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Background Substance use and offending are related in the context of other disinhibitory behaviours. Adolescents involved in the criminal justice system constitute a particularly vulnerable group, with a propensity to engage in risky behaviour that has long-term impact on their future health and well-being. Previous research of the RISKIT programme provided evidence of a potential effect in reducing substance use and risky behaviour in adolescents. Objectives To evaluate the clinical effectiveness and cost-effectiveness of a multicomponent psychosocial intervention compared with treatment as usual in reducing substance use for substance-using adolescents involved in the criminal justice system. Design A mixed-methods, prospective, pragmatic, two-arm, randomised controlled trial with follow-up at 6 and 12 months post randomisation. Setting The study was conducted across youth offending teams, pupil referral units and substance misuse teams across four areas of England (i.e. South East, London, North West, North East). Participants Adolescents aged between 13 and 17 years (inclusive), recruited between September 2017 and June 2020. Interventions Participants were randomised to treatment as usual or to treatment as usual in addition to the RISKIT-Criminal Justice System (RISKIT-CJS) programme. The RISKIT-CJS programme was a multicomponent intervention and consisted of two individual motivational interviews with a trained youth worker (lasting 45 minutes each) and two group sessions delivered over half a day on consecutive weeks. Main outcome measures At 12 months, we assessed per cent days abstinent from substance use over the previous 28 days. Secondary outcome measures included well-being, motivational state, situational confidence, quality of life, resource use and fidelity of interventions delivered. Results A total of 693 adolescents were assessed for eligibility, of whom 505 (73%) consented. Of these, 246 (49%) were allocated to the RISKIT-CJS intervention and 259 (51%) were allocated to treatment as usual only. At month 12, the overall follow-up rate was 57%: 55% in the RISKIT-CJS arm and 59% in the treatment-as-usual arm. At month 12, we observed an increase in per cent days abstinent from substances in both arms of the study, from 61% to 85%, but there was no evidence that the RISKIT-CJS intervention was superior to treatment as usual. A similar pattern was observed for secondary outcomes. The RISKIT-CJS intervention was not found to be any more cost-effective than treatment as usual. The qualitative research indicated that young people were positive about learning new skills and acquiring new knowledge. Although stakeholders considered the intervention worthwhile, they expressed concern that it came too late for the target population. Limitations Our original aim to collect data on offences was thwarted by the onset of the COVID-19 pandemic, and this affected both the statistical and economic analyses. Although 214 (87%) of the 246 participants allocated to the RISKIT-CJS intervention attended at least one individual face-to-face session, 98 (40%) attended a group session and only 47 (19%) attended all elements of the intervention. Conclusions The RISKIT-CJS intervention was no more clinically effective or cost-effective than treatment as usual in reducing substance use among adolescents involved in the criminal justice system. Future research The RISKIT-CJS intervention was considered more acceptable, and adherence was higher, in pupil referral units and substance misuse teams than in youth offending teams. Stakeholders in youth offending teams thought that the intervention was too late in the trajectory for their population. Trial registration This trial is registered as ISRCTN77037777. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 11, No. 3. See the NIHR Journals Library website for further project information. Plain language summary We explored how useful a psychological intervention was in reducing substance use among young people who had some involvement in the criminal justice system. We recruited young people aged between 13 and 17 years in four areas of England (i.e. South East, London, North West and North East). Young people were recruited from youth offending teams, pupil referral units and substance misuse teams. Those young people who were willing to participate were offered usual treatment and half, chosen at random, were offered an opportunity to take part in the RISKIT-Criminal Justice System (RISKIT-CJS) programme. The RISKIT-CJS programme had four distinct parts. The first was a 1-hour session that used an approach called motivational interviewing to explore the young person’s substance use and discuss different strategies to change their behaviour. This was followed by two group sessions delivered over 2 consecutive weeks. These group sessions addressed risks associated with substance use, what triggers use and the health and social consequences. In addition, young people were taught new skills to help them manage in situations in which they might normally use substances. At the end of the group sessions, the young people had another motivational interview. Twelve months after participants started, we found that the frequency of substance use had decreased in both groups; however, the RISKIT-CJS intervention was no better than treatment as usual. When we spoke with young people who had taken part and staff involved with this population, we got a mixed picture. In some settings, particularly pupil referral units, the RISKIT-CJS intervention was well received by young people and staff, and staff felt that it was a useful additional resource to the work that they were currently undertaking. On the other hand, in the youth offending teams, the staff thought that the programme was too different from their normal work to be implemented easily and they considered the population they work with too established in their substance use and criminal activity to benefit from the programme. Scientific summary Background Adolescence is a critical developmental stage when young people make behavioural and lifestyle choices that have the potential to affect their health and well-being into adulthood. Six per cent of youths aged 14 years and 11% of youths aged 15 years report having used cannabis in the last month, with 2% of 14-year-olds and 4% of 15-year-olds reporting use of a class A substance at least once. Data from the Juvenile Cohort Study [Wilson E. Youth Justice Interventions – Findings from the Juvenile Cohort Study (JCS). London: Ministry of Justice Analytical Series; 2013] show that 32% of young offenders indicate substance use is, at least in part, a reason for them associating in criminal activity. Substance use is defined as the use of alcohol, traditional illicit substances and legal highs, as well as inappropriate use of prescribed medication. Although the relationship between substance use and criminal activity is complex, it is clearly a major issue in the youth offending population. To date, systematic reviews of interventions for substance-using offenders in criminal justice system (CJS) environments have not identified a clear evidence-based intervention strategy. Systematic reviews have revealed the paucity of good-quality research in the area and a lack of UK-based studies, with no scientifically rigorous studies focusing on