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Tularemia is a zoonotic disease caused by the facultative intracellular gram-negative bacterium Francisella tularensis. F. tularensis has a very low infection dose by the aerosol route which can result in an acute, and potentially lethal, infection in humans. Consequently, it is classified as a Category A bioterrorism agent by the US Centers for Disease Control (CDC) and is a pathogen of concern for the International Biodefence community. There are currently no licenced tularemia vaccines. In this study we report on the continued assessment of a tularemia subunit vaccine utilising β-glucan particles (GPs) as a vaccine delivery platform for immunogenic F. tularensis antigens. Using a Fischer 344 rat infection model, we demonstrate that a GP based vaccine comprising the F. tularensis lipopolysaccharide antigen together with the protein antigen FTT0814 provided partial protection of F344 rats against an aerosol challenge with a high virulence strain of F. tularensis, SCHU S4. Inclusion of imiquimod as an adjuvant failed to enhance protective efficacy. Moreover, the level of protection afforded was dependant on the challenge dose. Immunological characterisation of this vaccine demonstrated that it induced strong antibody immunoglobulin responses to both polysaccharide and protein antigens. Furthermore, we demonstrate that the FTT0814 component of the GP vaccine primed CD4+ and CD8+ T-cells from immunised F344 rats to express interferon-γ, and CD4+ cells to express interleukin-17, in an antigen specific manner. These data demonstrate the development potential of this tularemia subunit vaccine and builds on a body of work highlighting GPs as a promising vaccine platform for difficult to treat pathogens including those of concern to the bio-defence community. [ABSTRACT FROM AUTHOR]

Limited studies examine the impact of multicultural counseling and training conceptual models on the experiences of community clients. The Community Counseling, Education, and Research Center (CCERC) model is designed to meet community client needs for counseling services and training needs of counseling students through multiculturalism, love ethic, and trauma sensitivity. A thematic analysis of client responses about their experience of the model revealed that counseling was validating, positive, meaningful, and helpful. Implications and recommendations for future research are provided. [ABSTRACT FROM AUTHOR]

Odd‐clawed spiders (Gradungulinae), which are considered to be 'living fossils', are a faunal element of the mesic forests of eastern Australia and the South Island of New Zealand. To date, 16 species in seven genera are known, with most being highly endemic and hard to find, explaining their scarcity in collections worldwide. Particularly noteworthy is the Australian genus Progradungula that includes only two relict species from eastern Australia (Progradungula carraiensis from the Carrai limestone caves in northern New South Wales and Progradungula otwayensis from Nothofagus rainforests in the Otway Range, southern Victoria) and are known from only a handful of adult specimens. Both species are large nocturnal predators with a rather cryptic lifestyle, which construct unique ladder‐like catching webs composed of non‐combed and combed cribellate silk with exceptional properties. Here, we describe a new relict species, Progradungula barringtonensis Michalik & Smith, sp. nov., from isolated Nothofagus forest patches in Barrington Tops National Park (NSW, Australia). The male of this species is significantly larger than those of P. carraiensis and P. otwayensis and exhibits characteristics of the male genitalia of both species. The webs are similar to those of the other Progradungula species. Field observations revealed that the catching ladder had few looping segments, similar to P. otwayensis, but an immature in captivity constructed webs with more looping segments, similar to P. carraiensis, supporting the previously proposed hypothesis that food availability may explain the plasticity of the catching ladder structure. [ABSTRACT FROM AUTHOR]

