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Abstract Background Lower limb oedema is a common co‐morbidity in those with diabetes and foot ulceration and is linked with increased amputation risk. There is no current guidance for the treatment of concurrent diabetic foot ulcers and lower limb oedema, leading to uncertainty around the safety and efficacy of combination approaches incorporating offloading and compression therapies. To determine indications and contraindications for such strategies and identify any other supplementary treatment approaches, a scoping review was undertaken to map the evidence relating to off‐loading and compression therapy strategies to treat both diabetic foot ulcers and lower limb oedema in combination. Methods Following the Joanna Briggs Institute (JBI) and PRISMA – Scoping Review (ScR) guidance, this review included published and unpublished literature from inception to April 2022. Literature was sourced using electronic databases including Cochrane Library, PubMed, CINAHL, AMED; websites; professional journals and reference lists of included literature. Eligible literature discussed the management of both diabetic foot ulceration and lower limb oedema and included at least one of the treatment strategies of interest. Data extraction involved recording any suggested off‐loading, compression therapy or supplementary treatment strategies and any suggested indications, contraindications and cautions for their use. Results Five hundred twenty‐two publications were found relating to the management of diabetic foot ulcers with an off‐loading strategy or the management of lower limb oedema with compression therapy. 51 publications were eligible for inclusion in the review. The majority of the excluded publications did not discuss the situation where diabetic foot ulceration and lower limb oedema present concurrently. Conclusions Most literature, focused on oedema management with compression therapy to conclude that compression therapy should be avoided in the presence of severe peripheral arterial disease. Less literature was found regarding off‐loading strategies, but it was recommended that knee‐high devices should be used with caution when off‐loading diabetic foot ulcers in those with lower limb oedema. Treatment options to manage both conditions concurrently was identified as a research gap. Integrated working between specialist healthcare teams, was the supplementary strategy most frequently recommended. In the absence of a definitive treatment solution, clinicians are encouraged to use clinical reasoning along with support from specialist peers to establish the best, individualised treatment approach for their patients. Trial registration Open Science Framework (osf.io/crb78).

Overgrowth of Candida yeasts in the oral cavity may result in the development of oral thrush in immunocompromised individuals. This study analyzed the diversity and richness of the oral mycobiota of patients clinically diagnosed with oral thrush (OT), follow-up of oral thrush patients after antifungal therapy (AT), and healthy controls (HC). Oral rinse and oral swab samples were collected from 38 OT patients, 21 AT patients, and 41 healthy individuals (HC). Pellet from the oral rinse and oral swab were used for the isolation of oral Candida yeasts on Brilliance Candida Agar followed by molecular speciation. ITS1 amplicon sequencing using Illumina MiSeq was performed on DNA extracted from the oral rinse pellet of 16 OT, 7 AT, and 7 HC oral rinse samples. Trimmed sequence data were taxonomically grouped and analyzed using the CLC Microbial Genomics Module workflow. Candida yeasts were isolated at significantly higher rates from oral rinse and swab samples of OT (68.4%, p < 0.001) and AT (61.9%, p = 0.012) patients, as compared to HC (26.8%). Predominance of Candida albicans specifically, was noted in OT (60.5%, p < 0.001) and AT (42.9%, p = 0.006) vs. HC (9.8%), while non-albicans Candida species was dominant in HC. Analysis of oral mycobiota from OT patients showed the presence of 8 phyla, 222 genera, and 309 fungal species. Low alpha diversity (Shannon index, p = 0.006; Chao-1 biased corrected index, p = 0.01), varied beta diversity (Bray-Curtis, p = 0.01986; Jaccard, p = 0.02766; Weighted UniFrac, p = 0.00528), and increased relative abundance of C. albicans (p = 3.18E-02) was significantly associated with the oral mycobiota of OT vs. HC. This study supported that C. albicans is the main etiological agent in oral thrush and highlights the association of fungal biodiversity with the pathophysiology of oral thrush.

BackgroundMultiple long-term conditions are rising across all groups but people experiencing socioeconomic deprivation are found to have a higher prevalence. Self-management strategies are a vital part of healthcare for people with long-term conditions and effective strategies are associated with improved health outcomes in a variety of health conditions. The management of multiple long-term conditions are, however, less effective in people experiencing socioeconomic deprivation, leaving them more at risk of health inequalities. The purpose of this review is to identify and synthesise qualitative evidence on the barriers and facilitators of self-management on long-term conditions in those experiencing socioeconomic deprivation.MethodsMEDLINE, EMBASE, AMED, PsycINFO and CINAHL Plus were searched for qualitative studies concerning self-management of multiple long-term conditions among socioeconomically disadvantaged populations. Data were coded and thematically synthesised using NVivo.FindingsFrom the search results, 79 relevant qualitative studies were identified after the full text screening and 11 studies were included in the final thematic synthesis. Three overarching analytical themes were identified alongside a set of sub-themes: (1) Challenges of having multiple long-term conditions; prioritisation of conditions, impact of multiple long-term conditions on mental health and wellbeing, polypharmacy, (2) Socioeconomic barriers to self-management; financial, health literacy, compounding impact of multiple long-term conditions and socioeconomic deprivation, (3) Facilitators of self-management in people experiencing socioeconomic deprivation; maintaining independence, 'meaningful' activities, support networks.DiscussionSelf-management of multiple long-term conditions is challenging for people experiencing socioeconomic deprivation due to barriers around financial constraints and health literacy, which can lead to poor mental health and wellbeing. To support targeted interventions, greater awareness is needed among health professionals of the barriers/challenges of self-management among these populations.

Open, reproducible, and replicable research practices are a fundamental part of science. Training is often organized on a grassroots level, offered by early career researchers, for early career researchers. Buffet style courses that cover many topics can inspire participants to try new things; however, they can also be overwhelming. Participants who want to implement new practices may not know where to start once they return to their research team. We describe ten simple rules to guide participants of relevant training courses in implementing robust research practices in their own projects, once they return to their research group. This includes (1) prioritizing and planning which practices to implement, which involves obtaining support and convincing others involved in the research project of the added value of implementing new practices; (2) managing problems that arise during implementation; and (3) making reproducible research and open science practices an integral part of a future research career. We also outline strategies that course organizers can use to prepare participants for implementation and support them during this process.