young offenders. Importantly, previous research has identified what has been proven not to work, and this includes focusing on negative aspects of risk and risk abstinence. Promising intervention approaches identified include motivational interviewing and cognitive and socioemotional life skills training. In addition, there is emerging recognition of the importance of providing interventions in a structured manner and, with the young people’s preference for peer group interventions, the importance of managing the potentially negative effects of labelling and peer influence. The RISKIT-Criminal Justice System (RISKIT-CJS) programme is a structured psychosocial intervention developed from evidence reviews and co-production with young people. Pilot research work among risk-taking adolescents in school settings found that the intervention was acceptable and associated with significant reductions in substance use. Objectives To conduct a prospective, pragmatic, randomised controlled trial (RCT) to evaluate the clinical effectiveness of the RISKIT-CJS intervention in reducing the frequency of substance use, compared with treatment as usual (TAU), among substance-using adolescents involved in the CJS. To evaluate the cost-effectiveness of the RISKIT-CJS intervention compared with TAU. To explore participants’ and criminal justice staff’s experience of the intervention and the acceptability of the methods employed. To assess the fidelity with which the intervention was conducted and to explore the role of fidelity, therapeutic alliance and baseline psychological factors on the outcomes observed. Methods The study evaluated the clinical effectiveness of the RISKIT-CJS programme using a prospective, pragmatic RCT. The study was conducted across three settings [i.e. youth offending teams (YOTs), pupil referral units (PRUs) and substance misuse teams] across four geographical areas of England (i.e. South East, London, North West and North East). Embedded within the trial was a comprehensive qualitative component that explored young people’s and stakeholders’ perspectives on the acceptability and usefulness of the RISKIT-CJS programme. Young people aged between 13 and 17 years (inclusive) who were eligible and consented were randomised with equal probability to TAU or to TAU augmented with the RISKIT-CJS programme. The RISKIT-CJS programme was a multicomponent psychosocial intervention, which involved two individual sessions, using motivational interviewing approaches, and two group sessions, employing cognitive–behavioural approaches. An initial individual session was followed by two half-day group sessions, delivered over consecutive weeks, followed by a final individual session. The primary end point for the study was at 12 months post randomisation and the primary outcome measure was the frequency of substance use, assessed as per cent days abstinent (PDA) from substances in the past 28 days, derived from the Timeline Followback 28. Results Overall, 693 young people were assessed for eligibility into the trial, of whom 505 were eligible and consented. Among the 188 young people who did not participate, the main reason was declining consent (n = 55, 29%). Of the 505 participants, 246 (49%) were randomised to the RISKIT-CJS programme and 259 (51%) were randomised to TAU. At the primary end point, 275 (57%) participants were followed up, 130 (55%) in the RISKIT-CJS arm and 145 (59%) in the TAU arm. The most common substance used was cannabis (used by 76% of young people). Of those participants randomised to the RISKIT-CJS programme, 214 (87%) attended the first face-to-face session, but only 98 (40%) attended the first group session. Overall, 104 (42%) participants attended at least one individual session and one group session and 47 (19%) participants attended all sessions. Over the 12 months of the study, the PDA from substance use increased in both groups, with a median increase from 60.7% to 85.7% in the RISKIT-CJS arm and a median increase from 61.8% to 83.9% in the TAU arm. A fractional regression indicated no difference between the groups in terms of PDA from substance use at month 12 (odds ratio 1.14, 95% confidence interval 0.74 to 1.76). A similar finding was confirmed when missing data were imputed and a per-protocol analysis undertaken. No differences were observed between the groups on secondary outcomes of well-being and quality of life. The health economic analysis found that the RISKIT-CJS programme had a probability of being cost-effective of 69% when a commissioner’s willingness-to-pay (WTP) threshold was zero. At an established WTP threshold of £20,000–30,000, the probability that the RISKIT-CJS programme was cost-effective reduced to 60–63%. The qualitative analysis explored the views of young people who took part in the RISKIT-CJS programme and of stakeholders working in the services in which the programme was delivered. It addressed three key areas: (1) strengths and weaknesses, (2) usefulness and acceptability, and (3) implementation. The data covered 59 interviews with young people, 14 focus groups with young people, 23 interviews with professionals and 18 sets of research field notes. Several young people and stakeholders identified strengths of the programme, including the varied content and delivery styles and the opportunity to discuss issues in a safe and non-judgemental environment. Weaknesses of the programme that were identified included the inappropriateness of the programme for some participants, particularly older participants with entrenched substance use and criminal histories. In terms of usefulness, stakeholders tended to agree that the programme was more useful for the younger end of the cohort. Acceptability from the perspective of young people varied by setting, with those in PRUs, where group interventions are relatively common, considering the intervention more acceptable than those in YOTs. Analysis of fidelity indicated high levels of fidelity in the delivery of motivational behavioural change interventions. The exploratory analysis of prognostic factors that may affect outcome identified three predictors. Higher score on the SOCRATES-7DS (Stages Of Change Readiness And Treatment Eagerness Scale – 7 Dimension) preparatory stage, that is, an indicator of lower motivational state, predicted lower PDA at month 12. Higher self-efficacy, that is, the confidence to resist substance use, particularly as it related to managing unpleasant emotions and physical discomfort, predicted higher PDA at month 12. When the fidelity measures and therapeutic analysis were included in the model for the RISKIT-CJS arm only, the findings remained similar; however, there was a strong therapist effect, with strong therapeutic alliance predicting higher PDA at month 12. Conclusions The results of the statistical and economic analysis showed no significant differences between the trial arms for any of the primary or secondary outcomes. This finding was consistent when underlying assumptions were varied and missing data imputed. The qualitative findings were more mixed, with those in PRUs finding the intervention the most useful and acceptable and those in YOTs finding the intervention least useful and acceptable. Trial registration The trial is registered as ISRCTN77037777. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 11, No. 3. See the NIHR Journals Library website for further project information.

