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Abstract Background The Near Visual Acuity Questionnaire Presbyopia (NAVQ-P) is a patient-reported outcome (PRO) measure that was developed in a phakic presbyopia population to assess near vision function impacts. The study refined and explored the psychometric properties and score interpretability of the NAVQ-P and additional PRO items assessing near vision correction independence (NVCI), near vision satisfaction (NVS), and near vision correction preference (NVCP). Methods This was a psychometric validation study conducted using PRO data collected as part of a Phase IIb clinical trial (CUN8R44 A2202) consisting of 235 randomized adults with presbyopia from the US, Japan, Australia, and Canada. Data collected at baseline, week 2, and months 1, 2, and 3 during the 3-month trial treatment period were included in the analyses to assess item (question) properties, NAVQ-P dimensionality and scoring, reliability, validity, and score interpretation. Results Item responses were distributed across the full response scale for most NAVQ-P and additional PRO items. Confirmatory factor analysis supported the pre-defined unidimensional structure and calculation of a NAVQ-P total score as a measure of near vision function. Item deletion informed by item response distributions, dimensionality analyses, item response theory, and previous qualitative findings, including clinical input, supported retention of 14 NAVQ-P items. The 14-item NAVQ-P total score had excellent internal consistency (α = 0.979) and high test-retest reliability (Intraclass Correlation Coefficients > = 0.898). There was good evidence of construct-related validity for all PROs supported by strong correlations with concurrent measures. Excellent results for known-groups validity and ability to detect change analyses were also demonstrated. Anchor-based and distribution-based methods supported interpretation of scores through generation of group-level and within-individual estimates of meaningful change thresholds. A meaningful within-patient change in the range of 8-15-point improvement on the NAVQ-P total score (score range 0–42) was recommended, including a more specific responder definition of 10-point improvement. Conclusions The NAVQ-P, NVCI, and NVS are valid and reliable instruments which have the ability to detect change over time. Findings strongly support the use of these measures as outcome assessments in clinical/research studies and in clinical practice in the presbyopia population.

Abstract Introduction Chronic ocular surface pain (COSP) is described as a persistent, moderate-to-severe pain at the ocular surface lasting more than 3 months. Symptoms of COSP have a significant impact on patients’ vision-dependent activities of daily living (ADL) and distal health-related quality of life (HRQoL). To adequately capture patient perspectives in clinical trials, patient-reported outcome (PRO) measures must demonstrate sufficient evidence of content validity in the target population. This study aimed to explore the patient experience of living with COSP and evaluate content validity of the newly developed Chronic Ocular Pain Questionnaire (COP-Q) for use in COSP clinical trials. Methods Qualitative, combined concept elicitation (CE) and cognitive debriefing (CD) interviews were conducted with 24 patients experiencing COSP symptoms in the USA. Interviews were supplemented with real-time data collection via a daily diary app task in a subset of patients (n = 15) to explore the day-to-day patient experience. Three healthcare professionals (HCPs) from the USA, Canada, and France were also interviewed to provide a clinical perspective. CE results were used to further inform development of a conceptual model and to refine PRO items/response options. CD interviews assessed relevance and understanding of the COP-Q. Interviews were conducted across multiple rounds to allow item modifications and subsequent testing. Results Eye pain, eye itch, burning sensation, eye dryness, eye irritation, foreign body sensation, eye fatigue, and eye grittiness were the most frequently reported symptoms impacting vision-dependent ADL (e.g., reading, using digital devices, driving) and wider HRQoL (e.g., emotional wellbeing, social functioning, work). COP-Q instructions, items, and response scales were understood, and concepts were considered relevant. Feedback supported modifications to instruction/item wording and confirmed the most appropriate recall periods. Conclusions Findings support content validity of the COP-Q for use in COSP populations. Ongoing research to evaluate psychometric validity of the COP-Q will support future use of the instrument in clinical trial efficacy endpoints.

Abstract Background Dry eye disease (DED), Meibomian gland dysfunction (MGD), and Sjögren’s syndrome dry eye disease (SS-DED) are eye dryness conditions that show significant overlap in various symptoms of ocular discomfort. The aim of this study was to qualitatively explore the patient experience and evaluate content validity of the newly developed Dry Eye Disease Questionnaire (DED-Q). Methods Semi-structured interviews were conducted with 61 US adults who reported experiencing ocular symptoms due to their physician-confirmed primary diagnosis of DED (n = 21), MGD (n = 20), or SS-DED (n = 20). The open-ended concept-elicitation phase was followed by cognitive debriefing (CD) of the DED-Q to evaluate participants’ understanding and relevance of the instructions, items, response options, and recall periods. Interviews were also conducted with eight specialist healthcare professionals to assess clinical relevance of the concepts included. Verbatim interview transcripts were analyzed using thematic analysis in ATLAS.ti v8 software. Results A total of 29 symptoms and 14 impacts on quality of life were reported across participant interviews. Primary ocular symptoms reported included eye dryness (n = 61/61; 100%), eye irritation (n = 55/61; 90%), eye itch (n = 54/61; 89%), burning sensation (n = 52/61; 85%), and foreign body sensation (n = 51/61; 84%). The most impacted aspects of daily life were using digital screens (n = 46/61; 75%), driving (n = 45/61; 74%), working (n = 39/61; 64%), and reading (n = 37/61; 61%). CD findings showed most participants had good understanding of DED-Q items and confirmed most concepts were relevant to the lived experience of their condition. Aside from few minor changes to the items and examples to facilitate more accurate interpretation, the proposed instruction wording was modified for various symptom and impact modules to encourage participants to focus only on dry eye vision problems. Conclusions This research identified multiple prevalent symptoms and impacts of DED, MGD, and SS-DED, most of which were similar across the conditions. The DED-Q was confirmed to be a content-valid PRO measure suitable for use in clinical studies to assess the patient experience of DED, MGD, and SS-DED. Future work will focus on evaluating the psychometric properties of the DED-Q for use as an efficacy endpoint in clinical trials.

