task (a dot probe task using emotionally negative and neutral stimuli). Media multitasking was associated with negative emotions, such as (social/trait) anxiety, depression, and cognitive behavioural avoidance. However, attentional avoidance was not linked to media multitasking, negative mood, or behavioural avoidance. Taken together, the results provide preliminary evidence that media multitasking is associated with negative emotions and behavioural avoidance, but not with an attentional avoidance of emotionally negative stimuli. The finding suggests that media multitasking behaviour may be used to help detect anxiety and depression, and treating these mental health disorders could include exploring the relationships between media multitasking, negative emotions, and avoidance coping. [ABSTRACT FROM AUTHOR]

Evaluate the independent effect of age on baseline neurocognitive performance. Baseline ImPACT scores from tests taken by 7454 athletes aged 12–22 from 2009 to 2019 were split into three age cohorts: 12–14 years (3244), 15–17 years (3732), and 18–22 years (477). Linear regression analyses were used to evaluate the effect of age on ImPACT composite scores while controlling for demographic differences, medication-use, and symptom burden. Significance values have been set at p < 0.05. Linear regression analyses demonstrated that increased age does not significantly affect symptom score (β = 0.06, p = 0.54) but does improve impulse control (β = −0.45, p < 0.0001), verbal memory (β = 0.23, p = 0.03), visualmotor (β = 0.77, p < 0.0001), and reaction time (β = −0.008, p < 0.0001) scores. However, age did not have an effect on visual memory scores (β = −0.25, p = 0.07). Age was shown to be an independent modifier of impulse control, verbal memory, visual motor, and reaction time scores but not visual memory or symptom scores. This underscores the previous literature showing developmental differences as age increases among the adolescent athlete population. This data also indicates the need for repeat neurocognitive baseline testing every other year as baseline scoring is likely to change as athletes become older. [ABSTRACT FROM AUTHOR]

There is an increasing need to identify and treat sleep disturbances in Tourette syndrome (TS), a neurodevelopmental condition characterized by tics. This study explored sleep, tics, and executive functioning in children with TS (n=136) and neurotypical controls (n=101) through parent-report scales and open-ended questions. 85% of children with TS scored in the clinical range for a sleep disorder. Higher tic severity predicted increased sleep disturbances and executive difficulties. Qualitative insights indicated a bidirectional link between sleep and tics, which warrants consideration in clinical settings. Further research is needed to explore causal links. [ABSTRACT FROM AUTHOR]

People who are homeless and at-risk have been significantly impacted by the COVID-19 pandemic. Homelessness services are on the frontline of the pandemic response. Operating these services effectively in pandemic conditions is challenging. This article examines the perceptions of homelessness services workers about the impacts of, and responses to, the COVID-19 pandemic in homelessness services in Australia. A mixed-methods survey was distributed to homelessness services across Australia in June–July 2020. Fifty-nine services from all eight states and territories responded. Homelessness services workers discussed the impacts of COVID-19 and responses to the pandemic under the following six themes: (i) changes in the numbers of people seen, referred, and accommodated; (ii) immediate responses to the pandemic; (iii) the impact on staff hours, stress, and workload; (iv) use of service emergency and contingency plans; (v) effectiveness of service and government responses; and (vi) the future impacts on services. Respondents reported that although the impacts of the COVID-19 pandemic were significant, services responded by actively changing delivery to meet needs and demands. Understanding the impacts of and responses to the pandemic is vital to informing the activities undertaken by homelessness services as they continue to operate in pandemic conditions and prepare for pandemic recovery. Homelessness services are on the frontline of the COVID-19 pandemic response. The impacts of the pandemic on Australian homelessness services have been significant, and workers need support to maintain and expand upon their innovative responses. Understanding the impacts of and responses to the pandemic will inform activities undertaken by homelessness services workers, who continue to operate in pandemic conditions and prepare for pandemic recovery. [ABSTRACT FROM AUTHOR]

Introduction: Internationally mental distress is more prominent in the LGBTI community than the general population. The LGBTIreland study was set up to take stock of this in the Republic of Ireland. This paper reports on the analysis of the transgender group with reference to minority stress theory and cognitive dissonance theory. Method: An online survey was conducted addressing several aspects of mental health and distress that received responses from all groupings (n = 2,264) among which 12.3% (n = 279) identified as transgender. The survey consisted of several validated tools to measure depression, anxiety, stress (DASS-21), coping (CSES), self-esteem (RSES), alcohol and drugs misuse (AUDIT) and a variety of questions addressing demographics, experiential aspects, coping and self-related factors. Data analysis focused on predicting mental distress using DASS-general (composite of depression, anxiety and stress). Results: Transgender participants reported higher levels of mental distress, self-harm, suicidal ideation and attempts, and lower levels of self-esteem in comparison with the LGB groups, as well as the general population. Hierarchical multiple regression showed that 53% of variance in mental distress could be predicted from reduced self-esteem, the experience of harassment and not belonging in school. Furthermore, mental distress was highest among younger participants, those who were 'not out', those who had self-harmed and used avoidant coping. There was no significant difference in distress levels among those who had sought mental health support and those who had not. Conclusions: To understand mental distress in transgender people, the minority stress model is useful when taking into account both adverse external (environmental) and internal (cognitive/emotional) factors. The cognitive dissonance mechanism is essential in outlining the mechanism whereby gender incongruence is associated with psychological discomfort, low self-esteem and high mental distress. [ABSTRACT FROM AUTHOR]

