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Within mathematical cognition the development of conceptual knowledge is seen as critical to developing understanding. Sleep has been well established to play a role in the consolidation of newly learned information and schema-based information but has yet to be explored within mathematical cognition. Across three experiments participants (N = 167) were assigned to a sleep or wake group and then viewed lectures on either p-values, t-test, or z-scores. The sleep group watched the lecture at 9pm, completed an immediate recall task to explain the concept, then a second recall task 12h later at 9am. The wake groups watched the lecture at 9am, and completed an immediate recall task then a second recall task 12h later at 9pm. Written responses were then assessed using a comparative judgement task by subject experts. Across all three experiments, results showed that participants in the sleep group retained their knowledge from the immediate recall to 12 hours later, while in the wake group, participants' knowledge declined significantly between sessions. These results suggest that sleep may be involved in an important process of maintaining the information learned from statistical concepts.

Background: With growing evidence suggesting that levels of emotional well-being have been decreasing globally over the past few years, demand for easily accessible, convenient, and affordable well-being and mental health support has increased. Although mental health apps designed to tackle this demand by targeting diagnosed conditions have been shown to be beneficial, less research has focused on apps aiming to improve emotional well-being. There is also a dearth of research on well-being apps structured around users' lived experiences and emotional patterns and a lack of integration of real-world evidence of app usage. Thus, the potential benefits of these apps need to be evaluated using robust real-world data., Objective: This study aimed to explore usage patterns and preliminary outcomes related to mental health and well-being among users of an app (Paradym; Paradym Ltd) designed to promote emotional well-being and positive mental health., Methods: This is a pre-post, single-arm evaluation of real-world data provided by users of the Paradym app. Data were provided as part of optional built-in self-assessments that users completed to test their levels of depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder Questionnaire-7), life satisfaction (Satisfaction With Life Scale), and overall well-being (World Health Organization-5 Well-Being Index) when they first started using the app and at regular intervals following initial usage. Usage patterns, including the number of assessments completed and the length of time between assessments, were recorded. Data were analyzed using within-subjects t tests, and Cohen d estimates were used to measure effect sizes., Results: A total of 3237 app users completed at least 1 self-assessment, and 787 users completed a follow-up assessment. The sample was diverse, with 2000 users (61.8%) being located outside of the United States. At baseline, many users reported experiencing strong feelings of burnout (677/1627, 41.6%), strong insecurities (73/211, 34.6%), and low levels of thriving (140/260, 53.8%). Users also experienced symptoms of depression (mean 9.85, SD 5.55) and anxiety (mean 14.27, SD 6.77) and reported low levels of life satisfaction (mean 12.14, SD 7.42) and general well-being (mean 9.88, SD 5.51). On average, users had been using the app for 74 days when they completed a follow-up assessment. Following app usage, small but significant improvements were reported across all outcomes of interest, with anxiety and depression scores improving by 1.20 and 1.26 points on average, respectively, and life satisfaction and well-being scores improving by 0.71 and 0.97 points, respectively., Conclusions: This real-world data analysis and evaluation provided positive preliminary evidence for the Paradym app's effectiveness in improving mental health and well-being, supporting its use as a scalable intervention for emotional well-being, with potential applications across diverse populations and settings, and encourages the use of built-in assessments in mental health app research., (©Athina Marina Metaxa, Shaun Liverpool, Mia Eisenstadt, John Pollard, Courtney Carlsson. Originally published in JMIR Formative Research (https://formative.jmir.org), 23.01.2025.)

Behçet's disease is an autoinflammatory disorder characterized by relapsing and remitting vasculitis that can manifest in various forms, including gastrointestinal Behçet's disease (GIBD). Its complications (e.g., intestinal perforation) are among the primary causes of morbidity and mortality. GIBD pathogenesis involves the enhanced production of certain cytokines, e.g., tumor necrosis factor α and interleukin-6 (IL-6), which could serve as a target for potential therapies. This review provides an overview of GIBD, including the diagnosis and immunopathogenesis as it is currently understood, and evaluates the emerging role of the inhibition of IL-6 (classic and trans-signaling) as an alternative treatment option for patients with GIBD. Given the current paucity of data, we reflected on the potential of IL-6 inhibitors such as tocilizumab and olamkicept based on immunopathogenic considerations and available clinical data in patients with inflammatory bowel disease (IBD), in whom clinical response or remission was induced. The selective inhibition of IL-6 trans-signaling may bring new impetus to the development of this drug class, particularly regarding safety. Still, the benefits of IL-6 inhibitors for patients with GIBD need to be evaluated in appropriate proof-of-concept studies. The clinical outcomes of IL-6 inhibitors in IBD are promising and may suggest their potential relevance in GIBD.

Background: Head-on-head impacts are a risk factor for concussion, which is a concern for sports. Computer vision frameworks may provide an automated process to identify head-on-head impacts, although this has not been applied or evaluated in rugby., Methods: This study developed and evaluated a novel computer vision framework to automatically classify head-on-head and non-head-on-head impacts. Tackle events from professional rugby league matches were coded as either head-on-head or non-head-on-head impacts. These included non-televised standard-definition and televised high-definition video clips to train (n=341) and test (n=670) the framework. A computer vision framework consisting of two deep learning networks, an object detection algorithm and three-dimensional Convolutional Neural Networks, was employed and compared with the analyst-coded criterion. Sensitivity, specificity and positive predictive value were reported., Results: The overall performance evaluation of the framework to classify head-on-head impacts against manual coding had a sensitivity, specificity and positive predictive value (95% CIs) of 68% (58% to 78%), 84% (78% to 88%) and 0.61 (0.54 to 0.69) in standard-definition clips, and 65% (55% to 75%), 84% (79% to 89%) and 0.61 (0.53 to 0.68) in high-definition clips., Conclusion: The study introduces a novel computer vision framework for head-on-head impact detection. Governing bodies may also use the framework in real time, or for retrospective analysis of historical videos, to establish head-on-head rates and evaluate prevention strategies. Future work should explore the application of the framework to other head-contact mechanisms and also the utility in real time to identify potential events for clinical assessment., Competing Interests: Competing interests: AJG has a clinical practice in neuropsychology involving individuals who have sustained sport-related concussion. He is a contracted concussion consultant to Rugby Australia. He is the global clinical lead for the World Rugby Brain Health Service. He is a member of the World Rugby Concussion Working Group, and a member of the Australian Football League Concussion Scientific Advisory Committee. He has received travel funding or been reimbursed by professional sporting bodies, and commercial organisations for discussing or presenting sport-related concussion research at meetings, scientific conferences, workshops, and symposiums. Previous grant funding includes the NSW Sporting Injuries Committee, the Brain Foundation (Australia), an Australian-American Fulbright Commission Postdoctoral Award, a Hunter New England Local Health District, Research, Innovation and Partnerships Health Research & Translation Centre and Clinical Research Fellowship Scheme, and the Hunter Medical Research Institute (HMRI), supported by Jennie Thomas, and the HMRI, supported by Anne Greaves. He is currently supported by a National Health and Medical Research Council (NHMRC) Investigator Grant. He acknowledges unrestricted philanthropic support from the Tooth Foundation for concussion research and the National Rugby League for research in former professional rugby league players.MC is employed by Premiership Rugby and is a member of the World Rugby Concussion Working Group., (© Author(s) (or their employer(s)) 2025. No commercial re-use. See rights and permissions. Published by BMJ Group.)

Background: Ambulatory care sensitive conditions (ACSCs) are those for which hospital admission could be prevented by interventions in primary care. Children living in socioeconomic disadvantage have higher rates of emergency admissions for ACSCs than their more affluent counterparts. Emergency admissions for ACSCs have been increasing, but few studies have assessed how changing socioeconomic conditions (SECs) have impacted this. This study investigates the association between local SECs and emergency ACS hospital admissions in children in England., Methods: We examined longitudinal trends in emergency admission rates for ACSCs and investigate the association between local SECs and these admissions in children over time in England, using time-varying neighbourhood unemployment as a proxy for SECs. Fixed-effect regression models assessed the relationship between changes in neighbourhood unemployment and admission rates, controlling for unmeasured time-invariant confounding of each neighbourhood. We also explore the extent to which this relationship differs by acute and chronic ACSCs and is explained by access to primary and secondary care., Results: Between 2012 and 2017, paediatric emergency admissions for acute ACSCs increased, while admissions for chronic ACSCs decreased. At the neighbourhood level, each 1% point increase in unemployment was associated with a 3.9% and 2.7% increase in the rate of emergency admissions for acute ACSCs, for children aged 0-9 years and 10-19 years, respectively. A 2.6% increase in admission rates for chronic ACSCs was observed, driven by an association in 0-9 years old. Adjustment for primary and secondary care access did not meaningfully attenuate the magnitude of this association., Conclusions: Increasing trends in neighbourhood unemployment were associated with increases in paediatric emergency admission rates for ACSCs in England. This was not explained by available measures of differential access to care, suggesting policy interventions should address the causes of unemployment and poverty in addition to health system factors to reduce emergency admissions for ACSCs., Competing Interests: Competing interests: No, there are no competing interests., (© Author(s) (or their employer(s)) 2025. Re-use permitted under CC BY. Published by BMJ Group.)