Abstract Introduction Amblyopia is a reduction in vision in one or both eyes due to impaired development of the visual pathway. This study explored the experience of amblyopia and treatment from the patient, caregiver, and clinician perspectives. Methods A targeted literature review, including a review of social media listening (SML) studies, was conducted. Next, qualitative interviews were conducted with amblyopia patients, caregivers of children with amblyopia, and ophthalmologists with experience treating patients with amblyopia. The findings informed the development of a disease model. Amblyopia clinical experts provided input at key stages. Results Twelve data sources were reviewed, including qualitative studies in the literature and SML studies. Overall, 133 patients/caregivers were interviewed (23 adults, 16 adolescents, 47 child–caregiver dyads), plus 10 ophthalmologists from the United States, France, and Germany. Reduced visual acuity, impaired depth perception, impaired peripheral vision, and double vision were the most frequently reported symptoms. Amblyopia impacted daily activities (reading, using digital devices), the ability to move around, school/work (productivity, seeing the board in class), emotional well-being (frustration, sadness), and social functioning (difficulty socializing). Treatments, including patching and corrective lens, also impacted daily activities (using digital devices, sports/leisure), mobility (bumping into things), and work/school (tasks taking longer) as well as emotional well-being (embarrassment), and social functioning (bullying/stigma). Conclusion The findings contribute valuable insights into the adult and pediatric experience of amblyopia from a multi-stakeholder perspective. The findings were used to critically assess existing clinical outcome assessments and supported the development of patient- and observer-reported outcome measures for use in amblyopia clinical trials.

BackgroundOcular pain has multifactorial etiologies that affect activities of daily life, psychological well-being, and health-related quality of life (QoL). Chronic ocular surface pain (COSP) is a persistent eye pain symptom lasting for a period longer than 3 months. ObjectiveThe objective of this social media listening study was to better understand COSP and related symptoms and identify its perceived causes, comorbidities, and impact on QoL from social media posts. MethodsA search from February 2020 to February 2021 was performed on social media platforms (Twitter, Facebook, blogs, and forums) for English-language content posted on the web. Social media platforms that did not provide public access to information or posts were excluded. Social media posts from Australia, Canada, the United Kingdom, and the United States were retrieved using the Social Studio platform—a web-based aggregator tool. ResultsOf the 25,590 posts identified initially, 464 posts about COSP were considered relevant; the majority of conversations (98.3%, n=456) were posted by adults (aged >18 years). Work status was mentioned in 52 conversations. Patients’ or caregivers’ discussions across social media platforms were centered around the symptoms (61.9%, n=287) and causes (58%, n=269) of ocular pain. Patients mentioned having symptoms associated with COSP, including headache or head pressure, dry or gritty eyes, light sensitivity, etc. Patients posted that their COSP impacts day-to-day activities such as reading, driving, sleeping, and their social, mental, and functional well-being. ConclusionsInsights from this study reported patients’ experiences, concerns, and the adverse impact on overall QoL. COSP imposes a significant burden on patients, which spans multiple aspects of daily life.

The Einstein Probe (EP) achieved its first detection and localization of a bright X-ray flare, EP240219a, on 2024 February 19, during its commissioning phase. Subsequent targeted searches triggered by the EP240219a alert identified a faint, untriggered gamma-ray burst (GRB) in the archived data of Fermi Gamma-ray Burst Monitor (GBM), Swift Burst Alert Telescope (BAT), and Insight-HXMT/HE. The EP Wide-field X-ray Telescope (WXT) light curve reveals a long duration of approximately 160 s with a slow decay, whereas the Fermi/GBM light curve shows a total duration of approximately 70 s. The peak in the Fermi/GBM light curve occurs slightly later with respect to the peak seen in the EP/WXT light curve. Our spectral analysis shows that a single cutoff power-law (PL) model effectively describes the joint EP/WXT–Fermi/GBM spectra in general, indicating coherent broad emission typical of GRBs. The model yielded a photon index of ∼–1.70 ± 0.05 and a peak energy of ∼257 ± 134 keV. After detection of GRB 240219A, long-term observations identified several candidates in optical and radio wavelengths, none of which was confirmed as the afterglow counterpart during subsequent optical and near-infrared follow-ups. The analysis of GRB 240219A classifies it as an X-ray-rich GRB (XRR) with a high peak energy, presenting both challenges and opportunities for studying the physical origins of X-ray flashes, XRRs, and classical GRBs. Furthermore, linking the cutoff PL component to nonthermal synchrotron radiation suggests that the burst is driven by a Poynting flux-dominated outflow.

