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Unacceptable levels of adverse healthcare events, combined with changes to training, have put the spotlight on junior doctor decision-making. This study aimed to describe the decisions made by junior doctors and the contextual factors influencing how decisions were made and justified. Stimulated recall interviews with 20 junior doctors across five hospitals in SW England were undertaken to co-construct accounts of observers (researchers) and performers (junior doctors), enabling deep insights into individual capability and support needs. Decisions identified included prioritisation of patients and of tasks, and whether and when to intervene clinically. There were a surprising number of "inherited decisions", made by somebody else but enacted by the junior doctor. Through their decisions, participants sought various outcomes, including impressing senior staff. Two contrasting theoretical lenses that focused on the individual decision-maker and the healthcare system enabled creative ideas about supporting education and training to emerge as recommendations.

This paper explores the aims and purpose of long term art therapy. This is done by focusing on the experience of a woman with learning disabilities whom we have called Isobel White (pseudonym). In this paper we set out a theoretical context and then consider key aspects of the therapy process. We have included excerpts from reflective discussions between the three authors.

The aim of this study was to replicate and extend results of a previous trial that investigated the effectiveness of 2 peer-led eating disorders prevention interventions in reducing eating disorder risk factors in undergraduate women (C. B. Becker, L. M. Smith, & A. C. Ciao, 2006). To extend findings from the previous study by allowing for investigation of differential response, the authors randomly assigned a larger sample of both higher and lower risk sorority members (N = 188; age M = 18.64 years, range = 18-21; 20% minority) to either a cognitive dissonance (CD) or a media advocacy (MA) intervention under naturalistic conditions. Interventions were delivered by trained sorority peer leaders and consisted of two 2-hr group sessions. Participants completed questionnaires that assessed eating disorder risk factors at pretreatment, posttreatment, 7-week follow-up, and 8-month follow-up. Results indicate that both interventions reduced thin-ideal internalization, body dissatisfaction, dietary restraint, and bulimic pathology at 8 months, although higher and lower risk participants responded somewhat differently. Both CD and MA generally appeared effective for higher risk participants; only CD, however, appeared to benefit lower risk participants. Results further support the viability of using peer leaders in dissonance-based prevention. (Contains 4 tables, 1 figure, and 2 footnotes.)

Biscuits contain high proportions of saturated fats, which could lead to an adverse health effect. The objective of this study was to study the functionality of a complex nanoemulsion (CNE), stabilised with hydroxypropyl methylcellulose and lecithin, when used as a saturated fat replacer in short dough biscuits. Four biscuit formulations were studied including a control (butter) and three formulations where 33% of the butter was replaced with either extra virgin olive oil (EVOO), with CNE, or with the individual ingredients of the nanoemulsion added separately (INE). The biscuits were evaluated by texture analysis, microstructural characterisation, and quantitative descriptive analysis by a trained sensory panel. The results showed that incorporation of CNE and INE yielded doughs and biscuits with significantly higher (p < 0.05) hardness and fracture strength values than the control. The doughs made of CNE and INE showed significantly less oil migration during the storage than EVOO formulations, which was confirmed by the confocal images. The trained panel did not find significant differences in crumb density and hardness on the first bite among CNE, INE and the control. In conclusion, nanoemulsions stabilised with hydroxypropyl methylcellulose (HPMC) and lecithin can work as saturated fat replacers in short dough biscuits, providing satisfactory physical characteristics and sensory attributes. [ABSTRACT FROM AUTHOR]