Objective: Cauda Equina Syndrome (CES) poses significant neurological risks if untreated. Diagnosis relies on clinical and radiological features. As the symptoms are often non specific and common, the diagnosis is usually made after a MRI scan. A huge number of MRI scans are done to exclude CES but nearly 80% of them will not have cauda equina syndrome. This study aimed to develop and validate a machine learning model for automated CES detection from MRI scans to enable faster triage of patients presenting with CES like clinical features., Methods: MRI scans from suspected CES patients (2017-2022) were collected and categorized into normal scans/disc protrusion (0%-50% canal stenosis (CS)) and cauda equina compression (CEC, >50% CS). A convolutional neural network was developed and tested on a total of 715 images (80:20 split) Gradient descent heatmaps were generated to highlight regions crucial for classification., Results: The model achieved an accuracy of 0.950 (0.921-0.971), a sensitivity of 0.969 (0.941-0.987), a specificity of 0.859 (0.742-0.937), a positive predictive value of 0.969 (0.944-0.984) and an area under the curve of 0.915 (0.865-0.958). Gradient descent heatmaps demonstrated accurate identification of any clinically relevant disc herniation into the spinal canal., Conclusions: This study pilots a deep learning approach for predicting CEC presence, promising improved healthcare quality and timely CES management. As referrals rise, this tool can act as a fast triage system which can lead to prompt management of CES in environments where resources for radiological interpretation of mri scans is limited., (Copyright © 2025. Published by Elsevier Inc.)

Mechanisms controlling the process and patterning of blood vessel development in the placenta remain largely unknown. The close physical proximity of early blood vessels observed in the placenta and the cytotrophoblast, as well as the reported production of vasculogenic growth factors by the latter, suggests that signalling between these two niches may be important. Here, we have developed an in vitro model to address the hypothesis that the cytotrophoblast, by the secretion of soluble factors, drives differentiation of resident sub-trophoblastic mesenchymal stem cells (MSCs) along a vascular lineage, thereby establishing feto-placental circulation. BM-MSCs (a readily available model for placental stem cells) were treated with conditioned medium containing the secretome from human BeWo trophoblast cells, or endothelial growth medium (EGM2) supplemented with exogenous growth factors (VEGF, IGF1 and EGF) for 10-12 days. Trophoblast-conditioned media, found to contain detectable concentrations of cytokines including VEGF, uPAR, TIMP-1, TIMP-2, IL6 and placental growth factor, induced the expression of the endothelial genes CD31, von Willibrand factor (vWF), FLT-1, VEGFR2 and VE-Cadherin. Upregulation of vWF protein was also detected following growth in trophoblast-conditioned media, using immunocytochemistry. Wound healing (migration assay) and Matrigel-tube formation assays confirmed that the BM-MSCs cultured in trophoblast-conditioned media exhibited functional measures of endothelial cells in addition to expressing relevant markers. Identification of key trophoblast-secreted factors and their promotion of endothelial differentiation in BM-MSCs helps advance our theories regarding the close relationship of the mesenchymal stem cell-cytotrophoblast niche in coordinating the complex angiogenic events that occur in the placenta. The in vitro model presented here provides an accessible and reproducible tool for further investigations into placental development., Competing Interests: Declaration of Competing Interest None., (Copyright © 2025 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Children with cerebral palsy (CP) regularly fall over and this has negative effects on their physical and psychosocial wellbeing (e.g., reduced activity participation). However, the reasons for falls are not well understood. The way in which children negotiate challenging walking environments (e.g., uneven surfaces), may reveal more about how falls occur as these environments require gait modifications to maintain stability. Stability in challenging walking environments has been explored for children with CP; however, it remains unclear how these lead to falls., Research Question: Do challenging walking environments that mimic those faced in the real-world, contribute to increased fall occurrence and fall risk in children with CP?, Methods: Five databases were searched, and 1386 records screened to include ambulatory children with CP, aged 5-18 years old, investigating dynamic walking in challenging environments, with outcomes of fall occurrence or fall risk. The full protocol for this review was registered on PROSPERO (CRD42021290456)., Results: Sixteen studies met the inclusion criteria. One study reported occurrence of stumbles, two reported no falls. Fifteen studies identified gait alterations used by children with CP in challenging environments. Twenty-four gait characteristics were identified to be indicative of cautious walking strategies and seven gait characteristics identified to increase fall risk, suggesting a potential link. However, limited evidence exists as to whether this reflects falls faced in the real-world., Significance: Investigations into stability over challenging walking environments for children with CP are lacking any measures of fall occurrence. Investigations into the mechanisms that may contribute to high fall risk, or fall avoidance when negotiating obstacles, uneven surfaces, steep declines and stairs may reveal further causes of real-world falls, and in doing so inform future fall prevention techniques. Finally, understanding the multifaceted causes of falls in real-world challenging environments from the perspectives of children with CP is key for future research., Competing Interests: Declaration of Competing Interest The authors declare no conflicting interests., (Copyright © 2025 The Authors. Published by Elsevier B.V. All rights reserved.)

Mowing significantly influences nutrient cycling and stimulates metabolic adjustments in plants to promote regrowth. Plant growth-promoting rhizobacteria (PGPR) are crucial for enhancing plant growth, nutrient absorption, and stress resilience; however, whether inoculation with PGPR after mowing can enhance plant regrowth capacity further, as well as its specific regulatory mechanisms, remains unexplored. In this study, PGPR Pantoea eucalyptus (B13) was inoculated into mowed Leymus chinensis to evaluate its effects on phenotypic traits, root nutrient contents, and hormone levels during the regrowth process and to further explore its role in the regrowth of L. chinensis after mowing. The results showed that after mowing, root nutrient and sugar contents decreased significantly, while the signal pathways related to stress hormones were activated. This indicates that after mowing, root resources tend to sacrifice a part of growth and prioritize defense. After mowing, B13 inoculation regulated the plant's internal hormone balance by reducing the levels and signal of JA, SA, and ABA and upregulated the signal transduction of growth hormones in the root, thus optimizing growth and defense in a mowing environment. Transcriptomic and metabolomic analyses indicated that B13 promoted nutrient uptake and transport in L. chinensis root , maintained hormone homeostasis, enhanced metabolic pathways related to carbohydrates, energy, and amino acid metabolism to cope with mowing stress, and promoted root growth and regeneration of shoot. This study reveals the regenerative strategy regulated by B13 in perennial forage grasses, helping optimize resource utilization, increase yield, and enhance grassland stability and resilience.

Competing Interests: Conflict of interest Robert J. Moots is a Co-Editor-in-Chief of the journal. The article was subject to the journal’s standard procedures, with peer review handled independently of the editor.

Mangrove forests thrive along global tropical coasts, acting as a barrier that protects coastlines against storm surges and as nurseries for an entire food web. They are also known for their high carbon sequestration rates and soil carbon stocks. We introduce a new global mangrove canopy height map generated from TanDEM-X spaceborne elevation measurements collected during the 2011-2013 period with a 12-meter spatial resolution and an accuracy of 2.4 meters (RMSE). Height was calibrated and validated using GEDI mission data and independently verified with airborne Lidar. The tallest mangrove stands reach nearly 60 meters in Colombia and Gabon, and potentially other countries. The map captures a broader range of canopy heights with finer spatial details than other available global products that use optical imagery. This new global mangrove height dataset can aid in evaluating mangrove ecosystem services at local and regional scales, improving our understanding of factors controlling mangrove structure, and supporting conservation, climate mitigation and adaptation strategies., Competing Interests: Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

The present study investigated the influence of emotional stimuli in the flanker task. In six experiments, separate influences of anticipating and reacting to valence-laden stimuli (affective pictures or facial expressions) on the flanker effect and its sequential modulation (also known as conflict adaptation) were examined. The results showed that there was little evidence that emotional stimuli influenced cognitive control when positive and negative stimuli appeared randomly during the flanker task. When positive and negative stimuli were separated between different participant groups in order to exclude a possible contamination from the effect of one valence to that of another, the sequential modulation was reduced when valence-laden stimuli were anticipated or had been presented on a preceding trial, regardless of the valence of the stimuli. A similar pattern was also obtained with facial expressions but only for response accuracy and only after valence-laden stimuli were presented on a preceding trial. The influences of anticipating and reacting to emotional stimuli were only partially replicated in the final two experiments where the arousal and valence of affective pictures were manipulated orthogonally. The lack of consistent influences of emotional stimuli on the flanker effect challenges the existing theories that implicate affective contributions to cognitive control.