This article examines heterogeneity in adverse events and conditions and how low-income African American young adults respond. Although nearly all individuals in the sample report at least one instance of adversity, the nature and frequency of adversity varies, as do the responses. Some individuals see their lives and plans derailed; others engage in more protective strategies. For still others, adversity presents a difficult trade-off between surviving and thriving. We formalize this trade-off as an extension of a basic model of costly human capital investments. The model shows that a rational, fully informed individual facing this brutal trade-off, in an effort to survive the fallout of adversity, may optimally choose not to make high-return investments that promote thriving in the future. Improved policy design would recognize this type of trade-off.

Integrated STEM education within North America has become a popular pedagogy; however, teachers identify challenges that arise when planning for and implementing integrated STEM education. These challenges may threaten STEM teachers' capacity to balance disciplinary and integrated learning, a core feature of effective STEM education. The purpose of this study was to investigate how exemplary STEM teachers navigate tensions of practice to balance disciplinary and integrated learning. Through an in-depth qualitative methodology, drawing on interview and artifact data from 14 purposefully selected exemplary secondary and elementary integrated STEM teachers, this study identified tensions that teachers faced as they navigated planning for and implementing integrated STEM education: (a) curriculum content versus skills; (b) guided instruction versus inquiry and play; (c) process versus task completion; and (d) collaboration versus individual needs. In line with a Worldly Perspective (Rennie et al., 2020), balancing these tensions leads to enhanced integration.

