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This study summarizes the comparison of interactive lecturing and technology-supported student-centered pedagogy across six semesters of an introductory physical geology course. A multiple linear regression analysis of 967 student scores shows that absent raw exam scores, homework, and in-class attendance, performance on the first exam (score <60%), and pedagogy are the strongest predictors of students' final exam scores. Individual final exam scores showed a significant negative difference between the two semesters with interactive lecturing and the four with student-centered pedagogy. STEM students performed better on average than non-STEM majors; however, this difference became less significant for students who scored <60% in the first exam. Female students scored on average 2% lower than males. We found no evidence that the transition to a swivel-seat auditorium from a fixed seat one in the last two semesters had an impact on the final exam or final grade. We conclude that a student-centered approach that relies heavily on technology does not necessarily imply higher efficacy over interactive lecturing, and that engaging students on how to effectively use learning resources is an important component of active learning.

Behavior analysts are frequently responsible for teaching concepts and operations. Whether teaching in academia, training employees within corporations, working with young learners, or serving disabled learners, behavior analysts primarily find themselves in an instructional position relaying information from themselves to others. They often design how this information is transmitted to the learner so that the person can operate upon the world proficiently with the new concept or operation. As a result, behavior-analytic instructional design has spent much time piecing together optimal ways of making instruction effective. Nevertheless, these instructional design practices are not widely disseminated or adapted to everyday clinical practice. Therefore, the current article proposes a comprehensive framework where a learner contacts different hierarchical instructional levels while establishing proficiency on each level before progressing toward the ultimate goal of the concept or operation. These levels include Discriminate, Generate, Operate, and Demonstrate. By progressing through this framework, the learner will apply and generalize the instructional concept or operation regardless of context and nuance.

Nonalcoholic fatty liver disease (NAFLD) is common and partially heritable and has no effective treatments. We carried out a genome-wide association study (GWAS) meta-analysis of imaging (n = 66,814) and diagnostic code (3,584 cases versus 621,081 controls) measured NAFLD across diverse ancestries. We identified NAFLD-associated variants at torsin family 1 member B (TOR1B), fat mass and obesity associated (FTO), cordon-bleu WH2 repeat protein like 1 (COBLL1)/growth factor receptor-bound protein 14 (GRB14), insulin receptor (INSR), sterol regulatory element-binding transcription factor 1 (SREBF1) and patatin-like phospholipase domain-containing protein 2 (PNPLA2), as well as validated NAFLD-associated variants at patatin-like phospholipase domain-containing protein 3 (PNPLA3), transmembrane 6 superfamily 2 (TM6SF2), apolipoprotein E (APOE), glucokinase regulator (GCKR), tribbles homolog 1 (TRIB1), glycerol-3-phosphate acyltransferase (GPAM), mitochondrial amidoxime-reducing component 1 (MARC1), microsomal triglyceride transfer protein large subunit (MTTP), alcohol dehydrogenase 1B (ADH1B), transmembrane channel like 4 (TMC4)/membrane-bound O-acyltransferase domain containing 7 (MBOAT7) and receptor-type tyrosine-protein phosphatase δ (PTPRD). Implicated genes highlight mitochondrial, cholesterol and de novo lipogenesis as causally contributing to NAFLD predisposition. Phenome-wide association study (PheWAS) analyses suggest at least seven subtypes of NAFLD. Individuals in the top 10% and 1% of genetic risk have a 2.5-fold to 6-fold increased risk of NAFLD, cirrhosis and hepatocellular carcinoma. These genetic variants identify subtypes of NAFLD, improve estimates of disease risk and can guide the development of targeted therapeutics.

Abstract Background Hepatic glycogen storage diseases (GSDs) are characterised by enzyme defects affecting liver glycogen metabolism, where carbohydrate supplementation to prevent overnight hypoglycaemia is common. Concerns around sleep quality in hepatic GSDs relate to emerging evidence that overnight dysglycaemia impacts sleep quality. Methods This prospective observational study reported sleep quality and duration in children with hepatic GSDs over 7 days utilising: actigraphy (Actiwatch 2 by Phillips Respironics), sleep diaries, proxy reported age‐appropriate sleep and quality‐of‐life (QoL) questionnaires, in the context of nocturnal glycaemic profiles continuous glucose monitor (CGM, Dexcom G6) and nocturnal dietary management strategies. Significant hypo‐ and hyperglycaemia were defined as ≥1% of sleep diary documented nocturnal period, recording 10.0 mmol/L, respectively. Results Seven children with hepatic GSD (aged 1–17 years) participated. Objective sleep quality was poor, with actigraphy demonstrating that no child achieved the minimum sleep duration recommended for age. Subjective sleep quality was also poor, with 4/5 documenting significant daytime sleepiness and 6/6 reporting poor sleep hygiene. Children prescribed overnight bolus feeds (OBF) (n = 2) recorded shorter sleep duration compared to other nocturnal management strategies. Parent‐reported QoL suggested poor disease‐related QoL outcomes for this cohort. Conclusion Objective and subjective sleep disturbances and reduced QoL are common within our sample of children with hepatic GSD. From our observations these outcomes may be linked to nutritional overnight interventions, especially OBFs, rather than overnight glucose levels. Consideration of the impacts of overnight feeding strategies on sleep quality and QoL in children with hepatic GSD should inform future management strategies.

Summary: In African American adults, the strongest genetic predictor of pneumonia appears to be the A allele of rs334, a variant in the β-globin gene, which in homozygous form causes sickle cell disease (SCD). No comparable studies have been done in African American children. We performed genome-wide association analyses of 482 African American children with documented pneumonia and 2,048 African American control individuals using genotypes imputed from two reference panels: 1000 Genomes (1KG) (which contains rs334) and TOPMed (does not contain rs334). Using 1KG imputed genotypes, the most significant variant was rs334 (A allele; odds ratio [OR] = 2.76; 95% CI, 2.21–3.74; p = 5.9 × 10−19); using TOPMed imputed genotypes the most significant variant was rs2226952, found in the β-globin locus control region (G allele; OR = 2.14; 95% CI, 1.78–2.57; p = 5.1 × 10−16). After conditioning on rs334, the most strongly associated variant in the β-globin locus, rs33930165 (T allele, 1KG: OR = 4.09; 95% CI, 2.29–7.29; p = 1.7 × 10−6; TOPMed: OR = 3.58; 95% CI, 2.18–5.90; p = 4.7 × 10−7), which as a compound heterozygote with rs334 A allele, can cause SCD. To compare the power of different sample sets we developed a way to estimate the power of sample sets with different sample sizes, genotype arrays, and imputation platforms. Our results suggest that, in African American children, the strongest genetic determinants of pneumonia are those that increase the risk of SCD.