This article assesses how and why the National Health Service (NHS) has remained at the forefront of British politics and society for 75 years amid significant economic pressures, organizational strain, shifting ideological trends, ongoing reforms, and an unprecedented public health emergency. The postwar "years of consensus" evolved into alleged decline and ostensible neglect during the 1980s, while New Labour sought to rejuvenate this core public service after 1997, featuring investment and often controversial reforms that challenged the party's social democratic values. Amid the New Labour era, NHS powers filtered down to devolved administrations, while from 2008 retrenchment and austerity ensued, fueled by global recession. Austerity eventually subsided, yet from early 2020 the NHS swiftly faced the extreme conditions of the globalized Covid-19 pandemic. The service continues to face challenges regarding its longer-term viability, and this article analyzes this scenario, within the context of the NHS's 75-year historical legacy, its contemporary status, comparative international trends, and likely future evolution., Competing Interests: Declaration of Conflicting InterestsThe author declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

The prevalence of anterior cruciate ligament injury in female soccer players has been attributed to hormonal fluctuations during the menstrual cycle (MC), with injury incidence greatest during the follicular phase. Eight, eumenorrheic, collegiate soccer players (19.5 ± 0.75 years, 1.62 ± 4.90 cm, 61.12 ± 7.6 kg mean ± SD) completed eccentric knee flexor and concentric knee extensor trials at 60 and 240°·s -1 during the follicular, ovulation and luteal phases of their MC. Peak torque and corresponding angle of peak torque were maintained across all phases of the MC, irrespective of testing modality and speed ( p  ≥ 0.149). Strength ratios defined using peak torque were also not sensitive to MC phase ( p  ≥ 0.933). However, Functional Range in eccentric knee flexion was significantly lower during the follicular phase ( p  = 0.017), at both testing speeds. This supports epidemiological observations but highlights the importance of analysing isokinetic data beyond the peak of the strength curve. Interpretation of isokinetic data should therefore focus on points of "weakness" as opposed to maximum strength, whilst (p)rehabilitative strategies should consider strength through range of motion, and at different speeds. Eccentric hamstring strength was observed to decrease significantly at the higher speed, contrary to observations in elite male players, and potentially reflecting a differential training adaptation.

Timolol maleate (TML) is a beta-blocker drug that is commonly used to lower the intraocular pressure in glaucoma. This study focused on using a 3D printing (3DP) method for the manufacturing of an ocular, implantable, sustained-release drug delivery system (DDS). Polycaprolactone (PCL), and PCL with 5 or 10% TML implants were manufactured using a one-step 3DP process. Their physicochemical characteristics were analysed using light microscopy, scanning electronic microscopy (SEM), differential scanning calorimetry (DSC) / thermal gravimetric analysis (TGA), and Fourier-transform infrared spectroscopy (FTIR). The in vitro drug release was evaluated by UV-spectrophotometry. Finally, the effect of the implants on cell viability in human trabecular meshwork cells was assessed. All the implants showed a smooth surface. Thermal analysis demonstrated that the implants remained thermally stable at the temperatures used for the printing, and FTIR studies showed that there were no significant interactions between PCL and TML. Both concentrations (5 & 10%) of TML achieved sustained release from the implants over the 8-week study period. All implants were non-cytotoxic to human trabecular cells. This study shows proof of concept that 3DP can be used to print biocompatible and personalised ocular implantable sustained-release DDSs for the treatment of glaucoma., Competing Interests: Declarations. Ethics approval and consent to participate: Not applicable in these studies. Consent for publication: Not applicable, there are no human’s participation in these studies. Competing interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024. The Author(s).)

Children's literature is rife with anthropomorphic or non-human characters that may be used as a scaffold to teach children about theory of mind (ToM) or the ways in which people think or feel about the social world. In this study, 107 typically developing U.K. school children in Years 1, 3, and 5 (5-10 years of age) completed a human and anthropomorphic ToM test that tested their understanding of faux pas. Specifically, children from these three age groups were given a human version of 20 faux pas stories and an identical animal version of the same stories 1 week apart (with counterbalancing between classes). Pairwise comparison showed that participants in Year 1 did significantly better on the animal ToM test compared with the human ToM test, matching ToM scores of children in Year 3. On the human version of the task, there was a clear progression in age-related ToM abilities, with older children outperforming younger children and improving when the stories were human rather than anthropomorphic. Implications and future directions are discussed, in line with theories of species specialization and the importance of anthropomorphism for children., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

We do not have a veridical representation of our body in our mind. For instance, tactile distances of equal measure along the medial-lateral axis of our limbs are generally perceived as larger than those running along the proximal-distal axis. This anisotropy in tactile distances reflects distortions in body-shape representation, such that the body parts are perceived as wider than they are. While the origin of such anisotropy remains unknown, it has been suggested that visual experience could partially play a role in its manifestation. To causally test the role of visual experience on body shape representation, we investigated tactile distance perception in sighted and early blind individuals comparing medial-lateral and proximal-distal tactile distances of stimuli presented on the ventral and dorsal part of the forearm, wrist, and hand. Overestimation of distances in the medial-lateral over proximal-distal body axes were found in both sighted and blind people, but the magnitude of the anisotropy was significantly reduced in the forearms of blind people. We conclude that vision does not drive the emergence of tactile distance anisotropies, but visual experience can however modulate its expression on some specific body parts., Competing Interests: Declaration of competing interest The authors declare no conflict of interest., (Copyright © 2024 Elsevier B.V. All rights reserved.)

In human culture, an object's value is influenced by tangible properties (e.g. visual desirability and constituent materials) and intangible ownership history (e.g. authentic objects owned by celebrities are often worth more than similar inauthentic objects). Children are sensitive to both of these factors as independent determinants of value, but research has yet to elucidate how they interact. Here, we investigate whether children aged 5-11 years consider object properties or authentic ownership history to be the greater determinant of value and examine how their object valuations are influenced by owners' characteristics. In Study 1, visually desirable and undesirable items belonging to 'famously good' owners received higher valuations than similar items belonging to non-famous owners, whereas desirable items belonging to 'famously bad' owners received significantly lower values. In Study 2, children considered items made from cheap materials belonging to famously good owners, but not famously bad owners, to be as valuable as similar items made from expensive materials belonging to non-famous owners. In Study 3, physical contact with a famously bad owner had a detrimental impact on value, but worn and unworn objects belonging to famously good owners did not significantly differ in value. Across studies, we documented evidence that children's sensitivity to authentic ownership history and physical contact as determinants of value increases with age. Together, these findings demonstrate that children's valuation of ownership history relative to object properties depends on the owner's 'essence', and their sensitivity to owner contact as a mediator of value indicates awareness of 'magical contagion'., Competing Interests: Declaration of competing interest No authors have any conflicts to declare., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Shoulder fractures (proximal humerus fractures) are common, painful, debilitating injuries. Recovery is a long process often hindered by complications such as mal-union and frozen shoulder. The purpose of this qualitative study was to explore the experiences and information needs of people at different time points after a shoulder fracture and how views on recovery change over time., Methods: This longitudinal telephone interview study used a semi-structured approach based on a pre-planned interview topic guide. Recruitment was from June to November 2023. Participants were interviewed approximately two months and five to six months after their injury. Interviews were audio-recorded and transcribed verbatim. Data were analysed using thematic analysis., Results: 14 participants were recruited (age range 44-80 years; three male). The themes identified were dependence, vulnerability, information needs, and recovery. Loss of function and identity were associated with dependence. Feelings of vulnerability were present for most participants at six months post-injury. Information needs evolved, with information about the extent of the injury and practical advice needed first, but later participants emphasized the importance of reassurance and expected timelines for recovery. Recovery meant regaining function and independence, and returning to meaningful activities, which was also not fully achieved for most participants by six months., Conclusions: This study is the first to explore information needs and experiences along the timeline of recovery from a shoulder fracture. What recovery means to individual patients, along with recognition of the extent to which feelings of vulnerability affect recovery are important factors to consider. Clinicians should be aware of the full impact of these injuries to guide patients on their recovery journey, including identifying feelings of vulnerability and regaining their identity. Adopting a person-centred care approach, and considering the changing priorities and information needs of patients throughout their recovery journey may lead to improved patient care., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2024 May et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Workplace-based assessments (WPBAs) in postgraduate training may not always provide an accurate representation of a trainee's capability to perform a given task, or a true measure of a trainee's overall competence in clinical practice settings. This article describes how trainers can use a theory-driven and evidence-based intervention called dynamic assessment for providing an individual with the best opportunity to demonstrate a more accurate representation of their performance, and ultimately present the best version of themselves when undergoing an observed WPBA, such as a Direct Observation of Procedural Skills (DOPS) or Mini Consultation Evaluation Exercise (MiniCEX). Dynamic assessment simultaneously combines educational support with assessment as the trainee undergoes the WPBA by using focussed questions as prompts to facilitate an individual trainee's essential coordination of their motivational and thinking processes since this is often challenged during assessments. In addition, the response to the prompts can also provide trainers with information to inform specific feedback for future professional development.