Abstract The relevance of mustelids in SARS‐CoV‐2 transmission has become increasingly evident. Alongside experimental demonstration of airborne transmission among ferrets, the major animal model for human respiratory diseases, transmission of SARS‐CoV‐2 within‐ and/or between‐commercial mink farms has occurred and continues to occur. The number of mink reared for the luxury fur trade is approximately 60.5 million, across 36 mustelid‐farming countries. By July 2021, SARS‐CoV‐2 outbreaks have been reported in 12 of these countries, at 412 European and 20 North American mink farms. Reverse zoonotic transmission events (from humans to mink) have introduced the virus to farms with subsequent extensive mink‐to‐mink transmission as well as further zoonotic (mink‐to‐human) transmission events generating cases among both farm workers and the broader community. Overcrowded housing conditions inherent within intensive mink farms, often combined with poor sanitation and welfare, both guarantee spread of SARS‐CoV‐2 and facilitate opportunities for viral variants, thereby effectively representing biotic hubs for viral transmission and evolution of virulence. Adequate preventative, surveillance and control measures within the mink industry are imperative both for the control of the current global pandemic and to mitigate against future outbreaks.

Universities are attempting to ensure that all of their research is publicly accessible because of funding mandates. Many universities have established campus open access (OA) repositories but are struggling with how to upload millions of manuscripts under numerous license agreements while also linking metadata to make them discoverable. To do this manually requires around 15 minutes per manuscript from an experienced librarian. The time and cost to do this campus-wide is prohibitive. To radically reduce the time and costs of this process and to harvest all past work, this article reports on the development and testing of a free and open source (FOSS) JavaScript-based application, aperta-accessum, which does the following: 1) harvests names and emails from a department’s faculty webpage; 2) identifies scholars’ Open Researcher and Contributor IDentifiers (ORCID iDs); 3) obtains digital object identifiers (DOIs) of publications for each scholar; 4) checks for existing copies in an institution’s OA repository; 5) identifies the legal opportunities to provide OA versions of all of the articles not already in the OA repository; 6) sends authors emails requesting a simple upload of author manuscripts; and 7) adds link-harvested metadata from DOIs with uploaded preprints into a bepress repository; the code can be modified for additional repositories. The results of this study show that, in the administrative time needed to make a single document OA manually, aperta-accessum can process approximately five entire departments worth of peer-reviewed articles. Following best practices discussed, it is clear that this open-source OA harvester enables institutional library’s stewardship of OA knowledge on a mass scale for radically reduced costs.

Aim: To assess real-world management of patients diagnosed with hepatocellular carcinoma (HCC) within an integrated delivery network. Materials & methods: A retrospective cohort analysis of adults newly diagnosed with HCC from January 2014 to March 2019. Overall survival and treatment journey were assessed over the entire available follow-up period per patient. Results: Of the 462 patients, 85% had ≥1 treatment. The 24-month overall survival rate (95% CI) from first treatment was 77% (72–82%). Majority of Child-Pugh class A (71%) and B (60%) patients received locoregional therapy first. Half (53.6%) of the patients with liver transplantation first were Child-Pugh class C patients. Sorafenib was the predominant systemic therapy. Conclusion: This integrated delivery network data analysis offers a comprehensive insight into the real-world management of HCC.

Introduction: Detection of atrial fibrillation (AF) is challenging in patients after ischemic stroke due to its paroxysmal nature. We aim to determine the utility of a combined clinical, electrocardiographic and genetic variables model to predict AF in a post-stroke population. Materials and Methods: We performed a cohort study at a single comprehensive stroke centre from 09/11/2009 to 31/10/2017. All patients recruited were diagnosed with acute ischemic stroke or transient ischemic attacks. Electrocardiographic variables including p-wave terminal force (PWTF), corrected QT interval (QTc) and genetic variables including single nucleotide polymorphisms (SNP) at the 4q25 (rs2200733) were evaluated. Clinical, electrocardiographic and genetic variables of patients without AF and those who developed AF were compared. Multiple logistic regression analysis and receiver operating characteristics were performed to identify parameters and determine their ability to predict the occurrence of AF. Results: Out of 709 patients (median age of 59 years, IQR 52-67) recruited, sixty (8.5%) were found to develop AF on follow-up. Age (odds ratio (OR): 3.49, 95% confidence interval (CI): 2.03-5.98, p

Background: Health literacy is the ability to find information, understand information, know how to act on information and know which services to use. Having higher levels of health literacy may help patients to look after minor problems themselves (self-care). It may also help to reduce patients’ perceived need for contacting health services for minor health problems, to reduce the perceived urgency of problems or to improve patients’ ability to identify and choose from the range of available services. Interventions to improve health literacy for minor health problems have been evaluated, but their effectiveness at reducing use of primary care and emergency services has not been synthesised. Objectives: The key objectives were as follows: (1) to construct a typology of interventions that aim to reduce primary or emergency care use, (2) to synthesise evidence of the effectiveness of different types of health literacy interventions and (3) to consider how stakeholders in the UK could operationalise the evidence. Interventions: The interventions being reviewed were initiatives that help members of the population to self-care or make decisions about whether or not and where to seek health care for minor health problems. Design: This study was a systematic review with stakeholder involvement. Data sources and review methods: A meeting was held with 14 stakeholders (including patients, carers and the public) to guide the systematic review. This was followed by a multicomponent review of quantitative and qualitative research. Database literature searches were undertaken in Ovid MEDLINE, The Cochrane Library (via Wiley Interscience), EMBASE (via OVID), the Cumulative Index to Nursing and Allied Health Literature (via EBSCO), PsycINFO (via OVID), Web of Science and Sociological Abstracts. The search was limited to English-language publications from 1990–2020. To assess study quality, the Cochrane Risk of Bias tool was used for randomised controlled trials and the Newcastle–Ottawa Scale was used for non-randomised studies. A narrative synthesis was undertaken. The review was followed by a meeting with 16 stakeholders to interpret the results. Results: A total of 67 articles (64 studies) were included: 37 from the USA, 16 from the UK, 12 from the rest of Europe and two from the rest of the world. There were seven intervention types: navigation tools directing people to the range of services available (n = 7); written education about managing minor health problems in booklet or website format (n = 17); person-delivered education (n = 5); written education with person-delivered education (n = 17); multicomponent of written education, person-delivered education and mass media campaign (n = 5); self-triage (n = 9); and other (n = 7). Our team assessed the readability and user-friendliness of interventions, and found that these varied widely. When assessed, most studies measuring satisfaction with the intervention, enablement and perceived changes to behaviour showed positive results. Of 30 articles reporting impact on emergency department attendances, 19 (63%) showed a reduction, and 16/27 (59%) articles measuring impact on general practice consultations showed a reduction. Variation in the evidence base was not explained by any research, context or intervention characteristics. Only eight articles measured safety: these identified no problems. Limitations: There was inconsistency in how the outcomes were measured, so a meta-analysis was not possible. Conclusions: Health literacy interventions have potential to affect emergency and primary care use, but the evidence base is inconsistent. Future research: It is important to continue to evaluate these types of initiatives. Study registration: This study is registered as PROSPERO CRD42020214206. Funding: This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 38. See the NIHR Journals Library website for further project information.