Background: Our primary objective evaluated the perception of emergency medical service (EMS) providers’ review of automated hospital outcome data. Secondarily, we assessed participation in outcome review as a means of microlearning to obtain continuing education (CE).Methods: From October–December 2023, three high-volume EMS systems participated in a three-part intervention with results evaluated using a mixed-methods approach. First, EMS providers (emergency medical technicians and paramedics) were invited, via their electronic health record (EHR), to complete a presurvey evaluating their perceptions of reviewing outcomes. Then, EMS providers were notified about the opportunity to earn CE via a microlearning intervention, offering Commission on Accreditation for Pre-Hospital Continuing Education (CAPCE)-approved CE hours for completion of outcome reviews and associated learning modules. Finally, EMS providers were invited to complete a post-survey mirroring the pre-survey. Qualitative analyses identified themes among open-ended responses. Quantitative analyses examined perceptions between pre- and post- surveys.Results: Of 843 providers contacted, 217 responded to the pre-survey (25.7%). The most endorsed rationale for reviewing outcomes included improving clinical knowledge (95%), improving patient care (94%), and knowing whether care made a difference (93%). Nearly all (91%) reported being more likely to review outcomes if CE were awarded. Among the 67 who completed the open-ended items, the three dominant themes included enhance personal confidence and competence (43%); acquire personal knowledge (39%); and operations (21%). Of 211 providers who participated in the intervention, 56 (27%) were awarded CE. A total of 152 providers responded to the post-survey, and the percentage who agreed that reviewing outcomes improves job satisfaction rose from 89% to 95% between pre- and post-surveys (P = 0.05).Conclusion: EMS providers supported the personal and professional development and patient care improvement of reviewing patients’ outcomes with associated CE. Further study is warranted to evaluate the generalizability of these findings and the best user experience.

Addressing calls to develop assessment theories for integrated teaching and learning, we propose an evidence-informed perspective on grading in Science, Technology, Engineering, Arts and Mathematics (STEAM) education. We leveraged a qualitative collective case study design to generate rich profiles of three exemplary STEAM teachers' grading approaches and practices. Data sources included semi-structured interviews and artefacts of teachers' instruction and assessment practice. We analysed qualitative data from interviews and artefacts using a general inductive approach. The teachers in our study pushed back against 'objective' views of grading, whereby grades are composites of summative assessments, in favour of informed and contextualised grading, which aims to document and support a negotiated understanding of each student's learning journey. Teachers' grading practices aligned with a hermeneutic approach to classroom assessment validity: the teachers (a) collected and interpreted a wide range of evidence of student (re)learning; (b) centred students' perspectives and evidences; and (c) employed their professional judgement to determine students' grades. Teachers characterised grading as a process of accounting for all available evidence, blurring the boundaries between formative and summative assessment. Documenting the learning process, rather than focusing on products, can support deeply integrated learning. Importantly, the teachers supported students in documenting their own learning and negotiating their grades with reference to self-generated evidence. This practice stands to reduce power imbalances between students and teachers and foster students' self-regulated learning. Our findings inform a framework which STEAM educators can use to guide grading in integrated classrooms, an enduring challenge for integrated learning.

Knowing how science teachers develop their professional knowledge has been a challenge. One potential way to determine the professional knowledge of teachers is through videos. In the study described here, the authors recruited 60 elementary and secondary science teachers, showed them one of two 10-min videos, and recorded and analyzed their comments when watching the videos. The coding focused on their noticing of student learning, teacher's teaching, types of teaching practices, and the use of interpretative frames. The noticing data were collected and analyzed to determine the differences between groups of teachers. The findings from the analysis indicated that most science teachers noticed the instruction of teachers rather than the learning of students, and these noticing events were often focused on general instructional practices as opposed to the science practices emphasized in the "Next Generation Science Standards" (National Research Council, 2013). The only difference between the teachers was in the area of evaluating the videos. Secondary science teachers and experienced elementary teachers were more likely to evaluate the videos than were novice elementary teachers. This may be a result of the knowledge base of the teachers. These results suggest a need for explicit reform-based instruction and a revision of this research process.

Deficits in memory performance have been linked to a wide range of neurological and neuropsychiatric conditions. While many studies have assessed the memory impacts of individual conditions, this study considers a broader perspective by evaluating how memory recall is differentially associated with nine common neuropsychiatric conditions using data drawn from 55 international studies, aggregating 15,883 unique participants aged 15-90. The effects of dementia, mild cognitive impairment, Parkinsons disease, traumatic brain injury, stroke, depression, attention-deficit/hyperactivity disorder (ADHD), schizophrenia, and bipolar disorder on immediate, short-, and long-delay verbal learning and memory (VLM) scores were estimated relative to matched healthy individuals. Random forest models identified age, years of education, and site as important VLM covariates. A Bayesian harmonization approach was used to isolate and remove site effects. Regression estimated the adjusted association of each clinical group with VLM scores. Memory deficits were strongly associated with dementia and schizophrenia (p < 0.001), while neither depression nor ADHD showed consistent associations with VLM scores (p > 0.05). Differences associated with clinical conditions were larger for longer delayed recall duration items. By comparing VLM across clinical conditions, this study provides a foundation for enhanced diagnostic precision and offers new insights into disease management of comorbid disorders.