Introduction: The use of Janus kinase inhibitors (JAKis) in immune-mediated inflammatory diseases (IMIDs) beyond licence is expanding rapidly. The aim of this scoping review was to identify and present the available evidence on the efficacy of JAKis in all conditions without marketing authorisation., Methods: Through a systematic literature search we identified studies including 5 or more patients that assessed the use of any JAKi for any efficacy outcome. Quantitative analyses in the form of pairwise meta-analyses were performed for eligible data from randomised controlled trials (RCTs) only., Results: Eighty-three (n = 83) studies in total were included in our review, assessing efficacy of JAKis in 34 IMIDs. In most conditions, JAKis exhibited generally positive effects, though the majority of evidence came from observational, non-comparative studies. Pairwise meta-analyses were possible for hidradenitis suppurativa and systemic lupus erythematosus (SLE). For hidradenitis suppurativa, we found a clear benefit of treatment with JAKis compared with placebo in achieving clinical response [OR 2.35, 95 % CI (1.24 to 4.46)]. For treatment-resistant SLE, the results were equivocal; JAKi showed some benefit over placebo but statistical significance was only reached for one of the two meta-analysed outcome measures [SLE Responder Index 4, OR 1.41, 95 % CI (1.01 to 1.98); SLE Disease Activity Index 2000; OR 1.36, 95 % CI (0.99 to 1.88)]., Conclusions: There is a rapidly increasing use of JAKis beyond current licencing in most IMIDs. Large comparative trials are necessary to confirm efficacy and guide future licencing decisions., Competing Interests: Declaration of competing interest, (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

Introduction: Paediatric emergency department (ED) attendances and admissions in England are increasing. Fever is a common presenting problem for these attendances. Anxiety and misperceptions surrounding appropriate management of fever persist among parents. Little evidence exists on the pathways to ED for fever, and doctors' perceptions of why parents present their child to the ED., Objectives: To understand perceptions of parents and doctors of the reasons for ED presentation for children (0-18 years) with fever in England., Design: This forms the first part of a qualitative study, using reflective thematic analysis., Participants: 15 parents (12 mothers and 3 fathers) who had taken their febrile child to hospital (2015-2023), and 5 ED doctors (4 consultants and 1 resident doctor) who had experienced treating a febrile child in an ED in England., Methods: Semistructured remote (Zoom) interviews were conducted (2022-2023)., Results: Reflexive thematic analysis facilitated investigation into current parental concerns regarding fever and decision-making leading to ED attendance. The overarching theme 'factors influencing unscheduled care' comprised four key themes that reflected the complex interplay between factors influencing parental decision-making to seek emergency care, at the individual and wider structural level. These were parental proficiency and experience; social networks and access to services; fever phobia, uncertainty and anxiety; and reassurance. Doctors also acknowledged the importance of these factors, such as reassurance and showing compassion and further indicated a persistent educational gap surrounding fever between doctors and parents., Conclusions: We widen the evidence base of why parents attend ED for paediatric fever and their perceptions of other health services. Parents face challenges when seeking care and perceived ED as a last resort. Interventions to support parental decision-making and management of fever could help to alleviate these challenges, as well as potentially reducing the demand for emergency care., Competing Interests: Competing interests: No, there are no competing interests., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ Group.)

Survivorship after pediatric critical illness is high in developed countries, but many suffer physical morbidities afterwards. The increasing focus on follow-up after critical illness has led to more pediatric studies reporting muscle mass changes (using ultrasound), albeit with different results. A systematic literature review was undertaken examining muscle mass changes, assessed by ultrasound of the quadriceps femoris muscle in children who are critically ill. Secondary objectives were to determine if muscle mass was associated with protein intake and/or energy. Databases were searched in July 2024. Eligible experimental or observational studies, published from January 2010 to July 2024 and including children who are critically ill that were aged between ≥37 weeks' gestational age and 18 years who were admitted to the pediatric critical care unit were included. The Joanna Briggs Institute for observational studies critical appraisal instrument was used to assess studies for methodological quality. One hundred and thirty-five studies were screened, and eight prospective cohort studies were included, involving 411 children. Overall, muscle mass changes reported in seven out of eight of the papers showed a pooled mean muscle mass loss of 8.9% (95% confidence interval [CI] 6.6-11.4) from baseline to days 5-7. Five of the eight publications defined muscular atrophy as a decrease in muscle mass of >10%. Using this cutoff, 92 (49.2%) children developed muscular atrophy during their PICU admission. Overall, muscle mass decreased by nearly 10% during a child's first week in PICU, with almost half of children developing muscular atrophy during their admission., (© 2024 The Author(s). Journal of Parenteral and Enteral Nutrition published by Wiley Periodicals LLC on behalf of American Society for Parenteral and Enteral Nutrition.)

Background: Arts therapies, encompassing art therapy, music therapy, drama therapy, and dance movement therapy with the broader practice of expressive arts therapies, have demonstrated positive outcomes in the treatment of neurodevelopmental and neurological disorders (NNDs). Integrating arts therapies into telehealth has become increasingly important to improve accessibility for people with mobility impairments or those living in remote areas. This study aims to map the existing body of literature to provide an in-depth overview of telehealth in arts therapies for individuals with NNDs., Methodology: This scoping review followed the PRISMA guidelines. Six databases were systematically searched, with 2,888 articles screened for eligibility. Inclusion criteria focused on primary research peer-reviewed articles in English that addressed telehealth arts therapies for NNDs., Results: Seventeen telehealth studies published between 2009 and March 2024 were included, with a notable increase in publications after 2020. The studies covered various neurodevelopmental disorders, including autism spectrum disorders, attention deficit hyperactivity disorder (ADHD), Rett syndrome, and neurological disorders such as stroke, epilepsy, cerebral palsy, central nervous system (CNS) tumors, dementia, Alzheimer's disease, Parkinson's disease, spinal cord injuries, and mild cognitive impairment. Music therapy was the most widely studied modality. Interventions ranged from therapeutic singing and songwriting to virtual reality experiences. Different platforms and specialized virtual environments were used alongside pre-recorded sessions. Positive benefits included psychological enrichment, social connectivity, cognitive improvements, and brain changes, although some studies reported mixed or no significant effects in certain areas., Conclusion: Telehealth in arts therapies significantly benefits individuals with NNDs, improving accessibility and providing psychological, emotional, social, and cognitive benefits. The positive benefits observed highlight the potential of these interventions to improve overall well-being and daily functioning. Future research may focus on high-quality qualitative studies and neuroimaging assessments to further validate the impact of telehealth arts therapies., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2024 Reitere, Duhovska, Karkou and Mārtinsone.)

Several microtechnology devices quantify the external load of team sports using Global Positioning Systems sampling at 5, 10, or 15 Hz. However, for short, explosive actions, such as collisions, these sample rates may be limiting. It is known that very high-frequency sampling is capable of capturing changes in actions over a short period of time. Therefore, the aim of this study was to compare the mean acceleration and entropy values obtained from 100 Hz and 1000 Hz tri-axial accelerometers in tackling actions performed by rugby players. A total of 11 elite adolescent male rugby league players (mean ± SD; age: 18.5 ± 0.5 years; height: 179.5 ± 5.0 cm; body mass: 88.3 ± 13.0 kg) participate in this study. Participants performed tackles ( n = 200), which were recorded using two triaxial accelerometers sampling at 100 Hz and 1000 Hz, respectively. The devices were placed together inside the Lycra vests on the players' backs. The mean acceleration, sample entropy (SampEn), and approximate entropy (ApEn) were analyzed. In mean acceleration, the 1000 Hz accelerometer obtained greater values ( p < 0.05). However, SampEn and ApEn were greater with the 100 Hz accelerometer ( p < 0.05). A large relationship was observed between the two devices in all the parameters analyzed (R 2 > 0.5; p < 0.0001). Sampling frequency can affect the quality of the data collected, and a higher sampling frequency potentially allows for the collection of more accurate motion data. A frequency of 1000 Hz may be suitable for recording short and explosive actions.

