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Abstract Background Emerging evidence points at substantial comorbidity between adult attention deficit hyperactivity disorder (ADHD) and cardiometabolic diseases, but our understanding of the comorbidity and how to manage cardiometabolic disease in adults with ADHD is limited. The ADHD Remote Technology study of cardiometabolic risk factors and medication adherence (ART-CARMA) project uses remote measurement technology to obtain real-world data from daily life to assess the extent to which ADHD medication treatment and physical activity, individually and jointly, may influence cardiometabolic risks in adults with ADHD. Our second main aim is to obtain valuable real-world data on adherence to pharmacological treatment and its predictors and correlates during daily life from adults with ADHD. Methods ART-CARMA is a multi-site prospective cohort study within the EU-funded collaboration ‘TIMESPAN’ (Management of chronic cardiometabolic disease and treatment discontinuity in adult ADHD patients) that will recruit 300 adults from adult ADHD waiting lists. The participants will be monitored remotely over a period of 12 months that starts from pre-treatment initiation. Passive monitoring, which involves the participants wearing a wrist-worn device (EmbracePlus) and downloading the RADAR-base Passive App and the Empatica Care App on their smartphone, provides ongoing data collection on a wide range of variables, such as physical activity, sleep, pulse rate (PR) and pulse rate variability (PRV), systolic peaks, electrodermal activity (EDA), oxygen saturation (SpO2), peripheral temperature, smartphone usage including social connectivity, and the environment (e.g. ambient noise, light levels, relative location). By combining data across these variables measured, processes such as physical activity, sleep, autonomic arousal, and indicators of cardiovascular health can be captured. Active remote monitoring involves the participant completing tasks using a smartphone app (such as completing clinical questionnaires or speech tasks), measuring their blood pressure and weight, or using a PC/laptop (cognitive tasks). The ART system is built on the RADAR-base mobile-health platform. Discussion The long-term goal is to use these data to improve the management of cardiometabolic disease in adults with ADHD, and to improve ADHD medication treatment adherence and the personalisation of treatment.

Spatially congruent cues increase the speed of bimanual reach decisions compared with abstract symbolic cues, particularly for asymmetric reaches. Asymmetric rhythmic bimanual movements are less stable than symmetric rhythmic movements, but it is not well understood if spatially congruent cues similarly increase the stability of asymmetric rhythmic bimanual movements. To address this question, in Experiment 1, participants performed symmetric and asymmetric bimanual rhythmic finger tapping movements at different movement frequencies in time with flickering spatially congruent and abstract symbolic stimuli. As expected, symmetric movements were more stable. Spatially congruent cues similarly increased the stability of symmetric and asymmetric movements compared with abstract symbolic cues. The benefits of spatial congruence and movement symmetry were restricted to high movement frequencies (>2 Hz). To better understand if the emergence of these effects at high movement frequencies was driven by a change in movement strategy, in Experiment 2, video of the hands was concurrently recorded during task performance. Markerless motion tracking software revealed that participants switched from discontinuous to continuous movement strategies with increasing movement frequency. Because discontinuous and continuous movements are thought to be controlled by distinct neurocognitive systems, this might explain why the beneficial effects of spatial congruence and response symmetry emerged only at high movement frequencies. Overall, results from the current study indicate that the perceptual quality of the stimulus use to cue movement frequency can have powerful effects on the stability of rhythmic bimanual movements, but that these effects may depend on whether discontinuous or continuous movement strategies are selected. [ABSTRACT FROM AUTHOR]