Background: Oral mucositis is a debilitating and painful complication of head and neck cancer irradiation that is characterised by inflammation of the mucous membranes, erythema and ulceration. Oral mucositis affects 6000 head and neck cancer patients per year in England and Wales. Current treatments have not proven to be effective. International studies suggest that low-level laser therapy may be an effective treatment. Objectives: To assess the clinical effectiveness and cost-effectiveness of low-level laser therapy in the management of oral mucositis in head and neck cancer irradiation. To identify barriers to and facilitators of implementing low-level laser therapy in routine care. Design: Placebo-controlled, individually randomised, multicentre Phase III superiority trial, with an internal pilot and health economic and qualitative process evaluations. The participants, outcome assessors and therapists were blinded. Setting: Nine NHS head and neck cancer sites in England and Wales. Participants: A total of 87 out of 380 participants were recruited who were aged ≥ 18 years and were undergoing head and neck cancer irradiation with ≥ 60 Gy. Intervention: Random allocation (1 : 1 ratio) to either low-level laser therapy or sham low-level laser therapy three times per week for the duration of irradiation. The diode laser had the following specifications: wavelength 660 nm, power output 75 mW, beam area 1.5 cm2, irradiance 50 mW/cm2, exposure time 60 seconds and fluence 3 J/cm2. There were 20–30 spots per session. Sham low-level laser therapy was delivered in an identical manner. Main outcome measure: The mean Oral Mucositis Weekly Questionnaire-Head and Neck Cancer score at 6 weeks following the start of irradiation. Higher scores indicate a worse outcome. Results: A total of 231 patients were screened and, of these, 87 were randomised (low-level laser therapy arm, n = 44; sham arm, n = 43). The mean age was 59.4 years (standard deviation 8.8 years) and 69 participants (79%) were male. The mean Oral Mucositis Weekly Questionnaire-Head and Neck Cancer score at 6 weeks was 33.2 (standard deviation 10) in the low-level laser therapy arm and 27.4 (standard deviation 13.8) in the sham arm. Limitations: The trial lacked statistical power because it did not meet the recruitment target. Staff and patients willingly participated in the trial and worked hard to make the LiTEFORM trial succeed. However, the task of introducing, embedding and sustaining new low-level laser therapy services into a complex care pathway proved challenging. Sites could deliver low-level laser therapy to only a small number of patients at a time. The administration of low-level laser therapy was viewed as straightforward, but also time-consuming and sometimes uncomfortable for both patients and staff, particularly those staff who were not used to working in a patient’s mouth. Conclusions: This trial had a robust design but lacked power to be definitive. Low-level laser therapy is relatively inexpensive. In contrast with previous trials, some patients found low-level laser therapy sessions to be difficult. The duration of low-level laser therapy sessions is, therefore, an important consideration. Clinicians experienced in oral cavity work most readily adapt to delivering low-level laser therapy, although other allied health professionals can be trained. Blinding the clinicians delivering low-level laser therapy is feasible. There are important human resource, real estate and logistical considerations for those setting up low-level laser therapy services. Future work: Further well-designed randomised controlled trials investigating low-level laser therapy in head and neck cancer irradiation are needed, with similar powered recruitment targets but addressing the recruitment challenges and logistical findings from this research. Trial registration: This trial is registered as ISRCTN14224600. Funding: This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 46. See the NIHR Journals Library website for further project information.

Abstract Background Bipolar disorder is associated with circadian disruption and a high risk of suicidal behavior. In a previous exploratory study of patients with bipolar I disorder, we found that a history of suicide attempts was associated with differences between winter and summer levels of solar insolation. The purpose of this study was to confirm this finding using international data from 42% more collection sites and 25% more countries. Methods Data analyzed were from 71 prior and new collection sites in 40 countries at a wide range of latitudes. The analysis included 4876 patients with bipolar I disorder, 45% more data than previously analyzed. Of the patients, 1496 (30.7%) had a history of suicide attempt. Solar insolation data, the amount of the sun’s electromagnetic energy striking the surface of the earth, was obtained for each onset location (479 locations in 64 countries). Results This analysis confirmed the results of the exploratory study with the same best model and slightly better statistical significance. There was a significant inverse association between a history of suicide attempts and the ratio of mean winter insolation to mean summer insolation (mean winter insolation/mean summer insolation). This ratio is largest near the equator which has little change in solar insolation over the year, and smallest near the poles where the winter insolation is very small compared to the summer insolation. Other variables in the model associated with an increased risk of suicide attempts were a history of alcohol or substance abuse, female gender, and younger birth cohort. The winter/summer insolation ratio was also replaced with the ratio of minimum mean monthly insolation to the maximum mean monthly insolation to accommodate insolation patterns in the tropics, and nearly identical results were found. All estimated coefficients were significant at p

Abstract Background Posttraumatic stress disorder (PTSD) and substance use disorder (SUD) have high comorbidity. Although prior research indicated that PTSD can effectively be treated with Prolonged Exposure (PE) in these patients, reported effects are small and treatment dropout rates high. Eye Movement Desensitization and Reprocessing (EMDR) and Imagery Rescripting (ImRs) are other promising treatment options for PTSD, that have not yet been examined in this patient group. Furthermore, it is unclear whether PTSD treatment is most effective when offered simultaneous to or after SUD treatment. Methods In this article, the Treatment Of PTSD and Addiction (TOPA) study is described: a Dutch randomized controlled trial (RCT) that studies the effectiveness of PTSD treatment as an add-on to regular SUD treatment in patients with SUD and co-occurring PTSD. Effects of PE, EMDR, ImRs, and a 3-month SUD treatment only condition will be compared, as well as simultaneous SUD/PTSD treatment to sequential SUD/PTSD treatment. The primary outcome measure is PTSD symptoms. Secondary outcomes are: treatment completion, psychological distress, substance use, interpersonal problems, emotion dysregulation, and trauma-related emotions guilt, shame, and anger. Discussion This study is the first to compare effects of PE, EMDR, and ImRs in one study and to compare simultaneous SUD/PTSD treatment to sequential SUD/PTSD treatment as well. This RCT will provide more knowledge about the effectiveness of different treatment strategies for PTSD in patients with co-occurring SUD and will ultimately improve treatment outcomes for patients with this common co-morbidity worldwide. Trial registration Netherlands Trial Register (NTR), Identifier: NL7885 . Registered 22 July 2019.