Many scientific societies have emphasized the importance of evaluating the clinical utility of reproductive carrier screening (RCS). This systematic review aims to assess the clinical utility of RCS and synthesize the outcomes in a meta-analysis. A total of eleven studies were included. The number of conditions screened in the studies varied from three to 176 and led to the identification of one to 24 high-risk couples (HRCs) per 1,000 screened individuals. Pooled estimations were as follows: the prenatal diagnosis (PND) rate among pregnant HRCs 0.644 (95% CI = 0.364, 0.923), the termination rate among affected pregnancies 0.714 (95% CI = 0.524, 0.904), and the rate of in-vitro fertilization (IVF) with preimplantation genetic testing (PGT) 0.631 (95% CI = 0.538, 0.725). There is a statistically significant decrease in the rates of undertaking PND and termination as the number of screened conditions increases. Carriers of conditions classified as having a more severe impact were found to be more likely to choose termination or IVF with PGT. Our review suggests that the number and the severity of screened conditions can significantly impact HRCs' reproductive decisions. Future work needs to investigate the definition of clinical utility and the design of screening panels. [ABSTRACT FROM AUTHOR]

When new threats arise, how do weaker partners allied with great powers choose among loyalty (remaining allied to their great power patrons), hedging (improving political relations with the challenger, or – in the nuclear age – pursuing nuclear weapons), and exit (leaving the alliance by declaring neutrality or defecting to the rising challenger)? We argue that, in general, as protégés come to doubt the ability or willingness of patrons to defend them, they are likely to shift away from loyalty and towards exit. Where they end up on this alliance spectrum, however, depends on additional factors that we identify, including signals of commitment from patrons and the territorial claims of challengers against protégés. We illustrate our argument and these conditions in three cases from interwar and early Cold War Europe and draw implications for U.S. alliances today. [ABSTRACT FROM AUTHOR]

Traditionally Strength and Conditioning Coaches have been prepared for their roles through the development of a strong theoretical knowledge base and demonstrating proficiency across a range of technical frameworks. Importantly, however, recent research within Strength and Conditioning (S & C) has argued for a focus on cognitive skills and processes to support the comprehensive and established bio-physical educational materials available to learners. Accordingly, an area of growing interest within S & C is how to most appropriately prepare coaches for the authentic demands of the workplace. In other professional domains, Cognitive Apprenticeship (CA) methods have been researched and adopted to enhance the effectiveness of workers. This article provides an overview of the characteristics of CA and how these pedagogical tools could be applied across different S & C learning environments. The approaches discussed, and conceptually modelled, offer a practical and feasible solution for future coach preparation methods. Such an approach would focus on developing more contextually aware and impactful coaches and improve the services provided to an organisation. [ABSTRACT FROM AUTHOR]

This paper draws on the breadth of Forest School research literature spanning the past ten years in order to categorise theorisations across the papers. As Forest Schools in the UK are still a fairly recent development research is still limited in quantity and can lack theorisation at a broader level of abstraction. The systematic literature review draws largely on the framework produced by the Evidence for Policy and Practice Information and Co-ordinating Centre (EPPI-Centre) ([2019b]. What is a Systematic Review? Accessed: 13 August 2020. http://eppi.ioe.ac.uk/cms/Default.aspx?tabid=67). The paper highlights a set of overarching themes for Forest School research as well as providing a conceptual map representing three distinct contexts: early years, special education needs and disability, and formal education. In addition, a set of more abstract themes emerged from work associated with the Forest School space. [ABSTRACT FROM AUTHOR]

Controversy exists with regard to risk of secondary exposure of health care workers caring for patients who have ingested an organophosphate insecticide. We aim to report clinical effects of staff members caring for an organophosphate poisoned patient. A 76-year-old male presented to the Emergency Department exhibiting a cholinergic toxidrome requiring atropine, intubation and mechanical ventilation. We undertook a retrospective chart review of any Emergency Department presentations for medical assessment in relation to the incident and conducted telephone interviews of any healthcare workers who did not present but were deemed to be closely involved with patient care. We collected data including age, gender, symptoms reported and plasma cholinesterase activity measurement. We collected data from 13 individuals, of whom nine presented for medical assessment, including the patient's spouse. Five additional staff members were interviewed, having been identified via Emergency Department rostering documentation. The 13 healthcare workers comprised five nurses, four paramedics and four doctors. Dizziness and nausea were reported in two and the patient's spouse reported one episode of vomiting. Of the nine patients who had plasma cholinesterase activity measured, none were below the laboratory reference range, including those who experienced symptoms. We found no clinical nor biochemical evidence of toxicity in healthcare workers caring for a critically ill patient with organophosphate ingestion. These findings are consistent with previously published guidelines advocating standard/Level D personal protective equipment. We believe that emergency departments should not be closed as a safety measure. [ABSTRACT FROM AUTHOR]

Despite efforts to increase the number of students from socio-economically marginalised communities in higher education (HE) they remain under-represented, a situation likely to perpetuate economic and social inequality. University is a form of HE that is especially vulnerable to decreased representation of students from marginalised communities. This study draws on the perspectives of multiple stakeholders in HE access to identify contemporary barriers to attending university in the Republic of Ireland. It highlights the perspectives of stakeholder groups connected with a university peer mentoring access initiative, including secondary education students and their parents, HE students and graduates, and university and secondary school staff. Findings suggest that contemporary barriers to accessing universities are manifold and include socio-cultural, financial and structural factors involved in applying for, and attending, university. Stakeholders identified supports that would address these factors, with a strong emphasis on the need for relational supports provided through the peer mentoring programme to ensure students feel included in, and prepared to succeed at university. Differences in perspectives by stakeholder group were evident. Secondary education students frequently highlighted socio-cultural and structural barriers to university, for example the low expectations of themselves or others and the 'points' entry system. In contrast, university students and graduates emphasised the need for relational support, knowledge and preparedness in applying for and attending university. The series of barriers identified in this study begin in secondary education and continue throughout HE indicating a need for ongoing responsive supports at various stages throughout students' educational journey. [ABSTRACT FROM AUTHOR]

