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In this article we share our learning experiences on the organizational design barriers we perceived to have encountered with scenario planning in higher education for program development. Our perceived barriers discussed include misalignment of culture and change intervention; constructing organizational reality and meaning making; knowledge creation and transfer of knowledge; and short term versus long term outcomes. Our retrospective analysis contributes to the understanding of the complexity of change in higher education and adds to the knowledge base on using scenario planning in a bureaucratic, hierarchical context. Our experiences are incongruent with implicit assumptions that scenario planning can be used in any context (Balarezo et al., 2017), and illustrate some important constraints to consider before using this type of forward-thinking intervention. We provide recommendations for using scenario planning and for transformational change in higher education. These changes have implications for more creative, future-oriented educational planning processes for improving higher education teaching and learning experiences.

Abstract Background Exposure to military burn pit smoke during deployment is associated with different respiratory and non-respiratory diseases. However, information linking smoke exposure to human pulmonary health is lacking. This study examined the effects of simulated burn pit smoke condensates on human airway epithelial cells (HAECs) from twelve donors (smokers/non-smokers, biological female/male) cultured at an air-liquid interface and exposed to condensates from three simulated burn pit waste materials (cardboard, plywood, and plastic) incinerated at two combustion conditions: smoldering and flaming. Cellular gene expression was analyzed using bulk RNA sequencing, and basolateral media cytokine levels were assessed using multiplex immunoassay. Results Flaming smoke condensates caused more significant differentially expressed genes (DEGs) with plywood flaming smoke being the most potent in altering gene expression and modulating cytokine release. Cardboard and plywood flaming condensates primarily activated detoxification pathways, whereas plastic flaming affected genes related to anti-microbial and inflammatory responses. Correlation analysis between smoke condensate chemicals and gene expression to understand the underlying mechanism revealed crucial role of oxygenated polycyclic aromatic hydrocarbons (PAHs) and aluminum, molybdenum, and silicon elements; IL6 expression was positively correlated with most PAHs. Stratification of data based on HAEC donor demographics suggests that these affect gene expression changes. Enrichment analysis indicated similarity with several deployment-related presumptive and reported diseases, including asthma, emphysema, and cancer of different organs. Conclusions This study highlights that simulated burn pit smoke exposure of HAECs causes gene expression changes indicative of deployment-related diseases with more pronounced effects seen in smokers and females. Future studies are needed to further characterize how sex and smoking status affect deployment-related diseases.

Abstract Background The Safe Environment for Every Kid (SEEK) model was developed to address psychosocial risk factors (financial worries, depressive symptoms, major parental stress, alcohol misuse and intimate partner violence) in the pediatric primary care setting but has not been evaluated from the parents’ perspective. To further investigate the usefulness of SEEK, it is important to explore how parents perceive the model. Objective The aim of the present study was to explore parents’ perceptions of the SEEK model as a part of regular health visits in the Child Health Services in Sweden. Participants and setting Eighteen parents (13 women and five men) in two Swedish counties participated in the study. Methods Semi-structured telephone interviews were conducted, and the resulting data were analyzed using reflective thematic analysis. Results Three themes were identified: Acceptance and understanding of the SEEK model in the child health services, The questionnaire as a bridge to a dialogue, and Feeling trust in the system and the child health nurse’s professional competence. Further, an overarching theme was created that encompassed a core meaning of all three themes; SEEK provides a process-oriented framework to receive support in parenting with a focus on child health. Conclusions The study showed that parents express both acceptance and understanding of the SEEK model and they perceive that the model provides an avenue for repeated dialogues about the family’s situation during the child’s upbringing and an opportunity to access support if needed.

This article contributes knowledge regarding professionals' experiences, conceptions, and expectations of a coordinator role in preschools/schools while multiprofessionally collaborating for supporting children "at risk". Data were collected via semi-structured interviews with professionals involved in a project in a Swedish municipality intended to prevent children from getting into difficulties. Procedures for thematic analysis were followed, and Billig's ideological dilemmas were used as a methodological tool. A coordinator role, assigned to head teachers, emerges as tense where dilemmas need to be addressed. The dilemmas are related to opposed, overarching ideas -- education for "all" versus treatment for specific children -- which require coordination. This article suggests that dialogues between actors need to be held when opposite positions can be articulated. To initiate and maintain such dialogues, a coordinator role is important.

COVID-19 has caused a revelation of change across the world. Higher education leaders faced significant challenges during the unprecedented crisis, particularly in the early stage of the pandemic. We examined the University of Sydney's response to the pandemic using key informant interviews with leaders at different levels of the university structure to fill the crisis management gap in Australia's higher education sector. Key themes that emerged from the interviews focused on the importance of communication strategies in crisis, how the level of collaboration affected the pandemic response efforts and that adaptability to change was essential for engagement and communication in a time where face-to-face contact was limited. We applied the thematic analysis results from the interviews to Mitroff and Pearson's crisis management model to reflect on the University's response. We identified several recommendations from the experiences for future public health crisis responses.

BACKGROUND: Digitization (using novel digital tools and strategies) and consumerism (taking a consumer-oriented approach) are increasingly commonplace in clinical trials, but the implications of these changes are not well described. METHODS: We assembled a group of trial experts from academia, industry, non-profit, and government to discuss implications of this changing trial landscape and provide guidance. RESULTS: Digitization and consumerism can increase the volume and diversity of trial participants and expedite recruitment. However, downstream bottlenecks, challenges with retention, and serious issues with equity, ethics, and security can result. A click and mortar approach, combining approaches from novel and traditional trials with the thoughtful use of technology, may optimally balance opportunities and challenges facing many trials. CONCLUSION: We offer expert guidance and three click and mortar approaches to digital, consumer-oriented trials. More guidance and research are needed to navigate the associated opportunities and challenges.