BackgroundHealthcare organisations risk harming patients and their families twofold. First, through the physical, emotional and/or financial harm caused by safety incidents themselves, and second, through the organisational response to incidents. The former is well-researched and targeted by interventions. However, the latter, termed ‘compounded harm’ is rarely acknowledged.AimsWe aimed to explore the ways compounded harm is experienced by patients and their families as a result of organisational responses to safety incidents and propose how this may be reduced in practice.MethodsWe used framework analysis to qualitatively explore data derived from interviews with 42 people with lived or professional experience of safety incident responses. This comprised 18 patients/relatives, 16 investigators, seven healthcare staff and one legal staff. People with lived and professional experience also helped to shape the design, conduct and findings of this study.FindingsWe identified six ways that patients and their families experienced compounded harm because of incident responses. These were feeling: (1) powerless, (2) inconsequential, (3) manipulated, (4) abandoned, (5) de-humanised and (6) disoriented.DiscussionIt is imperative to reduce compounded harm experienced by patients and families. We propose three recommendations for policy and practice: (1) the healthcare system to recognise and address epistemic injustice and equitably support people to be equal partners throughout investigations and subsequent learning to reduce the likelihood of patients and families feeling powerless and inconsequential; (2) honest and transparent regulatory and organisational cultures to be fostered and enacted to reduce the likelihood of patients and families feeling manipulated; and (3) the healthcare system to reorient towards providing restorative responses to harm which are human centred, relational and underpinned by dignity, safety and voluntariness to reduce the likelihood of patients and families feeling abandoned, de-humanised and disoriented.

Background: Perceived social support is an established predictor of post-traumatic stress disorder (PTSD) after exposure to a traumatic event. Gender is an important factor that could differentiate responses to social support, yet this has been little explored. Symptoms of complex PTSD are also common following trauma but have been under-researched in this context. Large scale studies with culturally diverse samples are particularly lacking.Objectives: In a multi-country sample, we examined: (a) gender differences in perceived social support and both posttraumatic stress symptom severity (PTSS) and complex posttraumatic stress symptom severity (CPTSS); (b) associations between social support and PTSS/CPTSS; and (c) the potential moderating role of gender in the relationship between perceived social support and trauma-related distress.Method: A total of 2483 adults (Mage = 30yrs, 69.9% females) from 39 countries, who had been exposed to mixed trauma types, completed the Multidimensional Scale of Perceived Social Support and the International Trauma Questionnaire (which captures PTSS/CPTSS). Regression analyses examined associations between gender, perceived social support, and PTSS/CPTSS; and tested for gender by social support interactions in predicting PTSS/CPTSS scores. Models were adjusted for age and socioeconomic status.Results: In our cross-country sample, females had greater PTSS/CPTSS than males (B = .23 [95% CI 0.16, 0.30], p

Objective: Young people with post-traumatic stress disorder experience difficulties in social and interpersonal domains. We examined whether the best-evidenced treatments of PTSD for children and young people (Trauma-focussed Cognitive Behavioural Therapy or Eye Movement Desensitisation and Reprocessing; aged 5–25) improve social or interpersonal factors in randomised controlled trials, compared to a comparator condition.Method: The review was preregistered on PROSPERO (CRD42023455615; 18th August 2023). Web of Science Core Collection, EMBASE, CINAHL, Pubmed, PsycINFO, Cochrane Central Register of Controlled Trials and PTSDPubs were searched, and data were extracted for social and interpersonal outcomes post treatment. A random effect meta-analysis was conducted to obtain between-group pooled effect size estimates.Results: The search resulted in 792 studies, of which 17 met our inclusion criteria (N = 2498). Our meta-analysis included 13 studies which investigated social skills and functioning, revealing a small but non-significant effect favouring the evidence-based treatment versus comparison (g = .20, 95% CI [−0.03, 0.44], p = .09). We narratively synthesised six studies which reported other social-related outcomes (e.g. perceptions of social support), and four out of six reported improved social domain outcomes for the evidence-based PTSD treatment condition. There was a large amount of heterogeneity, with no evidence that this could be explained by moderators.Conclusion: Few trials report on social and interpersonal outcomes, and where they are reported the evidence is mixed. It may be that trauma-focused therapies for PTSD need to be adapted in some circumstances, so that they address social and interpersonal deficits often seen in children and young people with PTSD.

"Emotionally based school avoidance" (EBSA) is a term used to describe young people who have difficulty attending school due to emotional needs. In comparison to previously favoured terms such as "school refuser", EBSA highlights the impact of unmet emotional needs over school non-attendance, which then informs the intervention offered for students struggling to attend school. This paper presents an exploratory single-case study undertaken at a specialist GCSE setting (School X) for students experiencing EBSA. The work was commissioned by the programme following three consecutive years in which all students completing their GCSEs (national curriculum) showed improvement in attendance and 85% achieved above their predicted grade. In addition, 95% of students were still in post-16 study after leaving the school. The study, therefore, aimed to explore students' views of protective factors in a setting where they have previously made progress in terms of attendance and achievement. Qualitative data were gathered using semi-structured questions with students in a group setting, delivered online using an anonymised computer software system. Quantitative data were gathered with students in a one-to-one situation using an adaption of the Q-sort technique, a self-contained "qualiquantilogical" methodology that aims to explore human subjectivity. Findings were collectively analysed using thematic analysis, which produced two over-arching themes: interconnectivity and psychological safety. Findings from this study are considered alongside research about interventions suggested to be effective for supporting students experiencing EBSA to re-engage with school and education.

Despite more than 150 years of research on the Jurassic and Cretaceous trigoniid bivalves of the Pacific Coast of North America, little mention is made of Washington State trigoniids. In this study, five trigoniid species from the Methow Basin are documented from three sites in the Lower Cretaceous conglomerate of Patterson Lake (cPL). Three of the species, Yaadia whiteavesi, Columbitrigonia condoni, and Notoscabrotrigonia oregana, are well-known in the literature. The other two, Parvitrigonia n. gen. cooperi n. sp. and Earlpackardia methowensis n. sp. are undescribed rutitrigoniids. These identifications revise the faunal lists from previous geological studies of the Methow Basin and allow a middle Albian age assignment to the upper portion of the cPL.