Abstract Introduction Amblyopia is a neurodevelopmental vision disorder, characterized by poor vision in one or both eyes. Given the lack of existing clinical outcome assessments (COA) considered fit-for-purpose for amblyopia clinical trials, this study developed new COAs to assess amblyopia symptoms and health-related quality of life (HRQoL) impacts in adult and pediatric amblyopia populations that conform with best practice standards and regulatory guidelines. Methods Findings from a targeted qualitative literature review informed the development of three versions of the new Amblyopia Quality of Life Questionnaire (AmbQoL): a patient-reported outcome measure (PRO) for individuals aged 13 years and older, a PRO for children aged 9–12 years, and an observer-reported outcome measure (ObsRO) for caregivers of children aged 4–8 years. Qualitative interviews were conducted with the target populations, and with ophthalmologists experienced in treating amblyopia patients to evaluate the content validity for further development of the AmbQoL. A translatability assessment was conducted to ensure cultural appropriateness and usability across multiple languages. Feedback from Food and Drug Administration (FDA) was also sought on the instruments, and clinical experts provided input at key stages. Results Interviews were conducted with 112 patients/caregivers and ten ophthalmologists from the USA, France, and Germany. The instructions, items, and response options were well understood across all AmbQoL versions. Feedback from the patients, caregivers, ophthalmologists, the translatability assessment, the FDA, and the expert clinicians informed minor wording modifications to enhance clarity and translatability. Some items were removed due to low relevance. The study resulted in a 23-item adult/adolescent PRO, 24-item child PRO, and 12-item ObsRO, each employing a 7-day recall period. Conclusion Each AmbQoL version has documented support for its face and content validity for use in amblyopia populations aged ≥ 4 years. Further research is necessary to evaluate the psychometric measurement properties of the AmbQoL instruments to enable their use in amblyopia treatment trials.

Abstract Introduction Retinitis Pigmentosa (RP) and Leber Congenital Amaurosis (LCA) are rare inherited retinal degenerative disorders. The Visual Symptom and Impact Outcomes patient-reported outcome (ViSIO-PRO) and observer-reported outcome (ViSIO-ObsRO) instruments were developed in this population to assess visual function symptoms and impacts on vision-dependent activities of daily living (ADL) and distal health-related quality of life (HRQoL). This study aimed to explore the psychometric properties of the ViSIO-PRO and ViSIO-ObsRO in RP/LCA. Methods The 49-item ViSIO-PRO and 27-item ViSIO-ObsRO instruments were completed by 83 adult and adolescent patients and 22 caregivers of child patients aged 3–11 years with RP/LCA, respectively, at baseline and 12–16-day follow-up. Concurrent measures were also administered at baseline. Psychometric analyses assessed item (question) properties, dimensionality, scoring, reliability, validity, and score interpretation. Results Item responses were mainly evenly distributed across the response scale, and inter-item correlations were mostly moderate to strong (> 0.30) at baseline within hypothesized domains. Item deletion was informed by item properties, qualitative data, and clinical input and supported retention of 35 ViSIO-PRO items and 25 ViSIO-ObsRO items. Confirmatory factor analysis in line with pre-hypothesized domains supported a four-factor model assessing visual function symptoms, mobility, vision-dependent ADL, and distal HRQoL. A bifactor model supported calculation of total scores and four domain scores. Internal consistency was high for domain and total scores (Cronbach’s alpha > 0.70) and test–retest reliability for total scores was strong between baseline and 12–16-day follow-up (intraclass correlation coefficients 0.66–0.98). Convergent validity was supported by strong correlations in a logical pattern with concurrent measures. Mean baseline scores differed significantly between severity groups. Distribution-based methods provided initial insights to guide interpretation of scores. Conclusions Findings supported item reduction and established scoring of the instruments. Evidence of reliability and validity as outcome measures in RP/LCA was also reported. Further research is ongoing to explore responsiveness of the ViSIO-PRO and ViSIO-ObsRO instruments and interpretation of change scores.

BackgroundPost–COVID-19 condition (PCC), colloquially known as long COVID, is a multisystem condition characterized by persistent symptoms beyond 4 weeks after the SARS-CoV-2 infection. More than 60 million people with PCC worldwide need prompt assessment, diagnosis, and monitoring, with many requiring specialist help from a multidisciplinary team of health care professionals (HCPs). Consequently, a scalable digital system is required for both people with PCC and HCPs to capture the breadth of symptoms and their impact on health, using patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs). ObjectiveWe aim to develop and implement a novel PCC digital PROM (DPROM) platform for (1) securely collecting PROM and PREM data from people with PCC, (2) enabling users to monitor symptoms longitudinally and assess response to treatment, (3) generating reports for the electronic health records (EHRs), (4) providing summary reports on PCC services based on national requirements, and (5) facilitating the sharing of relevant data with authorized research teams to accelerate our understanding of this new condition and evaluate new strategies to manage PCC. MethodsWe (1) undertook requirement analysis with people with PCC, HCPs, and researchers to identify the needs of the DPROM platform and determine its required functionalities; (2) designed and developed a clinically useful web portal for staff and a mobile app for patients, with a web-based alternative app to improve patient and staff choice, limit the risk of digital exclusion, and account for variability across services; (3) determined the PROMs and PREMs that PCC services would prefer to use on the platform; and (4) designed the summary report function that can be generated for each user for the EHR and for reporting to national health authorities. ResultsA DPROM platform to record PCC symptom profile, condition severity, functional disability, and quality of life, based on the C19-YRS (Yorkshire Rehabilitation Scale) and other PROMs and PREMs, was developed. Individual-level medical information and details on the COVID-19 illness can be captured systematically. The platform generates easy-to-understand scores, radar plots and line graphs for people with PCC to self-monitor their condition and for HCPs to assess the natural course of the condition and the response to interventions. Clinics can configure a suite of PROMs and PREMs based on their local and national service and commissioning requirements and support research studies which require large-scale data collection on PROMs. The DPROM platform enables automatic aggregate data analysis for services to undertake service evaluation and cost-effectiveness analysis. The DPROM platform generated summary report can be uploaded to the EHRs of people with PCC. ConclusionsA multifunctional DPROM platform to assess, grade, and monitor PCC has been developed. Future research will analyze the system’s usability in specialist PCC clinical services and other long-term conditions.