Background Aims Method & Procedures Outcome & Results Conclusions & Implications What this paper adds What is already known on this subject What this study adds What are the clinical implications of this work? Evidence supports the effectiveness of shared book reading for promoting language and literacy development, but it is known that families experiencing vulnerability may have reduced access to books and are less likely to share books regularly at home. Community hubs often provide support to families experiencing vulnerability and may provide an opportunity to create environments that support families to engage in shared book reading, especially if families are invited into the creation of these environments through co‐design. However, there is currently little evidence regarding the impact of co‐designing shared book reading environments with families in community settings.The current study is part of a broader project which used co‐design to develop a shared book reading environment in collaboration with stakeholders in a community hub. This small‐scale study aimed to provide a preliminary evaluation of the impact of this co‐designed shared book reading environment at the community hub on (1) the frequency of shared book reading at the hub; (2) participants’ confidence and enjoyment of reading with children at the hub; and (3) participants’ experiences of shared book reading at the hub.The co‐design project was carried out in four phases with families, staff and community partners at the community hub. A convergent mixed‐methods approach was used to collect and analyse quantitative and qualitative data in the first and last phase of the project to evaluate project outcomes. Quantitative data (environmental observations of reading at the hub and participant ratings of confidence and enjoyment of reading with children at the hub) were analysed using descriptive statistics and nonparametric statistical tests. Qualitative data (participants’ responses regarding their experiences of changes implemented in the community hub) were analysed using inductive content analysis.An increased frequency of shared book reading was observed within the community hub after changes were implemented, and positive changes in enjoyment of book reading were recorded. Qualitative responses from participants following conclusion of the project were organised into three main categories, which showed that (1) children and families were reading more and enjoying reading activities that were happening; (2) children and families were borrowing more books; and (3) families had changed the way they were reading at home with their children.A co‐designed shared book reading environment within a community hub had a positive impact on shared book reading experiences for families in areas with high levels of vulnerability. Community hubs provide a unique opportunity to support early language and literacy development in partnership with families in areas of vulnerability; however, there is limited literature investigating the impacts of these supports. A previous study utilised co‐design to develop a shared book reading environment with stakeholders at a community hub in an area where a high proportion of children are considered to be ‘vulnerable’ in terms of language and literacy development. It was found that co‐design enabled the development of collaborative changes to support shared book reading that were valued and owned by families, staff and community partners at the community hub. The current study focused on evaluating the impact of a co‐design project on the frequency of shared book reading at the hub and participants’ experiences, confidence and enjoyment of reading with children at the hub. Analysis of pre‐ and post‐data provide preliminary evidence that a co‐designed shared book reading environment in a community hub can have a positive impact on increasing families’ awareness and engagement with book borrowing, engagement in shared book reading activities in the community and at home, and participants’ confidence and enjoyment of reading with children. Speech pathologists have an important role to play in prevention and promotion. This study has shown that collaboration with families experiencing vulnerability can support the implementation of strategies to promote shared reading in a community hub and demonstrate increased quality and frequency of shared book reading. The utilisation of a community hub also highlights the opportunities for the speech pathology profession to deliver community‐based promotion and prevention initiatives as a strategy to address equitable language outcomes. [ABSTRACT FROM AUTHOR]

Artificially intelligent systems (AISs) are being created by software developing companies (SDCs) to influence clinical decision‐making. Historically, clinicians have led healthcare decision‐making, and the introduction of AISs makes SDCs novel actors in the clinical decision‐making space. Although these AISs are intended to influence a clinician's decision‐making, SDCs have been clear that clinicians are in fact the final decision‐makers in clinical care, and that AISs can only inform their decisions. As such, the default position is that clinicians should hold responsibility for the outcomes of the use of AISs. This is not the case when an AIS has influenced a clinician's judgement and their subsequent decision. In this paper, we argue that this is an imbalanced and unjust position, and that careful thought needs to go into how personal moral responsibility for the use of AISs in clinical decision‐making should be attributed. This paper employs and examines the difference between prospective and retrospective responsibility and considers foreseeability as key in determining how personal moral responsibility can be justly attributed. This leads us to the view that moral responsibility for the outcomes of using AISs in healthcare ought to be shared by the clinical users and SDCs. [ABSTRACT FROM AUTHOR]