The design and manufacturing of objects in various industries have been fundamentally altered by the introduction of D-dimensional (3D) and four-dimensional (4D) printing technologies. Four-dimensional printing, a relatively new technique, has emerged as a result of the ongoing development and advancements in 3D printing. In this study, a stimulus-responsive material, N-Vinylcaprolactam-co-DEGDA (NVCL-co-DEGDA) resin, was synthesised by Stereolithography (SLA) 3D printing technique. The N-Vinylcaprolactam-co-DEGDA resins were initiated by the Diphenyl (2,4,6-trimethylbenzoyl) phosphine oxide (TPO) photoinitiator. A range of Di(ethylene glycol) diacrylate (DEGDA) concentrations in the NVCL-co-DEGDA resin was explored, ranging from 5 wt% to 40 wt%. The structural properties of the 3D printed objects were investigated by conducting Attenuated Total Reflectance–Fourier Transform Infrared Spectroscopy (ATR-FTIR). Additionally, the 3D printed samples underwent further characterisation through differential scanning calorimetry (DSC) and swelling analysis. The results revealed an inverse relationship between DEGDA concentration and Tg values, indicating that higher concentrations of DEGDA resulted in lower Tg values. Additionally, the pulsatile swelling studies demonstrated that increasing DEGDA concentration prolonged the time required to reach the maximum swelling ratio. These findings highlight the influence of DEGDA concentration on both the thermal properties and swelling behaviour of 3D printed samples.

Over the past two years, educators have turned to digital technologies and media more than ever to meet the needs of students amidst a global pandemic. While many edtech tools enable educators to create interactive materials with digital media (e.g., Nearpod, Kahoot!, Quizizz), educators more often seek existing digital resources to supplement their curriculum rather than create them from scratch (National Center for Education Statistics, 2021). Interactive Lessons (ILs) on PBS LearningMedia, produced by GBH Education and fellow PBS (Public Broadcasting Service) member stations, provide teachers with free, standards-aligned, classroom-ready resources. This panel will discuss how GBH Education develops ILs and the IL authoring platform, including findings from research studies on IL usage. Two educators will also discuss how they participate in IL development and integrate ILs into their classrooms to support diverse learners.

Introduction Children exposed to trauma are vulnerable to developing post-traumatic stress disorder (PTSD) and other adverse mental health outcomes. In low-and middle-income countries (LMICs), children are at increased risk of exposure to severe trauma and co-occurring adversities. However, relative to high-income countries, there is limited evidence of the factors that predict good versus poor psychological recovery following trauma exposure in LMIC children, and the role of caregiver support in these high-adversity communities.Methods and analysis We will conduct a longitudinal, observational study of 250 children aged 8–16 years and their caregivers in South Africa, following child exposure to acute trauma. Dyads will be recruited from community hospitals following a potentially traumatic event, such as a motor vehicle accident or assault. Potential participants will be identified during their hospital visit, and if they agree, will subsequently be contacted by study researchers. Assessments will take place within 4 weeks of the traumatic event, with 3-month and 6-month follow-up assessments. Participants will provide a narrative description of the traumatic event and complete questionnaires designed to give information about social and psychological risk factors. Child PTSD symptoms will be the primary outcome, and wider trauma-related mental health (depression, anxiety, behavioural problems) will be secondary outcomes. Regression-based methods will be used to examine the association of psychosocial factors in the acute phase following trauma, including caregiver support and responding, with child PTSD and wider mental health outcomes.Ethics and dissemination Ethical approvals have been granted by Stellenbosch University and the University of Bath, with additional approvals to recruit via hospitals and healthcare clinics being granted by the University of Cape Town, the Department of Health and the City of Cape Town. Study findings will be disseminated via publication in journals, workshops for practitioners and policy-makers, and public engagement events.

The Mini-International Neuropsychiatric Interview (MINI) is a widely used structured diagnostic interview that assesses common mental health disorders in the DSM-5 and ICD-10. Using data from the 2004 Pelotas Birth Cohort Study, we highlight that the criteria for manic episodes in the MINI is not coded according to DSM-5 or ICD-10 criteria. The implications of this are discussed

Purpose: To determine normal anatomical variation of abdominal wall musculature.Methods: A retrospective analysis of CT scans was performed on adults (>18 years) with normal abdominal wall muscles. Two radiologists analysed the images independently. Distances from three fixed points in the midline were measured. The fixed points were; P1, mid-way between xiphoid and umbilicus, P2, at the umbilicus, and P3, mid-way between umbilicus and pubic symphysis. From these three fixed points the following measurements were recorded; midline to lateral innermost border of the abdominal wall musculature, midline to lateral edge of rectus abdominis muscle, and midline to medial edges of all three lateral abdominal wall muscles. To obtain aponeurotic width, rectus abdominis width was subtracted from the distance to medial edge of lateral abdominal wall muscle.Results: Fifty normal CT scan were evaluated from between March 2023 to August 2023. Mean width of external oblique aponeurosis at P1 was 16.2 mm (IQR 9.2 mm to 20.7 mm), at P2 was 23.5 mm (IQR 14 mm to 33 mm), and at P3 no external oblique muscle was visible. Mean width of the internal oblique aponeurosis at P1 was 32.1 mm (IQR 17.5 mm to 45 mm), at P2 was 10.13 (IQR 1 mm to 17.5 mm), and at P3 was 9.2 mm (IQR 3.0 mm to 13.7 mm). Mean width of the transversus abdominis aponeurosis at P1 was −25.1 mm (IQR 37.8 mm to −15.0 mm), at P2 was 29.4 mm (IQR 20 mm to 39.8 mm), and at P3 was 20.3 mm (IQR 12 mm to 29 mm).Conclusion: In this study we describe normal anatomical variation of the abdominal wall muscles. Assessing this variability on the pre-operative CT scans of ventral hernia patients allows for detailed operative planning and decision making.