It has been recognized that well-connected networks of protected areas are needed to halt the continued loss of global biodiversity. The recently signed Kunming-Montreal biodiversity agreement commits countries to protecting 30% of terrestrial lands in well-connected networks of protected areas by 2030. To meet these ambitious targets, land-use planners and conservation practitioners will require tools to identify areas important for connectivity and track future changes. In this study we present methods using circuit theoretic models with a subset of sentinel park nodes to evaluate connectivity for a protected areas network. We assigned a lower cost to natural areas within protected areas, under the assumption that animal movement within parks should be less costly given the regulation of activities. We found that by using mean pairwise effective resistance (MPER) as an indicator of overall network connectivity, we were able to detect changes in a parks network in response to simulated land-use changes. As expected, MPER increased with the addition of high-cost developments and decreased with the addition of new, low-cost protected areas. We tested our sentinel node method by evaluating connectivity for the protected area network in the province of Ontario, Canada. We also calculated a node isolation index, which highlighted differences in protected area connectivity between the north and the south of the province. Our method can help provide protected areas ecologists and planners with baseline estimates of connectivity for a given protected area network and an indicator that can be used to track changes in connectivity in the future.

Since their first discovery in the late 1960s, gamma-ray bursts have attracted an exponentially growing interest from the international community due to their central role in the most highly debated open questions of the modern research of astronomy, astrophysics, cosmology, and fundamental physics. These range from the intimate nuclear composition of high-density material within the core of ultra-dense neuron stars, to stellar evolution via the collapse of massive stars, the production and propagation of gravitational waves, as well as the exploration of the early universe by unveiling the first stars and galaxies (assessing also their evolution and cosmic re-ionization). GRBs in the past ∼50 years have stimulated the development of cutting-edge technological instruments for observations of high-energy celestial sources from space, leading to the launch and successful operations of many different scientific missions (several of them still in data-taking mode currently). In this review, we provide a brief description of the GRB-dedicated missions from space being designed and developed for the future. The list of these projects, not meant to be exhaustive, shall serve as a reference to interested readers to understand what is likely to come next to lead the further development of GRB research and the associated phenomenology.

Objective Dry eye disease (DED) is a multifactorial disease involving the tears and ocular surface. It impacts a patient’s quality of life (QoL) and ability to perform daily activities. This study assessed the burden of self-reported DED among adults in eight European countries.Design Online cross-sectional survey.Setting General population in France, Italy, Germany, Greece, the Netherlands, Portugal, Spain and Sweden.Participants Adults aged ≥18 years with (n=6084) and without (n=6161) self-reported DED were recruited via emails and screened.Main outcome measures All participants completed National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25) and EuroQol-5 Dimension-5 Level Questionnaire (EQ-5D-5L). All DED participants completed the Eye Dryness Score (EDS) Visual Analogue Scale, and Ocular Comfort Index and Work Productivity and Activity Impairment Questionnaire: Specific Health Problem questionnaires. In addition, half of the respondents with DED completed Survey A (Impact of Dry Eye on Everyday Life) and the other half completed Survey B (Standard Patient Evaluation of Eye Dryness Questionnaire) and Dry Eye Questionnaire-5.Results Participants with self-reported DED had lower functional vision and lower overall health status than participants without self-reported DED as measured by the NEI-VFQ and EQ-5D-5L, respectively.Increasing self-reported DED severity as measured by the EDS was shown to correspond with worse symptom severity/frequency, lower functional vision, higher impact on work productivity, daily activities and QoL.Conclusion This study showed that patients’ reported burden of self-reported DED was similar across the eight European countries. Those with self-reported DED reported lower health status and functional vision compared to those without self-reported DED and these parameters worsen with increasing disease severity.