Background: Emotion dysregulation commonly co-occurs with attention-deficit hyperactivity disorder (ADHD), leading to a range of negative outcomes. While psychological interventions have shown promise in bringing about positive changes in emotional and cognitive domains, there is still limited knowledge on the subjective experiences of change among the participants in these interventions. Aim: The present study explores the experiences of adults with ADHD who had participated in a blended digital and face-to-face intervention aimed at improving emotion dysregulation. The study focuses on understanding their experiences of change and identifying contributors to change. Methods: A total of 9 adults with ADHD participated in individual semi-structured, in-depth interviews following their participation in the intervention. The interviews were analyzed using thematic analysis. Results: The thematic analysis resulted in three core themes. The first theme, 'perceiving change', represents changes that the participants experienced, with four subthemes: 1a) being in control, 1b) feeling aware, 1c) accepting oneself and one's emotions and 1d) gaining insight and knowledge. The second theme, 'supporting change', captures factors that supported the participants' changes, with five subthemes: 2a) acquiring skills, 2b) being in it together, 2c) therapist guidance, 2d) finding motivation 2e) putting it into practice. Lastly, the third theme, 'sustaining change', includes aspects important to maintain change, with two subthemes: 3a) working consistently and 3b) giving it time. Conclusions: The findings show that the participants experienced various changes related to the management of their emotions following their participation in the intervention. Change was perceived as a multifaceted process, supported by internal factors such as motivation and engagement, along with external factors such as support from the other group members and the therapists. Taken together, the findings from the study could be important to the development of psychological interventions for adults with ADHD and may provide valuable knowledge to clinicians and policymakers. Trial registration: Registered on 21st November 2022 at ClinicalTrials.gov. ClinicalTrials.gov ID: NCT05644028. [ABSTRACT FROM AUTHOR]

The high proportion of people with HIV (PWH) in the 2022–2023 mpox outbreak has raised questions surrounding the association between HIV and mpox. The objectives of this study were to evaluate the association between engagement in HIV-associated healthcare and mpox diagnosis, as well as to characterize cases of mpox among PWH. The DC Cohort is a longitudinal cohort of PWH in Washington, DC. We conducted a 5:1 (controls:cases) nested case-cohort study on male participants, matching age and care site. Cases were participants with an identified mpox diagnosis. Conditional logistic regression was used to assess the impact of indicators of engagement in HIV-associated healthcare on mpox diagnosis. We identified 70 cases of mpox in DC Cohort participants randomly matched to 323 controls, for a total of 393 participants included in the analysis. Study participants were primarily non-Hispanic Black (72.3%) with a median age of 41 (IQR: 36, 50). There was no association between engagement in care and mpox diagnosis; however, low CD4 was associated with increased odds of mpox diagnosis (aOR: 4.60 (95% CI: 1.23, 17.11)). Among a cohort of PWH, engagement in care was not associated with mpox diagnosis, suggesting that the overrepresentation of PWH among mpox cases is not due to surveillance bias.

Reading is a critical neurodevelopmental skill for school-aged children, which requires a distributed network of brain regions including the cerebellum. However, we do not know how functional connectivity between the cerebellum and other brain regions contributes to reading. Here we used resting-state functional connectivity to understand the cerebellum's role in decoding, reading speed, and comprehension in a group of struggling readers (RD) and a group of adolescents and children with typical reading abilities (TD). We observed an increase in functional connectivity between the sensorimotor network and the left angular gyrus, left lateral occipital cortex, and right inferior frontal gyrus in the RD group relative to the TD group. Additionally, functional connectivity between the cerebellum network and the precentral gyrus was decreased and was related to reading fluency in the RD group. Seed-based analysis revealed increased functional connectivity between crus 1, lobule 6, and lobule 8 of the cerebellum and brain regions related to the default mode network and the motor system for the RD group. We also found associations between reading performance and the functional connectivity between lobule 8 of the cerebellum and the left angular gyrus for both groups, with stronger relationships in the TD group. Specifically, the RD group displayed a positive relationship between functional connectivity, whereas the TD group displayed the opposite relationship. These results suggest that the cerebellum is involved in multiple components of reading performance and that functional connectivity differences observed in the RD group may contribute to poor reading performance.