A recent large-scale study on the portrayal of autism in British newspapers revealed a deficit-based coverage, which concentrated on children and boys in particular, typically represented from the mothers' perspective. This follow-up study refines these representations, considering how they differ by gender and family role. We analysed 2998 text samples, which discussed autism in the context of four combinations of gender and family roles, namely, BOY, GIRL, FATHER and MOTHER. These samples included sources with different publication dates, reporting style and political orientation. Autism representations remained negative regardless of gender and family role. Over time, stories about autistic girls started to emerge, identifying them as a distinct group explicitly compared to autistic boys. Newspapers, especially broadsheets, associated girls with diagnostic difficulties, camouflaging and sometimes gender dysphoria - discussed particularly for those assigned female at birth. The child's autism was more often attributed to maternal than paternal behaviours or lifestyle. Autistic mothers were mentioned more often than fathers and were portrayed negatively. We conclude that newspapers portray female autism as less significant than male autism and, in addition, place mothers under more ethical scrutiny than fathers. These disparities reflect both historical biases in autism research and gender and family-role stereotypes., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Purpose: Physical activity (PA) can improve health-related outcomes for head and neck cancer (HaNC) patients, and PA guidance from healthcare professionals' can increase patients' PA levels. However, less than 9% of HaNC patients are physically active. This study explored healthcare professionals' promotion of PA across the National Health Service (NHS) in North West England and North Wales, to HaNC patients., Methods: A cross-sectional online survey exploring healthcare professionals' promotion of PA in HaNC. The International Physical Activity Questionnaire-Short Form was used to estimate healthcare professionals' PA levels. Quantitative data were analyzed using descriptive or inferential statistics and qualitative data were analyzed using reflexive thematic analysis. Data were synthesized drawing on the capability-opportunity-motivation-behavior model and theoretical domains framework., Results: Eighty-one professionals participated. Fifty-three percent self-reported high levels of PA. Seventy-five percent considered PA promotion as part of their role; however, only 39% discussed PA with their patients (reflective motivation and social/professional role and identity). Only 38% felt confident initiating PA discussions and 76% reported needing further training. Training on the benefits of PA for HaNC patients and how to encourage health-related behavior change were identified as beneficial (psychological capability and knowledge)., Conclusion: Healthcare professionals are influential in enabling patients to adopt health-related behavior change; however, PA promotion was not routine practice for professionals involved in the care of HaNC patients. Training should be provided to professionals on PA promotion, with a focus on behavior change techniques. Future research should explore how behavior change techniques can be implemented into clinical practice to improve health-related outcomes in HaNC., Competing Interests: Declarations. Ethics approval: Ethical approval was granted by the Greater Manchester West NHS Research Ethics Committee (REC) (REC: 21/NW/0108; IRAS ID: 293302). All procedures involving human participants were conducted in accordance with the ethical standards of the REC committee and conformed to the provision of the Declaration of Helsinki. Consent to participate: Informed consent was obtained from all participants included in this study. Consent to publish: Informed consent gained by participants included consent to publish their non-identifiable data. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Purpose: Indicators of socioeconomic status (SES), such as education and occupational grade, are known to be associated with alcohol use but this has not been examined among individuals with a mental health problem. This study developed latent classes of SES, their associations with alcohol use, and examined the indirect effect via social support and neighbourhood environment., Methods: A secondary analysis of the 2014 Adult Psychiatric Morbidity Survey was conducted among participants with a mental health problem (N = 1,436). SES classes were determined using a range of indicators. Alcohol use was measured using the Alcohol Use Disorder Identification Test. Social support and neighbourhood neighbourhood environment were measured using validated questionnaires. A latent class analysis was conducted to develop SES classes. Multinomial logistic regression examined associations of SES and alcohol use. Structural equation models tested indirect effects via social support and neighbourhood environment., Results: A four-class model of SES was best-fitting; "economically inactive,GCSE-level and lower educated,social renters", "intermediate/routine occupation,GCSE-level educated,mixed owner/renters", "retired, no formal education,homeowners", and "professional occupation,degree-level educated,homeowners". Compared to "professional occupation,degree-level educated, homeowners", SES classes were more likely to be non-drinkers; odds were highest for "economically inactive,GCSE-level and lower educated,social renters" (OR = 4.96,95%CI 3.10-7.93). "Retired, no formal education,homeowners" were less likely to be hazardous drinkers (OR = 0.35,95%CI 0.20-0.59). Associations between "economically inactive,GCSE-level and lower educated,social renters" and "retired, no formal education,homeowners" and non- and harmful drinking via social support and neighbourhood environment were significant., Conclusions: In contrast to the alcohol harms paradox, among individuals with a mental health problem, lower SES groups were more likely to be non-drinkers while no associations with harmful drinking were found. There is also a need to examine the alcohol harms paradox in the context of the area in which they live., (© 2024. The Author(s).)

There is increasing pressure to accelerate health professions education programs and educators have the challenge of ensuring that students can effectively transfer their learning into clinical practice. In this personal view, we discuss how insights from cognitive science can inform the redesign of current curricula and highlight the challenge of implementing these new approaches for instructional design and assessment. We also recommend that educators disseminate the important lessons learned from their endeavors.

Background: Shoulder osteoarthritis is a common cause of pain, disability and difficulty sleeping. Patient information leaflets are produced by NHS Trusts with the aim of informing patients about their diagnosis and available treatment options., Objectives: The aim of this study was to identify and describe the non-surgical management of people with shoulder osteoarthritis according to publicly available information leaflets produced by NHS Trusts., Methods: One reviewer undertook an electronic search using Google to identify publicly available patient-facing information leaflets (PIL) produced by NHS Trusts which detailed non-surgical management strategies for people with shoulder osteoarthritis. Relevant data were extracted by one reviewer and verified by two reviewers., Results: Seventeen PILs from 17 different UK NHS Trusts were identified ranging from December 2016 to February 2024. Information provided in the PIL varied, with topics including general osteoarthritis management, exercise, analgesia, injections, and surgical indications. No PIL covered all areas recommended in the NICE Osteoarthritis Management guidelines., Conclusion: PILs developed and published by NHS Trusts are variable in content and do not fully reflect current clinical guidelines. High-quality research to inform consistent, clinically, and cost-effective treatment pathways, including information provision, for patients with shoulder osteoarthritis is needed., (© 2024 The Author(s). Musculoskeletal Care published by John Wiley & Sons Ltd.)

An external focus of attention, enhanced expectancies, and autonomy support (i.e., OPTIMAL factors) are key factors to optimise motor performance and uncover latent movement capabilities. However, research on the combination of OPTIMAL factors, particularly in children's dynamic movement settings is limited. Therefore, this study examined the combined effects of OPTIMAL factors on children's performance on a dynamic movement assessment battery, hypothesising higher performance scores in the optimised version of the assessment battery versus standardised version of the assessment. Forty-nine children (15 boys, 34 girls; mean age 10.61 ± 1.38 years) completed the Dragon Challenge (DC) dynamic movement assessment battery. Performance was measured via a summation of movement process (technique), outcome, and time-to-completion scores (max score N = 54) with higher scores representing better performance. Participants completed a standardised and an optimised version of the DC in a counterbalanced fashion. For the latter, DC protocols were optimised via the provision of choice (autonomy support); external focus instructions augmented by simple knowledge statement, positive feedback and promotion of a growth mindset (Enhanced expectancies). Results indicate that motor performance (DC score) was better in the optimised (M = 31.08 ± 6.66) vs. standardised (M = 29.04 ± 5.88). The findings indicate that the combination of OPTIMAL factors can improve children's motor performance in dynamic movement settings and that standardised motor assessment may not reveal children's true movement capabilities., Competing Interests: Declaration of competing interest The Authors declare that there is no conflict of interest. This research did not revive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors., (Copyright © 2024. Published by Elsevier B.V.)

Introduction: Structured diabetes self-management education (DSME) is internationally recommended for people with type 2 diabetes to support self-management and to prevent associated long-term complications. 'Attendance' at DSME is currently benchmarked as having completed a registration form and at least one active engagement with programme content, and 'completion' measured against ≥60% completion, despite landmark trials reporting outcomes based on the full completion of a programme. Little is known about the effectiveness of DSME on the psychological and emotional health of people with diabetes who complete less than the full DSME programme. We report a protocol for a single-centre randomised feasibility study to assess the impact of differing completion rates of a face-to-face DSME programme on patient reported outcomes of self-care, diabetes distress and quality of life in people with type 2 diabetes., Methods: A randomised feasibility study in 120 people with type 2 diabetes due to attend a secondary care diabetes clinic in the North West UK for DSME. Participants will be randomised into one of the four groups: Group 1 full DSME programme, Group 2 60%, Group 3 10% and Group 4 0% (delayed education). Psychometric questionnaire scores will be evaluated at baseline and 3-4 months post-intervention. Measures of feasibility (eligibility, recruitment and retention rates) will be reported., Ethics and Dissemination: The DIABETES-PRO study was approved by the London-Surrey Borders Research Ethics Committee (24/LO/0235). Results will be shared with study participants and published in peer-reviewed journals., Trial Registration: Clinicaltrials.gov NCT06419907., (© 2024 The Author(s). Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.)

Background: The timeline of the 3 Pediatric International Nutrition Studies (PINS) coincided with the publication of 2 major guidelines for the timing of parenteral nutrition (PN) and recommended energy and protein delivery dose., Objective: The study's main objective was to describe changes in the nutrition delivery practice recorded in PINS1 and PINS2 (PINS1-2) (conducted in 2009 and 2011, preexposure epoch) vs PINS3 (conducted in 2018, postexposure epoch), in relation to the published practice guidelines., Design: This study is a secondary analysis of data from a multicenter prospective cohort study., Participants/setting: Data from 3650 participants, aged 1 month to 18 years, admitted to 100 unique hospitals that participated in 3 PINS was used for this study., Main Outcome Measures: The time in days from pediatric intensive care unit admission to the initiation of PN and enteral nutrition delivery were the primary outcomes. Prescribed energy and protein goals were the secondary outcomes., Statistical Analyses Performed: A frailty model with a random intercept per hospital with stratified baseline hazard function by region for the primary outcomes and a mixed-effects negative binomial regression with random intercept per hospital for the secondary outcomes., Results: The proportion of patients receiving enteral nutrition (88.3% vs 80.6%; P < .001) was higher, and those receiving PN (20.6% vs 28.8%; P < .001) was lower in the PINS3 cohort compared with PINS1-2. In the PINS3 cohort, the odds of initiating PN during the first 10 days of pediatric intensive care unit admission were lower, compared with the PINS1-2 cohort (hazard ratio 0.8, 95% CI 0.67 to 0.95; P = .013); and prescribed energy goal was lower compared with the PINS1-2 cohort (incident rate ratio 0.918, 95% CI 0.874 to 0.965; P = .001)., Conclusions: The likelihood of initiation of PN delivery significantly decreased during the first 10 days after admission in the PINS3 cohort compared with PINS1-2. Energy goal prescription in children receiving mechanical ventilation significantly decreased in the postguidelines epoch compared with the preguidelines epoch., (Copyright © 2024 Academy of Nutrition and Dietetics. Published by Elsevier Inc. All rights reserved.)