Governments around the world have acknowledged that urgent action is needed to conserve and restore ecological connectivity to help reverse the decline of biodiversity. In this study we tested the hypothesis that functional connectivity for multiple species can be estimated across Canada using a single, upstream connectivity model. We developed a movement cost layer with cost values assigned using expert opinion to anthropogenic land cover features and natural features based on their known and assumed effects on the movement of terrestrial, non-volant fauna. We used Circuitscape to conduct an omnidirectional connectivity analysis for terrestrial landscapes, in which the potential contribution of all landscape elements to connectivity were considered and where source and destination nodes were independent of land tenure. Our resulting map of mean current density provided a seamless estimate of movement probability at a 300 m resolution across Canada. We tested predictions in our map using a variety of independently collected wildlife data. We found that GPS data for individual caribou, wolves, moose, and elk that traveled longer distances in western Canada were all significantly correlated with areas of high current densities. The frequency of moose roadkill in New Brunswick was also positively associated with current density, but our map was not able to predict areas of high road mortality for herpetofauna in southern Ontario. The results demonstrate that an upstream modelling approach can be used to characterize functional connectivity for multiple species across a large study area. Our national connectivity map can help governments in Canada prioritize land management decisions to conserve and restore connectivity at both national and regional scales.

We report the discovery of the unusually bright long-duration gamma-ray burst (GRB), GRB 221009A, as observed by the Neil Gehrels Swift Observatory (Swift), Monitor of All-sky X-ray Image, and Neutron Star Interior Composition Explorer Mission. This energetic GRB was located relatively nearby ( z = 0.151), allowing for sustained observations of the afterglow. The large X-ray luminosity and low Galactic latitude ( b = 4.°3) make GRB 221009A a powerful probe of dust in the Milky Way. Using echo tomography, we map the line-of-sight dust distribution and find evidence for significant column densities at large distances (≳10 kpc). We present analysis of the light curves and spectra at X-ray and UV–optical wavelengths, and find that the X-ray afterglow of GRB 221009A is more than an order of magnitude brighter at T _0 + 4.5 ks than that from any previous GRB observed by Swift. In its rest frame, GRB 221009A is at the high end of the afterglow luminosity distribution, but not uniquely so. In a simulation of randomly generated bursts, only 1 in 10 ^4 long GRBs were as energetic as GRB 221009A; such a large E _γ _,iso implies a narrow jet structure, but the afterglow light curve is inconsistent with simple top-hat jet models. Using the sample of Swift GRBs with redshifts, we estimate that GRBs as energetic and nearby as GRB 221009A occur at a rate of ≲1 per 1000 yr—making this a truly remarkable opportunity unlikely to be repeated in our lifetime.

Abstract Background Evidence-based clinical practice is an inherent component of mental health professional practice in developed countries. However, little is known about professional perspectives of evidence-based practice in mental in developing countries such as Ghana. This paper describes the processes involved in the delivery of best practice in Ghana. The paper reports on a realistic evaluation of mental health nurses and allied health professionals’ views on the evidence-based therapeutic process in Ghana. Methods A purposive sample of 30 mental health professionals (MHPs) was recruited to participate in semi-structured, in-depth interviews. Thematic analysis was used to analyse the data. A program theory of Context + Mechanism = Outcome (CMO) configuration was developed from the analysis. Results The thematic analysis identified two contexts, mechanism and outcome configurations (themes): 1) technical competency stimulates evidence-based mental health services, and 2) therapeutic relationship building ensures effective interaction. The study demonstrates that contextual factors (technical competencies and therapeutic relationship building) together with mechanisms (intentional and unintentional) help to promote quality in mental health service provision. However, contextual factors such as a lack of sign language interpreters yielded unintended outcomes including barriers to communication with providers for consumers with hearing impairment and those from linguistic minority backgrounds. Conclusion Government stakeholders and policymakers should prioritise policies, periodic monitoring and adequate financial incentives to support the mechanisms that promote technical competence in MHPs and the building of therapeutic relationship.

Abstract We use NASA's Van Allen Probes data to build a 3‐dimensional Radiation Belt Daily Average Electron flux model (RB‐Daily‐E) covering 25 differential energies (33–7,700 keV), 17 pitch angles, and a variable number of L shells from 2 to 7. RB‐Daily‐E can be used to deduce the fluences observed by any satellite that flew within Van Allen Probes' 7‐year mission lifetime. We supplement Van Allen Probes fluxes with THEMIS average fluxes to cover higher L shells when applying the model to a secondary satellite. RB‐Daily‐E agrees with both the Arase high‐energy electron experiment (XEP) flux data and the GPS Combined X‐ray Dosimeter (CXD) electron flux approximately within a factor of two or better, and comparisons with AE9 are as expected. The RB‐Daily‐E Model has applications for when actual fluxes on day‐timescales are required for post‐anomaly investigations, including long‐term radiation environment effects such as solar cell and solar array degradation. We therefore applied the model to two GPS satellites to determine electron fluence inputs to the Equivalent Flux (EQFLUX) solar cell degradation model. The modeled voltage degradation well‐matched the voltage degradation trends identified in the GPS telemetry data, suggesting that the radiation environment is the primary cause of the voltage degradation. The current degradation was largely underestimated, suggesting that current degradation is influenced by other sources.

