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This design case details a seven-year iterative design process to create an app for use in online physical education classes. Each iteration addresses the shortcomings of the previous version. The most recent iteration of the app allows students to use Fitbit™ devices to record heart rate data, which each student sees as progress toward course goals on the homepage of the course. The current version of the app has evolved to provide a seamless student experience using a web application programming interface (API) and data standards such as learning tools interoperability (LTI). The student experience of using the app is thoroughly documented, as are design processes and principles for engaging in similar design processes.

This study aimed to understand the ways in which college students with intellectual and developmental disabilities (IDD) experience and develop their understanding of emotions and emotional wellness. Semi-structured interviews with college students with IDD were conducted. The research team utilized consensual qualitative research (CQR) to analyze interviews and came to consensus in generating domains, core ideas, and a cross-analysis to answer the research question, "What are the experiences of college students with IDD in developing an understanding of emotions and emotional wellness?" Findings suggest college students with IDD have experience developing and maintaining their emotional wellness, though they may experience barriers prior to and during college enrollment. Limitations and implications for future research are discussed.

Brittany E Levy,1 Jennifer T Castle,1 Roshmita Bardhan,2 Mark Dignan,3 Avinash Bhakta1 1Division of Colorectal Surgery, University of Kentucky College of Medicine, Lexington, KY, USA; 2Mercy Health – The Jewish Hospital, Cincinnati, OH, USA; 3Department of Internal Medicine, University of Kentucky College of Medicine, Lexington, KY, USACorrespondence: Mark Dignan, Department of Internal Medicine, University of Kentucky College of Medicine, 760 Press Avenue, Room 335, Lexington, KY, 40536-0679, USA, Tel +1 859 913 0207, Email Mark.dignan@uky.eduPurpose: Appalachian Kentucky, a 32-county region in the eastern part of the state, has elevated colon cancer mortality rates. While recommended as the standard of care, access to adjuvant chemotherapy treatment is limited in this region due to scarce health services and significant social and geographical barriers. The purpose of this investigation was to improve understanding of barriers that cancer patients residing in rural areas not served directly by tertiary medical systems must overcome in completing adjuvant therapy.Methods: Participants were recruited from two medical centers: A tertiary care NCI designated Cancer Center and a regional hospital. Participants underwent a 15– 20 minute interview to assess factors associated with adherence to adjuvant treatment recommendations. Grounded theory identified themes related to patient behaviors and non-adherence to standard of care recommendations.Results: Data were collected in 45 telephone and in-person patient interviews, 26 from an NCI-designated cancer center and 19 from a rural hospital. Statistically the two groups were equivalent in terms of age, subjective health status, and medical comorbidities. Six themes were identified from analysis of the transcribed interviews including: confidence in my care provider, communication, treatment issues, distrust, faith, and barriers to obtaining healthcare. Participants completing adjuvant therapy were more likely to express trust in their provider and describe fewer barriers to obtaining healthcare than those not completing adjuvant therapy.Conclusion: Barriers to completing adjuvant therapy may differ between rural and urban healthcare systems which may yield opportunities for targeted interventions to improve rates of completion of colon cancer adjuvant chemotherapy.Keywords: cancer, rural, barriers to care, adjuvant therapy

Abstract Cervical cancer, while preventable through screening and treatment of cervical precancer, remains a global challenge with a disproportionately high burden of disease in resource-limited settings, especially in low- and middle-income countries (LMICs). Lack of affordable, easy-to-use screening and diagnostic tests contributes to this disparity. Most commercially available tests are not appropriate for use in LMICs due to resource constraints. Specifically, HPV mRNA and oncoprotein tests that have high specificity for cervical precancer and cancer require complex sample preparation protocols and expensive instrumentation. To address these limitations, an HPV E7 oncoprotein assay for HPV16, 18, and 45 was developed that is appropriate for use at the point of care. The assay is paper-based, involves only five simple steps, and does not require instrumentation. A clinically relevant limit of detection was demonstrated with cellular samples. Additionally, clinical performance was demonstrated with a small pilot study (n = 19), in which the HPV E7 paper-based assay was found to have 95% accuracy when compared to histopathologic diagnosis of cervical intraepithelial neoplasia grade 2 or more severe (CIN2+). With further clinical validation, this assay could enable highly specific point-of-care testing for cervical precancer and cancer that is instrumentation-free, affordable, and ideal for use in resource-limited settings.