The article explores sick sympathies and slavery in the novel "Dred: A Tale of the Great Dismal Swamp" by Harriet Beecher Stowe. Topics include ways in which slavery corrupts the sympathies and the bodies of the characters in the novel, argument on slavery's immoral influence, Stowe's vision for the future as expressed in the novel, and a discussion of the setting and characters in the anti-slavery story.

Objective: The aim of this study was to establish the utility of the NIH Toolbox as a cognitive screener of executive functions in the clinical context. Additionally, we aimed to investigate whether age and time on transfusion were related to executive function performance. Method: Twenty-eight children and adolescents with sickle cell anemia (SCA) between 8 and 18 years (M = 13.28, SD = 3.05) on transfusion treatment were included. Participants completed five NIH Toolbox tasks (three executive function tasks and two non-executive function control tasks). Results: Mean scores on one of the three executive function measures (inhibitory control) fell below the average range (M = 81.36, SD = 14.01) with approximately 70% of children from both groups below the average range. Scores for processing speed (M = 86.82, SD = 22.01) and cognitive flexibility (M = 85.75, SD = 12.67) were low averages. As expected, scores on non-executive measures (language and memory) fell within the average range. No significant differences were observed between children with silent stroke and no stroke on executive function measures. Older age (p <.01) and length of time on transfusion (p <.05) predicted lower inhibitory control scores. Conclusions: Findings provide evidence for poor development of inhibitory control with age in this patient population. As the NIH Toolbox successfully highlighted expected deficits in this patient population, this study supports the use of this tool as a brief screening measure for children with SCD. The clinical and theoretical implications of the findings are discussed. [ABSTRACT FROM AUTHOR]

The Apuseni Mts. is a key area to study the interplay between intra-continental extensional tectonics, sedimentation, and magmatism. These events occurred from ~14.5 to 7 Ma, covering the collision of the Tisza-Dacia mega-unit with the East European Platform at ~11 Ma and formation of a thin-skinned fold-thrust belt in the East Carpathians. The Zărand-Brad-Zlatna basin (~120 km in length) is the main graben system associated with the magmatic activity. To its south, it is bounded by two younger (<12 Ma) sub-basins: Caraci and Săcărâmb both hosting active magmatism. To the north-east, the smaller Roşia Montană–Baia de Arieş–Bucium sub-basin and, to the south-east, the Deva sub-basin are also associated with magmatism. Several andesite intrusions are also known in the northernmost Apuseni Mts. at Moigrad. Volcanism from ~14.5 to ~12 Ma displays a typical calc-alkaline affinity with high 208Pb/204Pb (38.6–38.8) and 207Pb/204Pb (15.65–15.67), moderate to high 87Sr/86Sr (0.7047–0.7085) and low to high δ18Owr (>7‰) values. The younger igneous rocks (<12 Ma) show high Sr/Y and a variable but significant enrichment in LILE up to ~7 Ma, coupled with low 87Sr/86Sr (0.7040–0.7045), low 208Pb/204Pb (38.2–38.6) and 207Pb/204Pb (15.59–15.63), and low δ18O (5.5–5.7‰). The geodynamic evolution of the area started as regional transtensional with rotational tectonics generating horst and graben structures and ended with a transpressional event. This setting provided the conditions for the formation of a large underplated magma chamber at the crust – mantle boundary (MASH zone), in response to hot upwelling convective asthenosphere. Melting of the lower crust and mixing with mantle melts may have played an important part in the magmatic evolution. The spatial and temporal changes in composition were generated in magma at the crust – mantle boundary, with different crustal thicknesses. Further crustal assimilation and minor fractional crystallization in crustal magma chambers were characteristic for each region. [ABSTRACT FROM AUTHOR]

Coaches require support to successfully navigate the integration of professional, interpersonal and intrapersonal knowledge to be effective within their environment. There is a need for coaches to have access to, and utilization of, a practical tool to identify and appraise elements of their coaching delivery. There is a wealth of literature on the role of coaches, development of a coaching philosophy, and the importance of the athlete–coach relationship. However, understanding and refining this research to assist in constructing meaningful heuristics that can support coaching delivery and decision making is not a strength for all coaches. Support for coach decision making within their environment(s) is important, especially for those operating without the guidance of mentors or support coaches to provide peer feedback. [ABSTRACT FROM AUTHOR]

A reconfiguration of relational space in schools is investigated to challenge a diametric spatial opposition between nature and culture, highlighted as a Western biased construct by Descola's anthropological framework, building on Lévi-Strauss' cross-cultural contrasts between diametric and concentric structured systems. Though a neglected research and policy domain, there is growing interest internationally in combining a focus on outdoor education with personal and social development for educational contexts of socio-economic exclusion. This action research study sought to evaluate socio-emotional benefits for children of keeping hens in school and its potential to provide teachers with an intervention for developing such socio-emotional competences in boys and girls, 5–9-years old, in a junior urban primary school of high socio-economic exclusion. The qualitative, focus group results revealed benefits for the children regarding responsibility, empathy, respect for the natural world, cooperation and relaxation. These were also perceived by their teachers, who additionally reported improvement in motivation and child-led, hands-on and peer-assisted learning processes. [ABSTRACT FROM AUTHOR]