Previous studies have shown how test anxiety is positively related to symptoms of emotion disorder and that highly test anxious persons can meet diagnostic thresholds for emotion disorder. However, many studies are somewhat dated and based on older conceptualizations of key constructs. In addition, well-being is rarely considered alongside test anxiety and emotion disorder. In the present study, we addressed this limitation by using contemporaneous conceptualizations of test anxiety and emotion disorder, alongside school-related well-being (SRWB), using two analytic methods that are rarely combined to establish how constructs are related. The sample comprised 1167 participants (n male  = 500, n female  = 621, n non-binary  = 21, n declined to report  = 25; M age  = 15.4 years, SD = 1.81) from secondary and upper secondary education. Data were analyzed using psychometric network analysis and receiver-operator characteristic (ROC) curve analysis. The psychometric network analysis showed that test anxiety, generalized anxiety, panic disorder, social anxiety, major depression, and SRWB formed distinct and largely coherent communities. Generalized anxiety was principally linked to the worry and tension components of test anxiety, panic disorder to the physiological indicator's component, social anxiety and SRWB to the worry and cognitive interference components, and major depression to the cognitive interference component. The ROC curve analysis indicated that test anxiety scores from the 63rd to 75th scale percentiles could predict clinical risk with relatively high accuracy (0.79-0.88) and acceptable levels of sensitivity (0.75-0.86) and specificity (0.70-0.77). Results suggest that test anxiety, emotion disorder, and SRWB are distinct, albeit related constructs. Although constrained by the cross-sectional design, our findings suggest that high test anxiety presents an elevated risk for the development of emotion disorder., Competing Interests: Declaration of competing interest We have no known conflict of interest to disclose. The materials, dataset, and analytic code, on which analyses within this manuscript were conducted can be accessed at https://doi.org/10.17605/OSF.IO/UF8SJ., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

This study aimed to examine how parents develop personal resilience when facing the challenges of caring for a child with tracheostomy. This study employed a longitudinal qualitative design. Unstructured narrative interviews with 12 parents (from nine families) whose child had a new tracheostomy were undertaken at three time points over 12 months. Data were analysed using a socio-narratology method. Findings reveal the journey parents experienced, how their feelings changed and the processes involved in developing resilience over the first 12 months of their child having a tracheostomy. Stories told by parents early in their journey revealed emotional upheaval, negative emotions, stress and shock. Due to medical need, parents had little or no choice for their child to have a tracheostomy. Once their child's life was out of danger, parents started to reframe their experiences and beliefs. Resilience played a major part in how parents perceived and faced their situation, allowing them to deal with what came their way and to move forward with their lives. Different aspects of resilience such as self-awareness, grit, gratitude, internal locus of control and reframing came to the fore at different time points. Parents talked feeling stretched by the challenges they faced and how they reframed their perspectives about their child's tracheostomy. Parents' resilience and reframing is discussed in relation to the ABC-X model. This study identifies a theoretical model that explains this process of change, this results in transferable knowledge, useful for understanding and explaining the experience of other parents and families., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Introduction: Sodium bicarbonate (NaHCO 3 ) ingestion has been found to be ergogenic in high-intensity exercise that ranges from 1 to 10 min; however, limited studies have investigated high-intensity exercise beyond this duration., Purpose: The present study aimed to determine the effect of NaHCO 3 ingested using a carbohydrate hydrogel delivery system on 40 km time trial (TT) performance in trained male cyclists., Methods: Fourteen trained male cyclists ingested 0.3 g kg -1 BM NaHCO 3 (Maurten AB, Sweden) to determine individualised peak alkalosis, which established time of ingestion prior to exercise. Participants completed a 40 km familiarisation TT, and two 40 km experimental TTs after ingestion of either NaHCO 3 or placebo in a randomised, double-blind, crossover design., Results: NaHCO 3 supplementation improved performance (mean improvement = 54.14 s ± 18.16 s; p = 0.002, g = 0.22) and increased blood buffering capacity prior to (HCO 3 - mean increase = 5.6 ± 0.2 mmol L -1 , p < 0.001) and throughout exercise (f = 84.82, p < 0.001, pη 2  = 0.87) compared to placebo. There were no differences in total gastrointestinal symptoms (GIS) between conditions either pre- (NaHCO 3 , 22 AU; Placebo, 44 AU; p = 0.088, r = 0.46) or post-exercise (NaHCO 3 , 76 AU; Placebo, 63 AU; p = 0.606, r = 0.14)., Conclusion: The present study suggests that ingesting NaHCO 3 mini-tablets in a carbohydrate hydrogel can enhance 40 km TT performance in trained male cyclists, with minimal GIS. This ingestion strategy could therefore be considered by cyclists looking for a performance enhancing ergogenic aid., Competing Interests: Declarations Conflicts of interest ESS, AR, BD, XY, and LRM have no conflicts of interest. At the time of study design, data collection and analysis, SAS was a colleague of ESS, AR, BD, and LRM, but is now employed by Maurten AB, Sweden. Maurten AB Sweden had no input to the design, data collection, analysis, or interpretation of these data. Maurten AB provided the sodium bicarbonate product free of charge., (© 2024. The Author(s).)

Aims: The aim of this audit was to assess and improve the completeness and accuracy of the National Joint Registry (NJR) dataset for arthroplasty of the elbow., Methods: It was performed in two phases. In Phase 1, the completeness was assessed by comparing the NJR elbow dataset with the NHS England Hospital Episode Statistics (HES) data between April 2012 and April 2020. In order to assess the accuracy of the data, the components of each arthroplasty recorded in the NJR were compared to the type of arthroplasty which was recorded. In Phase 2, a national collaborative audit was undertaken to evaluate the reasons for unmatched data, add missing arthroplasties, and evaluate the reasons for the recording of inaccurate arthroplasties and correct them., Results: Phase 1 identified 5,539 arthroplasties in HES which did not match an arthroplasty on the NJR, and 448 inaccurate arthroplasties from 254 hospitals. Most mismatched procedures (3,960 procedures; 71%) were radial head arthroplasties (RHAs). In Phase 2, 142 NHS hospitals with 3,640 (66%) mismatched and 314 (69%) inaccurate arthroplasties volunteered to assess their records. A large proportion of the unmatched data (3,000 arthroplasties; 82%) were confirmed as being missing from the NJR. The overall rate of completeness of the NJR elbow dataset improved from 63% to 83% following phase 2, and the completeness of total elbow arthroplasty data improved to 93%. Missing RHAs had the biggest impact on the overall completeness, but through the audit the number of RHAs in the NJR nearly doubled and completeness increased from 35% to 70%. The accuracy of data was 94% and improved to 98% after correcting 212 of the 448 inaccurately recorded arthroplasties., Conclusion: The rate of completeness of the NJR total elbow arthroplasty dataset is currently 93% and the accuracy is 98%. This audit identified challenges of data capture with regard to RHAs. Collaboration with a trauma and orthopaedic trainees through the British Orthopaedic Trainee Association improved the completeness and accuracy of the NJR elbow dataset, which will improve the validity of the reports and of the associated research., Competing Interests: Z. Hamoodi reports research fellowship funding from Royal College of Surgeons, National Joint Registry, and The John Charnley Trust, related to this study. A. Sayers is senior statistician on the HQIP/NJR Lot 2 contract. M. R. Whitehouse is the principal investigator for the HQIP/NJR Lot 2 contract to provide statistical support, analysis and associated services to the NJR, related to this study, and reports multiple grants or contracts from the NIHR and Ceramtec, royalties or licenses from Taylor & Frances, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Heraeus, all of which are unrelated to this study. A. C. Watts reports royalties or licenses and patents planned, issued or pendingfrom Adler, consulting fees from Medartis, payment or honoraria for lectures, presentations, speakers bureaus, manuscript writing or educational events from Medartis, Stryker, and Arthrex, all of which are unrelated to this study, and is also a member of the editorial boards of the National Joint Registry and The Bone & Joint Journal., (© 2024 The British Editorial Society of Bone & Joint Surgery.)