Abstract We report a simple, economical and low temperature route for phase-pure synthesis of two distinct phases of Cu–Sb–S, chalcostibite (CuSbS2) and tetrahedrite (Cu12Sb4S13) nanostructures. Both compounds were prepared by the decomposition of a mixture of bis(O-ethylxanthato)copper(II) and tris(O-ethylxanthato)antimony(III), without the use of solvent or capping ligands. By tuning the molar ratio of copper and antimony xanthates, single-phases of either chalcostibite or tetrahedrite were obtained. The tetrahedrite phase exists in a cubic structure, where the Cu and Sb atoms are present in different coordination environments, and tuning of band gap energy was investigated by the incorporation of multivalent cationic dopants, i.e. by the formation of Zn-doped tetrahedrites Cu12−xZnxSb4S13 (x = 0.25, 0.5, 0.75, 1, 1.2 and 1.5) and the Bi-doped tetrahedrites Cu12Sb4−xBixS13 (x = 0.08, 0.15, 0.25, 0.32, 0.4 and 0.5). Powder X-ray diffraction (p-XRD) confirms single-phase of cubic tetrahedrite structures for both of the doped series. The only exception was for Cu12Sb4−xBixS13 with x = 0.5, which showed a secondary phase, implying that this value is above the solubility limit of Bi in Cu12Sb4S13 (12%). A linear increase in the lattice parameter a in both Zn- and Bi-doped tetrahedrite samples was observed with increasing dopant concentration. The estimated elemental compositions from EDX data are in line with the stoichiometric ratio expected for the compounds formed. The morphologies of samples were investigated using SEM and TEM, revealing the formation of smaller particle sizes upon incorporation of Zn. Incorporation of Zn or Bi into Cu12Sb4S13 led to an increase in band gap energy. The estimated band gap energies of Cu12−xZnxSb4S13 films ranges from 1.49 to 1.6 eV, while the band gaps of Cu12Sb4−xBixS13 films increases from 1.49 to 1.72 eV with increasing x.

Key Point The editors thank the 2021 peer reviewers

Abstract Background Several typologies and guidelines are available to address the methodological and practical considerations required in mental health research. However, few studies have actually attempted to systematically identify and synthesise these considerations. This paper provides an integrative review that identifies and synthesises the available research evidence on mental health research methodological considerations. Methods A search of the published literature was conducted using EMBASE, Medline, PsycINFO, CINAHL, Web of Science, and Scopus. The search was limited to papers published in English for the timeframe 2000–2018. Using pre-defined inclusion and exclusion criteria, three reviewers independently screened the retrieved papers. A data extraction form was used to extract data from the included papers. Results Of 27 papers meeting the inclusion criteria, 13 focused on qualitative research, 8 mixed methods and 6 papers focused on quantitative methodology. A total of 14 papers targeted global mental health research, with 2 papers each describing studies in Germany, Sweden and China. The review identified several methodological considerations relating to study design, methods, data collection, and quality assurance. Methodological issues regarding the study design included assembling team members, familiarisation and sharing information on the topic, and seeking the contribution of team members. Methodological considerations to facilitate data collection involved adequate preparation prior to fieldwork, appropriateness and adequacy of the sampling and data collection approach, selection of consumers, the social or cultural context, practical and organisational skills; and ethical and sensitivity issues. Conclusion The evidence confirms that studies on methodological considerations in conducting mental health research largely focus on qualitative studies in a transcultural setting, as well as recommendations derived from multi-site surveys. Mental health research should adequately consider the methodological issues around study design, sampling, data collection procedures and quality assurance in order to maintain the quality of data collection.

Abstract Background Many older people (care recipients) experience long-term psychological distress due to the fear of falling again. Falls can affect carers due to concerns about their care recipients falling. Understanding carers’ fall concern is crucial to determine if carers are coping with the provision of care or have adequate knowledge and support in preventing their care recipients from falling at home. Methods A descriptive qualitative study was conducted to explore carers’ concern about their care recipients being at risk of falling and their management of fall risk at home. Twenty-two carers were recruited from two research registers and a large tertiary hospital in a regional centre of Australia. Carers were interviewed face-to-face, or by telephone using a semi-structured interview guide about their fall concern. The data was analysed using an inductive content analysis method. Results Eight major themes emerged from the interviews. Four themes described key factors influencing carers’ fall concern which include: 1) carers’ perception of fall and fall risk, 2) care recipients’ behaviour and attitude towards fall risk, 3) care recipients’ health and function, and 4) care recipients’ living environment. Another four themes described the management of care recipients’ fall risk which include: 5) fall prevention strategies used, 6) risk of preventing falls, 7) support from family and friends, and 8) support from healthcare professionals. Conclusions The findings from this qualitative study provide an insight into the carers’ awareness of fall risk, knowledge, and the availability of support in preventing their care recipients from falling at home. Healthcare professionals are encouraged to include carers and address their fall concern to improve fall prevention programmes for care recipients at risk of falling at home.

Abstract Accurate measurements of trapped energetic electron fluxes are of major importance for the studies of the complex nature of radiation belts and the characterization of space radiation environment. The harmonization of measurements between different instruments increases the accuracy of scientific studies and the reliability of data‐driven models that treat the specification of space radiation environment. An intercalibration analysis of the energetic electron flux measurements of the Magnetic Electron Ion Spectrometer (MagEIS) and the Relativistic Electron‐Proton Telescope (REPT) instruments on‐board the Van Allen Probes (VAP) Mission versus the measurements of the Extremely High Energy Electron Experiment (XEP) unit on‐board Arase satellite is presented. The performed analysis demonstrates a remarkable agreement between the majority of MagEIS and XEP measurements and suggests the rescaling of MagEIS HIGH unit and of REPT measurements for the treatment of flux spectra discontinuities. The proposed adjustments were validated successfully using measurements from ESA Environmental Monitoring Unit (EMU) on‐board GSAT0207 and the Standard Radiation Monitor (SREM) on‐board INTEGRAL. The derived results lead to the harmonization of science‐class experiments on‐board VAP (2012–2019) and Arase (2017–) and propose the use of the data sets as reference in a series of space weather and space radiation environment developments.