To establish the molecular diagnosis in two brothers presenting with the ocular features of Knobloch Syndrome using whole genome sequencing (WGS). Clinical examination and ophthalmological phenotyping were completed under general anaesthesia. DNA samples were tested on a targeted retinal dystrophy next-generation sequencing panel. Subsequently, WGS was performed to identify additional variants. Clinical examination confirmed the diagnosis of Knobloch Syndrome. Targeted sequencing identified a novel heterozygous frameshift pathogenic variant in COL18A1, c.2864dupC; p.(Gly956ArgfsX20), inherited from their mother. A second paternally inherited heterozygous missense variant was identified in both brothers, c.5014 G > A; p.(Asp1672Asn), which was initially considered to have too high frequency to be pathogenic (MAF 8.8%). This led to an in-depth analysis of the COL18A1 locus using WGS data, which confirmed that Asp1672Asn is a likely pathogenic hypomorphic allele. To date, all confirmed genetic diagnoses of Knobloch syndrome are attributable to variants in COL18A1. The family described here has a heterozygous novel loss of function variant. Detailed analysis of WGS data combined with family segregation studies concluded that although Asp1672Asn has a high population frequency, it is the most likely second pathogenic variant in our family. This supports the hypothesis that this is a hypomorphic allele, which, in combination with a loss of function pathogenic variant, leads to Knobloch syndrome. To our knowledge, this is the first time that WGS has been used to confirm a molecular diagnosis of Knobloch syndrome in this way and has provided further insight into the molecular mechanisms in this rare disorder. [ABSTRACT FROM AUTHOR]

Economic-evaluations of Cerebral palsy (CP) were based on utility estimates of health-related quality of life (HRQoL) from generic multi-attribute utility instruments (MAUIs). However, generic instruments had limited use as they could not capture some of the important aspects of living with CP. The Cerebral palsy 6 Dimension (CP-6D) is a disease specific MAUI. In this study, we compared the results of CP-6D with the Assessment of Quality of Life (AQoL-4D), a generic MAUI, and tested the criterion validity of the CP-6D in the general population. An online survey of the Australian general population (n = 2002), who completed both the AQoL-4D and CP-6D MAUIs, was conducted. Validity was assessed from the correlations between the domains, items and instruments. ANOVA and t-tests were used to assess the instrument's discrimination in different social demographic categories. There was a moderate correlation between the instruments (0.64). Differences in socio-demographic characteristics showed a medium effect size (p < 0.001) in both instruments and had a similar effect on utility weights in both instruments. Although the CP-6D was more sensitive to changes in income and education. Our results suggest that CP-6D and AQoL-4D were measuring a similar underlying construct. Both instruments responded similarly to socio-demographic differences. [ABSTRACT FROM AUTHOR]

Autosomal recessive (AR) and x-linked (XL) conditions are rare but collectively common which impact millions of people globally on morbidity, mortality and costs. Advanced medical technologies allow prospective parents to make informed reproductive decisions to avoid having affected children. Economic evaluations targeting on reproductive carrier screening (RCS) for AR and/or XL conditions have been conducted, but there has not been a systematic review in this area. A systematic search of economic evaluations for RCS was undertaken using the following databases – EMBASE, MEDLINE and SCOPUS. The search strategy was designed to capture full economic evaluations related to RCS since 1990. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) strategy. The included 23 studies adopted various types of methodologies to conduct economic evaluations. The majority of studies examined a single condition. The various clinical strategies and screened conditions caused the different cost-effectiveness conclusions in the published studies. Establishing a validated and practical clinical strategy of RCS and investigating the cost-effectiveness of multiple conditions in one economic evaluation are critical for implementing RCS in the future. Further economic evaluations are essential to provide evidence-based practice for decision-makers. [ABSTRACT FROM AUTHOR]

Familial Platelet Disorder with associated Myeloid Malignancy (FPDMM) is a rare inherited disorder confirmed with the presence of a pathogenic germline RUNX1 variant and is thought to be heavily underdiagnosed. RUNX1 has also been found to be mutated in up to 10% of adult AML cases and other cell malignancies. We performed targeted next-generation sequencing and subsequent MLPA analysis in a kindred with multiple affected individuals with low platelet counts and a bleeding history. We detected a novel heterozygous exon 3–7 large deletion in the RUNX1 gene in all affected family members which is predicted to remove all of the Runt-homology DNA-binding domain and a portion of the Activation domain. Our results show that the combination of targeted NGS and MLPA analysis is an effective way to detect copy number variants (CNVs) which would be missed by conventional sequencing methods. This precise diagnosis offers the possibility of accurate counseling and clinical management in such patients who could go onto develop other cell malignancies. [ABSTRACT FROM AUTHOR]

Many children who enter the care system and are subsequently adopted have had exposure to a range of potentially traumatising experiences including domestic violence, abuse, neglect and loss of key caregivers. There are also an increasingly high number of adopted children presenting with the impact of intrauterine exposure to alcohol, drugs and stress. They are often adopted by adults with their own experiences of loss and fertility difficulties. Despite the low overall level of adoption disruption, it is becoming clear that some adoptive parents may face difficulties in terms of forming and maintaining secure attachments across time with their children. A 9-week therapeutic group intervention was delivered to a group of 15 adoptive parents in Northern Ireland. This incorporated psychoeducation on a range of topics including attachment theory, trauma and the impact on brain development. It also incorporated theory and practical strategies for parenting therapeutically with traumatised children, and those with foetal alcohol and drug-related difficulties. The main focus of the group was on developing the capacity for mind-mindedness in the parents, through the more reflective focus of the second half of each group. The results from the evaluation indicated the positive impact of this intervention on parents' understanding of their children, increased confidence in parenting, and increased sense of competence in coping with challenging behaviour. It also indicated a positive change in the children's behaviour and in the parent-child relationships. [ABSTRACT FROM AUTHOR]