Industrial hemp (Cannabis sativa) production is complex, with strict regulatory constraints and challenges associated with a lack of labeled pesticides due to its status as a novel crop in the US. Four experiments were conducted in 2020 and 2021 to establish herbicide tolerances for hemp production in the coastal plain of Georgia, USA. Objectives included evaluating hemp response to pretransplant or posttransplant herbicides, determining if planting method influenced herbicide injury from residual preplant applied herbicides, and understanding how plastic mulch may influence hemp flower yields. When applied one day prior to transplanting, maximum hemp crop visual injury was less than 12% compared to the untreated control, with acetochlor, flumioxazin, fomesafen, pendimethalin, and norflurazon while dithiopyr, halosulfuron, isoxaben, and isoxaflutole resulted in greater than 50% injury. Posttransplant applications of S-metolachlor, acetochlor, pendimethalin, and clethodim resulted in less than 15% injury while halosulfuron, metribuzin, trifloxysulfuron, imazethapyr, and prometryn applications resulted in greater than 50% injury to plants. Preplant and posttransplant applied herbicides were found to have little effect on total tetrahydrocannabinol (THC), cannabidiol (CBD), or total cannabinoids in the dry flower after harvest. In a separate experiment, injury from halosulfuron and metribuzin was 52% to 56% less when planted with a mechanical transplanter as compared to the practice of using a transplant wheel to depress a hole in the soil followed by hand transplanting. In the final experiment, hemp dry flower yield in a non-plastic mulched (bareground) system was similar to that in a plastic mulched system. However, early season plant above-ground biomass was less in the plastic mulched system, which may have been due to elevated soil temperatures inhibiting early season growth.

Abstract Background Four out of five people living with osteoarthritis (OA) also suffer with at least one other long-term health condition. The complex interaction between OA and multiple long-term conditions (MLTCs) can result in difficulties with self-care, restricted mobility, pain, anxiety, depression and reduced quality of life. The aim of the MulTI-domain Self-management in Older People wiTh OstEoarthritis and Multi-Morbidities (TIPTOE) trial is to evaluate the clinical and cost-effectiveness of the Living Well self-management support intervention, co-designed with people living with OA, integrated into usual care, in comparison to usual care alone. Methods TIPTOE is a multi-centre, two-arm, individually randomised controlled trial where 824 individuals over 65 years old with knee and/or hip joint pain from their OA affected joint and at least one other long-term health condition will be randomised to receive either the Living Well Self-Management support intervention or usual care. Eligible participants can self-refer onto the trial via a website or be referred via NHS services across Wales and England. Those randomised to receive the Living Well support intervention will be offered up to six one-to-one coaching sessions with a TIPTOE-trained healthcare practitioner and a co-designed book. Participants will be encouraged to nominate a support person to assist them throughout the study. All participants will complete a series of self-reported outcome measures at baseline and 6- and 12-month follow-up. The primary outcome is symptoms and quality of life as assessed by the Musculoskeletal Health Questionnaire (MSK-HQ). Routine data will be used to evaluate health resource use. A mixed methods process evaluation will be conducted alongside the trial to inform future implementation should the TIPTOE intervention be found both clinically and cost-effective. An embedded ‘Study Within A Project’ (SWAP) will explore and address barriers to the inclusion of under-served patient groups (e.g. oldest old, low socioeconomic groups, ethnic groups). Discussion TIPTOE will evaluate the clinical and cost-effectiveness of a co-designed, living well personalised self-management support intervention for older individuals with knee and/or hip OA and MLTCs. The trial has been designed to maximise inclusivity and access. Trial registration ISRCTN 16024745 . Registered on October 16, 2023.

AbstractThe acute toxicity (sometimes called “overdose” or “poisoning”) crisis has affected Canadians from all walks of life and of all ages—children, youth, adults including older adults have died.

RésuméLa crise des intoxications aiguës (parfois appelées « surdoses » ou « empoisonnements ») touche la population canadienne à toutes les étapes de vie, que ce soit les jeunes, les adultes ou les aînés.

Abstract Periodontitis affects billions of people worldwide. To address relationships of periodontal niche cell types and microbes in periodontitis, we generated an integrated single-cell RNA sequencing (scRNAseq) atlas of human periodontium (34-sample, 105918-cell), including sulcular and junctional keratinocytes (SK/JKs). SK/JKs displayed altered differentiation states and were enriched for effector cytokines in periodontitis. Single-cell metagenomics revealed 37 bacterial species with cell-specific tropism. Fluorescence in situ hybridization detected intracellular 16 S and mRNA signals of multiple species and correlated with SK/JK proinflammatory phenotypes in situ. Cell-cell communication analysis predicted keratinocyte-specific innate and adaptive immune interactions. Highly multiplexed immunofluorescence (33-antibody) revealed peri-epithelial immune foci, with innate cells often spatially constrained around JKs. Spatial phenotyping revealed immunosuppressed JK-microniches and SK-localized tertiary lymphoid structures in periodontitis. Here, we demonstrate impacts on and predicted interactomics of SK and JK cells in health and periodontitis, which requires further investigation to support precision periodontal interventions in states of chronic inflammation.