Purpose: The purpose of the present study was to translate and culturally validate the University of Washington Quality of Life Questionnaire, Version 4.1 (UW-QOL v4.1) in Malayalam, a language commonly used in the state of Kerala in India., Methods: The tool underwent translation and adaptation. The translated instrument then underwent a pretest survey in 30 patients. The intention was to identify any problems with the questionnaire when applied to the participants and make any minor changes if required. This was followed by validation in 100 patients. The reliability was tested for internal consistency with Cronbach's alpha. Concurrent validity was tested by correlating it with the concurrently administered FACT-HN questionnaire scores. Construct validity was tested using 'Known-group validity.', Results: Pretest survey did not identify any major problems. There was a moderate to strong correlation between the PF, SEF subscales and the composite scores on UW-QOL scores and the Head and Neck Cancer subscale and the FACT-H&N Total score. QOL scores were more in early staged patients and those who underwent no reconstructive procedure. This proved the construct validity., Conclusion: This study validates the Malayalam version of the UW-QOL instrument. It is reliable, valid and culturally adapted., Competing Interests: Conflicts of interestThe author declares that they have no conflicts of interest., (© The Association of Oral and Maxillofacial Surgeons of India 2021.)

Information may be required within a short time-frame for making decisions about programmes and interventions in health professions education. Rapid research methods have been increasingly used in healthcare, especially for qualitative research studies and literature reviews. An essential aspect of using rapid research methods is pragmatism, in which there is a balance between the constraints of the short time frame (typically less than 3 months), the available resources, and the rigour for an appropriate standard of quality. Achieving this balance requires careful attention to the design of the research, including clarification of the decision-maker's information needs and the use of rapid methods for literature review, selection of participants, and data collection and analysis. The intention of the article is to provide a practical guide for how rapid research methods for qualitative research studies and literature reviews can be adapted for health professions education.

Aims: We explored healthcare professionals' perceptions and understandings of the factors and considerations underlying inequities in technology access in children and young people (CYP) with type 1 diabetes., Methods: We interviewed (n = 29) healthcare professionals working in paediatric diabetes in England recruited from (n = 15) purposively selected sites. We analysed data thematically., Results: Interviewees highlighted multiple, often overlapping barriers to accessing technology faced by CYP with type 1 diabetes from deprived and/or ethnic minority backgrounds. They described the impacts of deprivation on technology uptake, together with the complex social, ethnic and cultural factors that could also reinforce disparities in technology access. Interviewees further highlighted staffing shortfalls as a significant barrier to supporting CYP to use technology, especially those from under-represented groups who they perceived as requiring more staff time to be trained to use technology. While interviewees suggested that unconscious bias has become less prominent, they reported being less likely to recommend technology (especially pumps) to CYP/caregivers who they feared would not use it safely and effectively (e.g. those with low literacy levels). Interviewees also highlighted geographical variability in the technology commissioning process (a 'postcode lottery')., Conclusions: Our findings suggest that without targeted interventions, technology inequities may continue to persist amongst CYP from the most and least deprived areas and from white and ethnic minority groups in the United Kingdom. Additionally, our findings suggest that closing the technology gap will require large-scale governmental and health policies aimed at fostering socioeconomic, ethnic and cultural equality alongside targeted measures to improve technology accessibility., (© 2024 The Author(s). Diabetic Medicine published by John Wiley & Sons Ltd on behalf of Diabetes UK.)

Objective: Our aim was to define the priorities for future research in safeguarding athletes from interpersonal violence (IV) in sport through a Delphi consensus study of researchers in the field., Methods: An internet-based three-round Delphi method was used as a multistage facilitation technique to arrive at a group consensus (set at ≥75% agreement). A targeted literature search was conducted to develop a list of potential research priorities that were presented as short statements in the first round., Results: A total of 52 participants (researchers in IV in sport) took part in the first round, 52 completed the second round and 44 completed the third round. Respectively, 47 items, 83 items and 60 items were included in each round. The participants achieved consensus on 11 statements in the first round, seven in the second round and 31 in the third round, for a total of 49 consensus research priorities. The first four priorities that reached consensus (78.8-80.8% agreement) directly following the first Delphi round were scored with high importance (between 6.2 and 6.3 on a scale of 7). Those four priorities included: (1) documenting the experiences of children athletes and minors, (2) studying the disclosure or reporting of violence, (3) developing, evaluating and advising on interventions targeting education and training and (4) documenting the experiences of violence of para athletes., Conclusion: This study defines research priorities for IV in sport that may elucidate further gaps in current policies and practices., Competing Interests: Competing interests: MM is a Deputy Editor of the British Journal of Sports Medicine., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Objective: Interpersonal violence (IV) in sport is challenging to define, prevent and remedy due to its subjectivity and complexity. The 2024 International Olympic Committee Consensus on Interpersonal Violence and Safeguarding aimed to synthesise evidence on IV and safeguarding in sport, introduce a new conceptual model of IV in sport and offer more accessible safeguarding guidance to all within the sports ecosystem by merging evidence with insights from Olympic athletes., Methods: A 15-member expert panel performed a scoping review following Joanna Briggs Institute methodologies. A seminal works-driven approach was used to identify relevant grey literature. Four writing groups were established focusing on: definitions/epidemiology, individual/interpersonal determinants, contextual determinants and solutions. Writing groups developed referenced scientific summaries related to their respective topics, which were discussed by all members at the consensus meeting. Recommendations were then developed by each group, presented as voting statements and circulated for confidential voting following a Delphi protocol with ≥80% agreement defined a priori as reaching consensus., Results: Of 48 voting statements, 21 reached consensus during first-round voting. Second-round and third-round voting saw 22 statements reach consensus, 5 statements get discontinued and 2 statements receive minority dissension after failing to reach agreement. A total of 43 statements reached consensus, presented as overarching (n=5) and topical (n=33) consensus recommendations, and actionable consensus guidelines (n=5)., Conclusion: This evidence review and consensus process elucidated the characterisation and complexity of IV and safeguarding in sport and demonstrates that a whole-of-system approach is needed to fully comprehend and prevent IV. Sport settings that emphasise mutual care, are athlete centred, promote healthy relationships, embed trauma- and violence-informed care principles, integrate diverse perspectives and measure IV prevention and response effectiveness will exemplify safe sport. A shared responsibility between all within the sports ecosystem is required to advance effective safeguarding through future research, policy and practice., Competing Interests: Competing interests: YAT-W and MM are associate editors of BJSM. KB is director of the IOC Safe Sport Unit., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

The spinous processes act as a lever for attachments of muscles and ligaments. Spinal imaging is commonly performed as a diagnostic test for pain and radiculopathy. A myriad of incidental or unexpected findings, both potentially asymptomatic and symptomatic, may be encountered during the interpretation of these images, which commonly comprise radiographs, Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). Isolated lesions of the spinous process, although less common, are some of the lesions that may be encountered and can present a diagnostic dilemma. These can range from congenital abnormalities, traumatic lesions, neoplasms and lesions of inflammatory, infective and metabolic aetiology. The literature specifically reviewing these lesions is sparse. The article reviews a range of pathologies affecting the spinous process, along with their pertinent imaging features, based on isolated pathologies of spinous process lesions identified on imaging by the authors at a tertiary orthopaedic centre over a 10-year period. A search on the hospital Picture Archive and Communication System (PACS) and Radiology Information System (RIS) was performed using the keyword "spinous process" and a list of the isolated pathologies of the spinous process based on the imaging reports was compiled for the purpose of this narrative review. It is important that radiologists consider these lesions when they are identified on routine imaging of the spine.

Background: High flow nasal cannula therapy (HFNC) and continuous positive airway pressure (CPAP) are two widely used modes of non-invasive respiratory support in paediatric critical care units. The FIRST-ABC randomised controlled trials (RCTs) evaluated the clinical and cost-effectiveness of HFNC compared with CPAP in two distinct critical care populations: acutely ill children ('step-up' RCT) and extubated children ('step-down' RCT). Clinical effectiveness findings (time to liberation from all forms of respiratory support) showed that HFNC was non-inferior to CPAP in the step-up RCT, but failed to meet non-inferiority criteria in the step-down RCT. This study evaluates the cost-effectiveness of HFNC versus CPAP., Methods: All-cause mortality, health-related Quality of Life (HrQoL), and costs up to six months were reported using FIRST-ABC RCTs data. HrQoL was measured with the age-appropriate Paediatric Quality of Life Generic Core Scales questionnaire and mapped onto the Child Health Utility 9D index score at six months. Quality-Adjusted Life Years (QALYs) were estimated by combining HrQoL with mortality. Costs at six months were calculated by measuring and valuing healthcare resources used in paediatric critical care units, general medical wards and wider health service. The cost-effectiveness analysis used regression methods to report the cost-effectiveness of HFNC versus CPAP at six months and summarised the uncertainties around the incremental cost-effectiveness results., Results: In both RCTs, the incremental QALYs at six months were similar between the randomised groups. The estimated incremental cost at six months was - £4565 (95% CI - £11,499 to £2368) and - £5702 (95% CI - £11,328 to - £75) for step-down and step-up RCT, respectively. The incremental net benefits of HFNC versus CPAP in step-down RCT and step-up RCT were £4388 (95% CI - £2551 to £11,327) and £5628 (95% CI - £8 to £11,264) respectively. The cost-effectiveness results were surrounded by considerable uncertainties. The results were similar across most pre-specified subgroups, and the base case results were robust to alternative assumptions., Conclusions: HFNC compared to CPAP as non-invasive respiratory support for critically-ill children in paediatric critical care units reduces mean costs and is relatively cost-effective overall and for key subgroups, although there is considerable statistical uncertainty surrounding this result., Competing Interests: Declarations. Ethical approval and consent to participate: The FIRST-ABC master protocol was approved by the East of England–Cambridge South Research Ethics Committee (19/EE/0185) and the UK Health Research Authority (IRAS 260536). The trial was registered with the International Standard Randomised Controlled Trial Number (ISRCTN) Registry (ISRCTN60048867). Written informed consent was obtained from parents/legal guardians of each trial participant. Consent for publication: Not applicable. Competing interests: The authors report funding from the National Institute for Health and Social Care Research (NIHR) Health Technology Assessment Programme to their institutions for the work presented in the manuscript. KR is Director of the NIHR Health and Social Care Delivery Research Programme., (© 2024. The Author(s).)