BackgroundRemote measurement technology (RMT) has the potential to address current research and clinical challenges of attention-deficit/hyperactivity disorder (ADHD) symptoms and its co-occurring mental health problems. Despite research using RMT already being successfully applied to other populations, adherence and attrition are potential obstacles when applying RMT to a disorder such as ADHD. Hypothetical views and attitudes toward using RMT in a population with ADHD have previously been explored; however, to our knowledge, there is no previous research that has used qualitative methods to understand the barriers to and facilitators of using RMT in individuals with ADHD following participation in a remote monitoring period. ObjectiveWe aimed to evaluate the barriers to and facilitators of using RMT in individuals with ADHD compared with a group of people who did not have a diagnosis of ADHD. We also aimed to explore participants’ views on using RMT for 1 or 2 years in future studies. MethodsIn total, 20 individuals with ADHD and 20 individuals without ADHD were followed up for 10 weeks using RMT that involved active (questionnaires and cognitive tasks) and passive (smartphone sensors and wearable devices) monitoring; 10 adolescents and adults with ADHD and 12 individuals in a comparison group completed semistructured qualitative interviews at the end of the study period. The interviews focused on potential barriers to and facilitators of using RMT in adults with ADHD. A framework methodology was used to explore the data qualitatively. ResultsBarriers to and facilitators of using RMT were categorized as health-related, user-related, and technology-related factors across both participant groups. When comparing themes that emerged across the participant groups, both individuals with and without ADHD experienced similar barriers and facilitators in using RMT. The participants agreed that RMT can provide useful objective data. However, slight differences between the participant groups were identified as barriers to RMT across all major themes. Individuals with ADHD described the impact that their ADHD symptoms had on participating (health-related theme), commented on the perceived cost of completing the cognitive tasks (user-related theme), and described more technical challenges (technology-related theme) than individuals without ADHD. Hypothetical views on future studies using RMT in individuals with ADHD for 1 or 2 years were positive. ConclusionsIndividuals with ADHD agreed that RMT, which uses repeated measurements with ongoing active and passive monitoring, can provide useful objective data. Although themes overlapped with previous research on barriers to and facilitators of engagement with RMT (eg, depression and epilepsy) and with a comparison group, there are unique considerations for people with ADHD, for example, understanding the impact that ADHD symptoms may have on engaging with RMT. Researchers need to continue working with people with ADHD to develop future RMT studies for longer periods.

Undergraduate courses in immunology are content‐heavy and combined with a new, complex vocabulary, can be an overwhelming subject for students. In‐class active learning approaches have been found to improve understanding of difficult concepts in science, technology, engineering and mathematics (STEM) disciplines; however, many undergraduate courses maintain a high dependence on lecture‐style teaching because of time constraints, content demands and student resistance. We designed an online, out‐of‐class activity, the “Life and Death of a T cell”, to complement a lecture on a complex immunological concept, T‐cell development. Inspired by the “Choose Your Own Adventure” children's books, a fictional narrative was created in which students assume the role of a cell with a dream of becoming a helper T cell. Decision‐making scenarios then prompt students to draw on their knowledge from the lecture to successfully navigate the steps of T‐cell development. The activity was built on two platforms, Google Forms and H5P (HTML 5 Package), both of which are readily accessible and allow the inclusion of branching logic and the creation of a decision tree–based activity. An anonymous survey revealed that students found this interactive approach enjoyable, and their perceived understanding of the content significantly increased. Students appreciated the inclusion of a novel learning resource, with requests for similar activities to be developed for other immunological concepts. In conclusion, we developed a narrative‐based, decision‐making activity to complement a lecture on T‐cell development. As an out‐of‐class activity, this style of learning approach can potentially capitalize on the benefits of active learning, while also overcoming barriers of student resistance. [ABSTRACT FROM AUTHOR]