Background: The study aim was to investigate the efficacy of an intervention designed to provide a basis for informed choices about future parenthood to special upper secondary school students with intellectual disabilities. Methods: A randomised trial with a waiting list control group was used. In total, 108 special upper secondary school students with mild or moderate intellectual disabilities, age 16-21 years, provided informed consent and participated. The intervention included education using the Parenting Toolkit and a Real Care Baby simulator. The analyses included 91 students (intervention group n = 46, 24F/22M; control group n = 45, 26F/19M). Results: The result showed that intervention group changed their attitudes to future parenting, from 'do not know' to 'know', significantly more than control group. The intervention increased knowledge levels in the intervention group. Conclusions: The intervention group showed increased ability to make informed choices and decisions about parenthood.

Background Hospital ‘command centres’ use digital technologies to collect, analyse and present real-time information that may improve patient flow and patient safety. Bradford Royal Infirmary has trialled this approach and presents an opportunity to evaluate effectiveness to inform future adoption in the United Kingdom. Objective To evaluate the impact of the Bradford Command Centre on patient care and organisational processes. Design A comparative mixed-methods study. Operational data from a study and control site were collected and analysed. The intervention was observed, and staff at both sites were interviewed. Analysis was grounded in a literature review and the results were synthesised to form conclusions about the intervention. Setting The study site was Bradford Royal Infirmary, a large teaching hospital in the city of Bradford, United Kingdom. The control site was Huddersfield Royal Infirmary in the nearby city of Huddersfield. Participants Thirty-six staff members were interviewed and/or observed. Intervention The implementation of a digitally enabled hospital command centre. Main outcome measures Qualitative perspectives on hospital management. Quantitative metrics on patient flow, patient safety, data quality. Data sources Anonymised electronic health record data. Ethnographic observations including interviews with hospital staff. Cross-industry review including relevant literature and expert panel interviews. Results The Command Centre was implemented successfully and has improved staff confidence of better operational control. Unintended consequences included tensions between localised and centralised decision-making and variable confidence in the quality of data available. The Command Centre supported the hospital through the COVID-19 pandemic, but the direct impact of the Command Centre was difficult to measure as the pandemic forced all hospitals, including the study and control sites, to innovate rapidly. Late in the study we learnt that the control site had visited the study site and replicated some aspects of the command centre themselves; we were unable to explore this in detail. There was no significant difference between pre- and post-intervention periods for the quantitative outcome measures and no conclusive impact on patient flow and data quality. Staff and patients supported the command-centre approaches but patients expressed concern that individual needs might get lost to ‘the system’. Conclusions Qualitative evidence suggests the Command Centre implementation was successful, but it proved challenging to link quantitative evidence to specific technology interventions. Staff were positive about the benefits and emphasised that these came from the way they adapted to and used the new technology rather than the technology per se. Limitations The COVID-19 pandemic disrupted care patterns and forced rapid innovation which reduced our ability to compare study and control sites and data before, during and after the intervention. Future work We plan to follow developments at Bradford and in command centres in the National Health Service in order to share learning. Our mixed-methods approach should be of interest to future studies attempting similar evaluation of complex digitally enabled whole-system changes. Study registration The study is registered as IRAS No.: 285933. 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: NIHR129483) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 41. See the NIHR Funding and Awards website for further award information. Plain language summary Safety-critical industries like airports often use ‘command centres’ to manage operations safely and efficiently. In contrast, most National Health Service hospitals have operational management that is fragmented across many departments and poorly co-ordinated. This may pose risks to the safety and care of patients and may partially explain excessive waiting times. Bradford Royal Infirmary is one of the first National Health Service hospitals to try out a command-centre approach using new digital technologies. Hospital staff at Bradford now work together in a purpose-built Command Centre room and monitor a ‘wall of analytics’ that displays real-time data from the hospital’s information systems. This study examines the implementation at Bradford in order to learn lessons that may help the National Health Service improve the way hospitals provide safe and efficient patient care. We reviewed what is known about the approach, analysed hospital data, observed teams working in the Command Centre, interviewed staff and ran workshops with patients. We also compared Bradford with a similar hospital that did not initially have a command centre. Our results showed the Bradford Command Centre does work. Staff told us the Command Centre helped them manage the hospital through the COVID-19 pandemic. Staff described how they used the new technology to improve efficiency and safety. We observed some challenges, including tension between the central team and local departments and concerns to make sure data were good quality. We could not measure the direct impact of the Command Centre on patient flow and safety using the hospital’s data because the pandemic disrupted normal operations so much. Patients expressed strong support for what they saw as modern methods but were concerned to ensure that the National Health Service tradition of personal care was preserved. Other National Health Service hospitals are interested in following a command-centre approach and our results should help them to learn from Bradford. Scientific summary Background A hospital command centre (CC) is a new approach to the management of hospital operations based on the colocation of decision-making staff and supported by digital technology to provide these staff with close to real-time information. Recent adoption of hospital CCs in the USA predominantly has demonstrated that the approach can be applied to manage hospital operations, despite their complexity. The supporting technology often includes decision-support algorithms that trigger digital notifications and alerts that identify potential safety or flow issues. These algorithms may be based on simple rules or more complex rules generated by machine learning from historic data, and the software technology has therefore been described as AI, meaning either artificial intelligence or, more accurately, augmented intelligence. In the UK, the implementation of a CC and associated technology by Bradford Teaching Hospitals NHS Trust represents a first of type for the UK NHS. To date, there has been limited evidence of the effectiveness of the CC approach and this study aims to address that evidence gap. Bradford Teaching Hospitals NHS Trust manages Bradford Royal Infirmary, an 800-bed NHS hospital located in Bradford in northern England. The Bradford Hospital Command Centre was implemented at Bradford Royal Infirmary through a phased approach in late 2019, was operational through the COVID-19 pandemic, and remains operational to date. It is designed to integrate and centralise operational decision-making to improve patient flow and patient safety across the whole hospital. The Comand Centre (CC) is implemented in a dedicated room in which up to 30 trained non-clinical management and support staff from different operational functions can sit together in teams facing a wall on which 8 large digital display screens are mounted. Each staff member answers telephone calls and performs their operational role using Information Technology (IT) systems on their desktop computer, information on the wall of display screens and communicating with team members and other teams within the room. A senior clinician or manager supports decision-making. The CC was implemented in November 2019, several months before the COVID-19 pandemic began to have a major impact on hospitals in the UK and globally. It was operational throughout the pandemic and, to date, it is firmly established as the centre for operational management of the hospital. The implementation of the CC at Bradford Royal Infirmary presents an opportunity to evaluate the potential strengths and weaknesses of the approach and to generate learning that can inform other hospitals considering adopting the approach. Objectives We aimed to evaluate the impact of the Bradford Command Centre on patient care and organisational processes. We hypothesised that the CC would improve patient flow, reduce bottlenecks and delays, enhance situational awareness to support operational decision-making, and facilitate identification and timely mitigation of threats to patient safety. This study had four research objectives: to evaluate the impact of the CC on patient safety, hospital operational efficiency and related organisational processes to understand the process of implementation of the CC and its integration into hospital management to contextualise the findings using cross-sector and cross-industry perspectives to synthesise the research findings to inform future investment and practice. Methods We conducted a comparative mixed-method case study at two sites: Study site – the CC at Bradford Royal Infirmary. Control site – Huddersfield Royal Infirmary, a hospital in the city of Huddersfield. The control site was selected as being geographically close (15 miles) and part of a similar-sized NHS hospital trust with similar challenges serving areas of high deprivation. At the start of this study, the control site had no plans to implement a CC but, during the study, they learnt from the study site and replicated some aspects of the Bradford Command Centre as part of their own pandemic response. The study combined ethnographic observation and interviews with data analytics of time-series operational data. We accessed and analysed data in the form of anonymised electronic health records from the study and control sites between January 2018 and August 2021 to cover the period before and after implementation of the Bradford Command Centre in November 2019. We conducted 72 hours of ethnographic observations of the CC operation over a period of 9 