Background and Aims: We conducted a systematic literature review to understand the evidence supporting treatment decisions for cholestatic pruritus associated with primary biliary cholangitis (PBC) and primary sclerosing cholangitis (PSC). Methods: Studies that enrolled ≥ 75% participants with PBC or PSC and reported ≥ 1 endpoint(s) related to efficacy, safety, health-related quality of life (HRQoL) or other patient-reported outcomes were included. Bias was assessed using the Cochrane risk of bias tool for randomised controlled trials (RCTs) and the Quality of Cohort studies tool for non-RCTs. Results: Thirty-nine publications were identified, covering 42 studies and six treatment classes (including investigational and approved products): anion-exchange resins, antibiotics (rifampicin/derivatives), opiates, selective serotonin reuptake inhibitors, fibrates, ileal bile acid transporter inhibitors and other agents not categorised in these six classes. Across studies, median sample size was small (n = 18), 20 studies were over 20 years old, 25 followed patients for ≤ 6 weeks, only 25 were RCTs. Pruritus was assessed using several different tools, with inconsistencies in their application. Cholestyramine, considered first-line therapy for moderate-severe cholestatic pruritus, was assessed in six studies (two RCTs) including 56 patients with PBC and 2 with PSC, with evidence of efficacy demonstrated in only three studies, among which, two RCTs were assessed as having a high risk of bias. Findings were similar for other drug classes. Conclusions: There is a lack of consistent and reproducible evidence available on efficacy, impact on HRQoL, and safety of cholestatic pruritus treatments, leaving physicians to rely on clinical experience rather than evidence-based medicine for treatment selection. [ABSTRACT FROM AUTHOR]

The Supervision House is introduced as a tool for use in group supervision of masters-level counselors-in-training and novice counselors in the field. Impactful group supervision is a vital forum for counselor development and requires structural elements to maintain group cohesion and enable the sharing of peer experiences and concerns. The Supervision House provides structure in group supervision that helps the counselor reflect on factors that impact them and share strategies that address the developmental tasks of the supervision process. In this article, the rationale for the development of the Supervision House is offered, as well as suggestions on how to implement it in group supervision. Research results from this study highlighting student feedback on the technique are discussed as well as implications for further use in counselor education and supervision of counselors-in-training in their work settings. [ABSTRACT FROM AUTHOR]

Mannan-rich fraction (MRF) isolated from Saccharomyces cerevisiae has been studied for its beneficial impact on animal intestinal health. Herein, we examined how MRF affected the formation of reactive oxygen species (ROS), impacting antibiotic susceptibility in resistant Escherichia coli through the modulation of bacterial metabolism. The role of MRF in effecting proteomic change was examined using a proteomics-based approach. The results showed that MRF, when combined with bactericidal antibiotic treatment, increased ROS production in resistant E. coli by 59.29 ± 4.03% compared to the control (p ≤ 0.05). We further examined the effect of MRF alone and in combination with antibiotic treatment on E. coli growth and explored how MRF potentiates bacterial susceptibility to antibiotics via proteomic changes in key metabolic pathways. Herein we demonstrated that MRF supplementation in the growth media of ampicillin-resistant E. coli had a significant impact on the normal translational control of the central metabolic pathways, including those involved in the glycolysis–TCA cycle (p ≤ 0.05). [ABSTRACT FROM AUTHOR]

Introduction: Growing numbers of older patients occupy hospital beds despite being 'medically fit' for discharge. These Delayed Transfers of Care amplify inefficiencies in care and can cause harm. Delayed transfer because of family or patient choice is common; yet, research on patient and family perspectives is scarce. To identify barriers to, and facilitators of, shorter hospital stays, we sought to understand older people's and caregivers' thoughts and feelings about the benefits and harms of being in hospital and the decisions made at discharge. Methods: A multimethod qualitative study was carried out. Content analysis was carried out of older people's experiences of health or care services submitted to the Care Opinion online website, followed by telephone and video interviews with older people and family members of older people experiencing a hospital stay in the previous 12 months. Results: Online accounts provide insight into how care was organized for older people in the hospital, including deficiencies in care organization, the discharge process and communication, as well as how care was experienced by older people and family members. Interview‐generated themes included shared meanings of hospitalization and discharge experiences and the context of discharge decisions including failure in communication systems, unwarranted variation and lack of confidence in care and lack of preparation for ongoing care. Conclusion: Poor quality and availability of information, and poor communication, inhibit effective transfer of care. Communication is fundamental to patient‐centred care and even more important in discharge models characterized by limited assessments and quicker discharge. Interventions at the service level and targeted patient information about what to expect in discharge assessments and after discharge could help to address poor communication and support for improving discharge of older people from hospital. Patient or Public Contribution: The Frailty Oversight Group, a small group of older people providing oversight of the Community Aging Research 75+ study, provided feedback on the research topic and level of interest, the draft data collection tools and the feasibility of collecting data with older people during the COVID‐19 pandemic. The group also reviewed preliminary findings and provided feedback on our interpretation. [ABSTRACT FROM AUTHOR]