ABSTRACT Determining the antibiotic sensitivity of disease-causing microorganisms is a fundamental process in a clinical microbiology laboratory. With the continued use of antibiotics, the emergence of antibiotic resistance has become a significant health issue. However, the principles and laboratory testing to determine antibiotic sensitivity are generally not taught to first-year undergraduate students. This is partly due to the limited time to cover the fundamental biology of microorganisms and the mechanism of action of antibiotics in an introductory course. We overcame these limitations by teaching first-year students the fundamental principles of antibiotic sensitivity using an online data generator/simulation. Using the Kirby-Bauer disk diffusion test, students replicated the effects of antibiotic dose on bacterial growth and determined the antimicrobial susceptibility testing of their allocated bacterium. After 2–3 weeks, the antimicrobial sensitivity testing was replicated in an authentic face-to-face laboratory setting over 2 days. The impact of the intervention on student learning was assessed using a written laboratory report and a short questionnaire containing Likert and free-text questions. Student self-reported understanding of the content rose significantly, with nearly all students passing the written assessment. The approach was found to be enjoyable and interactive and facilitated authentic learning in first-year students. This cohort of students will continue to use more advanced versions of this simulation in future years, allowing for the long-term benefits of this approach to be assessed.

Production of high-quality multiple-choice questions (MCQs) for both formative and summative assessments is a time-consuming task requiring great skill, creativity and insight. The transition to online examinations, with the concomitant exposure of previously tried-and-tested MCQs, exacerbates the challenges of question production and highlights the need for innovative solutions. Several groups have shown that it is practical to leverage the student cohort to produce a very large number of syllabus-aligned MCQs for study banks. Although student-generated questions are well suited for formative feedback and practice activities, they are generally not thought to be suitable for high-stakes assessments. In this study, we aimed to demonstrate that training can be provided to students in a scalable fashion to generate questions of similar quality to those produced by experts and that identification of suitable questions can be achieved with minimal academic review and editing. Second-year biochemistry and molecular biology students were assigned a series of activities designed to coach them in the art of writing and critiquing MCQs. This training resulted in the production of over 1000 MCQs that were then gauged for potential by either expert academic judgement or via a data-driven approach in which the questions were trialled objectively in a low-stakes test. Questions selected by either method were then deployed in a high-stakes in-semester assessment alongside questions from two academically authored sources: textbook-derived MCQs and past paper questions. A total of 120 MCQs from these four sources were deployed in assessments attempted by over 600 students. Each question was subjected to rigorous performance analysis, including the calculation of standard metrics from classical test theory and more sophisticated item response theory (IRT) measures. The results showed that MCQs authored by students, and selected at low cost, performed as well as questions authored by academics, illustrating the potential of this strategy for the efficient creation of large numbers of high-quality MCQs for summative assessment.

Abstract Background Canine diabetes mellitus (DM) is a common endocrine disease in domestic dogs. A number of pathological mechanisms are thought to contribute to the aetiopathogenesis of relative or absolute insulin deficiency, including immune-mediated destruction of pancreatic beta cells. DM risk varies considerably between different dog breeds, suggesting that genetic factors are involved and contribute susceptibility or protection. Associations of particular dog leucocyte antigen (DLA) class II haplotypes with DM have been identified, but investigations to date have only considered all breeds pooled together. The aim of this study was to analyse an expanded data set so as to identify breed-specific diabetes-associated DLA haplotypes. Methods The 12 most highly represented breeds in the UK Canine Diabetes Register were selected for study. DLA-typing data from 646 diabetic dogs and 912 breed-matched non-diabetic controls were analysed to enable breed-specific analysis of the DLA. Dogs were genotyped for allelic variation at DLA-DRB1, -DQA1, -DQB1 loci using DNA sequence-based typing. Genotypes from all three loci were combined to reveal three-locus DLA class II haplotypes, which were evaluated for statistical associations with DM. This was performed for each breed individually and for all breeds pooled together. Results Five dog breeds were identified as having one or more DLA haplotype associated with DM susceptibility or protection. Four DM-associated haplotypes were identified in the Cocker Spaniel breed, of which one haplotype was shared with Border Terriers. In the three breeds known to be at highest risk of DM included in the study (Samoyed, Tibetan Terrier and Cairn Terrier), no DLA haplotypes were found to be associated with DM. Conclusions Novel DLA associations with DM in specific dog breeds provide further evidence that immune response genes contribute susceptibility to this disease in some cases. It is also apparent that DLA may not be contributing obvious or strong risk for DM in some breeds, including the seven breeds analysed for which no associations were identified.