This article provides an analysis and evaluation of peer-reviewed evidence on the contribution of crop biotechnology to climate change mitigation and adaption. While there is a range of agricultural technologies and products that contribute to climate change mitigation, this literature landscape analysis focuses on the development of genetically modified traits, their use and adoption in major commodity crops and responsive changes in production techniques. Jointly, these technologies and products are contributing to climate change mitigation, yet the technology, the literature and evidence is still evolving as more sophisticated research methods are used with greater consistency. The literature analysis is undertaken with consideration of the consequential impact that regulatory regimes have on technology development. This assessment utilizes the Maryland Scientific Methods Scale and citation analysis, concluding that GM crops provide benefits that contribute to climate change mitigation.

Abstract Background National guidance recognises the key role of rehabilitation in improving outcomes for people living with chronic kidney disease. Implementation of this guidance is reliant upon an adequate and skilled rehabilitation workforce. Data relating to this is currently lacking within the UK. This survey aimed to identify variations and good practices in kidney physiotherapy (PT), occupational therapy (OT) and clinical exercise physiologist (CEP) provision; and to understand barriers to implementation. Methods An online survey was sent to all 87 UK kidney units between June 2022 and January 2023. Data was collected on the provision of therapy services, barriers to service provision and responses to the COVID-19 pandemic. The quantitative survey was analysed using descriptive statistics. Free-text responses were explored using reflexive thematic analysis. Results Forty-five units (52%) responded. Seventeen (38%) units reported having a PT and 15 (33%) an OT with a specialist kidney role; one unit (7%) had access to a CEP. Thirty units (67%) offered inpatient therapy services, ten (22%) outpatient therapy clinics, six (13%) intradialytic exercise, six (13%) symptom management and three (7%) outpatient rehabilitation. Qualitative data revealed lack of money/funding and time (both n = 35, 85% and n = 34, 83% respectively) were the main barriers to delivering kidney-specific therapy. Responders saw an increase in the complexity of their caseload, a reduction in staffing levels and consequently, service provision during the COVID-19 pandemic. Exemplars of innovative service delivery, including hybrid digital and remote services, were viewed as positive responses to the COVID-19 pandemic. Conclusion Despite clear evidence of the benefits of rehabilitation, across the UK, there remains limited and variable access to kidney-specific therapy services. Equitable access to kidney-specific rehabilitation services is urgently required to support people to ‘live well’ with kidney disease.

BackgroundMental health service users are more likely to smoke tobacco and are as likely to make quit attempts as people not experiencing SMI, but they are less likely to succeed. Quitting tobacco can be harder for people experiencing SMI due to higher levels of nicotine dependence, more severe withdrawal, and many other complex factors. The Quitlink study was a randomized controlled trial combining a tailored 8-week Quitline intervention delivered by dedicated Quitline counsellors plus combination nicotine replacement therapy for people who experience SMI. The purpose of this paper is to report on the medium- and longer-term findings from interviews conducted at 5 and 8 months.MethodsAs a part of the broader Quitlink study, participants were invited to qualitative interviews at 2, 5 and 8 months following recruitment, in line with quantitative follow-up time points. Interviews were conducted with 28 participants in the Quitlink trial (intervention group n = 12, control group n = 16). Interviews were transcribed and analyzed with a thematic analysis methodology using NVivo 12. Key themes were determined using inductive coding.ResultsSix key themes were identified. These included: internal/external attributions for tobacco smoking, social relationships and relapse, the role of hopefulness in quitting, the role of clinicians in initiating and maintaining a quit attempt, increasing cessation literacy, and efficacy of the study intervention. Overall, findings suggested that participants’ quit attempts were often precarious and vulnerable, but active support and feelings of social connectedness were key to supporting participants to initiate a quit attempt and maintain gains.ConclusionsPeople who experience SMI can make attempts to quit smoking tobacco with support from clinicians and social networks. Connectedness and hope are significant enablers of making and sustaining quit attempts.Trial registrationThe Quitlink trial was registered with ANZCTR (www.anzctr.org.au): ACTRN12619000244101 prior to the accrual of the first participant and updated regularly as per registry guidelines.