Many experimental and computational efforts have sought to understand DNA origami folding, but the time and length scales of this process pose significant challenges. Here, we present a mesoscopic model that uses a switchable force field to capture the behavior of single- and double-stranded DNA motifs and transitions between them, allowing us to simulate the folding of DNA origami up to several kilobases in size. Brownian dynamics simulations of small structures reveal a hierarchical folding process involving zipping into a partially folded precursor followed by crystallization into the final structure. We elucidate the effects of various design choices on folding order and kinetics. Larger structures are found to exhibit heterogeneous staple incorporation kinetics and frequent trapping in metastable states, as opposed to more accessible structures which exhibit first-order kinetics and virtually defect-free folding. This model opens an avenue to better understand and design DNA nanostructures for improved yield and folding performance.

BACKGROUND: In India, the prevalence of Latent TB infection (LTBI) is estimated to be around 40%. Various formulations of PPD(Purified protein derivative) are available, for diagnosis of LTBI, which may give variable responses. The commercially available PPD in India is by Arkray Healthcare (TST-Arkray). It is unclear if this product may have a similar sensitivity compared to other internationally accepted tuberculins (TST-Tubersol). OBJECTIVES: To assess the performance of the two TSTs compared to Quantiferon-Gold Plus (QFT-Plus). METHODOLOGY: A blood sample was collected for the QFT-Plus test. Both the TSTs were placed in the right and the left volar aspect of the forearms and 48 hrs later, the subjects came back to the study site for reading. RESULTS: Among the 512 participants who were recruited, 326 subjects were healthcare professionals and 186 subjects were household contacts of patients with tuberculosis. They were tested with both TST-Tubersol and TST-Arkray, 139(27 %) participants tested positive for TST-Tubersol (≥10 mm), whereas 203 participants (40.1 %)tested positive for TST-Arkray. There was moderate agreement between the two tests with k = 0.58. Also, there was only poor agreement between both the TSTs with QFT Plus(kappa = 0.19 for Tubersol and 0.17 for Arkray). With QFT-Plus as gold standard, the sensitivity, specificity, PPV and NPV of TST-Tubersol, ast an induration cut-off of 10 mm was 46.8 %,76.3 %,31.8 % and 85.8 %. respectively and TST- Arkray; 60.6 %, 64 %, 28.5 % and 87.2 % respectively. CONCLUSION: The Indian TST (Arkray Diagnostics) has shown moderate agreement with the internationally accepted Tubersol. Additionally, there was poor agreement between the TSTs and QFT plus test.

Abstract Background An important methodological challenge in conducting pediatric economic evaluations is estimating the preference-based health-related quality of life (HRQoL) of children. Current methods are highly variable and there is no single instrument available to value HRQoL consistently across multiple pediatric age groups. The Pediatric Quality of Life Inventory (PedsQL) is a non-preference-based generic HRQoL instrument validated for children 2–18 years, but it cannot be directly used in economic evaluations. The aim of this study was to establish the core dimension structure of the PedsUtil health state classification system using confirmatory factor analysis, which is the first step of deriving a preference-based measure of HRQoL based on the PedsQL. Methods Four competing dimension structures of the PedsUtil health state classification system were developed based on published literature and expert opinion. Using data from the Longitudinal Study of Australian Children (LSAC) (n = 45,207), the 4 dimension structures were evaluated using the robust weighted least squares estimation method. The analyses were stratified by 2-year age intervals (from 2 to 17 years) to reflect the study design of the LSAC, as well as special healthcare needs status of the child. Model fit was evaluated by examining standardized factor loadings and various fit indices including the comparative fit index (CFI), Tucker-Lewis Index (TLI), and the root mean square error of approximation (RMSEA). Modification indices and residual correlations were examined to re-specify the models to improve model fit when necessary. Results The findings supported a 7-dimension structure (i.e., Physical Functioning, Pain, Fatigue, Emotional Functioning, Social Functioning, School Functioning, and School Absence) of the PedsUtil health state classification system. The 7-dimension model exhibited adequate fit across subgroups with CFI values that ranged from 0.929 to 0.954, TLI values from 0.916 to 0.946, and RMSEA values from 0.058 to 0.102. Conclusions This study established the core dimension structure of the PedsUtil health state classification system using confirmatory factor analysis. The 7-dimension structure was found to be applicable across diverse pediatric populations. Research is currently ongoing to select the most representative item within each dimension of the PedsUtil health state classification system and valuation surveys will be fielded to estimate the PedsUtil scoring system.