This systematic review aims to (1) establish how different types of assessment measure sensory modulation difficulties in children with ADHD, and (2) to examine whether sensory modulation difficulties can be separated from ADHD symptomatology. The review protocol was registered with PROSPERO (CRD42018091730). PRISMA guidelines were used. Three databases (PsycINFO, PubMed, CINAHL) were searched using a predetermined search string from 1980 to 2020. Twenty-five studies met inclusion criteria. Sensory modulation difficulties are more likely to be reported when caregiver-report or behavioural measures are used, relative to physiological methods. Despite the focus to date on difficulties in auditory and tactile processing in this patient population, the reported studies show no evidence for these difficulties being more prevalent than difficulties in other sensory domains. Caregiver reports show evidence for differences in children with sensory modulation difficulties and ADHD, and those with ADHD only. This review reports variability in the prevalence of sensory modulation difficulties in children with ADHD that is dependent on the tools used to measure this domain. Approaches to the assessment of sensory modulation, and the implications for clinical practice, are considered. [ABSTRACT FROM AUTHOR]

This paper reports on findings from an integrative literature review of evaluation studies undertaken into sexual health promotion preparation programmes aimed at professionals with a sexual health promotion remit. Using a pre-defined search strategy, inclusion criteria and PRISMA guidelines, databases were systematically searched. Studies were screened and those included were quality assessed. Twenty-seven relevant studies were identified. Thematic analysis showed programmes were diverse in terms of how they had been developed, the content included, approaches to evaluation and outcomes identified. Evaluations showed participation in a training programme encouraged participants to feel more comfortable and confident to discuss sexual health within their role and more likely to introduce sexual health into client discussions. The types of programmes and evaluation approaches were diverse making direct comparison between them challenging. There should be agreed core outcome impact measures for sexual health education programmes in the areas of knowledge, comfort, skills and changes to practice, to allow for more direct comparison in future evaluation studies. [ABSTRACT FROM AUTHOR]

To evaluate the cost utility of adjunct racecadotril and oral rehydration solution (R + ORS) versus oral rehydration solution (ORS) alone for the treatment of diarrhoea in children under five years with acute watery diarrhoea in four low-middle income countries. A cost utility model, previously developed and independently validated, has been adapted to Egypt, Morocco, Philippines and Vietnam. The model is a decision tree, cohort model programmed in Microsoft Excel. The model structure represents the country-specific clinical pathways. The target population is children under the age of five years presenting with symptoms of acute watery diarrhea to an outpatient clinic or general physician practice. A healthcare payer perspective has been analysed with the model parameterised with local data, where available. Most recent cost data has been used to inform the drug, outpatient and inpatient costs. Uncertainty has been explored with univariate deterministic sensitivity. According to the base case models, R + ORS is dominant (cost-saving, more effective) versus ORS alone in Egypt, Morocco, Philippines and Vietnam. The incremental cost-effectiveness ratios in each country fall in the southeast (cost-saving, more effective) quadrant and represent a cost savings of −304,152 EGP per QALY gain in Egypt; −6,561 MAD per QALY gain in Morocco; −428,612 PHP per QALY gain in Philippines and −113,985,734 VND per QALY gain in Vietnam. Univariate deterministic sensitivity analysis shows that the three most influential parameters across all country adaptations are the utility of children without diarrhea; the utility of inpatient children with diarrhea and the cost of one night of inpatient care. In keeping with similar findings in upper-middle and high-income countries, the cost utility of R + ORS versus ORS is favourable in low-middle income countries for the treatment of children under five with acute watery diarrhoea. Decision-makers rely on cost utility models to inform decisions about whether to publicly fund treatments as part of Universal Health Care. In low-middle income countries, the capacity to prepare cost utility models may be limited and using existing validated models is a practical solution to assist decision making. This study uses a cost utility model developed and independently validated for the United Kingdom, and adapts it to Philippines, Egypt, Morocco and Vietnam. The model evaluates the clinical benefit and economic impact of using racecadotril in addition to rehydration solution to treat diarrhoea in children. The results show that racecadotril is cost-saving and improves the quality of life for children in Philippines, Egypt, Morocco and Vietnam. [ABSTRACT FROM AUTHOR]

Objective: The aim of the current study was to examine relations between sleep problems and family factors and early markers of ADHD in young children with and without a familial risk for ADHD. Methods: Differences in sleep behavior and family functioning in children under 6 years with (n = 72) and without (n = 139) a familial risk for ADHD were investigated. The influence of family and sleep factors on the development of early temperament markers of ADHD (effortful control and negative affect) was explored. Parents/caregivers completed questionnaires on family functioning, child sleep behavior, and general regulatory behaviors. Results: A significant difference was observed between high-risk and low-risk groups for family functioning in the infant/toddler (<3 years) and preschool (>3 years) cohorts. Parents of infants/toddlers in the high-risk group reported poorer infant sleep. However, there were no sleep differences reported for the preschool cohort. Family functioning was found to predict effortful control, while sleep quality predicted negative affect. Conclusion: The results of this study highlight potential family and sleep issues for young children with a familial history of ADHD and the potential influence of these factors on early temperament markers of ADHD. Future research should explore these relations further in order to better establish whether early sleep and family interventions could mitigate later ADHD symptomatology. [ABSTRACT FROM AUTHOR]