BackgroundTransgender and nonbinary individuals have received increasing attention within HIV research, with studies documenting the pervasive role stigma plays in creating and sustaining health inequities. However, the proliferation of HIV stigma research with this population has also raised concerns about research practices that may unintentionally stigmatize or retraumatize the very communities they are designed to benefit. Conducting stigma research is critical for generating accurate information about HIV epidemiology, risk and protective factors, and intervention strategies for transgender and nonbinary individuals. Yet, little research has directly examined the experiences of transgender and nonbinary individuals when participating in these studies or identified specific research practices (eg, recruitment materials or study framing, choice of specific survey measures, data collection protocols, and researcher behaviors) that may influence study participation, retention, and data quality. Equally important, research has not adequately examined the potential for unintended harm due to emotional distress experienced by participating in such research and what specific strategies might mitigate against potential distressful research experiences. ObjectiveThis study aimed to develop a set of empirically based trauma-informed guidelines for conducting HIV-related stigma research with transgender and nonbinary individuals to increase researchers’ capacity to recruit and retain transgender and nonbinary individuals in HIV-related stigma research, enhance the quality of data collected, and reduce unintentional harm in stigma research methodology. MethodsThe study will engage in primary data collection using both qualitative and quantitative methodology. First, we will use in-depth qualitative interviews with 60 participants representing 3 participant groups: researchers, mental health clinicians, and transgender and nonbinary individuals who have participated in HIV-related and sexual health research. Second, the qualitative findings will be used to develop an initial set of survey items representing a preliminary set of guidelines. Third, we will engage 75 participants in a 3-round modified Delphi method, to refine the guidelines and promote their acceptability among key stakeholders. ResultsThe study is funded by the National Institute of Mental Health starting in July 2022 and data collection began January 2023. The study’s findings underscore the critical importance of adopting a trauma-informed approach to HIV stigma research with transgender and nonbinary individuals. ConclusionsTo make meaningful strides in stigma research, it is imperative to examine experiences of stigma that may happen within the research context and identify strategies for improving data quality and reducing unintentional harm in study recruitment, methodology, implementation, and dissemination. International Registered Report Identifier (IRRID)DERR1-10.2196/66800

IntroductionThis article offers unique insight into Team Ukraine's experiences of attending an international sporting event for veterans living with disability and injured active-duty personnel (the United States' Department of Defense Warrior Games, “The Games”) and a 5-week preparatory camp in the United Kingdom (UK).MethodsA survey gathered qualitative data at three time points: during the second and final week of training camp, and the in the two weeks immediately following participation at The Games. Forty-four out of 55 members of Team Ukraine (including veterans, active-duty personnel, support staff, and family members) provided responses in Survey 1, 20 in Survey 2, and 18 in Survey 3. These responses were thematically analysed to explore experiences and motivations for participation.Results and discussionFive main themes were identified: Rest and recuperation; The ongoing conflict as a source of motivation; The sporting experience; Veterans in sport; and Relationships. Whilst physically demanding, the camp was an opportunity for respite and emotional processing, and participants reflected on social benefits and improvements to physical health and sporting abilities. Perhaps of greatest significance was the role of the ongoing conflict in their motivations to attend The Games. The conflict brought participants together in their collective goals of representing Ukraine on an international stage, raising awareness of the war, and demonstrating strength through sporting success. Findings highlight the challenges experienced and overcome by Team Ukraine and provides insight into the role that competitive sporting events may play during times of conflict as a means of demonstrating national strength and pride, and meeting individuals' health and well-being needs.