months after implementation. We conducted 15 interviews with hospital staff at the study site and 4 interviews with staff at the control site. To evaluate the impact of the CC (Objective 1), we described (qualitatively) and evaluated (statistically) the effect on hospital operations and outcomes. We used Interrupted Time Series Analysis to analyse variation in key output indicators in patient safety, patient flow and data quality. We qualitatively investigated situational awareness, operational decision-making, risk and co-ordination/communication across organisational units, from multiple stakeholder perspectives. To understand the process of implementation (Objective 2) our interviews explored staff recall of the implementation, including critical implementation factors and exploring unintended consequences. We used the interviews with staff at the control site to understand how a similar organisation adapted and changed over the same study period. To contextualise the findings (Objective 3), we reviewed the literature on command and control processes in non-healthcare safety-critical operations to extract key principles and contextual factors that may influence transferability of these models into a hospital setting. We also searched for evidence of other hospital CC implementations in the UK and worldwide. To synthesise the research findings (Objective 4), we developed a logic model to map system preconditions, processes, technology and outcomes. Results We were unable to evaluate the impact of the CC as fully as we had planned because the study was impacted by the COVID-19 pandemic. Hospital staff were extremely busy and access on site was challenging. The additional work negotiating access and the direct impact of the pandemic on our own team meant that we had fewer resources and were unable to complete all our objectives. We were able to observe how the CC helped support the hospital manage its operations through the pandemic and received strong positive evidence of its success. Complex pandemic challenges and rapid innovation to meet these challenges made it difficult to attribute outcomes to the specific intervention of the CC. Evaluation of the impact of the Command Centre (Objective 1) Our ethnographic observations and interviews with 15 study-site staff provided documentary evidence of successful use in a complex environment. The CC made a significant impact on the management of the hospital through the pandemic including through the introduction of a COVID-19 ‘tile’ which was used to managed COVID-19-specific processes. The CC and its staff worked with the new technology to change the way that the hospital operated. We identified unintended consequences that included front-line staff developing a sense of being monitored and a fear of interventions from the CC team that were perceived as unwelcome. Linked to this were challenges keeping electronic records up to date and acting on evidence of operational issues that were seen as being under local autonomy or ownership. Data quality was a constant concern for staff working in and around the CC and there were limitations in how up to date and accurate (or complete) records were, often necessitating triangulation and verification from multiple sources and systems and discrepancy between the data in the systems and what front-line staff reported. Compromise, goodwill and a shared sense of purpose were necessary to ensure the CC was effective. We were able to extract time-series data on patient safety, patient flow and data quality from operational systems by selecting representative indicators and plotting these over time. We were able to measure changes in these indicators over time and evaluate statistically the long-term impact of the CC on these indicators. We were not able to isolate improvements in these indicators that could directly be attributed to the introduction of the CC. Similarly, we were unable to isolate noticeable improvements in these indicators between study and control site. We found improvements in mortality and reduced rates of re-admission at the study site but caution against drawing conclusions from this at a time when the pandemic was raging. Some indicators, notably data quality, worsened rather than improved. We reason that the pandemic had such a profound impact on all aspects of operation that it is not possible to separate out and measure the impact of the CC. Similarly, the later adoption of a CC approach by the control site means we cannot use it to draw strong comparisons. Understanding the process of implementation of the Command Centre (Objective 2) Our project started after the CC had been implemented so our results rely on staff recall of the implementation. We identified five phases in the implementation: (1) pre-intervention, (2) a patient flow change programme, (3) Command Centre tile roll-in, (4) Command Centre go-live and (5) post-intervention engagement. Phase 2 was an organisational change, Phase 3 represents a soft-implementation period of training and familiarisation and Phase 4 represents the hard implementation of the new technology and new ways of working. Staff interviews suggest that the overall implementation approach was effective but that they found the implementation challenging and identified some need for more training and software improvements. The intention had been for a period of post-intervention engagement to support staff in getting used to new ways of working and to adapt procedures and technologies to optimise the new approach. This was disrupted by the pandemic, which started to impact on hospital operations only a few months after Phase 4 was complete. Staff recollections are therefore mixed between the pandemic response and the new technology but there is strong evidence that staff worked well together to find ways of working that were consistent with the CC approach while solving immediate challenges. Analysis of time-series data on patient safety, patient flow and data quality at different stages of implantation revealed patterns of change in response to the implementation, but these were confounded by the impact of the pandemic on the same outcome measures. When only the technology part of the Command Centre was assumed as the intervention, there was no significant difference between the pre- and post-intervention periods in the patient safety and patient flow indicators. The data quality had largely worsened in the post-implementation phase and we attribute this to the impact of the pandemic. Qualitative results show that the Command Centre has had a long bedding-in process and that this is expected to be a long process as the hospital and its staff adapt to new ways of working. Our qualitative results suggest that major improvements in patient flow, patient safety and data quality have yet to be achieved. Contextualising the findings using cross-sector and cross-industry perspectives (Objective 3) Results from the literature review found a strong body of research to support the adoption of a CC approach as part of a successful and resilient organisation. CCs are described as supporting situational awareness, decision-making, team structure and workload with the main aim of successfully delivering safety-critical operations reliably over time and in the face of dynamic risks and variations in the operating environment and system conditions. Digital technologies need to be tailored to the work done in the respective domain and should contribute to system resilience. Most articles attribute performance improvements to the physical and functional features of the centres themselves; this often includes the use of technology to generate and display real-time and/or predictive data in the centres. The implementation process usually affects process and policy changes in the organisation, including introducing new ways of working and workload distribution, adding new roles and altering the existing hierarchy of decision-making and responsibility. The literature advises caution in attributing improvements to the physical and functional aspects of the CCs versus the process and policy changes within the organisation that often arise out of the implementation process. There is emerging evidence that a CC approach can be adopted in acute health care. Effective implementations are characterised by a strong sense of shared situational awareness within a team with a shared focus on specific focal points for intelligence and intensification of this focus as threat level increases. System resilience is maintained in these implementations through simultaneous responsive and anticipatory strategies with variable resource allocation for both proactive planning for expected deviations and events with varying timescales. One paper advised caution in using the term ‘command and control’, as it may overly restrict the exploring of new ideas and new approaches seen as important to meeting the specific needs of health care, hospitals and staff given the strong culture of autonomy on the clinical front line. Synthesis of research findings to inform future investment and practice (Objective 4) We found evidence that the approach to implementation was broadly successful but that benefits take time and significant additional innovation to realise. We consolidate our learning as an intervention logic model that can be used by other hospitals planning an implementation of a digitally enabled hospital CC. Conclusions This study has presented a case study of a successful implementation of a CC in the UK NHS. The Bradford Command Centre demonstrates that systems are available but it also reveals challenges in the reliability, timeliness and quality of these data that reduce transparency and limit confidence. Management and staff have managed to overcome many of these challenges through determination, negotiation and gradual improvements while also dealing with the pandemic. There was a strong sense that the CC had been invaluable during the pandemic but we were not able to empirically validate this. Our case study was affected by the pandemic and does not provide sufficient evidence to demonstrate major benefits on its own. We therefore recommend: Command centres are a viable approach that should be considered. Reliable, modern hospital-wide information systems are an essential foundation for command-centre technology and poor data quality will undermine implementation if not addressed. Further work should follow the evolving use of the Bradford Command Centre and disseminate learning to other hospitals considering adoption. Further studies that use our time-series approach for performance metrics would allow comparison across more hospitals and support the evaluation of other implementations. Studies should consider mixed methods rather than relying solely on qualitative or quantitative approaches to draw conclusions. Study registration The study is registered as IRAS No.: 285933. 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: NIHR129483) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 41. See the NIHR Funding and Awards website for further award information.