Journaling assignments are generative practices for the sport management classroom because they can help students process course content through self-reflection and relate their acquired knowledge to their experiences and worldviews. This essay presents journaling as an example of contemplative pedagogy, an educational technique that supports the development of skills in mindful self-awareness, as well as the translation of course content to practical knowledge through calm and creative expression. The essay outlines the practical implementation of contemplative journaling in undergraduate courses and contends that it is a useful pedagogical tool for the sport management classroom, particularly in helping students engage with topics concerning social justice and inequalities in the industry.

Purpose: This study aims to investigate student mentors' perceptions of peer mentor relationships in a health professions education program. Design/methodology/approach: The design uses embodied hermeneutic phenomenology. The data comprise 10 participant interviews and visual "body maps" produced in response to guided questions. Findings: The findings about student mentors' perceptions of peer mentor relationships include a core theme of nurturing a trusting learning community and five related themes of attunement to mentees, commonality of experiences, friends with boundaries, reciprocity in learning and varied learning spaces. Originality/value: The study contributes original insights by highlighting complexity, shifting boundaries, liminality, embodied social understanding and trusting intersubjective relations as key considerations in student peer mentor relationships.

Diversity and inclusion are identified as necessary for enhancing the sport industry. Undergraduate sport management programs play an important role in educating aspiring sport professionals with respect to these topics. However, the literature indicates that sport management education can improve with respect to this work. Therefore, the purpose of this instructional technique review is to discuss two comparable teaching activities that sought to incorporate diversity and inclusion education into the content area of disability and sport-related compliance with the Americans with Disabilities Act. Student feedback showed that despite similarities between the activities (i.e., active engagement with the Americans with Disabilities Act as it pertains to sport facilities), students had substantially different reported learning outcomes related to diversity and inclusion. This review is thus designed to illustrate the importance of deliberate framing decisions in the sport management classroom, which can have a transformative impact on students' learning around diversity and inclusion content.

Inspired by the recent 21st century social and educational movements toward equity, diversity, and inclusion for disadvantaged groups, educational researchers have sought in conceptualizing fairness in classroom assessment contexts. These efforts have provoked promising key theoretical foundations and empirical investigations to examine fairness in assessment. This review study aims to critically review these theoretical foundations and associated empirical studies to examine their potential for addressing the complex and evolving notions of fairness in classroom assessment contexts. This study also builds on fairness and justice literature in social sciences and broader educational discourses to provide additional theoretical grounds to rethink fairness in classroom assessment. Overall, this study contributes theoretical grounds for future theory-driven empirical research to advance fair assessment practices in classrooms.

Introduction The historical focus of vaccines on child health coupled with the advent of novel vaccines targeting adult populations necessitates exploring strategies for adult vaccine implementation.Areas covered This scoping review extracts insights from the past decade’s experiences introducing adult vaccines in low- and middle-income countries. Among 25 papers reviewed, 19 focused on oral cholera vaccine, 2 on Meningococcal A vaccines, 2 on tetanus toxoid vaccine, 1 on typhoid vaccine, and 1 on Ebola vaccine. Aligned with WHO’s Global Framework for New TB Vaccines for Adults and Adolescents, our findings center on vaccine availability, accessibility, and acceptance.Expert Opinion Availability findings underscore the importance of understanding disease burden for prioritization, multi-sectoral collaboration during planning, and strategic resource allocation and coordination. Accessibility results highlight the benefits of leveraging existing health infrastructure and adequately training healthcare workers, and contextually tailoring vaccine delivery approaches to reach challenging sub-groups like working male adults. Central to fostering acceptance, resonant sensitization, and communication campaigns engaging the communities and utilizing trusted local leaders countered rumors and increased awareness and uptake. As we approach the introduction of a new adult TB vaccine, insights from this review equips decision-makers with key evidence-based recommendations to support successful and equitable vaccinations targeting adults.