Background: Current evidence suggests a need for a care model that supports the prevention of secondary health conditions in people with spinal cord injury. Multiple complex factors influence the prevention of secondary health conditions. There is a need for holistic and systems-based prevention approaches, which target multiple levels. Objective: To identify the services and interventions needed to prevent secondary health conditions throughout the life span of people with spinal cord injury. Method: We used a descriptive qualitative approach. Data was collected using focus group discussions with professionals in the rehabilitation field. The recorded group discussions were transcribed verbatim, and content analysis was conducted. Results: Four focus group discussions were conducted. Four themes emerged from the analyses: patient-centred care, access to resources, promotion of health, and skilled healthcare workers. Conclusions: The suggested services and interventions needed to prevent secondary health conditions target the individuals with spinal cord injury (SCI), health providers, health systems care approach and other sectors outside the health system. These services and interventions will inform the development of a preventive care model.

The World Health Organization's revised NTD Roadmap and the newly launched Guidelines target elimination of schistosomiasis as a public health problem in all endemic areas by 2030. Key to meeting this goal is elucidating how selective pressures imposed by interventions shape parasite populations. Our aim was to identify any differential impact of a unique cluster-randomized tri-armed elimination intervention (biannual mass drug administration (MDA) applied alone or in association with either mollusciciding (snail control) or behavioural change interventions) across two Zanzibarian islands (Pemba and Unguja) on the population genetic composition of Schistosoma haematobium over space and time. Fifteen microsatellite loci were used to analyse individual miracidia collected from infected individuals across islands and intervention arms at the start (2012 baseline: 1,522 miracidia from 176 children; 303 from 43 adults; age-range 6-75, mean 12.7 years) and at year 5 (2016: 1,486 miracidia from 146 children; 214 from 25 adults; age-range 9-46, mean 12.4 years). Measures of genetic diversity included allelic richness (Ar), Expected (He) and Observed heterozygosity (Ho), inbreeding coefficient (FST), parentage analysis, estimated worm burden, worm fecundity, and genetic sub-structuring. There was little evidence of differential selective pressures on population genetic diversity, inbreeding or estimated worm burdens by treatment arm, with only the MDA+snail control arm within Unguja showing trends towards reduced diversity and altered inbreeding over time. The greatest differences overall, both in terms of parasite fecundity and genetic sub-structuring, were observed between the islands, consistent with Pemba's persistently higher mean infection intensities compared to neighbouring Unguja, and within islands in terms of infection hotspots (across three definitions). These findings highlight the important contribution of population genetic analyses to elucidate extensive genetic diversity and biological drivers, including potential gene-environmental factors, that may override short term selective pressures imposed by differential disease control strategies. Trial Registration: ClinicalTrials.gov ISRCTN48837681.

This article considers the various ways in which the topographies of Auschwitz are used as a symbolic means of articulating particular kinds of guilt in fiction relating to the Holocaust. To do this, I analyse three primary examples: John Donoghue’s The Death’s Head Chess Club (2015), Martin Amis’ The Zone of Interest (2014), and Dalton Trumbo’s unfinished novel, Night of the Aurochs (1979). These texts, I argue, employ the complex spatial dynamics of the site in order to address important questions of power, agency, and moral ambiguity. More specifically, such imagery reveals a spectrum of complicity that, without exonerating those responsible for the genocide, suggests the need for a more nuanced understanding of the Holocaust and those that were responsible for its implementation.

Schistosomiasis control strategies rely on mass drug administration (MDA) using praziquantel. Here, Berger et al. perform whole-genome sequencing of larvae from infected children across Ugandan regions with differing MDA histories. They find extensive gene flow with limited positive selection suggesting minimal change post MDA.

Abstract Background Low back pain is a leading cause of disability worldwide. Health literacy has been associated with pain intensity and pain control. However, there is a paucity of evidence regarding this association. In the field of low back pain research, inconsistent reporting of outcomes has been highlighted. To address this issue a Core Outcome Set has been developed. Objectives The objectives of this scoping review were: (1) The health literacy measures currently employed for low back pain and the aspects of health literacy they include. (2) The low back pain health outcomes included in such work. (3) The extent to which these health outcomes reflect the Core Outcome Set for Clinical Trials in Non-Specific Low Back Pain. Methods The search included thirteen bibliographic databases, using medical subject heading terms for low back pain and health literacy, and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. The eligibility criteria were defined by the Joanna Briggs Institute PCC mnemonic. A thematic framework approach was used for analysis. Results The search yielded ten relevant studies for inclusion, amongst which a total of nine health literacy measures and 50 health outcome measures were used. Most health literacy measures focused on functional health literacy, with few assessing communicative and critical health literacy. The health outcomes assessed by the included studies could be broadly categorised into: Pain, Disability, Behaviour, Knowledge and Beliefs, and Resource Utilisation. Most of these outcome measures studied (36 out of 50) did not directly reflect the Core Outcome Set for Clinical Trials in Non-Specific Low Back Pain. Conclusions To allow for comparison across findings and the development of a rigorous evidence base, future work should include the Core Outcome Set for Clinical Trials in Non-Specific Low Back Pain. There is an urgent need to broaden the evidence-base to include regions where low back pain morbidity is high, but data is lacking. Such work demands the incorporation of comprehensive measures of health literacy that have both generic and culturally sensitive components.

Neuropathic pain affects ~ 6.9–10% of the general population and leads to loss of function, anxiety, depression, sleep disturbance, and impaired cognition. Here, we report the safety, tolerability, and pharmacokinetics of a voltage‐dependent and use‐dependent sodium channel blocker, vixotrigine, currently under investigation for the treatment of neuropathic pain conditions. The randomized, placebo‐controlled, phase I clinical trials were split into single ascending dose (SAD) and multiple ascending dose (MAD) studies. Healthy volunteers received oral vixotrigine as either single doses followed by a ≥ 7‐day washout period for up to 5 dosing sessions (SAD, n = 30), or repeat doses (once or twice daily) for 14 and 28 days (MAD, n = 51). Adverse events (AEs), maximum observed vixotrigine plasma concentration (Cmax), area under the concentration‐time curve from predose to 24 hours postdose (AUC0–24), time to Cmax (Tmax), and terminal half‐life (t1/2), among others, were assessed. Drug‐related AEs were reported in 47% and 53% of volunteers in the SAD and MAD studies, respectively, with dizziness as the most commonly reported drug‐related AE. SAD results showed that Cmax and AUC increased with dose, Tmax was 1–2 hours, and t1/2 was ~ 11 hours. A twofold increase in accumulation was observed when vixotrigine was taken twice vs. once daily (MAD). Steady‐state was achieved from day 5 onward. These data indicate that oral vixotrigine is well‐tolerated when administered as single doses up to 825 mg and multiple doses up to 450 mg twice daily.