Grouping students at secondary school based on attainment is a prevalent practice in English schools. Despite this, research has suggested that those placed in low attaining groups are disadvantaged by their placement. This study aimed to provide an account of student engagement, teacher interactions and pedagogical approaches employed by English teachers. A mixed method, multiple case study design was used to report on classroom practices and student engagement in three low attaining Year 10 English classes in two secondary schools. Information was gathered using semi-structured interviews with teachers and students and lesson observations. Findings suggest that teachers of these classes promoted engagement by developing positive student--teacher relationships through praise that encouraged learning, minimising negative reprimands and adapting teaching to respond to their students' needs. The authors suggest that strategic use of these practices allows teachers to develop positive relationships with students, providing the foundation for engagement in lessons.

A high level of transparency in reported research is critical for several reasons, such as ensuring an acceptable level of trustworthiness and enabling replication. Transparency in qualitative research permits the identification of specific circumstances which are associated with findings and observations. Thus, transparency is important for the repeatability of original studies and for explorations of the transferability of original findings. There has been no investigation into levels of transparency in reported technology education research to date. With a position that increasing transparency would be beneficial, this article presents an analysis of levels of transparency in contemporary technology education research studies which employed interviews within their methodologies, and which were published within the "International Journal of Technology and Design Education and Design and Technology Education: An International Journal" (n = 38). The results indicate room for improvement, especially in terms of documenting researcher positionality, determinations of data saturation, and how power imbalances were managed. A discussion is presented on why it is important to improve levels of transparency in reported studies, and a guide on areas to make transparent is presented for qualitative and quantitative research.

Abstract Background Many adolescents who have been removed from the care of their biological parent(s) and placed in State or Local Authority care have experienced significant adversity, including high rates of maltreatment and other trauma(s). As a group, these young people experience far higher rates of mental health difficulties compared to their peers. While their mental health outcomes are well-documented, little is known about mechanisms that may drive this. One potential mechanism, linked to both trauma and adversity exposure and mental health, is affective control (the application of cognitive control in affective contexts). Methods We compared cognitive and affective control in 71 adolescents (65% girls) in care aged 11–18 (M = 14.82, SD = 2.10) and 71 age and gender-matched peers aged 11–19 years (M = 14.75, SD = 1.95). We measured cognitive and affective control using standard experimental tasks, and for those in care, we also examined associations with self-reported emotion regulation, mental health, and school well-being. Results After controlling for IQ, there was a significant group difference in affective control performance, with those in care on average performing worse across all tasks. However, further analyses showed this was driven by deficits in overall cognitive control ability, and was not specific to, or worsened by, affective stimuli. Further, we found no evidence that either cognitive or affective control was associated with emotion regulation abilities or the mental health and well-being of young people in care. Conclusions Results suggest that cognitive and affective control may not underlie mental health for young people in care, though limitations should be considered. We discuss implications for theory and intervention development, and avenues for further research. Trial registration: https://doi.org/10.17605/OSF.IO/QJVDA

Abstract Public and Patient Involvement in research is becoming a requirement on most research funding applications; this includes both healthcare and lab-based research. Whilst case studies and practical guides have been developed and are well documented for PPI in healthcare research, there is very little guidance available for PPI in lab-based research. In this piece we discuss our experience of how we have successfully involved patients in our translational cancer research, which is focused on developing personalised treatment for high-grade serous ovarian cancer. We discuss the benefits it has made to both our research and to us as researchers. The patients involved write about their experience, what they enjoyed, and the benefits they felt. Although PPI is quite topical and is being widely discussed, there is hesitancy among researchers, especially those in lab-based research about getting started because of a lack of practical guidance about how to implement it. Here, we have shared our experience, hopefully providing a practical example of how PPI can be incorporated into a lab-based research project.

Abstract Contiguous ABCD1/ DXS1357E deletion syndrome (CADDS) is a rare deletion syndrome involving two contiguous genes on Xq28, ABCD1 and BCAP31 (formerly known as DXS1357E). Only nine individuals with this diagnosis have been reported in the medical literature to date. Intragenic loss‐of‐function variants in BCAP31 cause the deafness, dystonia, and cerebral hypomyelination syndrome (DDCH). Isolated pathogenic intragenic variants in ABCD1 are associated with the most common peroxisomal disorder, X‐linked adrenoleukodystrophy (X‐ALD), a single transporter deficiency, which in its more severe cerebral form is characterised by childhood‐onset neurodegeneration and high levels of very‐long‐chain fatty acids (VLCFA). While increased VLCFA levels also feature in CADDS, the few patients described to date all presented as neonates with a severe phenotype. Here we report a tenth individual with CADDS, a male infant with dysmorphic facial features who was diagnosed through ultra‐rapid whole genome sequencing (WGS) in the setting of persistent cholestatic liver disease, sensorineural hearing loss, hypotonia and growth failure and developmental delay. Biochemical studies showed elevated VLCFA and mildly reduced plasmalogens. He died at 7 months having developed pancreatic exocrine deficiency and interstitial lung disease, two features we propose to be possible extensions to the CADDS phenotype. We also review the genetic, phenotypic, and biochemical features in previously reported individuals with CADDS.