Key Point The editors thank the 2020 reviewers

[This corrects the article DOI: 10.1371/journal.pone.0233351.].

Iron (III) thioselenoimidodiphosphinate complex, Fe{(SePPh2NPPh2S)2N}3], was synthesized from the ligand [Ph2P(S)HNP(Se)Ph2], and the complex employed as the combined source of the targeted elements (Fe and Se) to generate orthorhombic FeSe2. This was achieved by thermolysis using a quartz glass tube, under reduced pressure at 500 °C during 1 h 30 min. The crystalline product was revealed by X-ray diffraction (XRD), while the morphology consisted of polygonal crystallites according to the scanning electron microscopy (SEM) studies. Superconducting quantum interference device (SQUID) measurements on the material confirmed its ferromagnetism as observed from the magnetization curve, indicated by the field-cooled and zero field-cooled conditions under a magnetic field of 100 Oe. This ferromagnetic material, FeSe2 finds useful application in producing electrical semiconductors.

Abstract Peer reviewing is the foundation of modern scholarship, with external specialists being asked to fairly check and evaluate submitted work. This difficult and often time‐consuming activity is performed voluntarily, with the understanding that one's own scholarship shall benefit down the line from a careful analysis of its assumption, results, accuracy, and yes, language, as we are now evaluating someone else's work. At Space Weather, we pride ourselves on a fair but quick review process yielding high‐quality articles with a time from submission to first decision of under one month. This would not be possible without the hard work of all our reviewers. Once a year, we take the occasion to name these women and men in order to thank them for their service to the journal and the community.

The mission concept THESEUS (Transient High Energy Sky and Early Universe Surveyor) aims at exploiting Gamma-Ray Bursts (GRB) to explore the early Universe, as well as becoming a cornerstone of multi-messenger and time-domain astrophysics. To achieve these goals, a key feature is the capability to survey the soft X-ray transient sky and to detect the faint and soft GRB population so far poorly explored. Among the expected transients there will be high-redshift GRBs, nearby low-luminosity, X-ray Flashes and short GRBs. Our understanding of the physics governing the GRB prompt emission will benefit from the 0.3 keV–10 MeV simultaneous observations for an unprecedented large number of hundreds of events per year. In particular the mission will provide the identification, accurate sky localisation and characterization of electromagnetic counterparts to sources of gravitational wave and neutrino sources, which will be routinely detected during the 2030s by the upgraded second generation and third generation Gravitational Wave (GW) interferometers and next generation neutrino detectors.

Abstract Introduction The importance of accessible mental health treatment is a global concern, particularly when one in five people will experience a mental health problem in their lifespan. This is no less important in Ghana; however, no studies have yet attempted to appraise and synthesise the potential enablers and barriers to accessing services in Ghana. The aim of this integrative review is therefore to identify and synthesise existing evidence on the barriers and enablers to accessing mental health services in Ghana. Methods A search of the published literature was conducted using Medline, EMBASE, PsycINFO, CINAHL (EBSCO), Web of Science, and Scopus electronic databases. The search was limited to papers published in English and within 2000–2018. Using pre-defined inclusion and exclusion criteria, two reviewers independently screened the titles and abstracts of the retrieved papers. A data extraction form and a Critical Appraisal Checklist were used to extract and appraise data, respectively. The integrative review incorporates both qualitative and quantitative data into a single synthesis. Results Out of 42 papers that met the inclusion criteria, 50% used qualitative methods, 33.3% used mixed methods and 16.7% used quantitative methods alone. The potential barriers in accessing mental health services were attitudinal, knowledge about services, treatment cost, transportation and geographical proximity, as well as perceived efficacy of medication. Similarly, the health systems factors contributing to barriers were low priority, limited funding sources, irregular medicine supply, limited services for marginalised groups and poor state of psychiatric facilities, together with poor management of mental health cadres. The potential enablers for service users involved increased decentralisation and integration, task-shifting and existing support services. Conclusion The existing evidence on mental health in Ghana is skewed towards weaknesses in the systems and stigma, with rationally little, or no, evidence or emphasis on the effectiveness, or quality of mental health services. These attributes largely neglect the provision of psychiatric services for marginalised mental health service user groups, including children, adolescents, people with disabilities and the elderly.

Abstract Background When dependent older persons (carees) experience a fall at home, their carers worry that they will fall again. This ongoing concern affects the carers’ wellbeing, perception of burden and can potentially change care arrangements. Previous research has focused on carers of high fall risk older persons with stroke, dementia or Parkinson’s disease. However, little is known about the carers’ concerns for carees at risk of falling generally; and there is no validated instrument to measure this concern. This study aims to explore carers’ fall concern about carees at risk of falling and the development of an instrument to measure this concern. Methods This study utilises an exploratory sequential design in the development of an instrument to measure carers’ concerns. Phase One will explore carers’ fall concern using a descriptive qualitative approach. Phases Two and Three will involve expert review, pilot testing and field testing of the instrument. Twenty participants will be recruited by purposive sampling in phase one, and convenience sampling of 50 and 250 participants respectively, in Phases Two and Three. The participants will be recruited from research volunteer registers and local hospital outpatient clinics. Participants will be 18 years old and older and the main carer of an older person. Participants will be interviewed about their concerns about falls. Inductive content analysis will be used to analyse interviews and develop items for the instrument. The psychometric properties of the raw instrument will be tested using an online survey. This study has received ethics approval from the Hunter New England Human Health Research Ethics Committee. Discussion This study aims to provide greater depth of understanding about the psychological concerns and emotional burden related to carees’ falls for carers. Quantifying carers’ concerns will provide a context for interventions to assist and support carers and in the greater vigilance of monitoring the falling incidence of carees.