In this co-produced paper, we write about a collaboration that developed over more than a decade between a service user advisor and a social work educator within a higher education context. Starting with how we came to work together, the paper outlines early apprehensions about service user involvement, both as we experienced them and as expressed by colleagues, students, and managers. The paper discusses such themes as confidentiality, professional boundaries, and power imbalance. As authors w identify principles that have underpinned our relationship as well as obstacles faced and understandings reached. We emphasise possibilities discovered from this project which may have application for other courses and settings for the service user advisor role. As we write, we are confronting a new challenge as one of us continues in the work and one of us retires from it. [ABSTRACT FROM AUTHOR]

This study compares the survival rates of USOs formed by universities in the UK's West Midlands region between 1983 and 2013 with those from existing studies in the literature. Data were collected from a range of secondary sources to enhance the accuracy of the USO dataset. Survival rates were found to be significantly lower than in previous studies despite the existence of prominent research universities within the region. It is proposed that the difference is in part methodological with the current study including USOs that may have been omitted using different methodologies that rely on institutional memories. [ABSTRACT FROM AUTHOR]

The article argues that the term "autonomous" is misused in the tech industry when describing systems. While these systems may appear independent, they are actually constrained by goals set by human controllers and cannot choose their own goals. The article emphasizes that true autonomy involves the capacity for self-rule and the ability to determine one's own goals. The misuse of the term "autonomous" can have implications for responsibility and rights, as well as potentially divert attention from those responsible for designing and operating these systems. The authors suggest terminating the use of the term "autonomous systems." [Extracted from the article]

Background: Therapeutic lifestyle changes can reduce individual risk of type 2 diabetes (T2D) by up to 58%. In Singapore, rates of preventive practices were low, despite a high level of knowledge and awareness of T2D risk and prevention. The study explored the context of the discrepancy between knowledge and practices in T2D prevention among adults undiagnosed with the condition.Methods: In-depth interviews with 41 adults explored lay beliefs of T2D and the sources of these perceptions, subjective interpretation of how T2D may impact lives, and perceived costs and benefits of practising preventative behaviours. Purposive sampling was used to maximise the variability of participants in demographic characteristics. Thematic analysis was conducted to identify themes related to the domains of inquiry.Results: Participants' risk perceptions were influenced by familial, social, and cultural contexts of the representation and management of T2D conditions. The adverse effects of T2D were often narrated in food culture. The cost of adopting a healthy diet was perceived at a high cost of life pleasure derived from food consumption and social interactions. Inconveniences, loss of social functions, dependency and distress were the themes related to T2D management. Participants' motivation to preventive practices, such as exercise and weight loss, were influenced by short-term observable benefits.Conclusions: T2D risk communication needs to be addressed in emotionally impactful and interpersonally salient ways to increase the urgency to adopt preventative behaviours. Shifting perceived benefits from long-term disease prevention to short-term observable wellbeing could reduce the response cost of healthy eating. [ABSTRACT FROM AUTHOR]

Background: Despite the existence of global recommendations, postnatal care provided following childbirth is variable and often fails to address a woman's concerns about herself and the parents' concerns about their baby. Discharge from a facility after birth is a key moment to ensure the woman, parents and newborn receive support for the transition to care in the home. We mapped the current policies, guidance and literature on discharge preparation and readiness to identify key concepts and evidence and inform recommendations to be considered in a World Health Organization (WHO) guidance on postnatal care.Methods: We were guided by the Johanna Briggs Institute approach, and developed inclusion criteria based on existing defintions of discharge preparation and readiness, and criteria for discharge readiness compiled by international professional organisaitons. To identify guidelines and policies we searched websites and archives of guideline organisations, and contacted individuals and professional societies working on postnatal care. We searched 14 electronic databases to locate published research and other literature on discharge preparation and readiness. For documents that met the inclusion criteria we extracted key characteristics, summarised discharge readiness criteria and components and discharge preparation steps, and characterised interventions to improve discharge preparation.Results: The review provides a systematic map of criteria for discharge that are in use and the common steps healthcare providers take in preparing women and newborns for the transition home. The mapping also identified interventions used to strengthen discharge preparation, theories and models that conceptualise discharge preparation, scales for measuring discharge readiness and qualitative studies on the perspectives of women, men and healthcare providers on postnatal discharge.Conclusions: The findings highlight contrasts between the research literature and policy documents. They indicate potential gaps in current discharge policies, and point to the need for more comprehensive discharge assessment and education to better identify and meet the needs of women, parents/caregivers and families prior to discharge and identify those who may require additional support.Protocol Registration Details: The protocol for the review was registered with protocols.io on 23 November 2020: https://doi.org/10.17504/protocols.io.bpzymp7w. [ABSTRACT FROM AUTHOR]