Abstract The EFSA Panel on Food Additives and Flavourings (FAF) was requested to evaluate the safety of hesperetin dihydrochalcone [FL‐no: 16.137] as a new flavouring substance, in accordance with Regulation (EC) No 1331/2008. The substance is structurally related to the group of flavonoids evaluated in FGE.32 and is the aglycone of neohesperidine dihydrochalcone. Based on the data provided for [FL‐no: 16.137], the Panel considered that a read‐across between hesperetin dihydrochalcone and the substances in FGE.32 is not needed. Nevertheless, the flavonoids evaluated in FGE.32 were considered in a cumulative exposure assessment. The information provided on the manufacturing process, the composition and the stability of [FL‐no: 16.137] was considered sufficient. The Panel concluded that there is no concern with respect to genotoxicity. No absorption, distribution, metabolism and excretion (ADME) studies on [FL‐no: 16.137] were provided, but studies investigating the ADME of neohesperidine dihydrochalcone were submitted. The Panel noted that [FL‐no: 16.137] has the same fate in the organism, as that of neohesperidine dihydrochalcone and considered that [FL‐no: 16.137] can be anticipated to be metabolised to innocuous products only. In a prenatal developmental toxicity study, no maternal or foetal toxicity was observed. In a 90‐day toxicity study, indications were obtained that the substance affects thyroid hormone levels at all doses tested (100–1000 mg/kg bw per day). Since these changes were not accompanied by apical findings indicative of hypothyroidism, the Panel considered these hormonal effects as not adverse. Using 1000 mg/kg bodyweight (bw) per day as reference point, adequate margins of exposure were calculated for adults and children, when considering the chronic added portions exposure technique (APET) dietary exposure estimates. Cumulative chronic exposure estimates to [FL‐no: 16.137] and the four structurally related substances evaluated in FGE.32 do not raise a safety concern. The use of [FL‐no: 16.137] as food flavouring, under the proposed conditions of use, does not raise a safety concern.

Abstract The EFSA Panel on Food Additives and Flavourings (FAF Panel) evaluated the safety of the extension of uses of quillaia extract (E 999) as a food additive in food supplements supplied in a solid or liquid form, excluding food supplements for infants and young children. Quillaia extract (E 999) was re‐evaluated in 2019 by the EFSA FAF Panel, which derived an acceptable daily intake (ADI) of 3 mg saponins/kg bw per day for E 999, while in 2024 a follow‐up of the re‐evaluation was published by the FAF Panel, recommending some modifications of the existing EU specifications for quillaia extract (E 999). Currently, quillaia extract (E 999) is authorised in two food categories (FCs) i.e. FC 4.1.4 ‘Flavoured drinks’ and FC 14.2.3 ‘Cider and perry’ (excluding cidre bouché, cydr jakościowy, perry jakościowe, cydr lodowy, perry lodowe). A ‘food supplements consumers only’ scenario was calculated for this opinion considering the proposed extension of uses, together with the current authorised uses at both the maximum permitted level (MPLs) and the typical reported use levels of quillaia extract (E 999) at the time of the 2019 re‐evaluation. The Panel concluded that the exposure estimates using the typical reported use levels for the currently authorised food categories and considering the proposed extension of uses for E 999 in FC 17.1 ‘Food supplements supplied in a solid form, excluding food supplement for infants and young children’ and FC 17.2 ‘Food supplements supplied in a liquid form, excluding food supplement for infants and young children’, if authorised, would not result in an exceedance of the ADI in any population group.

Abstract The EFSA Panel on Food Contact Materials assessed the safety of 2,2′‐oxydiethylamine, which is intended to be used at up to 14% w/w as a monomer along with adipic acid and caprolactam to make polyamide thin films intended for single use, in contact with all types of food under all conditions of time and temperature. Specific migration of 2,2′‐oxydiethylamine was tested from a polyamide film in water and was below the limit of quantification (LOQ) of 0.015 mg/kg. Migration of impurities has been estimated pro‐rata. Migrating oligomers were identified and semi‐quantified in 10% ethanol, 3% acetic acid and olive oil. Considering the measured migration and the virtual presence at the LOQ of the oligomers below 1000 Da containing the substance, the estimated migration of these oligomers would be 1.042 mg/kg. Genotoxicity studies were performed on the substance and on 1‐oxa‐4,11,18‐triazacycloeicosane‐5,10,17‐trione and 1‐oxa‐4,11,18,25‐tetraazacycloheptacosane‐5,10,17,24‐tetraone. (Q)SAR analyses were provided on the oligomers of higher molecular masses. Based on these data, the Panel excluded genotoxicity concerns for the substance and its oligomers. From a 90‐day toxicity study on the 1‐oxa‐4,11,18‐triazacycloeicosane‐5,10,17‐trione, the Panel identified a NOAEL of 1040 mg/kg bw per day. Based on their physico‐chemical properties and experimental data, the Panel considered the potential for accumulation in humans of the oligomers containing the substance of no concern. The Panel concluded that the substance is not of safety concern for the consumer if it is used as a comonomer with 99.6% minimum purity at up to 14% w/w to manufacture polyamide films (maximum thickness: 25 μm) and intended to be used in contact with all types of foods, except infant formula and human milk, at all time and temperature conditions. The migrations of the substance and of the oligomers below 1000 Da containing the substance should not exceed 0.05 and 5 mg/kg food, respectively.