Enhanced buffering capacity following sodium citrate (SC) ingestion may be optimized when subsequent exercise commences at individual time-to-peak (TTP) alkalosis (blood pH or bicarbonate concentration [HCO3-]). While accounting for considerable interindividual variation in TTP (188-300 min), a reliable blood alkalotic response is required for practical use. This study evaluated the reliability of blood pH, HCO3-, and sodium (Na+) following acute SC ingestion. Fourteen recreationally active males ingested 0.4 or 0.5 g/kg body mass (BM) of SC on two occasions each and 0.07 g/kg BM of sodium chloride (control) once. Blood pH and HCO3- were measured for 4 hr postingestion. Blood pH and HCO3- displayed good reliability following 0.5 g/kg BM SC (r = .819, p = .002, standardized technical error [sTE] = 0.67 and r = .840, p < .001, sTE = 0.63, respectively). Following 0.4 g/kg BM SC, blood HCO3- retained good reliability (r = .771, p = .006, sTE = 0.78) versus moderate for blood pH (r = .520, p = .099, sTE = 1.36). TTP pH was moderately reliable following 0.5 (r = .676, p = .026, sTE = 1.05) and 0.4 g/kg BM SC (r = .679, p = .025, sTE = 0.91) versus poor for HCO3- following 0.5 (r = .183, p = .361, sTE = 5.38) and 0.4 g/kg BM SC (r = .290, p = .273, sTE = 2.50). Although the magnitude of (and displacement in) blood alkalosis, particularly HCO3-, appears reliable following potentially ergogenic doses of SC, strategies based on individual TTP cannot be recommended.

Objective: The objective of this study was to report 52-week safety and efficacy of ianalumab from phase 2b dose-finding study in patients with Sjögren's disease (SjD)., Methods: Patients randomly received (1:1:1:1) ianalumab (5, 50, or 300 mg) or placebo subcutaneously every 4 weeks until week 24 (treatment period [TP]1). At week 24, patients on 300 mg were rerandomized to continue 300 mg or receive placebo until week 52 (TP2), patients on placebo were switched to ianalumab 150 mg, and patients on 5 and 50 mg directly entered posttreatment safety follow-up. Patients who discontinued treatment early or completed treatment entered safety follow-up (≥20 weeks)., Results: During TP1, 190 patients were randomized (placebo = 49, 5 mg = 47, 50 mg = 47, 300 mg = 47). Of these 190 patients, 90 (47.4 %; 43 continued 300 mg and 47 received placebo) entered TP2, and 81 of 90 (90.0%) completed the study treatment. By week 52, efficacy was sustained in patients who continued 300 mg in TP2 (EULAR Sjögren's Syndrome Disease Activity Index, EULAR Sjögren's Syndrome Patient Reported Index, patient global assessment, and physician global assessment change from week 24: -1.45, -0.46, -4.69, and -6.86, respectively). Stimulated salivary flow rates and autoantibody levels numerically improved in the 300 mg group. Treatment-emergent adverse events were not dose-dependent, except for injection-site reactions. Cases of decreased neutrophil counts (Common Terminology Criteria for Adverse Events v4.03 grade 3 according to laboratory listings) were observed in three patients during the posttreatment follow-up, occurring at 3.5, 5.5, and 3 months, after the last ianalumab administration. None were associated with infection except one incidental finding of asymptomatic cytomegalovirus infection (IgM-positive)., Conclusion: In patients with SjD, ianalumab 300 mg demonstrated sustained efficacy through week 52 and a favorable safety profile up to two years of follow-up., (© 2024 American College of Rheumatology.)

The temporal stability of grasslands plays a key role in the stable provisioning of multiple ecosystem goods and services for humankind. Despite recent progress, our knowledge on how long-term mowing influences ecosystem stability remains unclear. Using a dataset from an 18-year-long mowing experiment with different treatment intensities (no-mowing, mowing once per year, and mowing twice per year) in grasslands of Inner Mongolia, China, we aimed to determine whether and how long-term mowing influenced grassland temporal stability in a temperate steppe. We found mowing decreased ecosystem stability in the early and intermediate periods (1-12 years of treatment), but increased stability in the later period (13-18 years of treatment), indicating responses of ecosystem stability to long-term mowing were phase dependent. Bivariate correlation and structural equation modeling analyses revealed that the degree of asynchrony both at the species and functional group levels, as well as dominant species stability, played key roles in stabilizing the whole community. In addition, portfolio effects rather than diversity made significant contributions to ecosystem stability. Our results suggest the phase-dependent temporal stability of grassland under long-term mowing is mainly mediated by species and functional group asynchrony. This finding provides a new insight for understanding how dryland grassland responds to long-term anthropogenic perturbations., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Health care staff should be given the opportunity to participate in research, but recruiting clinicians via their employing organisation is not always straightforward or quick in the UK. Unlike many countries outside the UK, very low-risk survey, interview or focus group studies can be subject to some of the same governance approval procedures as interventional studies. An exemplar study carried out by the NIHR funded Palliative Care Research Partnership North West Coast is used to highlight the challenges still faced by researchers and health care organisations when setting up a low-risk staff study across multiple NHS and non-NHS sites., Methods: A study database was created and information was collected on the first point of contact with the clinical site, Health Research Authority (HRA) and local organisational approval times, time from trust or hospice agreement to the first survey participant recruited and overall site survey recruitment numbers. Descriptive statistics (median, range) were used to analyse these data., Results: Across participating NHS trusts, it took a median of 147.5 days (range 99-195) from initial contact with the local collaborator to recruitment of the first survey participant and hospice sites mirrored these lengthy timescales (median 142 days, range 110-202). The lengthiest delays in the HRA approval process were the period between asking NHS trusts to assess whether they had capacity and capability to support the research and them granting local agreement. Local approval times varied between trusts and settings which may indicate organisations are applying national complex guidance differently., Conclusions: There is the potential for HRA processes to use more NHS resources than the research study itself when recruiting to a low-risk staff study across multiple organisations. There is a need to reduce unnecessary administrative burden and bureaucracy to give clinicians and research staff more opportunities to participate in research, and to free up NHS R&D departments, research nurses and clinicians to focus on more demanding and patient focused research studies. Hospices need standardised guidance on how to assess the risk of being involved in low-risk research without adopting the unnecessarily complex systems that are currently used within the NHS., Competing Interests: Declarations Ethics approval and consent to participate For the exemplar study, approval was granted by the East of England - Cambridge South Research Ethics Committee (Ref: 22/EE/0049) on the 24/02/2022. Survey instructions clarified that consent to participate was implied when the participant clicked through to the first page of the survey. Electronic consent was obtained prior to the working groups. Informed consent was obtained from all subjects. All methods were carried out in accordance with relevant guidelines and regulations. Consent for publication Not applicable. Competing interests All authors have completed the ICMJE uniform disclosure form at http://www.icmje.org/disclosure-of-interest/ and declare: all authors had financial support from NIHR Public Health Research strand NIHR135334 for the submitted work; AN has received a Churchill Fellowship to fund research related travel, BS is a member of the Advanced Disease & End of Life Care Workstream of the NCRI Living With and Beyond Cancer Clinical Studies Group and has received research grants from Marie Curie, North West Cancer Research and the NIHR, SM is chair of the Palliative Care Research Society, SP has received research grants from European Commission Horizon Europe, European Commission Horizon 2020 and NIHR Research for Patient Benefit NIHR204041, AD has received payments from Oxford University Press for royalties, Becton Dickinson for consulting fees, Napp Pharmaceuticals Ltd, Sandoz, Kyowa Kirin for educational purposes and is a committee member of the Association of Palliative and Supportive Care Pharmacy, no other relationships or activities that could appear to have influenced the submitted work. Data availability: Data are stored in Lancaster University’s PURE repository. The authors may be contacted to obtain further clarifications on aspects of the study not provided in this paper or supplementary material wherever ethically or legally appropriate., (© 2024. The Author(s).)