While cosponsorship is a useful tool for cosponsors, what is its impact on the bill? Adapting the mathematical concept of directed transportation networks for the American Congressional context, we suggest cosponsorship's impact on a bill comes in the form of an ideological signal. We offer a model of policymaking where ideological "weight" is added to bills each time legislators sign on as cosponsors. In addition to policy substance, the bill's final position in ideological space may also be considered as a function of all collaborators (i.e., initial sponsor and cosponsors). We conclude by extending and applying our model to two bills from the 115th U.S. House. Results comport with our model's expectations, suggesting we are capturing ideological signals from cosponsorship. [ABSTRACT FROM AUTHOR]

Objective: Our objective was to evaluate the impact of a standardized induction protocol on reducing maternal and neonatal morbidity in women undergoing an induction with an unfavorable cervix.Study Design: We performed a prospective cohort study of women undergoing an induction from May 2013 to June 2015. Women who were ≥18 years, ≥37 weeks with intact membranes and an unfavorable cervix (Bishop score of ≤6 and cervical dilation ≤2 cm) with no prior cesarean were included. We compared the following outcomes between women managed with the labor protocol versus women in an observation group, managed at the discretion of the provider: Labor length, cesarean delivery, maternal and neonatal morbidity, and neonatal intensive care unit admission for >48 hours. Multivariable models incorporated confounders specific to each outcome.Results: 855 women were included (491: labor protocol group; 364: observational group). Women in the labor protocol group had a shorter time to delivery (15.7 hours vs. 18.0 hours, p < .001), a decrease in maternal morbidity (7.3% vs. 11.5%, p = .04), lower rates of NICU admission >48 hours (3.5% vs 8%, p = .005), and a lower neonatal morbidity (3.0% vs. 7.7%, p = .003) compared to women in the observational group. There was no difference in rate of cesarean between the labor protocol and observational groups (27.7% vs. 32.7%, p = .13). When adjusting for confounders, women in the labor protocol group had a 60% reduction in NICU admission >48 hours (RR: 0.41, 95% CI: 0.22-0.76) and a 70% reduction in neonatal morbidity (RR: 0.31, 95% CI: 0.13-0.70). Time to delivery and maternal morbidity were not significantly different in adjusted models.Conclusion: Utilization of a standardized induction protocol was associated with a significant reduction in neonatal morbidity without increasing the risk of cesarean or maternal morbidity. [ABSTRACT FROM AUTHOR]

Nursing home (NH) residents have high psychosocial needs related to illness, disability, and changing life circumstances. The staff member with the most expertise in addressing psychosocial needs is the social worker. However, federal regulations indicate that only NHs with 120+ beds need hire a social services staff member and that a "qualified social worker" need not have a social work degree. Therefore, two-thirds of NHs are not required to employ a social services staff member and none are required to hire a degreed social worker. This is in stark contrast to NASW professional standards. Reporting findings from this nationally representative sample of 924 social services directors, we describe the NH social services workforce and document that most NHs do hire social services staff, although 42% of social services directors are not social work educated. 37% of NHs have a degreed and licensed social worker at the helm of social services. The odds of hiring a degreed and licensed social workers are higher for larger NHs, especially if not-for-profit and not part of a chain. NH residents deserve psychosocial care planned by staff with such expertise. Quality of psychosocial care impacts quality of life. [ABSTRACT FROM AUTHOR]

The Cerebral Palsy quality of life instrument is a well-known health-related quality of life measure for children with Cerebral Palsy. Due to its length it is not suitable as the basis of a preference-based instrument. The aim of this study is to develop a short version of the Cerebral Palsy quality of life instrument that can subsequently be scored as a multi-attribute utility instrument through assigning preference-based values. A sample of 473 participants who have a child with Cerebral Palsy completed the Cerebral Palsy quality of life instrument(proxy-version) instrument. After deleting questions related only to the proxy, the dimensional structure was obtained using exploratory factor analysis. Extended Rasch analysis was then undertaken to test the psychometric performance of items and select the best item to represent each dimension. Expert opinion was sought to confirm the dimensions and items. A six-dimension classification system was identified, in which four domains were extracted from the factor analysis. Following expert opinion, two other domains were also added, as these were considered to have significant impact on health-related quality of life in children with Cerebral Palsy. The combination of Factor and Rasch analysis along with consultation with patients, clinicians and experts in health-related quality-of-life instrument development, has resulted in a short version of the Cerebral Palsy quality of life instrument. This study provides the first classification system for children with Cerebral Palsy. The Cerebral Palsy-six dimension (CP-6D) survey, which is a short version of Cerebral Palsy Quality Of Life instrument, can be timesaving when measuring quality of life in children with Cerebral Palsy. The short version (CP-6D) can be used in preference based measurement and generate quality adjusted life years for children with Cerebral Palsy. [ABSTRACT FROM AUTHOR]