Fresh market vegetables are an essential component of the human diet. Maximizing yield is critical, and to achieve this goal, fields must be weed-free when vegetable crops are planted. Historically, removing emerged weeds just before planting has been accomplished using the herbicide glyphosate. However, recent research has indicated that glyphosate applied to sandy, low-organic-matter soils just before transplanting vegetables can be injurious. Two field experiments investigated 1) the response of transplanted squash to the residual activity of glyphosate, and 2) the effects of implementing tillage, irrigation, or extending the plant-back interval after application and before planting to mitigate injury from glyphosate. Glyphosate applied at 1.3, 2.5, or 3.8 kg ae/ha 1 day before transplanting injured squash 13%, 29%, and 53%, respectively; extending the interval between application and planting to 7 days reduced injury to 1%, 11%, and 28% at the same rates. An interaction between application rate and planting interval was also observed on squash plant widths and biomass, as well as early-season and total marketable fruit numbers and weights. Total marketable fruit number was reduced 29% and 52% by glyphosate at 2.5 or 3.8 kg ae/ha, respectively, and a reduction in fruit production of 36%, 28%, and 23% was observed when glyphosate was applied 1, 4, or 7 days before transplanting, respectively. In a separate study, light tillage (5 cm deep) was the most effective cultural practice evaluated because it eliminated damage by glyphosate. Overhead irrigation of 0.6 cm was not beneficial in mitigating injury by glyphosate. Recommendations from this research will help vegetable growers avoid injury from the residual activity of glyphosate through a FIFRA 2(ee) recommendation label.