Abstract Background Stratified care involves subgrouping patients based on key characteristics, e.g. prognostic risk, and matching these subgroups to early treatment options. The STarT-MSK programme developed and tested a new stratified primary care intervention for patients with common musculoskeletal (MSK) conditions in general practice. Stratified care involves changing General Practitioners’ (GPs) behaviour, away from the current ‘stepped’ care approach to identifying early treatment options matched to patients’ risk of persistent pain. Changing healthcare practice is challenging, and to aid the successful delivery of stratified care, education and support for GPs was required. This paper details the iterative development of a clinician support package throughout the lifespan of the programme, to support GPs in delivering the stratified care intervention. We argue that clinician support is a crucial aspect of the intervention itself, which is often overlooked. Methods Qualitative research with patients and GPs identified barriers and facilitators to the adoption of stratified care, which were mapped onto the Theoretical Domains Framework (TDF). Identified domains were ‘translated’ into an educational paradigm, and an initial version of the support package developed. This was further refined following a feasibility and pilot RCT, and a finalised support package was developed for the main RCT. Results The clinician support package comprised face-to-face sessions combining adult-learning principles with behaviour change theory in a multimethod approach, which included group discussion, simulated consultations, patient vignettes and model consultation videos. Structured support for GPs was crucial to facilitate fidelity and, ultimately, a successful trial. Clinician support is a two-way process– the study team can learn from and adapt to specific local factors and issues not previously identified. The support from senior clinicians was required to ensure ‘buy in’. Monitoring of GP performance, provision of regular feedback and remedial support are important aspects of effective clinician support. Conclusion Designing effective clinician support from the onset of trial intervention design, in an evidence-based, theory-informed manner, is crucial to encourage active engagement and intervention fidelity within the trial, enabling the delivery of a robust and reliable proof-of-principle trial. We offer practical recommendations for future general practice interventions.

Abstract Human mobility and migration are thought to have played essential roles in the consolidation and expansion of sedentary villages, long-distance exchanges and transmission of ideas and practices during the Neolithic transition of the Near East. Few isotopic studies of human remains dating to this early complex transition offer direct evidence of mobility and migration. The aim of this study is to identify first-generation non-local individuals from Natufian to Pre-Pottery Neolithic C periods to explore the scope of human mobility and migration during the Neolithic transition in the Southern Levant, an area that is central to this historical process. The study adopted a multi-approach resorting to strontium (87Sr/86Sr), oxygen (δ18OVSMOW) and carbon (δ13C) isotope ratio analyses of tooth enamel of 67 human individuals from five sites in Jordan, Syria, and Israel. The isotope ratios point both to a significant level of human migration and/or mobility in the Final Natufian which is compatible with early sedentarism and seasonal mobility and with population aggregation in early sedentary hamlets. The current findings, in turn, offer evidence that most individuals dating to the Pre-Pottery Neolithic were local to their respective settlements despite certain evidence of non-locals. Interestingly, isotopic data suggest that two possible non-local individuals benefitted from particular burial practices. The results underscore a decrease in human mobility and migration as farming became increasingly dominant among the subsistence strategies throughout the Neolithic transition of the Southern Levant.

This cluster-randomized pre-post study examined the effectiveness of Character Playbook, a digitally delivered, universal social-emotional learning (SEL) program, in enhancing social and emotional knowledge and confidence among rural middle school students. Pre- and post-assessments and surveys measured students' knowledge and self-reported confidence related to social and emotional skills. The sample consisted of 128 students from two rural middle schools. Analyses of covariance with multiple imputations to account for missing data revealed that students who participated in Character Playbook demonstrated significantly higher knowledge and more positive confidence toward their social and emotional learning competency than the control group. These findings, with acknowledged limitations, suggest that Character Playbook holds promise as an effective SEL program for rural middle school students, but further research is needed for confirmation. The study provides valuable preliminary insights into how a brief, digitally delivered, universal SEL program could benefit students in rural classrooms.

Emotions and the intellect interact and affect the quality of learning significantly, for better or for worse. This is often ignored or seen as irrelevant for teaching practices. A training package for teachers of older students was constructed to support kinds of practice which took emotions into account in planning and the classroom. In the spirit of design research intended to solve a practical problem, the package went through several iterations, each being informed by user evaluations of the preceding iteration. The outcome was a tool to support professional development. Notably and as useful, the process provided insights about diverse students' and teachers' attributes, variation in contexts, package adaptation to accommodate these, and areas of further research.

STEM (Science, Technology, Engineering, and Mathematics) education is a 21st century learning approach that is extremely important to students and children nowadays. Many developed countries have emphasized this approach to early childhood education (ECE). Although there are some challenges in promoting children's cognitive development in preschool, there are some best practices that early childhood educators can use as a guideline in planning, implementing, and evaluating their development at school. Four databases were used to find the best practices consist of Scopus, ERIC, Web of Science, and Science Direct. These databases are consulted to analyze published articles that produce findings on the best practices and challenges of implementing STEM activities that have been recorded either in kindergarten or preschool environments. The findings revealed there were 23 themes for the best practices and 10 themes for challenges that were successfully analyzed. In order to ensure that STEM education can be implemented with better quality in the future, educators should know the best way to implement the activities by practicing the best practices. In addition, educators also need to take action wisely when there are challenges in implementing STEM activities so that children can acquire meaningful experience when participating in the activities.

In recent years, there has been a growing concern in science education on the enhancement of preschoolers' knowledge and motivation for concepts by implementing efficient teaching methods. This study explored the development and effectiveness of the E-sky Module in increasing the development of preschoolers in Project-based Learning (PBL) activities conducted both within and outside of preschool. This study employed the Design and Development Research (DDR) approach, incorporating many research methods. During the qualitative interviews conducted in the needs analysis phase, three different themes related to the difficulties encountered by teachers when conducting early science projects were meticulously recorded and analysed. Based on a quantitative analysis completed by three experts in the field, this E-sky Module has been determined to have a substantial level of validity and a satisfactory level of reliability. This is evidenced by a Cronbach's alpha coefficient of (p < 0.82) observed. Moreover, throughout the evaluation phase, four distinct themes were effectively reported, suggesting that this module significantly contributed to the comprehensive development of preschoolers. Hence, future studies should explore the potential of enhancing knowledge acquisition through promoting motivation and the emergence of conducive learning environments in the context of PBL.

Faith and Indigenous healing ceremonies offer spiritually oriented interventions that maintain client wellness or mitigate client existential, biopsychosocial, or spiritual distress. Mental health practitioners of all identities may ethically apply ceremony-assisted treatments with Native and non-Native populations. Three such interventions are described in this article, drawn from Indigenous traditions as practiced personally and professionally by the first and third authors. Directives for use, including populations appropriate for application, adaptations, ethical considerations, and culturally responsive competency considerations, are included.