Vascular endothelial growth factors (VEGFs) are best known as key regulators of angiogenesis and lymphangiogenesis. Although VEGFs have been promising therapeutic targets for various cardiovascular diseases, their regulatory landscape in endothelial cells remains elusive. Several studies have highlighted the involvement of noncoding RNAs (ncRNAs) in the modulation of VEGF expression. In this study, we investigated the role of two classes of ncRNAs, long ncRNAs (lncRNAs) and enhancer RNAs (eRNAs), in the transcriptional regulation of VEGFA and VEGFC. By integrating genome-wide global run-on sequencing (GRO-Seq) and chromosome conformation capture (Hi-C) data, we identified putative lncRNAs and eRNAs associated with VEGFA and VEGFC genes in endothelial cells. A subset of the identified putative enhancers demonstrated regulatory activity in a reporter assay. Importantly, we demonstrate that deletion of enhancers and lncRNAs by CRISPR/Cas9 promoted significant changes in VEGFA and VEGFC expression. Transcriptome sequencing (RNA-Seq) data from lncRNA deletions showed downstream factors implicated in VEGFA- and VEGFC-linked pathways, such as angiogenesis and lymphangiogenesis, suggesting functional roles for these lncRNAs. Our study uncovers novel lncRNAs and eRNAs regulating VEGFA and VEGFC that can be targeted to modulate the expression of these important molecules in endothelial cells. [ABSTRACT FROM AUTHOR]

Major, minor and trace element compositions of mantle xenocrysts from Devonian kimberlite pipes in the Priazovie give an insight into the mantle structure beneath the SE Ukranian Shield and its evolution. Garnets yield low temperature conditions as determined by monomineral thermobarometry. The mantle lithosphere is sharply divided at 4.2 GPa, marked by a high temperature Cpx-Ilm-Phl trend, eclogites and changes in pyrope geochemistry. Seven layers are detected: Ist layer at 2.5–1 GPa is enriched mantle (Fe#Ol ~ 0.11 − 0.14) with Gar- pyroxenites and Sp peridotites; IInd at 2.5–3.2 GPa – Gar-Sp (Fe#Ol 0.08 − 0.10) peridotite. IIId at 4.3–3.2 GPa is formed of Archaean- Proterozoic peridotites with Fe#Ol ~0.07 − 0.095. IVth at 3.2–5 GPa- contains pyroxenitic Gar with higher Ca, eclogites, Chr and Cpx (Fe#Ol ~0.10 − 0.125); Vth at 5.8 − 5 GPa is marked by sub-Ca garnets, Cr-rich chromites and Mg-Cr ilmenites; VIth layer at 5.8–6.8 GPa contains Fe-enriched pyropes, almandines and Cr-Mg ilmenites near the lithosphere base; VIIth layer > 6.8 GPa consists of 'hot' Fe-rich garnets. Garnets show increasing enrichment in LREE, LILE, Hf, Zr with decreasing pressure. Primitive garnets have round REE patterns; depleted ones have S-type patterns inflected at Nd. Garnets from 6.5 to 3 GPa show increasing La/Ybn, Zr-Hf, LILE. Peridotitic clinopyroxenes have inclined linear trace element patterns rounded from La to Pr with high LILE and HFSE levels. The Fe-rich group (reacted with eclogites) shows bell-shaped irregular patterns with LILE close to the LREE levels. A possible reason for LILE (HFSE and) enrichment of the upper part of the mantle is subduction metasomatsm in Archaean times (with participation of mature continental sediments) activated by plumes at 1.8 Ga and earlier which produced pervasive focused melt flow with remelting of mica-amphibole metasomatites giving continuous REE and LILE enrichment in mantle lithologies from 5.8 to 2.5 GPa. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare the pattern of changes in brain structure resulting from congenital and acquired bilateral anophthalmia. Brain structure was investigated using 3T magnetic resonance imaging (MRI) in Oxford (congenital) or Manchester (acquired). T1-weighted structural and diffusion-weighted scans were acquired from people with anophthalmia and sighted control participants. Differences in grey matter between the groups were quantified using voxel-based morphometry and differences in white matter microstructure using tract-based spatial statistics. Quantification of optic nerve volume and cortical thickness in visual regions was also performed in all groups. The optic nerve was reduced in volume in both anophthalmic populations, but to a greater extent in the congenital group and anophthalmia acquired at an early age. A similar pattern was found for the white matter microstructure throughout the occipitotemporal regions of the brain, suggesting a greater reduction of integrity with increasing duration of anophthalmia. In contrast, grey matter volume changes differed between the two groups, with the acquired anophthalmia group showing a decrease in the calcarine sulcus, corresponding to the area that would have been peripheral primary visual cortex. In contrast, the acquired anophthalmia group showed a decrease in grey matter volume in the calcarine sulcus corresponding to the area that would have been peripheral primary visual cortex. There are both qualitative and quantitative differences in structural brain changes in congenital and acquired anophthalmia, indicating differential effects of development and degeneration. [ABSTRACT FROM AUTHOR]

Programme CYCLAMEN was initiated to manage the risk of non-conventional terrorism in the United Kingdom following Al-Qaeda's attacks against the United States in 2001. Under Programme CYCLAMEN, the UK developed a border monitoring capability to detect and deter the illicit cross-border movement of radiological and nuclear materials by malicious non-state actors. This paper examines the development of border monitoring technologies before and after 9/11 with a focus on Programme CYCLAMEN using two models of state response to terrorism. Under the Control Model, state agencies seek to manage the risk associated with terrorism through disruption of terrorist activities. Under the Regulatory Model, actions are conceptualised as safeguarding public health and safety from various sources of risk including terrorism. The Regulatory Model is found to be dominant before 9/11 but the Control Model dominated thereafter and Programme CYCLAMEN is best understood as emanating from the Control Model. However, earlier action under the Regulatory Model shaped later consideration of this particular border-based protective security measure. This paper explores this shaping process and concludes that the Regulatory Model is under-considered as a model of state response to terrorism. [ABSTRACT FROM AUTHOR]