Background Acute inpatient mental health services report high levels of safety incidents. The application of patient safety theory has been sparse, particularly concerning interventions that proactively seek patient perspectives. Objective(s) Develop and evaluate a theoretically based, digital monitoring tool to collect real-time information from patients on acute adult mental health wards about their perceptions of ward safety. Design Theory-informed mixed-methods study. A prototype digital monitoring tool was developed from a co-design approach, implemented in hospital settings, and subjected to qualitative and quantitative evaluation. Setting and methods Phase 1: scoping review of the literature on patient involvement in safety interventions in acute mental health care; evidence scan of digital technology in mental health contexts; qualitative interviews with mental health patients and staff about perspectives on ward safety. This, alongside stakeholder engagement with advisory groups, service users and health professionals, informed the development processes. Most data collection was virtual. Phase 1 resulted in the technical development of a theoretically based digital monitoring tool that collected patient feedback for proactive safety monitoring. Phase 2: implementation of the tool in six adult acute mental health wards across two UK NHS trusts; evaluation via focused ethnography and qualitative interviews. Statistical analysis of WardSonar data and routine ward data involving construction of an hour-by-hour data set per ward, permitting detailed analysis of the use of the WardSonar tool. Participants A total of 8 patients and 13 mental health professionals participated in Phase 1 interviews; 33 staff and 34 patients participated in Phase 2 interviews. Interventions Patients could use a web application (the WardSonar tool) to record real-time perceptions of ward safety. Staff could access aggregated, anonymous data to inform timely interventions. Results Coronavirus disease 2019 restrictions greatly impacted the study. Stakeholder engagement permeated the project. Phase 1 delivered a theory-based, collaboratively designed digital tool for proactive patient safety monitoring. Phase 2 showed that the tool was user friendly and broadly acceptable to patients and staff. The aggregated safety data were infrequently used by staff. Feasibility depended on engaged staff and embedding use of the tool in ward routines. There is strong evidence that an incident leads to increased probability of further incidents within the next 4 hours. This puts a measure on the extent to which social/behavioural contagion persists. There is weak evidence to suggest that an incident leads to a greater use of the WardSonar tool in the following hour, but none to suggest that ward atmosphere predicts future incidents. Therefore, how often patients use the tool seems to send a stronger signal about potential incidents than patients’ real-time reports about ward atmosphere. Limitations Implementation was limited to two NHS trusts. Coronavirus disease 2019 impacted design processes including stakeholder engagement; implementation; and evaluation of the monitoring tool in routine clinical practice. Higher uptake could enhance validity of the results. Conclusions WardSonar has the potential to provide a valuable route for patients to communicate safety concerns. The WardSonar monitoring tool has a strong patient perspective and uses proactive real-time safety monitoring rather than traditional retrospective data review. Future work The WardSonar tool can be refined and tested further in a post Coronavirus disease 2019 context. Study registration This study is registered as ISRCTN14470430. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128070) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 14. See the NIHR Funding and Awards website for further award information. Plain language summary Mental health wards can feel unsafe. We know that patients and staff have different ideas about what makes a hospital ward safe or unsafe. Patients are often the first to know when the atmosphere on a ward becomes tense but, often, no one asks them for input or feedback at the time. We worked with service users and staff to develop new technology to make it easy for patients to tell staff about changes in the ward atmosphere. We put everyone’s ideas together and some technical developers then built a digital safety tool to use on a tablet computer. Patients put in anonymous information about the ward atmosphere and staff can read it straight away. We tested it on six adult acute mental health wards for 10 weeks. We asked patients and staff what they thought about the tool and we looked at how it was being used. Patients and staff liked the look of the tool on the tablet computer. Some staff said they did not need it because they could tell how patients were feeling, but patients told us that staff did not talk with them much and did not always know when patients were feeling tense. Coronavirus disease 2019 made life difficult on the wards. Most ward managers said the tool could be helpful, but they had not had time to get used to it on the wards. Occasionally, the tablet computers were out of action. Many staff tried hard to use the tool. Most patient information was gathered when it was calm, perhaps because staff were not too busy to help them. We found that this tool could help staff know about tensions on the ward, but they need to get used to it and bring it into ward routines. Scientific summary Context Mental health services report high levels of safety incidents. This is a concern and an NHS priority. UK government records for 2020–1 show 300,703 reported incidents in mental health services in England. Incidents in acute mental health wards frequently involve violence and self-harm. Safety incidents have been associated with increased costs and harm to patients and staff. Furthermore, one incident may increase the likelihood of further incidents, via a disturbed ward milieu and social contagion. Successfully avoiding one incident may therefore reduce the probability of future incidents. Patient perspectives on safety highlight factors such as not being listened to, or not feeling psychologically safe; however, incident reporting systems fail to capture the spectrum of patients’ safety concerns. Although patient involvement is a mental health research priority, patient-reported safety data are rarely collected. Onerous processes and fear of repercussions discourage experience experts from participating in mental health research. Patients may experience harm but have difficulties raising concerns with staff. If patients had opportunities to report safety issues in real time, staff could potentially respond and intervene before situations escalate. Interpersonal dynamics on acute mental health wards can change rapidly, affecting care quality and feelings of safety. Potentially, prospective clinical surveillance could promote safety by monitoring rather than simply measuring safety. Proactive day-to-day monitoring of patient perspectives might bring greater benefits than relying on retrospective review, and could be part of a broader vision to improve ward safety. Currently, there is no mechanism by which moment-to-moment safety data from patients on acute mental health wards can be captured and made available to staff in real time. Research aims This study’s focus was to use co-design to develop a digital tool for collecting and monitoring real-time data directly from patients on adult acute mental health wards, and to explore whether this information could be used by staff on a daily basis to anticipate and avoid developing incidents, thereby proactively managing safety. The objectives were: to co-design with service users and staff a digital innovation that will allow real-time monitoring of safety on acute mental health wards; to explore the feasibility and acceptability of capturing real-time feedback from service users about safety; to explore how staff use this information when reported during daily handovers (or other mechanism); to explore how the resulting data are related to quality and safety metrics; to explore how these data can be used longitudinally to promote safety. Methodology Two-phase, mixed-methods design. Literature reviews Scoping review of the literature on patient involvement in safety interventions Systematic searches of academic databases [Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, MEDLINE, EMBASE, Web of Science and Scopus] and grey literature (2000–20) were conducted March–June 2020. Additional sources included 14 mental health-specific sources (e.g. Centre for Global Mental Health); 25 non-mental health-specific sources (e.g. Royal College of Nursing); the National Institute for Health and Care Excellence (NICE) evidence database; ProQuest Thesis and Dissertations database and three social media platforms. Following screening, a narrative synthesis of included literature was conducted. A total of 52 studies were included; 33 focused on reducing staff use of restrictive practices. About half reported limited patient participation. Patients were involved mainly as co-thinkers, advisers and partners rather than decision-makers. Safety interventions ranged across organisational change, ward-level decision-making and individual interventions (e.g. mobile phone app). The more extensive their involvement, the more likely patients were to have active roles in the research. High patient involvement seemed to be focused on forensic mental health and associated with reduction in restrictive practices. Low patient involvement tended to be associated with less reduction in restrictive practices. However, methodological quality of the reviewed papers was inconsistent. Evidence scan of the application of digital technology in mental health contexts An evidence scan of the literature around digital technology in a mental health context was conducted in November 2020 (databases: CINAHL, PsycINFO and Web of Science). Research in this field appears largely focused on therapeutic interventions, such as assessment of suicidality, and psychological support therapies, such as counselling. Limited research on telecare and the design of mental health apps for other contexts was identified but digital technologies specifically for mental health care are relatively new. Many digital technologies for health (mainly apps) have been designed within the tech industry, not always using mental health expertise. There was an emphasis on usability and accessibility and there were some concerns around confidentiality. Provided digital technology does not cause patients any harm it is seen as potentially helpful and useful. Successful technology implementation is supported by a reliable internet connection, training for users of the technology, technical support, and effective communication and leadership. Theoretical basis The current study is aligned with patient safety theory, specifically the Measurement and Monitoring Safety Framework domain ‘sensitivity to operations’. This domain, which emphasises monitoring the safety of care as it is delivered in real time, recognises patients and families as important information sources; and highlights the need for staff to be responsive to subtle changes and disturbances. Contagion and milieu were taken as underpinning concepts for promoting ward safety and the development of the safety monitoring tool. A logic model for the WardSonar monitoring tool was developed with a supporting programme theory. Patient and public involvement and engagement A member of the core research team who is a lived experience expert led the approach to patient and public involvement and engagement. This was based around principles of equality, diversity and inclusion. Stakeholder engagement sessions advised on the development of the monitoring tool; critiqued monitoring tool prototypes; and informed the strategies for implementation and evaluation. Study design This was a two-phase mixed-methods design, supported by two NHS trusts. Phase 1: overlapping stages progressed towards conceptual clarification, followed by technical specification and delivery of a testable intervention. Key components were literature reviews, stakeholder interviews and meaningful stakeholder engagement. Technical developers produced a web app that used patient feedback via a tablet computer for proactive safety monitoring: the WardSonar safety monitoring tool. The patient interface employed a weather analogy with questions such as ‘How does the ward atmosphere feel to you today?’ (very calm to very stormy). The staff dashboard displayed aggregated and anonymised information collected via the patient interface in real time. Phase 2: the monitoring tool was implemented in two NHS trusts and evaluated via qualitative interviews, focused ethnography, pre- and post-intervention measures, real-time measures and routinely collected ward data. Two monitoring tools were given to each of the six participating adult acute mental health wards, including two psychiatric intensive care units. Staff were asked to use the tool to invite patients to record their perceptions of the ward atmosphere, three times daily. Changes to protocol The project commenced in the very early stages of the coronavirus disease 2019 (COVID-19) pandemic. Pragmatic adjustments produced a feasible alternative with some virtual Phase 1 data collection and discussions, adjusted timescales and the removal of a phase of small-scale testing. Modes of analysis and interpretation Qualitative evaluation Design Focused ethnographic observations on the six wards explored implementation context. Patient and staff perspectives were explored through individual interviews. Data were synthesised using a pen portrait analytical process. Findings The design of the tool was well received. There was variation between how it was perceived and implemented but general patterns emerged. Patients liked the opportunity to express their concerns and talk with staff who brought the tool to them, explaining that they believed staff were often unaware when patients felt unsafe. Most staff thought the tool prompted useful conversations and could be helpful, although psychiatric intensive care unit staff tended to say it was unnecessary. However, the tool’s functionality for informing safety interventions via aggregated patient data was poorly understood. There was a drop off in engagement with the tool over time. Ward managers discussed the difficulties of motivating busy and exhausted staff to embed the technology into ward routines. Quantitative evaluation Design Staff perceptions of safety culture and ward atmosphere were examined using a pre- and post-implementation design. Baseline measurements including the EssenCES© (Climate Evaluation Schema; Institute of Forensic Psychiatry and Sex Research, Essen, Germany) scale and the Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture were taken at baseline and after a 10-week implementation period. Various statistical models were used to explore relationships between wards, WardSonar use and occurrence of incidents over time, including zero-inflated negative binomial models and ordinal logistic regression. The design matrix was consistent across all models. It consisted of fixed effects to capture time-invariant ward-specific effects, time of day variables and lagged values of incidents of WardSonar responses, depending on whether the model was explaining current incidents or current response. A simple linear trend determined any systematic deviation in use or response over time. Results Statistical analysis showed substantial and significant variation in the use of the device across wards, both in terms of the likelihood of any submission at a given time and the number of submissions. There were no statistically significant differences in staff perceptions of ward atmosphere or safety culture pre and post WardSonar implementation. Owing to the sample size, analyses were not conducted at the individual ward level. The volume of patient submissions via the monitoring tool corresponded more closely to incidents than ward atmosphere averages. It was lower over time, at night, at weekends, and when there were peaks in incidents. Submission volume decreased over time, but the probability of a submission reporting a better atmosphere increased slightly. Submission volume was higher during the daytime or before an incident and there was weak evidence of increased volume in the hour after an incident. The type of response for both direction and current atmosphere was not sensitive to whether or not there had been an incident. In terms of direction of atmosphere, there were significant differences across wards, but this was the only significant variable. Evenings led to greater likelihood of a worse atmosphere being reported, given that a submission was made. An incident in the previous four hours was strongly predictive of a further incident. An individual ‘stormy’ response or increased volume of submissions within the previous hour had some predictive value regarding a further incident. Qualitative analysis highlighted some data quality issues; for example, staff were more likely to collect submissions during quiet times and very unlikely to collect submissions during busy times; the tool was not used if the device was lost or otherwise out of action. There were some periods of days or weeks on some wards when no submissions were collected. The technology was pragmatically adapted for use within an NHS context. Some connectivity issues were identified, although data inputting did not seem to be affected. Further understanding of relationships between ward atmosphere and staff stress or absence due to sickness, contagion between incidents in the seclusion room and impact on staff and patients on the main ward and implementation processes would inform future implementation of WardSonar and interpretation of WardSonar data. Discussion The WardSonar patient safety monitoring tool can collect real-time data about patients’ perceptions of safety, to support staff in monitoring and improving the clinical environment. The research environment was affected by the COVID-19 pandemic and was severely atypical. Regarding the quantitative analysis, the lower volume of responses may have severely limited the power of the statistical analyses to identify statistically significant relationships between responses and outcomes. The decline in tool use over time may simply be an artefact of the pandemic or may have a number of causes. Previous studies have examined factors affecting participation and attrition in digital health technology research. The volume of routinely collected data was not affected and it is those data in which significant findings were identified. Strengths and limitations WardSonar’s strong patient perspective arguably gives it particular relevance for addressing patient safety. The co-design approach produced a tool that was apparently well designed, acceptable and easy to use. Stakeholder perspectives fundamentally impacted conceptualisation, development and operationalisation, adding to WardSonar’s validity. The separate components of the mixed-methods design were mutually beneficial, resulting in rounded insights into the study data, including strong evidence to support the idea of behavioural contagion between safety incidents. Some technical issues with connectivity cast doubt on the reliability of the tool. The amended research design was curtailed to adapt to the COVID-19 research context. The tools developed within the study used existing technology that was within budget and suitable for the research aims. Some technology challenges may be attributable to the limitations of this tool for data visualisation and could potentially be addressed in the future via a bespoke dashboard. Data were gathered from interviews with patients, staff and observations on each ward at selected time points, but because interviews were opportunistic, it is unclear how representative they were of staff and patient populations. Only the English language was used. It may have been valuable to include patients in the pre and post evaluation EssenCES (Climate Evaluation Schema) and Agency for Healthcare Research and Quality (AHRQ) assessments, although this could have been burdensome. Furthermore, one of the aims of assessing patient safety culture via the staff-facing AHRQ measure was to explore composite measures over time that linked to factors within the logic model and programme theory around how the staff dashboard may support staff in monitoring and improving the safety of the clinical environment. Equality, diversity and inclusion The current study was predicated on principles of equality, diversity and inclusion. Stakeholder perspectives were integral to design and development. The views of people not interviewed are unknown. Likewise, little information was collected concerning personal demographic characteristics of participants. This was a deliberate decision made with respect to the ethical arguments around collecting personal information, and because demographic information was not considered relevant in the current study. Reliance on the English language and the limited diversity data reduce the relevance of the results. Implications for decision-makers Further focus on the tool’s implementation in clinical practice warrants additional research; for example, implementation in a post COVID-19 environment could improve uptake, enhancing data validity. The WardSonar tool can facilitate measurement of contagion and may identify the likelihood of future incidents. The ability to monitor patient perspectives in real time provides a unique, proactive approach to safety. Avoiding reliance on the English language and collecting diversity data could broaden the relevance of the results in future studies. Future technical iterations could refine the staff dashboard and the model for deploying the tools in the ward environment. An approach whereby patients can input data unprompted may improve accuracy and reduce variation in use, enhancing results validity. Further development would require key decisions relating to ownership of the technology. Study registration This study is registered as ISRCTN14470430. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: NIHR128070) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 14. See the NIHR Funding and Awards website for further award information.