Abstract Background There is a lack of preference-based health-related quality of life (HRQoL) measures that consistently value health across a full range of child age groups. The PedsQL is a generic HRQoL instrument validated for children 2–18 years, but it is not preference-based. The objective of this study was to derive the PedsUtil health state classification system from the PedsQL as a basis for a preference-based HRQoL measure for children. Methods A two-step process was used to select PedsQL items to include in the health state classification system: 1) exclude poorly functioning items according to Rasch analysis in each of the previously established seven dimensions of the PedsUtil health state classification system and 2) select a single item to represent each dimension based on Rasch and psychometric analyses, as well as input from child health experts and parents. All secondary analyses were conducted using data from the Longitudinal Study of Australian Children (LSAC). Analyses were stratified by age group (i.e., 2–5 years, 6–13 years, and 14–17 years) to represent the different developmental stages of children and to reflect the study design of the LSAC. Rasch analyses were also performed on five random subsamples for each age group to enhance robustness of results. Results Twelve items were excluded from the PedsUtil health state classification system after the first step of the item selection process. An additional four items were excluded in the second step, resulting in seven items that were selected to represent the seven dimensions of the PedsUtil health state classification system: Physical Functioning (“participating in sports activity or exercise”), Pain (“having hurts or aches”), Fatigue (“low energy level”), Emotional Functioning (“worrying about what will happen to them”), Social Functioning (“other kids not wanting to be their friend”), School Functioning (“keeping up with schoolwork”), and School Absence (“missing school because of not feeling well”). Conclusions The PedsUtil health state classification system was derived from the PedsQL based on several criteria and was constructed to be applicable to children two years and older. Research is ongoing to elicit preferences for the PedsUtil health state classification system to construct the PedsUtil scoring system.

Burning rate plays a crucial role in determining the performance of solid rocket motors (SRMs). In the traditional approach for solid propellant propulsion, technical activities regarding burning rates are developed at three different operational levels: (i) Strand burners or laboratory-scale devices in general; (ii) Small-scale motors (SSMs); And (iii) full-size or end-item rocket motors. While strand burners are extensively used for propellant development (formulation exploration, ingredients screening, performance verification, and production control) and relatively little is done experimentally at the full-size motor level (being large-scale experimentation too expensive and dangerous), a lot is usually carried out at SSM level to obtain burning rate information under motor operating conditions. In the introductory part of this work, burning rate fundamentals are recalled and burning rate measurement devices are quickly summarized. Then, a survey of subscale motors is conducted and several automated procedures to deduce burning rate from SSM testing are analyzed. Data reduction methods commonly used by leading European companies are based on the thickness-over-time (TOT) definition. Attention is dedicated to procedures used in Italy and France for quality control of the European space launchers (solid propellant boosters of Ariane family and core solid rocket motors of VEGA family). In addition, automated data reduction methods based on mass balance (MB) and often used in USA are investigated. Specific features and general trends of the tested industrial procedures are pointed out. Since for any tests the actual burning rates are unknown, results can only be compared based on the statistical quality of the deduced ballistic data. Mainly reproducibility, ease of application, and suitability for automated computer implementation are of interest to industrial users. The effects of test variability, input data quality, and data reduction methods on result reproducibility are discussed with reference to fire tests of the successful Ariane-5 solid boosters. The systematic analysis of industrial data conducted in this work suggests that improving the actual mix reproducibility and quality of experimental data is more important than perfecting the current data reduction methods. Moreover, the international trends suggest that the fundamental TOT procedures are being replaced by MB procedures or advanced TOT procedures with burning times evaluated using pressure integrals.

The advent of various additive manufacturing technologies, such as 3D printing, has changed the structural design and preparation process of rocket fuels. In order to investigate the combustion properties of various common polymer materials that can be additively manufactured by fused deposition, the combustion tests of hybrid rocket fuels prepared by 3D printing were carried out. These materials include polylactic acid (PLA), wood-like polylactic acid (Wood), acrylonitrile-butadiene-styrene (ABS), acrylonitrile-styrene-acrylate (ASA), copolymers of nylon 6 and nylon 6,6 (CoPA), polycarbonate-polybutylene terephthalate (PC-PBT), flame retardant polycarbonate (PC-FR) and polyethylene terephthalateco-1,4-cylclohexylenedimethylene terephthalate (PETG). Thermogravimetric-differential scanning calorimetry (TG-DSC) analysis was carried out on these materials, the printing effect of the fuel grains was observed by three-dimensional X-ray microscopy (µCT) and the combustion performance of these fuels in gaseous oxygen flow (GOX) was recorded by high-speed photography at a constant pressure of 1 MPa. The results show that ASA and ABS exhibit good printing results. The regression rates of PC-PBT, PETG, ABS, ASA, CoPA and PLA are 0.792 mm/s, 0.592 mm/s, 0.536 mm/s and 0.477 mm/s, 0.368 mm/s, 0.339 mm/s (AtGOX=220kg/(m2·s)), respectively.