The primary-to-secondary school transition is a milestone for children because of the multiple changes they must navigate. Although most adjust successfully, approximately 30% of children have difficulties during this transition. Intersecting identities are also likely to influence how children navigate the adjustment of the school transfer, but there have been no syntheses of existing evidence relating to the impacts of intersectionality. We conducted an integrative review using eight databases (Education database, ERIC, ProQuest Education, PsychInfo, Scopus, SocIndex, Sociology Database, and Web of Science) and searched for quantitative or qualitative studies that examined how intersecting identities impact children's self-concept, mental health, and adjustment of the primary-to-secondary school transition. We initially identified a total of 3,193 studies through database searches, with 1,790 remaining after deduplication. After we screened the titles and abstracts, 83 studies were included for full-text screening, of which eight met the review criteria. The studies included in the review were published between 2000 and 2018; no studies were found after 2018. Syntheses of the included studies (three quantitative studies, four qualitative studies, and one mixed methods study) revealed three themes: (1) academic and social discord; (2) defining and constructing negative identities; and (3) the female body. Our findings from the review highlighted how children with minority intersecting identities are faced with additional challenges during the transition to secondary school and how these can have negative ramifications for their self-concept, mental health, and adjustment to the transition. Future research needs to be directed away from prioritizing identities, such as gender and ethnicity, to include intersectional identities.

Hybridization between different species of parasites is increasingly being recognised as a major public and veterinary health concern at the interface of infectious diseases biology, evolution, epidemiology and ultimately control. Recent research has revealed that viable hybrids and introgressed lineages between Schistosoma spp. are prevalent across Africa and beyond, including those with zoonotic potential. However, it remains unclear whether these hybrid lineages represent recent hybridization events, suggesting hybridization is ongoing, and/or whether they represent introgressed lineages derived from ancient hybridization events. In human schistosomiasis, investigation is hampered by the inaccessibility of adult-stage worms due to their intravascular location, an issue which can be circumvented by post-mortem of livestock at abattoirs for Schistosoma spp. of known zoonotic potential. To characterise the composition of naturally-occurring schistosome hybrids, we performed whole-genome sequencing of 21 natural livestock infective schistosome isolates. To facilitate this, we also assembled a de novo chromosomal-scale draft assembly of Schistosoma curassoni. Genomic analyses identified isolates of S. bovis, S. curassoni and hybrids between the two species, all of which were early generation hybrids with multiple generations found within the same host. These results show that hybridization is an ongoing process within natural populations with the potential to further challenge elimination efforts against schistosomiasis.

BackgroundSchools have been increasingly employing dance movement psychotherapists to support children cope with daily worries and stress, express and understand their emotions, develop self-awareness and self-esteem. However, evidence on the impact of dance movement psychotherapy as a tool for prevention of mental health difficulties in childhood remains limited.MethodsSixteen children (aged 7–9) with mild emotional and behavioral difficulties from two primary schools were randomly assigned to a Dance Movement Psychotherapy (DMP) intervention or to a waiting list, within a larger pilot cross-over randomized controlled study which aimed to (a) test whether all elements of study design can work together and run smoothly in a full-scale RCT; and (b) investigate the effectiveness of arts therapies in improving children’s health related quality of life (HRQOL; EQ-5D-Y), wellbeing and life functioning (Child Outcome Rating Scale; CORS), emotional and behavioral difficulties (Strengths and Difficulties Questionnaire; SDQ), and duration of sleep (Fitbits). The therapeutic process was also evaluated through interviews with children, participant observations, the Children’s Session Rating Scale (CSRS), and ratings of adherence to the therapeutic protocol.ResultsThe findings indicated that DMP led to improvements in children’s life functioning, wellbeing, duration of sleep, emotional and behavioral difficulties, but not in quality of life. The improvements were maintained at the follow-up stages, up to 6 months post-intervention. Interviews with children also suggested positive outcomes, such as self-expression; emotional regulation; mastery and acceptance of emotions; improved self-confidence and self-esteem; reduced stress; and development of positive relationships. However, children would have preferred smaller groups and longer sessions.ConclusionThis study indicated that all outcome measures would be suitable for inclusion in a larger randomized controlled trial, though the EQ-5D-Y is not recommended as a stand-alone measure due to its lack of sensitivity and specificity for young participants. The adherence to the therapeutic protocol ratings differed between children and adults, highlighting the need to include children’s voice in future research. Strategies are also proposed of how to conduct randomization of participants in ways that do not hinder the therapeutic process.

The European flat oyster (Ostrea edulis) is a bivalve mollusc that was once widely distributed across Europe and represented an important food resource for humans for centuries. Populations of O. edulis experienced a severe decline across their biogeographic range mainly due to overexploitation and disease outbreaks. To restore the economic and ecological benefits of European flat oyster populations, extensive protection and restoration efforts are in place within Europe. In line with the increasing interest in supporting restoration and oyster farming through the breeding of stocks with enhanced performance, the present study aimed to evaluate the potential of genomic selection for improving growth traits in a European flat oyster population obtained from successive mass-spawning events. Four growth-related traits were evaluated: total weight (TW), shell height (SH), shell width (SW) and shell length (SL). The heritability of the growth traits was in the low-moderate range, with estimates of 0.45, 0.37, 0.22, and 0.32 for TW, SH, SW and SL, respectively. A genome-wide association analysis revealed a largely polygenic architecture for the four growth traits, with two distinct QTLs detected on chromosome 4. To investigate whether genomic selection can be implemented in flat oyster breeding at a reduced cost, the utility of low-density SNP panels was assessed. Genomic prediction accuracies using the full density panel were high (> 0.83 for all traits). The evaluation of the effect of reducing the number of markers used to predict genomic breeding values revealed that similar selection accuracies could be achieved for all traits with 2K SNPs as for a full panel containing 4,577 SNPs. Only slight reductions in accuracies were observed at the lowest SNP density tested (i.e., 100 SNPs), likely due to a high relatedness between individuals being included in the training and validation sets during cross-validation. Overall, our results suggest that the genetic improvement of growth traits in oysters is feasible. Nevertheless, and although low-density SNP panels appear as a promising strategy for applying GS at a reduced cost, additional populations with different degrees of genetic relatedness should be assessed to derive estimates of prediction accuracies to be expected in practical breeding programmes.