BackgroundExercise rehabilitation is a promising strategy for reducing cardiovascular disease risk among patients with breast cancer. However, the evidence is primarily derived from programs based at exercise centers with in-person supervised delivery. Conversely, most patients report a preference for home-based rehabilitation. As such, there is a clear need to explore strategies that can provide real-time supervision and coaching while addressing consumer preferences. Evidence from cardiac rehabilitation has demonstrated the noninferiority of a smartphone-based telerehabilitation approach (REMOTE-CR) to improve cardiorespiratory fitness in people with cardiovascular disease compared to a center-based program. ObjectiveThis study aims to assess the feasibility, safety, and preliminary efficacy of the REMOTE-CR program adapted for patients with breast cancer at risk of cardiotoxicity (REMOTE-COR-B). We will also assess the satisfaction and usability of REMOTE-COR-B. MethodsWe will conduct a single-arm feasibility study of the REMOTE-COR-B program among patients with stage I-III breast cancer who are at risk of cardiotoxicity (taking treatment type and dose, as well as other common cardiovascular disease risk factors into account) and who are within 24 months of completing primary definitive treatment. Participants (target sample size of 40) will receive an 8-week smartphone-based telerehabilitation exercise program involving remotely delivered real-time supervision and behavior change support. The platform comprises a smartphone and wearable heart rate monitor, as well as a custom-built smartphone app and web application. Participants will be able to attend remotely monitored exercise sessions during set operating hours each week, scheduled in both the morning and evening. Adherence is the primary outcome of the trial, assessed through the number of remotely monitored exercise sessions attended compared to the trial target (ie, 3 sessions per week). Secondary outcomes include additional trial feasibility indicators (eg, recruitment and retention), safety, satisfaction, and usability, and objective and patient-reported efficacy outcomes (cardiovascular fitness, quality of life, fatigue, self-reported exercise, self-efficacy, habit strength, and motivation). Adherence, feasibility, and safety outcomes will be assessed during the intervention period; intervention satisfaction and usability will be assessed post intervention; and objective and patient-reported efficacy outcomes will be assessed at baseline, post intervention (2-month postbaseline assessment), and at follow-up (5-month postbaseline assessment). ResultsRecruitment for this trial commenced in March 2023, and 7 participants had been recruited as of the submission of the manuscript. The estimated completion date for the project is October 2024, with results expected to be published in mid-2025. ConclusionsThe REMOTE-COR-B intervention is a novel and promising approach to providing exercise therapy to patients with breast cancer at risk of cardiotoxicity who have unique needs and heightened safety risks. This project will provide important information on the extent to which this approach is satisfactory to patients with breast cancer, safe, and potentially effective, which is necessary before larger-scale research or clinical projects. Trial RegistrationAustralian New Zealand Clinical Trials Registry ACTRN12621001557820; www.anzctr.org.au/ACTRN12621001557820.aspx International Registered Report Identifier (IRRID)DERR1-10.2196/53301