Executive functioning (EF) skills are crucial for young students to meet academic and social demands at school. EF skill development is particularly amenable to environmental influences in the early years. In classroom settings, teachers play a vital role in providing support to promote these skills. Research is limited regarding teachers' understanding of EF domains and recognition of EF difficulties in students. Additionally, teachers' experiences with managing neuropsychological reports that involve EF supports and interventions are unexamined. To assess levels of understanding and explore teachers' experiences with EF and neuropsychological reports, an online questionnaire incorporating closed- and open-ended questions was developed. 106 primary school teachers in Ireland completed the questionnaire. Knowledge gaps for neuropsychological terminologies associated with EF were identified. Teachers recognised their role in supporting the promotion of executive skills, but issues with neuropsychological reports and resource limitations may restrict effective implementation of individualised supports and classroom-based interventions. [ABSTRACT FROM AUTHOR]

Repository corticotropin injection (RCI; Acthar Gel) is indicated to induce a diuresis or a remission of proteinuria in nephrotic syndrome (NS) without uremia of the idiopathic type or that due to lupus erythematosus. This study compares patient characteristics and measurable healthcare resource utilization (HCRU) between NS patients who received a prescription for RCI and then were either approved or denied treatment by their insurers. A retrospective analysis of adults with NS from January 2015 to December 2018 was conducted using a de-identified open-source claims database. Patients were included in the study if they had ≥1diagnosis associated with NS, were age 18+, and had medical claims activity at some point in the year preceding ("baseline") and year following ("follow up") their first approved or denied RCI prescription. Baseline characteristics were reported with p-values indicating the significance of characteristics between cohorts. To assess outcomes, approved and denied patients were matched (1:1) using propensity-matching to account for underlying differences. Overall, 1,232 patients met inclusion criteria for the study. At baseline, approved patients were older than denied patients (mean age 53.9 vs. 48.4) and had higher rates of comorbidities. A greater proportion of approved patients required inpatient admissions (34.1 vs. 28.0%) and "high" doses of corticosteroids (CS) (26.2 vs. 20.7%) at baseline. Matched outcomes showed directionally more denied patients with inpatient admissions compared to approved (64 vs. 52) and a greater utilization of deep vein thrombosis ultrasound (12.2 vs. 6.6%) and dialysis (10.5 vs. 6.1%). Matched, denied patients had directionally greater CS use during follow-up both in the number of patients receiving CS (104 vs. 95) and the average annualized daily dose (4.1 vs. 3.4 mg). Patients denied access to RCI treatment had directionally higher HCRU compared to matched, approved counterparts. Thus, the results of this study may aid providers and payers in evaluating scenarios where RCI may be beneficial and improve quality of care for NS patients. [ABSTRACT FROM AUTHOR]

This paper reports on the findings of a pre-post and follow-up evaluation of a sexual health promotion programme in Ireland. Substantial progress in skills, knowledge, confidence and comfort were reported by participants which were to a large extent maintained over time. Evidence emerged of the successful translation of learning into practice in a number of areas, including engaging proactively with service users about sexual health and developing educational programmes and materials. The paper highlights contextual factors that support and inhibit sustainable changes to practice that need to be addressed in order to maximise the impact of capacity building education. [ABSTRACT FROM AUTHOR]

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This article is intended to assist those leading the sport-specific physical preparation of athletes by providing a progressive approach to staging warmups. The approach encourages consideration of the movement and physical demands of the sport and collaboration with technical coaches. The approach includes utilization of specific movement primers and progressive decision making with the intention of preparing athletes physically, mentally and technically for sports practices. [ABSTRACT FROM AUTHOR]

The volume of certified, internet enduring materials produced per year has nearly doubled in the last decade. Meta-analyses indicate that Internet-based education for clinicians is effective; however, the relevance of these studies to the nearly 50,000 such activities certified per year is questionable. Effect size is one metric by which CME providers may assess effectiveness, but caution must be used in comparing effect size data with external benchmarks such as peer-reviewed literature. This report presents a pooled standardised mean difference (Cohen's d) for 40 accredited, Internet-based enduring materials produced between 2016 and 2018. Data suggests that a Cohen's d between 0.48 and 0.75 may be a useful benchmark. Benchmarks reported in the literature for this format are notably higher. The limitations of comparison to such benchmarks are considered. [ABSTRACT FROM AUTHOR]

Irish Travellers are a small indigenous minority group with a distinctive lifestyle and culture which sets them apart from the general population. Travellers are vulnerable to significant mental distress which is exacerbated by the social disadvantage that they experience. A Traveller Mental Health Liaison Nurse (TMHLN) was introduced in one health care region in Ireland to provide support for Travellers and increase their access to mental health services. The aim of this paper is to present the findings from an evaluation which explored Travellers access to and reasons for accessing the TMHLN, the interventions provided and their experiences of and perceptions of the role of the TMHLN. A descriptive qualitative approach was used. Ten Travellers who used the service were interviewed. Following data analysis, three themes emerged: factors affecting Traveller mental health; accessing the TMHLN and the Travellers experiences and perceptions of the TMHLN. The participants were extremely positive about the TMHLN and valued the support provided. The findings highlight how the interpersonal skills associated with mental health nursing set against recovery orientated and culturally congruent practices are suitable approaches when working with Travellers. [ABSTRACT FROM AUTHOR]