The objective for beginning writers is to learn how to generate alphabet-letters which are recognisable and easy to read. This study investigated the accuracy of Year 1 and 2 children's alphabet-letter-writing by evaluating their alphabet and orthographic knowledge, following evidence which identifies these skills as important for correctly representing the Latin alphabet-letters in written form. 408 typical children from the first two years of formal schooling were recruited from eight Western Australian schools and asked to write the twenty-six-lowercase alphabet-letters under three different writing conditions: from memory; the initial sounds of words; and copying. Performance was measured using the Perceive, Recall, Plan and Perform (PRPP) System of Task Analysis (Stage One). Analyses revealed the mean average number of the 26- lowercase alphabet-letters correctly written from memory was 8.17 (Year 1) and 12.76 (Year 2). Mean averages were similar across the three writing conditions. Comparative analysis showed children in Year 2 were significantly better than Year 1 children at recalling the alphabet-sequence, sound-letter-translation, and retrieving the letter-shape, letter-case, and letter-orientation. No significant difference was found in name-to-letter translation, letter-formation, or letter-placement skills. The results highlighted that many typical Year 1 and 2 children have difficulty accurately generating all 26- lowercase alphabet-letters. The findings suggested that the way early writers learn to form and place an alphabet-letter, whether it is accurate or not, is how they continue to write the alphabet-letter through their early school journey. Considerations for evaluation and instruction of alphabet-letter-writing are discussed.

School teachers have demonstrated poor mental health and low levels of wellbeing, globally. Despite the high prevalence of depression, burnout, stress, and anxiety, few programs have been developed in collaboration with teachers that are appropriate for their needs and circumstances. The current mixed-methods study involved consultation with members of the teaching workforce in Australia to understand their preferences for a program to address their mental health and wellbeing. The sample included teachers and other key representatives from the education sector in New South Wales, Australia. There were 47 participants who completed online surveys, with a subset (n = 16) also attending two group workshops (n = 10 in the first workshop, n = 6 in the second workshop). Data were collected between May 2021 and October 2021. Descriptive statistics were calculated to summarise quantitative survey data, and thematic analysis was used to analyse qualitative data. Results from surveys and workshops found that a new approach is needed to address teacher mental health and wellbeing in schools. Participants expressed a preference for a strategy that combined a face-to-face approach with a digital component and focused on three areas: staff relationships, supportive leadership, and practical skill development. The results of this study provide guidance about areas to target to improve teacher mental health and wellbeing.

SATB2-associated syndrome (SAS) is a genetic syndrome characterised by intellectual disability, severe speech delay, and palatal and dental problems. Behaviours that challenge (BtC) are reported frequently; however, there is limited research on specific forms of BtC and the correlates of these behaviours. The current study explores correlates of well-defined BtC, self-injury, aggression, and property destruction, in SAS. Eighty-one parents/caregivers of individuals with SAS (53.1% male, M[subscript age] 10.12 years) completed questionnaire measures of health, behavioural, emotional, and autism characteristics. Individuals with SAS were grouped based on caregiver responses to the presence or absence of self-injury, aggression, and property destruction on the Challenging Behaviour Questionnaire. Rates of self-injury, aggression and property destruction were 42%, 77% and 49%, respectively. Between-group comparisons were conducted to compare characteristics between behaviour groups. Significantly differing characteristics were entered into separate hierarchical logistic regressions for each form of BtC. Behavioural comparisons indicated variation in the characteristics associated with each behaviour. All hierarchical logistic regression models were significant (p < 0.001): self-injury (X[superscript 2](5) = 38.46, R[superscript 2] = 0.571), aggression (X[superscript 2](4) = 25.12, R[superscript 2] = 0.414), property destruction (X[superscript 2](4) = 23.70, R[superscript 2] = 0.346), explaining between 34.6% and 57.1% of the variance in behaviour presence. This is the first study to identify correlates of self-injury, aggression, and property destruction in SAS. Variability in the characteristics associated with each behaviour highlights the importance of specificity when examining BtC. Understanding correlates of specific forms of BtC has important implications for informing SAS-associated pathways to behavioural outcomes and the implementation of tailored behavioural interventions.

Violence and traumatic stress negatively affect physical health in youth. Incarcerated adolescents have high rates of violence exposure and health problems, however, few studies have examined medical records and violence exposure in this high-risk population. Self-reported violence exposure and symptoms of stress were collected in 115 incarcerated male adolescents. Medical charts were reviewed for the presence of somatic complaints and chronic health conditions. Regression modeling and odds ratios demonstrated that exposure to intimate partner violence (IPV), child abuse, and sexual abuse predicted specific health conditions. The hierarchical regression model established that traumatic stress and a history of sexual abuse predict cumulative health problems. The study demonstrates that early exposure to violence combined with the presence of traumatic stress symptoms increases the risk for later health problems and can be used by healthcare providers to identify youth at increased risk of long-term health outcomes in high-risk populations.

In this article, we enact a partial cartographic storying of reconceptualist turns in our work. We do this by situating ourselves in relation to each other and our work across time as a mode of tracing the (situated) possibilities that these turns have enacted for children-in-relation with worlds. In enacting this dialogic and cartographic storying, we collaborate in a way that is inspired by Black methodologies. This means that we intentionally think with liberatory possibilities in our work in early childhood education research and practice across modalities, disciplines, temporalities and geographies. Importantly, like Black methodologies this co-theorizing is also ontological; it is inseparable from our own relational becomings. Following an anticolonial ethos, we are interested in the liberatory potentials of our work, at multiple scales and in different but specific places. We attempt to enact the difficult task of (re)storying our childhood education research and practice in ways that pay attention to the interconnected presences and effects of white supremacy, human supremacy and colonialism, while simultaneously refusing to reinscribe a flattened damage-centred understanding of children, educators and their relational worlds.

In this exploratory descriptive study, changes in one cohort's responses to an authentic statistical investigation at the commencement of years 3 and 4 were analysed. Forty-four students made predictions by interpreting a data table of historical monthly temperatures, represented these data and explained their reasoning. An Awareness of Mathematical Pattern and Structure (AMPS) framework was extended to analyse students' responses at five increasing levels of predictive reasoning. More developed predictive reasoning was observed in year 4 than for year 3, as well as large individual differences in both years. Most year 4 students (87%) made predictions within the historical range, relative to half the same cohort in year 3 (54%). More year 4 students (79%) made predictions based on extraction, clustering and aggregation of these data than those in year 3 (51%). Year 4 students noticed patterns such as seasonal trends and variability in these data and observed measures of central tendency. By year 4, 57% of students' representations demonstrated transnumeration using extracted data from the table, including pictorial, column and line graphs. However, most students' representations and explanations of these data lagged behind their predictions at both year levels.