Abstract Protein‐based biomaterial use is expanding within medicine, together with the demand to visualize their placement and behavior in vivo. However, current medical imaging techniques struggle to differentiate between protein‐based implants and surrounding tissue. Here a fast, simple, and translational solution for tracking transplanted protein‐based scaffolds is presented using X‐ray CT–facilitating long‐term, non‐invasive, and high‐resolution imaging. X‐ray visible scaffolds are engineered by selectively iodinating tyrosine residues under mild conditions using readily available reagents. To illustrate translatability, a clinically approved hernia repair mesh (based on decellularized porcine dermis) is labeled, preserving morphological and mechanical properties. In a mouse model of mesh implantation, implants retain marked X‐ray contrast up to 3 months, together with an unchanged degradation rate and inflammatory response. The technique's compatibility is demonstrated with a range of therapeutically relevant protein formats including bovine, porcine, and jellyfish collagen, as well as silk sutures, enabling a wide range of surgical and regenerative medicine uses. This solution tackles the challenge of visualizing implanted protein‐based biomaterials, which conventional imaging methods fail to differentiate from endogenous tissue. This will address previously unanswered questions regarding the accuracy of implantation, degradation rate, migration, and structural integrity, thereby accelerating optimization and safe translation of therapeutic biomaterials.

Question For parents of children and young people (CYP) with diagnosed mental health difficulties, what are the levels of parents’ well-being and psychological need?Study selection and analysis Medline, PsycINFO, EMBASE, AMED, CINAHL, Web of Science and Cochrane Library of Registered Trials were searched from inception to June 2023. Inclusion criteria: parents of CYP aged 5–18 years with formal mental health diagnosis. Data were extracted from validated measures of well-being or psychological needs with established cut-off points or from a controlled study.Findings 32 of the 73 310 records screened were included. Pooled means showed clinical range scores for one measure of depression, and all included measures of anxiety, parenting stress and general stress. Meta-analyses showed greater depression (g=0.24, 95% CI 0.11 to 0.38) and parenting stress (g=0.34, 95% CI 0.20 to 0.49) in parents of CYP with mental health difficulties versus those without. Mothers reported greater depression (g=0.42, 95% CI 0.18 to 0.66) and anxiety (g=0.73, 95% CI 0.27 to 1.18) than fathers. Narrative synthesis found no clear patterns in relation to CYP condition. Rates of parents with clinically relevant levels of distress varied. Typically, anxiety, parenting stress and general stress scored above clinical threshold. Quality appraisal revealed few studies with a clearly defined control group, or attempts to control for important variables such as parent gender.Conclusions The somewhat mixed results suggest clinical anxiety, parenting and general stress may be common, with sometimes high depression. Assessment and support for parents of CYP with mental health problems is required. Further controlled studies, with consideration of pre-existing parental mental health difficulties are required.PROSPERO registration number CRD42022344453.

Nonalcoholic fatty liver disease (NAFLD) is a leading cause of chronic liver disease and is highly correlated with metabolic disease. NAFLD results from environmental exposures acting on a susceptible polygenic background. This study performed the largest multiethnic investigation of exonic variation associated with NAFLD and correlated metabolic traits and diseases. An exome array meta-analysis was carried out among eight multiethnic population-based cohorts (n = 16 492) with computed tomography (CT) measured hepatic steatosis. A fixed effects meta-analysis identified five exome-wide significant loci (P

Saccharomyces cerevisiae metabolism produces ethanol and other compounds during the fermentation of grape must into wine. Thousands of genes change expression over the course of a wine fermentation, allowing S. cerevisiae to adapt to and dominate the fermentation environment. Investigations into these gene expression patterns previously revealed genes that underlie cellular adaptation to the grape must and wine environments, involving metabolic specialization and ethanol tolerance. However, the majority of studies detailing gene expression patterns have occurred in controlled environments that may not recapitulate the biological and chemical complexity of fermentations performed at production scale. Here, an analysis of the S. cerevisiae RC212 gene expression program is presented, drawing from 40 pilot-scale fermentations (150 liters) using Pinot noir grapes from 10 California vineyards across two vintages. A core gene expression program was observed across all fermentations irrespective of vintage, similar to that of laboratory fermentations, in addition to novel gene expression patterns likely related to the presence of non-Saccharomyces microorganisms and oxygen availability during fermentation. These gene expression patterns, both common and diverse, provide insight into Saccharomyces cerevisiae biology critical to fermentation outcomes under industry-relevant conditions.IMPORTANCE This study characterized Saccharomyces cerevisiae RC212 gene expression during Pinot noir fermentation at pilot scale (150 liters) using industry-relevant conditions. The reported gene expression patterns of RC212 are generally similar to those observed under laboratory fermentation conditions but also contain gene expression signatures related to yeast-environment interactions found in a production setting (e.g., the presence of non-Saccharomyces microorganisms). Key genes and pathways highlighted by this work remain undercharacterized, indicating the need for further research to understand the roles of these genes and their impact on industrial wine fermentation outcomes.

Ribosomal DNA amplicon sequencing of grape musts has demonstrated that microorganisms occur nonrandomly and are associated with the vineyard of origin, suggesting a role for the vineyard, grape, and wine microbiome in shaping wine fermentation outcomes. Here, ribosomal DNA amplicon sequencing from grape musts and RNA sequencing of eukaryotic transcripts from primary fermentations inoculated with the wine yeast Saccharomyces cerevisiae RC212 were used to profile fermentations from 15 vineyards in California and Oregon across two vintages. These data demonstrate that the relative abundance of fungal organisms detected by ribosomal DNA amplicon sequencing correlated with neither transcript abundance from those same organisms within the RNA sequencing data nor gene expression of the inoculated RC212 yeast strain. These data suggest that the majority of the fungi detected in must by ribosomal DNA amplicon sequencing were not active during the primary stage of these inoculated fermentations and were not a major factor in determining RC212 gene expression. However, unique genetic signatures were detected within the ribosomal DNA amplicon and eukaryotic transcriptomic sequencing that were predictive of vineyard site and region. These signatures included S. cerevisiae gene expression patterns linked to nitrogen, sulfur, and thiamine metabolism. These genetic signatures of site offer insight into specific environmental factors to consider with respect to fermentation outcomes and vineyard site and regional wine characteristics.IMPORTANCE The wine industry generates billions of dollars of revenue annually, and economic productivity is in part associated with regional distinctiveness of wine sensory attributes. Microorganisms associated with grapes and wineries are influenced by region of origin, and given that some microorganisms play a role in fermentation, it is thought that microbes may contribute to the regional distinctiveness of wine. In this work, as in previous studies, it is demonstrated that specific bacteria and fungi are associated with individual wine regions and vineyard sites. However, this work further shows that their presence is not associated with detectable fungal gene expression during the primary fermentation or the expression of specific genes by the inoculate Saccharomyces cerevisiae strain RC212. The detected RC212 gene expression signatures associated with region and vineyard site also allowed the identification of flavor-associated metabolic processes and environmental factors that could impact primary fermentation outcomes. These data offer novel insights into the complexities and subtleties of vineyard-specific inoculated wine fermentation and starting points for future investigations into factors that contribute to regional wine distinctiveness.