Purpose: To analyze the most frequently searched questions associated with shoulder labral pathology and to evaluate the source-type availability and quality. Methods: Common shoulder labral pathology-related search terms were entered into Google, and the suggested frequently asked questions were compiled and categorized. In addition, suggested sources were recorded, categorized, and scored for quality of information using JAMA (The Journal of the American Medical Association) benchmark criteria. Statistical analysis was performed to compare the types of questions and their associated sources, as well as the quality of sources. Results: In this study, 513 questions and 170 sources were identified and categorized. The most popular topics were diagnosis/evaluation (21.5%) and indications/management (21.1%.). The most common website types were academic (27.9%), commercial (25.2%), and medical practice (22.5%). Multiple statistically significant associations were found between specific question categories and their associated source types. The average JAMA quality score for all sources was 1.56, and medical websites had significantly lower quality scores than nonmedical sites (1.05 vs 2.12, P < .001). Conclusions: Patients searching the internet for information regarding shoulder labral pathology often look for facts regarding the diagnosis and management of their conditions. They use various source types to better understand their conditions, with government sources being of the highest quality, whereas medical sites showed statistically lower quality. Across the spectrum of questions, the quality of readily available resources varies substantially. Clinical Relevance: The use of online resources in health care is expanding. It is important to understand the most commonly asked questions and the quality of information available to patients.

Exposure to teachers and teaching-related activities is vital for young children's learning. When COVID-19 closed schools, teachers responded with a mix of live- and prerecorded lessons and one-on-one communication with students, which necessitated shifts in planning time. The current study identifies pre-COVID predictors of time teachers devoted to each of these teaching-related activities to illuminate actionable levers for supporting educators during widespread educational disruption. Teachers with higher prepandemic job commitment devoted more overall time to pandemic-induced remote teaching. Teachers' prepandemic executive functioning and observed classroom instructional and organizational quality--features of successful teachers during normal times--predicted more during-pandemic time remote teaching, while teacher older age and having more high-needs students was associated with less remote teaching time. These results contribute to an emerging literature that spotlights potential promising avenues for supporting teachers via professional development during normal times as well as in future widespread educational disruptions.

We conducted a qualitative review of the research literature on STEM (science, technology, engineering, mathematics) related to high school students with disabilities (SWD). We selected and analyzed 53 articles to answer two questions: (1) How are high-school SWD prepared for careers in STEM? (2) How are educators prepared to support high-school SWD for opportunities in STEM? In answering the first question, four qualitative themes emerged: (a) barriers to STEM, (b) increasing STEM opportunities, (c) STEM readiness in college and career, and (d) STEM identity. In answering the second question, three qualitative themes emerged: (a) individualizing learning and supports for SWD, (b) using technology and collaboration among educators, and (c) professional development for educators. Limitations of this review related to search terms and inclusion criteria. Implications of this review related to the need for more research on STEM enrichment programs, STEM identity, and long-term outcomes.

Interleukin-6 (IL-6) plays a critical role in the pathogenesis of various chronic inflammatory diseases, tracked across numerous fields of research. Despite this, a crucial aspect often overlooked in studies is the differentiation between IL-6 classic-signaling and trans-signaling, leading to potential confounding of their findings; less than half of selected IL-6 studies included differentiation. This review delves into the distinction between IL-6 classic- and trans-signaling and their role in chronic inflammatory diseases and endometriosis. The unique pro-inflammatory nature of IL-6 trans-signaling, contrasted with the anti-inflammatory character of IL-6 classic-signaling, presents significant implications for research methodology, particularly in studies investigating anti-inflammatory interventions or interleukin inhibitors. Diagnostic failure to account for these distinct pathways may inadvertently misrepresent beneficial immune responses or the efficacy of interventions, posing significant challenges in predicting health outcomes. Interventions that do not differentiate these pathways could face reduced efficacy or safety. This review proposes adjustments to research methodologies and stresses the importance of careful interpretation of inflammatory markers in IL-6-related research. Examples of differentiation issues are discussed across the topics of endometriosis and multiple inflammatory diseases. By addressing this methodological issue, researchers could potentially improve patient outcomes, enhance the efficacy of interventions, and contribute to public health advancements.