Tuberculous meningitis (TBM), caused by Mycobacterium tuberculosis (Mtb), is the deadliest form of tuberculosis in humans, particularly in children and the geriatric population. However, the host-pathogen interactions underlying TBM is not well understood. Rabbits are a valuable model system to study TB in humans. The rabbit model of TB recapitulates several pathophysiological characteristics, including heterogeneity, architecture, and development of granulomas at the site of infection as observed in Mtb-infected human organs. Previously, our group has established a rabbit model of TBM that has been used to understand the host immune response to Mtb infection and to evaluate novel intervention therapies for TBM. In this model, rabbits infected intracisternally with Mtb showed histopathologic manifestations in the brain and meninges that are hallmarks of TBM in humans, including inflammatory cell accumulation and thickening of the leptomeninges. However, in this model, a helmet made of dental acrylic was attached to rabbit's skull with screws under anesthesia. At 24 h post-procedure, the animals were injected intracisternally with Mtb using a spinal needle. The rabbits were necropsied at various experimental time points up to 2 weeks post-infection. Although this method has been successful in establishing TBM, placement of the dental acrylic helmet on rabbit skull with screws that stays until the experimental endpoint poses stress to the animals and increases the chances of secondary infection. To alleviate these issues, we have developed an improved protocol, in which sedated rabbits are placed on specialised stereotaxic equipment and injected with Mtb intracisternally. This method is less cumbersome, faster, and more efficient in delivering the bacteria. Besides, the animals are not stressed by this method, compared to the previous one.

IntroductionIncorporating consumers' perspectives into the quality of mental health service measurement is a growing priority among mental health professionals' and policymakers. Despite this, there is limited empirical evidence related to consumer perspectives of quality of mental health services. This study, therefore, aims to measure the mediation and moderation effects of health system structure and process on mental health quality in Ghana.MethodsA random sample of 510 consumers were recruited to complete the Verona Satisfaction Scale (54-items), together with the WHO Disability Assessment Instrument (36 items) using the Redcap application. Confirmatory factor analysis (CFA) and Structural Equation Modelling were used to test the hypothesised theory using STATA 15.ResultsThe CFA showed that the hypothesised model had a good fit to the data. The findings confirmed the hypothesis that the process constructs mediate the relationship between the health system structure and the outcome of mental health services. Specifically, the health system structure had a positive and significant causal relationship with the mediator-process (β = 0.60; p0.05) and type of services (β = 0.025; p>0.05) had a positive moderating effect on the relationship between health system structure and outcome but were not significant.ConclusionImprovements to mental health system structure and the process could promote the quality of services as experienced by consumers. Government stakeholders are encouraged to accordingly strengthen health systems with the aim of improving the mental health outcomes for consumers.

The purpose of this article is to theoretically explore men’s preconception health as a mechanism to enhance fertility, as well as the health and well-being of the subject and his descendants. Premorbid risk factors and behaviors associated with stress, environmental toxins, excessive alcohol consumption, smoking, lack of exercise/obesity, and the use of illicit drugs are all known to affect fecundity. While there are many health clinics available to women, where advice in areas such as postnatal care of the newborn, family planning, and couples fertility is provided, there are few, if any, equivalent health clinics available to men. Additionally, getting men to attend primary health-care services has also been continuously problematic, even in the context of there being a clearly discernible need for treatment. It is argued in this article that an impetus is required to encourage men to focus on and improve their preconception health and to utilize primary health-care services to take action. An assertive men’s preconception health outlook can positively influence the conjugal relationship, fathering, male self-esteem, and continued good health. Using the sometimes complex concept of preconception health as a motivating factor for healthy lifestyle adaptation has the potential to improve male fertility outcomes and general health and well-being, as well as the health of future generations.

Foam cells are lipid-laden macrophages that contribute to the inflammation and tissue damage associated with many chronic inflammatory disorders. Although foam cell biogenesis has been extensively studied in atherosclerosis, how these cells form during a chronic infectious disease such as tuberculosis is unknown. Here we report that, unlike the cholesterol-laden cells of atherosclerosis, foam cells in tuberculous lung lesions accumulate triglycerides. Consequently, the biogenesis of foam cells varies with the underlying disease. In vitro mechanistic studies showed that triglyceride accumulation in human macrophages infected with Mycobacterium tuberculosis is mediated by TNF receptor signaling through downstream activation of the caspase cascade and the mammalian target of rapamycin complex 1 (mTORC1). These features are distinct from the known biogenesis of atherogenic foam cells and establish a new paradigm for non-atherogenic foam cell formation. Moreover, they reveal novel targets for disease-specific pharmacological interventions against maladaptive macrophage responses.