Summary: Despite extensive global research into genetic predisposition for severe COVID-19, knowledge on the role of rare host genetic variants and their relation to other risk factors remains limited. Here, 52 genes with prior etiological evidence were sequenced in 1,772 severe COVID-19 cases and 5,347 population-based controls from Spain/Italy. Rare deleterious TLR7 variants were present in 2.4% of young (

Introduction We describe the identification and management of general population screen-detected type 1 diabetes (T1D) and share learnings for best practice.Research design and methods Children diagnosed with T1D through a general population screening initiative, the EarLy Surveillance for Autoimmune diabetes (ELSA) study, were reviewed and described.Parents provided written, informed consent for inclusion in the case series.Results 14 children with insulin requiring (stage 3) T1D are described. These cases offer unique insights into the features of screen-detected T1D. T1D is identified sooner through screening programs, characterized by absent/short symptom duration, median presenting glycated hemoglobin 6.6% (49 mmol/mol) and insulin requirements

Abstract The main coal reserves in Brazil are located in the southern region, where the most important coalfield, including the Candiota mine, is found. The mineral exploration and mine planning programs of the companies mining these coal deposits are generally restricted to drilling data and cores, despite the exploratory potential of geophysical methods in coal prospecting. This study aims to investigate the ability of the seismic method known as Multichannel Analysis of Surface Waves (MASW) to identify coal seams in the Candiota area. The MASW method allows obtaining a layer model composed of a low-velocity (blind) layer and/or relatively thin (hidden) layer from the surface wave dispersion curves. The hidden and blind layer problems are pitfalls of the traditional seismic refraction method and the geological settings related to coal seams may encompass both problems. In addition, the Candiota mine has conditions favorable for applying the MASW method due to the shallow depths of the coal seams. The study was based on the analysis of synthetic seismic data generated from a 3-layer conceptual model of the Candiota deposit. The dispersion curves of the fundamental mode of the Rayleigh surface waves were generated and the effects of each of the parameters of the seismic model were evaluated, as well as the relationship between the parameters through objective function tests. A new inversion algorithm capable of obtaining the true model was implemented. The results obtained from the application of the inversion algorithm demonstrated the potential of the MASW method in identifying coal seams from S-wave profiles and proves it to be a powerful tool for coal mineral exploration programs.

In modern marketing, the emergence of mass customization has reoriented the focus from traditional marketing practices toward a customer-centric approach. The individualization feel among consumers and the innovative approach taken by businesses are currently evident in the market but has yet been holistically analyzed. This study applied a modified Theory of Planned Behavior by incorporating the need for individualization, hedonic and utilitarian motivations, with a 4Ps marketing mix – with the main objective to identify factors contributing to the intention to make purchase of customized products. The survey involved 311 participants who completed an online questionnaire utilizing purposive sampling approach, focusing on those who had previously bought customized products. Structural Equation Modeling was employed as a statistical method to analyze the data with SPSS AMOS v25. Findings revealed that the need for individualization proved to have the highest effect on the intention to purchase customized products, explaining that consumers who are strongly inclined toward individualization not only perceive greater value in customized products but also express a higher intention to purchase them. This was followed by its direct significant effect on attitude, with an even higher effect on perceived behavioral control, along with the marketing mix latent variable and customer perceived value on purchasing intention. This study offers valuable insights for retail brand management and provides potential strategies for business improvement. Moreover, a valuable contribution to the limited literature on the promotion of customized product purchases was identified. Lastly, the developed framework and implications may be applied and extended by future research in the consumer behavior field.

A common type of cytoskeletal morphology involves multiple microtubules converging with their minus ends at the microtubule organizing center (MTOC). The cargo-motor complex will experience ballistic transport when bound to microtubules or diffusive transport when unbound. This machinery allows for sequestering and subsequent dispersal of dynein-transported cargo. The general principles governing dynamics, efficiency, and tunability of such transport in the MTOC vicinity are not fully understood. To address this, we develop a one-dimensional model that includes advective transport toward an attractor (such as the MTOC) and diffusive transport that allows particles to reach absorbing boundaries (such as cellular membranes). We calculated the mean first passage time (MFPT) for cargo to reach the boundaries as a measure of the effectiveness of sequestering (large MFPT) and diffusive dispersal (low MFPT). We show that the MFPT experiences a dramatic growth, transitioning from a low to high MFPT regime (dispersal to sequestering) over a window of cargo on-/off-rates that is close to in vivo values. Furthermore, increasing either the on-rate (attachment) or off-rate (detachment) can result in optimal dispersal when the attractor is placed asymmetrically. Finally, we also describe a regime of rare events where the MFPT scales exponentially with motor velocity and the escape location becomes exponentially sensitive to the attractor positioning. Our results suggest that structures such as the MTOC allow for the sensitive control of the spatial and temporal features of transport and corresponding function under physiological conditions.