Autism has been associated with increased mortality risk among adult populations, but little is known about the mortality risk among children and young people (0-24 years). We used a 15-year nationwide birth cohort study using linked health and non-health administrative data to estimate the mortality risk among Autistic children and young people in Aotearoa/New Zealand. Time-to-event analysis was used to determine the association between autism and mortality, controlling for sex, age, ethnicity, deprivation and rurality of residence. The participant population included 895,707 children of whom 11,919 (1.4%) were identified as Autistic. Autism was associated with a significantly higher mortality risk (hazard ratio = 2.35; 95% confidence interval = 1.80-3.06) compared to the general population. In addition, using stratified analyses, we found that this risk was significantly higher among females (hazard ratio = 5.40; 95% confidence interval = 3.42-8.52) compared to males (hazard ratio = 1.82; 95% confidence int

In response to increasing concerns about the mental health and wellbeing of university students and staff, policy aims have shifted towards a 'whole-university approach' to mental health and wellbeing. This policy advocates for a culture wherein mental health and wellbeing are a key priority across all levels (individual, societal, environmental). Thereby, responsibility for mental health and wellbeing is distributed across the institution, requiring contributions from staff irrespective of whether mental health and wellbeing are central to their role. Consequently, boundaries of responsibility and expertise can be unclear, while individual and professional capacity and opportunity influence the consistency of support. Effective governance of the whole-university approach requires an understanding of the complex network of 'actors' in the wellbeing system to cohesively deliver strategic objectives. This mixed-methods case study of one Higher Education Institution (HEI) employed social network analysis (SNA) to identify network structures and connections between staff who promote mental health and wellbeing. Qualitative follow-up explored factors associated with network prominence, cohesion between the informal network and formal structures, and overall perceptions of the network. An informal network of 211 actors in the wellbeing system was identified, revealing disparities with formal governance structures. Prominence in the network was attributed to both extrinsic (e.g. workplace culture and leadership) and intrinsic (e.g. social rewards) factors, and was perceived to provide value by increasing cohesive and collaborative working. However, findings also indicate the need to raise awareness of the network and improve capacity for network membership and engagement.

Background: Documented inequalities in access to eye care for people with learning disabilities and/or autism are caused by poor uptake of primary eye care services, poor identification of eye problems, lack of signposting and reasonable adjustments of existing services, concerns about costs of care and the low priority historically given to these issues in eye care policy at a regional and national level. In 2019, the charity SeeAbility employed four eye care champions (ECCs) with lived experience of learning disability and/or autism to work in local communities in London and the Northwest of England. They provided peer-to-peer support on understanding the need for good eye health and engaged with policy makers, and learning disability, autism and eye care professionals at the local, regional and national levels to influence both the clinical practice of individual practitioners (within existing service/pathway models) and more widely to influence the commissioning of the Easy Eye Care pathway. This study explores the experiences of these ECCs. Methods: The study was conducted in April and May 2023. A case study approach was used to describe the experiences of the ECCs from March 2019 to March 2023. Data from structured interviews with the four ECCs and workload analysis were triangulated to provide a multifaceted understanding of this novel health promotion project. Findings: The ECCs found the role useful and reported that confidence in their practice and impact grew with time but they required ongoing support in the role. A good understanding of the promotional messages was reported. Developing a good network of contacts at an early stage, both people with learning disabilities and healthcare professionals, was key. Relationships with professionals were supportive and positive and a positive emotive response to their lived experience was reported in these interactions. Conclusions: From the perspective of the ECCs, the role is useful and beneficial. The work suggests some key recommendations for future development which include planning to build networks, support in presentation and communications skills and defining key messages and knowledge. Confidence of the ECCs builds with time in the role but also needs support the emotive impact of their lived experiences on audiences is highlighted. There is a need to evaluate how the programme is perceived by those who interact with it and how it changes behaviours which leads to better health outcomes.

The COVID-19 pandemic has negatively impacted the childcare industry over the past two years. This study examined how pandemic-related challenges impacted preschool-aged children by disability and obesity status. Participants were 216 children (80% Hispanic, 14% non-Hispanic Black) aged 2 to 5 years in 10 South Florida childcare centers. In November/December 2021, parents completed a COVID-19 Risk and Resiliency Questionnaire, and body mass index percentile (BMI) was collected. Multivariable logistic regression models examined the association of COVID-19 pandemic-related social challenges (transportation, employment) and child BMI and disability status. As compared to normal-weight children, those families with a child who was obese were more likely to report pandemic-related transportation (OR: 2.51, 95% CI: 1.03–6.28) challenges and food insecurity (OR: 2.56, 95% CI: 1.05–6.43). Parents of children with disabilities were less likely to report that food did not last (OR: 0.19, 95% CI: 0.07–0.48) and that they could not afford balanced meals (OR: 0.33, 95% CI: 0.13–0.85). Spanish-speaking caregivers were more likely to have a child who was obese (OR: 3.04, 95% CI: 1.19–8.52). The results suggest that COVID-19 impacts obese preschool children from Hispanic backgrounds, while disability was a protective factor.

BACKGROUND: Chronic kidney disease is common, affecting up to 13 % of the global population, and is predicted to become the fifth leading cause of life years lost by 2040. Individuals with end-stage kidney disease commonly develop complications such as protein-energy wasting and cachexia which further worsens their prognosis. The syndrome of renal cachexia is poorly understood, under-diagnosed and even if recognised has limited treatment options. OBJECTIVE: To explore the lived experience of renal cachexia for individuals with end-stage kidney disease and the interrelated experiences of their carers. DESIGN: This interpretive phenomenological study was designed to facilitate an in-depth exploration of how patients and carers experience of renal cachexia. To improve and document the quality, transparency, and consistency of patient and public involvement in this study the Guidance for Reporting Involvement of Patients and the Public-Short Format was followed. SETTING: The study was conducted across two nephrology directorates, within two healthcare trusts in the United Kingdom. PARTICIPANTS: Seven participants who met the inclusion criteria were recruited for this study, four patients (three female, one male) and three carers (two male, one female). METHODS: We employed a purposive sampling strategy. Data collection was conducted between July 2022 and December 2023. Interviews were semi-structured, audio-recorded, transcribed verbatim and analysed in six steps by two researchers using interpretive phenomenological analysis. Ethical approval was approved by the Office for Research Ethics Committees Northern Ireland (Reference: 22/NI/0107). RESULTS: Analysis generated six group experiential themes: the lived experience of appetite loss, functional decline and temporal coping, weight loss a visual metaphor of concern, social withdrawal and vulnerability, the emotional toll of eating challenges and psychological strain amidst a lack of information about cachexia. CONCLUSION: This is the first qualitative study exploring the lived experience of renal cachexia for patients and carers. Our study highlights that psycho-social and educational support is urgently needed. Additionally, healthcare professionals need better information provision to help them to recognise and respond to the needs of this population. Further research is required to develop models of holistic support which could help patients and carers cope with the impact of renal cachexia and optimally manage this syndrome within the family unit. REGISTRATION: N/A.