Abstract Background The aim of this study was to evaluate potential synergistic effects of a single, local application of human umbilical cord MSC-derived sEVs in combination with a low dose of recombinant human rhBMP-2 to promote the regeneration of a metaphyseal femoral defect in an osteoporotic rat model. Methods 6 weeks after induction of osteoporosis by bilateral ventral ovariectomy and administration of a special diet, a total of 64 rats underwent a distal femoral metaphyseal osteotomy using a manual Gigli wire saw. Defects were stabilized with an adapted Y-shaped mini-locking plate and were subsequently treated with alginate only, or alginate loaded with hUC-MSC-sEVs (2 × 109), rhBMP-2 (1.5 µg), or a combination of sEVs and rhBMP-2 (n = 16 for each group). 6 weeks post-surgery, femora were evaluated by µCT, descriptive histology, and biomechanical testing. Results Native radiographs and µCT analysis confirmed superior bony union with callus formation after treatment with hUC-MSC-sEVs in combination with a low dose of rhBMP-2. This finding was further substantiated by histology, showing robust defect consolidation 6 weeks after treatment. Torsion testing of the explanted femora revealed increased stiffness after application of both, rhBMP-2 alone, or in combination with sEVs, whereas torque was only significantly increased after treatment with rhBMP-2 together with sEVs. Conclusion The present study demonstrates that the co-application of hUC-MSC-sEVs can improve the efficacy of rhBMP-2 to promote the regeneration of osteoporotic bone defects.

Abstract Background While healthcare policy has fostered implementation strategies to improve inclusion and access of under-served groups to clinical care, systemic and structural elements still disproportionately prevent service users from accessing research opportunities embedded within clinical settings. This contributes to the widening of health inequalities, as the absence of representativeness prevents the applicability and effectiveness of evidence-based interventions in under-served clinical populations. The present study aims to identify the individual (micro), organisational (meso) and structural (macro) barriers to clinical research access in patients with comorbid alcohol use disorder and alcohol-related liver disease. Methods A focused ethnography approach was employed to explore the challenges experienced by patients in the access to and implementation of research processes within clinical settings. Data were collected through an iterative-inductive approach, using field notes and patient interview transcripts. The framework method was utilised for data analysis, and themes were identified at the micro, meso and macro levels. Results At the micro-level, alcohol-related barriers included encephalopathy and acute withdrawal symptoms. Alcohol-unrelated barriers also shaped the engagement of service users in research. At the meso-level, staff and resource pressures, as well as familiarity with clinical and research facilities were noted as influencing intervention delivery and study retention. At the wider, macro-level, circumstances including the ‘cost of living crisis’ and national industrial action within healthcare settings had an impact on research processes. The findings emphasise a ‘domino effect’ across all levels, demonstrating an interplay between individual, organisational and structural elements influencing access to clinical research. Conclusions A combination of individual, organisational and structural barriers, exacerbated by the COVID-19 pandemic, and the socioeconomic landscape in which the study was conducted further contributed to the unequal access of under-served groups to clinical research participation. For patients with comorbid alcohol use disorder and alcohol-related liver disease, limited access to research further contributes towards a gap in effective evidence-based treatment, exacerbating health inequalities in this clinical population.

The present study uses electroencephalography (EEG) with an N-back task (0-, 1-, and 2-back) to investigate if and how individual bilingual experiences modulate brain activity and cognitive processes. The N-back is an especially appropriate task given recent proposals situating bilingual effects on neurocognition within the broader attentional control system (Bialystok and Craik, 2022). Beyond its working memory component, the N-Back task builds in complexity incrementally, progressively taxing the attentional system. EEG, behavioral and language/social background data were collected from 60 bilinguals. Two cognitive loads were calculated: low (1-back minus 0-back) and high (2-back minus 0-back). Behavioral performance and brain recruitment were modeled as a function of individual differences in bilingual engagement. We predicted task performance as modulated by bilingual engagement would reflect cognitive demands of increased complexity: slower reaction times and lower accuracy, and increase in theta, decrease in alpha and modulated N2/P3 amplitudes. The data show no modulation of the expected behavioral effects by degree of bilingual engagement. However, individual differences analyses reveal significant correlations between non-societal language use in Social contexts and alpha in the low cognitive load condition and age of acquisition of the L2/2L1 with theta in the high cognitive load. These findings lend some initial support to Bialystok and Craik (2022), showing how certain adaptations at the brain level take place in order to deal with the cognitive demands associated with variations in bilingual language experience and increases in attentional load. Furthermore, the present data highlight how these effects can play out differentially depending on cognitive testing/modalities – that is, effects were found at the TFR level but not behaviorally or in the ERPs, showing how the choice of analysis can be deterministic when investigating bilingual effects.