Abstract Hybrid closed-loop (HCL) systems seamlessly interface continuous glucose monitoring (CGM) with insulin pumps, employing specialised algorithms and user-initiated automated insulin delivery. This study aimed to assess the efficacy of HCLs at 12 months post-initiation on glycated haemoglobin (HbA1c), time-in-range (TIR), hypoglycaemia frequency, and quality of life measures among children and young people (CYP) with type 1 diabetes mellitus (T1DM) and their caregivers in a real-world setting. Conducted between August 1, 2021, and December 10, 2022, the prospective recruitment took place in eight paediatric diabetes centres across England under the National Health Service England’s (NHSE) HCL pilot real-world study. A cohort of 251 CYP (58% males, mean age 12.3 years) with T1DM participated (89% white, 3% Asian, 4% black, 3% mixed ethnicity, and 1% other). The study utilised three HCL systems: (1) Tandem Control-IQ AP system, which uses the Tandem t:slim X2 insulin pump (Tandem Diabetes Care, San Diego, CA, USA) with the Dexcom G6® CGM (Dexcom, San Diego, CA, USA) sensor; (2) Medtronic MiniMed™ 780G with the Guardian 4 sensor (Medtronic, Northridge, CA, USA); and (3) the CamAPS FX (CamDiab, Cambridge, UK) with the Ypsomed insulin pump (Ypsomed Ltd, Escrick, UK) and Dexcom G6® CGM. All systems were fully funded by the NHS. Results demonstrated significant improvements in HbA1c (average reduction at 12 months 7 mmol/mol; P

Abstract Background Half of mental health problems are established by the age of 14 years and 75% by 24 years. Early intervention and prevention of mental ill health are therefore vitally important. However, increased demand over recent years has meant that access to child mental health services is often restricted to those in severest need. Watch Me Play! (WMP) is an early intervention designed to support caregiver attunement and attention to the child to promote social-emotional well-being and thereby mental health resilience. Originally developed in the context of a local authority mental health service for children in care, it is now also delivered online as a low intensity, scalable, preventative intervention. Although WMP shows promise and is already used in some services, we do not yet know whether it is effective. Methods A non-randomised single group feasibility study with embedded process evaluation. We propose to recruit up to 40 parents/carers of children aged 0–8 years who have been referred to early years and children’s services in the UK. WMP involves a parent watching the child play and talking to their child about their play (or for babies, observing and following signals) for up to 20 min per session. Some sessions are facilitated by a trained practitioner who provides prompts where necessary, gives feedback, and discusses the child’s play with the caregiver. Services will offer five facilitated sessions, and parents will be asked to do at least 10 additional sessions on their own with their child in a 5-week period. Feasibility outcomes examined are as follows: (i) recruitment, (ii) retention, (iii) adherence, (iv) fidelity of delivery, (v) barriers and facilitators of participation, (vi) intervention acceptability, (vii) description of usual care, and (viii) data collection procedures. Intervention mechanisms will be examined through qualitative interview data. Economic evaluation will be conducted estimating cost of the intervention and cost of service use for child and parents/carers quality-adjusted life years. Discussion This study will address feasibility questions associated with progression to a future randomised trial of WMP. Trial registration ISRCTN13644899 . Registered on 14th April 2023.

IntroductionLimited research exists on substance-related acute toxicity deaths (ATDs) in older adults (≥60 years) in Canada. This study aims to examine and describe the sociodemographic characteristics, health histories and circumstances of death for accidental ATDs among older adults. MethodsFollowing a retrospective descriptive analysis of all coroner and medical examiner files on accidental substance-related ATDs in older adults in Canada from 2016 to 2017, proportions and mortality rates for coroner and medical examiner data were compared with general population data on older adults from the 2016 Census. Chisquare tests were conducted for categorical variables where possible. ResultsFrom 2016 to 2017, there were 705 documented accidental ATDs in older adults. Multiple substances contributed to 61% of these deaths. Fentanyl, cocaine and ethanol (alcohol) were the most common substances contributing to death. Heart disease (33%), chronic pain (27%) and depression (26%) were commonly documented. Approximately 84% of older adults had contact with health care services in the year preceding their death. Only 14% were confirmed as having their deaths witnessed. ConclusionFindings provide insight into the demographic, contextual and medical history factors that may influence substance-related ATDs in older adults and suggest key areas for prevention.

IntroductionIl existe peu de recherches sur les décès liés à une intoxication aiguë due à une substance chez les aînés (60 ans et plus) au Canada. Cette étude vise à explorer et à décrire les caractéristiques sociodémographiques, les antécédents en matière de santé et les circonstances des décès en ce qui concerne les décès accidentels liés à une intoxication aiguë chez les aînés. MéthodologieÀ la suite d’une analyse descriptive rétrospective de tous les dossiers des coroners et des médecins légistes sur les décès accidentels liés à une intoxication aiguë due à une substance chez les aînés au Canada de 2016 à 2017, les pourcentages de décès et les taux de mortalité issus des données des coroners et des médecins légistes ont été comparés aux données sur les aînés de la population générale tirées du recensement de 2016. Dans la mesure du possible, nous avons réalisé des tests du chi carré pour les variables nominales. RésultatsEn 2016 et 2017, 705 décès accidentels liés à une intoxication aiguë chez les aînés ont été documentés. Dans 61 % des cas, ce sont plusieurs substances qui ont contribué au décès. Le fentanyl, la cocaïne et l’éthanol (alcool) sont les substances les plus souvent en cause. Les maladies du coeur (33 %), la douleur chronique (27 %) et la dépression (26 %) ont souvent été documentées. Environ 84 % des aînés avaient pris contact avec des services de soins de santé au cours de l’année précédant leur décès. Le décès a eu lieu en présence d’un témoin dans 14 % des cas seulement. ConclusionNos constatations permettent de mettre en lumière les facteurs sociodémographiques, contextuels et les antécédents médicaux pouvant avoir une incidence sur les décès liés à une intoxication aiguë due à une substance chez les aînés et d’ainsi proposer des aires clés de prévention.