Background: Despite an increased risk of visual impairment (V.I.) among adults from minority ethnic communities in the UK, limited research has explored their wider life experiences. Methods: A secondary analysis of V.I. Lives survey data explored priority issues among a sample of 46 Asian, 22 Black, and 77 White adults who have visual impairment A list of 24 issues were grouped into 10 life domains. Issue and domain mean importance scores were calculated for each to facilitate ranking of importance. Results: Kruskal–Wallis tests showed that there were statistically significant differences between the three groups for 7/10 domains and 19/24 issues. Post hoc comparisons showed that this largely reflected group differences between Asian and White participants. While there were no statistically significant differences between Asian and Black participants possibly due to small sample sizes, there were statistically significant differences between Asian and White participants in 7/10 domains and 14/24 issues. Additionally, there were significant differences between Black and White participants in 5/10 domains and 7/24 issues, specialist workplace equipment being the only issue with a significant difference between White and Black but not Asian participants. There were no group differences for confidence in ability to do everyday tasks and opportunities to take part in more sporting and leisure activities. Overall, White participants generally rated all issues as less important than Asian and Black participants. The top-three domains for Asian participants were ‘accessible environments’/‘finances’, ‘technology’, and ‘public attitudes’. The top-three issues were accessibility of public transport, employer attitudes, and reduction of street clutter. The top-three domains among Black participants were ‘employment’, ‘accessible environments’, and ‘emotional support’. The top-three issues were employer attitudes/specialised education for young people with V.I., specialist V.I. equipment in the workplace, and confidence in ability to do everyday tasks/accessibility of public transport. Conclusions: Differences in priorities between the groups suggest that the needs of individual communities may be lost when grouping culturally diverse communities together, highlighting the need for more research with different minority ethnic communities.

There is strong evidence that the implicit biases of health care professionals affect the treatment of patients, and that minority and other marginalized patients are disproportionately harmed. Assumptions made about patient knowledge or lack thereof function as judgments that are prone to bias, which then affect the education and advice imposed upon patients. We review how the motivational interviewing (MI) approach to patient engagement includes components of evidence-based bias-mitigating strategies, such as understanding circumstances from the patient?s point of view, and therefore we propose that the MI approach can reduce the impact of bias in patient care.

Background: Anterior cruciate ligament (ACL) ruptures occur frequently, with ACL reconstruction among the most commonly performed orthopaedic sports surgeries. The remnant ACL is typically debrided for visualization. However, further evidence has suggested that this remnant tissue contains a wealth of proprioceptive nerve fibers and a vascular blood supply. Theoretically, preserving the ACL remnant may improve joint proprioception and graft synovialization. Therefore, ACL hybrid remnant preservation reconstruction (HRPR) was developed to preserve and tension the native remnant in combination with an ACL reconstruction. Indications: Patients with proximal tears or femoral-sided avulsions, Sherman type 1 or 2, may be indicated for ACL-HRPR. Technique Description: In this technique, we use a bone–patellar tendon–bone (BTB) autograft, which can be harvested based on the surgeon's preference. After performing a diagnostic arthroscopy, the notch of the knee is debrided, with care to preserve the tibial ACL remnant. The tibial remnant is then undermined with electrocautery. Nonabsorbable suture is passed through the remnant tissue. A tibial guide is placed, and a pin is drilled just posterior to the tibial insertion. Next, the appropriately sized tibial tunnel is drilled just posterior to the tibial remnant insertion. Using an anteromedial-portal technique with the knee maximally flexed, an over-the-top guide with appropriate offset is used to insert the guide pin, and the femoral tunnel is drilled. The proximal graft bone block and the remnant sutures are then passed through the femoral tunnel. Metal screws are then inserted to fix the BTB graft bone blocks on the femoral side, followed by the tibial side. Backup fixation is also used by placing a biocomposite anchor 1 cm distal to the tibial tunnel. Results: A myriad of techniques exist for preserving the ACL remnant. For the present surgical technique, a retrospective cohort revealed that patients undergoing ACL-HRPR achieved full range of motion without extension loss and equivalent patient-reported outcomes, without increased complication rates. Discussion/Conclusions: For patients with femoral-sided ACL tears or avulsion, ACL-HRPR is a viable option that may augment traditional ACL reconstruction. Patient Consent Disclosure Statement: The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.