Learning disabilities are currently conceptualised as involving underlying weaknesses in cognitive processing, which has prompted growing interest in cognitive interventions that may alleviate learning challenges. One such programme , the Arrowsmith programme, targets a broad array of cognitive domains, but has not been evaluated. This study evaluated the cognitive and academic growth of students who participated in one academic year of the Arrowsmith programme and examined whether baseline MRI-derived myelin water fraction (MWF) and cognitive abilities were correlated with intervention outcomes. Participants demonstrated overall cognitive and academic growth as well as individual areas in which they improved after one year. Some areas of cognitive and academic growth were significantly correlated, suggesting a relationship in skill improvement. Baseline MWF and cognitive processing were related to higher or lower degrees of skill improvement in some areas. These results suggest that the Arrowsmith programme may be associated with improvements in cognitive and academic skills. In addition, they reflect the importance of considering individual characteristics at baseline when evaluating intervention outcomes.

Strongyloides stercoralis is a soil transmitted helminth endemic to tropical and subtropical areas that can persist for decades in immunocompetent human hosts as a chronic asymptomatic infection. The use of corticosteroids, a mainstay of treatment for patients hospitalized with severe coronavirus disease (COVID-19), can trigger a life-threatening Strongyloides hyperinfection syndrome and disseminated disease. We identified 22 previously published cases of strongyloidiasis occurring in individuals with COVID-19, with one death reported among the seven patients who had Strongyloides hyperinfection syndrome. A total of seventeen patients had previously received corticosteroids, and of the five with no prior corticosteroid use, one presented with hyperinfection syndrome. We identify the key challenges in the diagnosis and treatment of Strongyloides within the context of COVID-19, including our imprecise knowledge of the global distribution of Strongyloides, the overlapping symptoms and signs of COVID-19 and Strongyloides hyperinfection syndrome, the limited utility of eosinophilia as a clinical marker for strongyloidiasis in this setting, the lack of validated algorithms to screen for Strongyloides prior to corticosteroid use, and the paucity of treatment options for critically ill patients with COVID-19 who cannot take oral ivermectin. Future research should focus on improved diagnostic methods and population prevalence estimates, optimizing the approaches for Strongyloides screening in persons with COVID-19 (including clinical trial participants and strategies for resource-limited settings) and better defining the role of pre-emptive treatment.

Background As concerns about the prevalence of infections that are resistant to available antibiotics increase, attention has turned toward the use of these medicines both within and outside of formal healthcare settings. Much of what is known about use beyond formal settings is informed by survey-based research. Few studies to date have used comparative, mixed-methods approaches to render visible patterns of use within and between settings as well as wider points of context shaping these patterns.Design This article analyses findings from mixed-methods anthropological studies of antibiotic use in a range of rural and urban settings in Zimbabwe, Malawi and Uganda between 2018 and 2020. All used a ‘drug bag’ survey tool to capture the frequency and types of antibiotics used among 1811 households. We then undertook observations and interviews in residential settings, with health providers and key stakeholders to better understand the stories behind the most-used antibiotics.Results The most self-reported ‘frequently used’ antibiotics across settings were amoxicillin, cotrimoxazole and metronidazole. The stories behind their use varied between settings, reflecting differences in the configuration of health systems and antibiotic supplies. At the same time, these stories reveal cross-cutting features and omissions of contemporary global health programming that shape the contours of antibiotic (over)use at national and local levels.Conclusions Our findings challenge the predominant focus of stewardship frameworks on the practices of antibiotic end users. We suggest future interventions could consider systems—rather than individuals—as stewards of antibiotics, reducing the need to rely on these medicines to fix other issues of inequity, productivity and security.