Molecular 'assembly lines', in which organic molecules undergo iterative processes such as chain elongation and functional group manipulation, are found in many natural systems, including polyketide biosynthesis. Here we report the creation of such an assembly line using the iterative, reagent-controlled homologation of a boronic ester. This process relies on the reactivity of [alpha]-lithioethyl tri-isopropylbenzoate, which inserts into carbon-boron bonds with exceptionally high fidelity and stereocontrol; each chain-extension step generates a new boronic ester, which is immediately ready for further homologation. We used this method to generate organic molecules that contain ten contiguous, stereochemically defined methyl groups. Several stereoisomers were synthesized and shown to adopt different shapes--helical or linear--depending on the stereochemistry of the methyl groups. This work should facilitate the rational design of molecules with predictable shapes, which could have an impact in areas of molecular sciences in which bespoke molecules are required. The iterative, reagent-controlled homologation of a boronic ester is used to create an 'assembly line' capable of synthesizing organic molecules that contain ten contiguous, stereochemically defined methyl groups and which have different shapes depending on the stereochemistry of those groups. Assembly-line synthesis of defined complex molecules Biological systems have evolved sophisticated machinery for organic synthesis resembling molecular assembly-line processes. Until now chemists have been able to mimic this type of approach only to synthesize peptides and oligonucleotides, creating simple amide (C-N) or phosphate (P-O) bonds. These authors emulate nature by creating a molecular assembly line through iterative reagent-controlled homologations of boronic esters. The process relies on the reactivity of [alpha]-lithioethyl tri-ispopropylbenzoate, which inserts into carbon-boron bonds with high fidelity and stereocontrol. Each chain-extension step generates a new boronic ester, which is immediately ready for further homologation. They use this method to generate several organic molecules that contain ten contiguous, stereochemically defined methyl groups. This work is a step towards the rational design and synthesis of complex molecules with predictable shape., Author(s): Matthew Burns [sup.1] , Stéphanie Essafi [sup.1] , Jessica R. Bame [sup.1] , Stephanie P. Bull [sup.1] , Matthew P. Webster [sup.1] , Sébastien Balieu [sup.1] , James W. [...]

Abstract: Female athletes are at least as at risk as other women for eating disorders (EDs) and at risk for the female athlete triad (i.e., inadequate energy availability, menstrual disorders, and osteoporosis). This study investigated whether two evidence-based programs appear promising for future study if modified to address the unique needs of female athletes. Athletes were randomly assigned to athlete-modified dissonance prevention or healthy weight intervention (AM-HWI). ED risk factors were assessed pre/post-treatment, and 6-week and 1-year follow-up. Results (analyzed sample, N =157) indicated that both interventions reduced thin-ideal internalization, dietary restraint, bulimic pathology, shape and weight concern, and negative affect at 6 weeks, and bulimic pathology, shape concern, and negative affect at 1 year. Unexpectedly we observed an increase in students spontaneously seeking medical consultation for the triad. Qualitative results suggested that AM-HWI may be more preferred by athletes. [Copyright &y& Elsevier]

Protein fortified products are regularly recommended to older adults to improve nutritional status and limit sarcopenia. However protein fortification can elicit negative sensory attributes such as mouthdrying. Sensitivity to mouthdrying can increase with age, yet the influence of saliva flow and mucoadhesion remain uncertain. Here, two studies tested different whey protein beverages (WPB); 22 healthy younger volunteers completed a pilot and 84 healthy volunteers from two age groups (18–30; 65+) completed the main study. In both studies salivary flow rates (mL/min) were measured and saliva samples were collected at time intervals post beverage consumption to measure mucoadhesion to the oral cavity, where protein concentration was analysed by Bradford Assay. Volunteers rated perception and acceptability of WPBs in the main study. WPB consumption resulted in significantly increased protein concentration (p < 0.0001) in saliva samples compared with a control whey permeate beverage. Older adults had significantly lower unstimulated saliva flow (p = 0.003) and significantly increased protein concentration (p = 0.02) in saliva samples, compared with younger adults. Heating of WPB significantly (p < 0.05) increased mouthdrying and thickness perception and reduced sweetness compared with unheated WPB. Mucoadhesion is concluded to be a true phenomenon in WPBs and increases with age. [ABSTRACT FROM AUTHOR]