Abstract This opinion deals with the re‐evaluation of saccharin and its sodium, potassium and calcium salts (E 954) as food additives. Saccharin is the chemically manufactured compound 1,2‐benzisothiazol‐3(2H)‐one‐1,1‐dioxide. Along with its sodium (Na), potassium (K) and calcium (Ca) salts, they are authorised as sweeteners (E 954). E 954 can be produced by two manufacturing methods i.e. Remsen‐Fahlberg and Maumee. No analytical data on potential impurities were provided for products manufactured with the Maumee process; therefore, the Panel could only evaluate saccharins (E 954) manufactured with the Remsen‐Fahlberg process. The Panel concluded that the newly available studies do not raise a concern for genotoxicity of E 954 and the saccharins impurities associated with the Remsen‐Fahlberg manufacturing process. For the potential impurities associated with the Maumee process, a concern for genotoxicity was identified. The data set evaluated consisted of animals and human studies. The Panel considered appropriate to set a numerical acceptable daily intake (ADI) and considered the decrease in body weight in animal studies as the relevant endpoint for the derivation of a reference point. An ADI of 9 mg/kg body weight (bw) per day, expressed as free imide, was derived for saccharins (E 954). This ADI replaces the ADI of 5 mg /kg bw per day (expressed as sodium saccharin, corresponding to 3.8 mg /kg bw per day saccharin as free imide) established by the Scientific Committee on Food. The Panel considered the refined brand‐loyal exposure assessment scenario the most appropriate exposure scenario for the risk assessment. The Panel noted that the P95 exposure estimates for chronic exposure to saccharins (E 954) were below the ADI. The Panel recommended the European Commission to consider the revision of the EU specifications of saccharin and its sodium, potassium and calcium salts (E 954).

Abstract The EFSA Panel on Food Additive and Flavourings (FAF Panel) evaluated the safety of proposed changes to the currently permitted uses of the food additive steviol glycosides (E 960a–d) and of a proposed modification of the current acceptable daily intake (ADI) from 4 mg/kg body weight (bw) per day to 6 or 16 mg/kg bw per day, expressed as steviol equivalents. Currently, steviol glycosides (E 960a–d) are authorised in the EU in 32 different food categories (FCs). An extension of use was proposed for four new uses within FC 7.2 ‘Fine bakery wares’. In addition, an increase of the maximum permitted levels (MPLs) for FC 14.1.3 ‘Fruit nectars’ and for three uses within FC 14.1.4 ‘Flavoured drinks’ was requested. Consequently, the Panel updated the exposure estimates using the protocol for assessing exposure to sweeteners, developed to consider the specificities related to consumers' exposure to this functional class of food additives. Considering the proposed extension of use and increase of the MPLs, together with the currently authorised uses (at the MPLs) of E 960a–d, the highest 95th percentiles of exposure are 4.1 and 6.9 mg/kg bw per day for infants and toddlers, respectively. Based on the currently available absorption, distribution, metabolism and excretion (ADME) dataset for steviol glycosides (E 960a–d), the Panel concluded that that there is insufficient justification to increase the current ADI of 4 mg/kg bw per day, expressed as steviol equivalents. With respect to the proposed extension of use and increase of the MPLs, the Panel concluded that the calculated, conservative, dietary exposure would result in an increased exceedance of the ADI for toddlers at the 95th percentile.

This scoping review explored literature relating to employer attitudes towards employees and candidates with visual impairment (VI). Systematic searches identified 17 relevant articles published since 2018. Thematic synthesis highlighted findings relating to several themes: explicit and implicit attitudes of employers; employer concerns, including those relating to employee performance, and the experiences of both customers and colleagues; and factors which might impact on employer attitudes, such as gender and prior experience of having hired someone with VI. Findings indicate a tendency for employers to possess negative or, at best, neutral attitudes towards people with VI, and the central role that improved knowledge of VI and the capabilities of people with VI may play in generating positive employer attitudes. The review highlights the need for further exploration of this topic, particularly given the limited geographical spread of recent research, and a lack of consideration of the shared experience of employer and employee.