Background First Nations peoples face disproportionate vaccine-preventable risks due to social, economic, and healthcare disparities. Additionally, during the COVID-19 pandemic, there was also mistrust and hesitancy about the COVID-19 vaccines among First Nations peoples. These are rooted in factors such as colonial histories, discriminatory medical practices, and unreliable information. Objective To examine strategies to address COVID-19 vaccine hesitancy among First Nations peoples globally. Methods A systematic review was conducted. Searches were undertaken in OVID MEDLINE, OVID EMBASE, OVID PsycINFO, CINAHL, and Informit. Searches were date limited from 2020. Items included in this review provided primary data that discussed strategies used to address COVID-19 vaccine hesitancy in First Nations peoples. Results We identified several key strategies across four countries – Australia, the USA, Canada, and Guatemala in seventeen papers. These included understanding communities’ needs, collaborating with communities, tailored messaging, addressing underlying systemic traumas and social health gaps, and early logistics planning. Conclusion The inclusion of First Nations-centred strategies to reduce COVID-19 vaccine hesitancy is essential to delivering an equitable pandemic response. Implementation of these strategies in the continued effort to vaccinate against COVID-19 and in future pandemics is integral to ensure that First Nations peoples are not disproportionately affected by disease.

Food insecurity is a major threat to global public health and sustainable development. As of 2022, 2.4 billion people worldwide experienced moderate to severe food insecurity. The occurrence and severity of food insecurity can depend greatly on power and social hierarchies, with women and girls often being less food secure than men and boys even within the same household. Moreover, social roles, such as the socialization of a mother to feed her children, impact food insecurity and its consequences. This study aims to uncover the relationships between food insecurity and mental health for women in the Chitwan Valley of Nepal. Utilizing longitudinal data from the Chitwan Valley Family Study, we connect food security data from 2015 with mental health data collected from 2016 to 2018. We find that women have a higher prevalence of major depressive disorder, generalized anxiety disorder, and panic attacks than men, especially if they are experiencing food insecurity. Among women, we find that those who have recently experienced severe food insecurity have a significantly higher likelihood of meeting diagnostic criteria for generalized anxiety disorder and panic attacks than food-secure women. However, women's food insecurity is not significantly correlated with major depressive disorder. Moreover, we find that food insecurity is likely to co-occur with women's agricultural and wage work. These findings suggest a need for gender-attentive policy and programs accounting for both causes and consequences of food insecurity.

BackgroundLow- and lower-middle-income countries account for a higher percentage of global epidemics and chronic diseases. In most low- and lower-middle-income countries, there is limited access to health care. The implementation of open-source electronic health records (EHRs) can be understood as a powerful enabler for low- and lower-middle-income countries because it can transform the way health care technology is delivered. Open-source EHRs can enhance health care delivery in low- and lower-middle-income countries by improving the collection, management, and analysis of health data needed to inform health care delivery, policy, and planning. While open-source EHR systems are cost-effective and adaptable, they have not proliferated rapidly in low- and lower-middle-income countries. Implementation barriers slow adoption, with existing research focusing predominantly on technical issues preventing successful implementation. ObjectiveThis interdisciplinary scoping review aims to provide an overview of contextual barriers affecting the adaptation and implementation of open-source EHR systems in low- and lower-middle-income countries and to identify areas for future research. MethodsWe conducted a scoping literature review following a systematic methodological framework. A total of 7 databases were selected from 3 disciplines: medicine and health sciences, computing, and social sciences. The findings were reported in accordance with the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) checklist. The Mixed Methods Appraisal Tool and the Critical Appraisal Skills Programme checklists were used to assess the quality of relevant studies. Data were collated and summarized, and results were reported qualitatively, adopting a narrative synthesis approach. ResultsThis review included 13 studies that examined open-source EHRs’ adaptation and implementation in low- and lower-middle-income countries from 3 interrelated perspectives: socioenvironmental, technological, and organizational barriers. The studies identified key issues such as limited funding, sustainability, organizational and management challenges, infrastructure, data privacy and protection, and ownership. Data protection, confidentiality, ownership, and ethics emerged as important issues, often overshadowed by technical processes. ConclusionsWhile open-source EHRs have the potential to enhance health care delivery in low- and lower-middle-income-country settings, implementation is fraught with difficulty. This scoping review shows that depending on the adopted perspective to implementation, different implementation barriers come into view. A dominant focus on technology distracts from socioenvironmental and organizational barriers impacting the proliferation of open-source EHRs. The role of local implementing organizations in addressing implementation barriers in low- and lower-middle-income countries remains unclear. A holistic understanding of implementers’ experiences of implementation processes is needed. This could help characterize and solve implementation problems, including those related to ethics and the management of data protection. Nevertheless, this scoping review provides a meaningful contribution to the global health informatics discipline.

Paediatric systemic lupus erythematosus (pSLE) management and research could be enhanced by a mobile health application (app); however, no app designed for pSLE is currently available. A development and design committee comprising of patients, parents/caregivers and other stakeholders met to inform development and design of an app specific for pSLE. This meeting report summarises the group’s discussions and recommendations that could help create a useful and desirable app or mobile health tool for the pSLE community.