Background: Interest in and use of co-production in healthcare services and research is growing. Previous reviews have summarized co-production approaches in use, collated outcomes and effects of co-production, and focused on replicability and reporting, but none have critically reflected on how co-production in applied health research might be evolving and the implications of this for future research. We conducted this scoping review to systematically map recent literature on co-production in applied health research in the United Kingdom to inform co-production practice and guide future methodological research.Methods: This scoping review was performed using established methods. We created an evidence map to show the extent and nature of the literature on co-production and applied health research, based on which we described the characteristics of the articles and scope of the literature and summarized conceptualizations of co-production and how it was implemented. We extracted implications for co-production practice or future research and conducted a content analysis of this information to identify lessons for the practice of co-production and themes for future methodological research.Results: Nineteen articles reporting co-produced complex interventions and 64 reporting co-production in applied health research met the inclusion criteria. Lessons for the practice of co-production and requirements for co-production to become more embedded in organizational structures included (1) the capacity to implement co-produced interventions, (2) the skill set needed for co-production, (3) multiple levels of engagement and negotiation, and (4) funding and institutional arrangements for meaningful co-production. Themes for future research on co-production included (1) who to involve in co-production and how, (2) evaluating outcomes of co-production, (3) the language and practice of co-production, (4) documenting costs and challenges, and (5) vital components or best practice for co-production.Conclusion: Researchers are operationalizing co-production in various ways, often without the necessary financial and organizational support required and the right conditions for success. We argue for accepting the diversity in approaches to co-production, call on researchers to be clearer in their reporting of these approaches, and make suggestions for what researchers should record. To support co-production of research, changes to entrenched academic and scientific practices are needed. Protocol registration details: The protocol for the scoping review was registered with protocols.io on 19 October 2021: https://dx.doi.org/10.17504/protocols.io.by7epzje . [ABSTRACT FROM AUTHOR]

Study Question: Is the innate immunity system active in early human embryo development?Summary Answer: The pattern recognition receptors and innate immunity Toll-like receptor (TLR) genes are widely expressed in preimplantation human embryos and the pathway appears to be active in response to TLR ligands.What Is Known Already: Early human embryos are highly sensitive to their local environment, however relatively little is known about how embryos detect and respond to specific environmental cues. While the maternal immune response is known to be key to the establishment of pregnancy at implantation, the ability of human embryos to detect and signal the presence of pathogens is unknown.Study Design, Size, Duration: Expression of TLR family and related genes in human embryos was assessed by analysis of published transcriptome data (n = 40). Day 5 (D-5) human embryos (n = 25) were cultured in the presence of known TLR ligands and gene expression and cytokine production measured compared to controls.Participants/materials, Setting, Methods: Human embryos surplus to treatment requirements were donated with informed consent from several ART centres. Embryos were cultured to Day 6 (D-6) in the presence of the TLR3 and TLR5 ligands Poly (I: C) and flagellin, with gene expression measured by quantitative PCR and cytokine release into medium measured using cytometric bead arrays.Main Results and the Role Of Chance: TLR and related genes, including downstream signalling molecules, were expressed variably at all human embryo developmental stages. Results showed the strongest expression in the blastocyst for TLRs 9 and 5, and throughout development for TLRs 9, 5, 2, 6 and 7. Stimulation of Day 5 blastocysts with TLR3 and TLR5 ligands Poly (I: C) and flagellin produced changes in mRNA expression levels of TLR genes, including the hyaluronan-mediated motility receptor (HMMR), TLR5, TLR7, nuclear factor kappa-light-chain-enhancer of activated B cells (NF-κB) and monocyte chemoattractant Protein-1 (MCP-1) (P < 0.05, P < 0.001 compared to unstimulated controls), and release into culture medium of cytokines and chemokines, notably IL8 (P = 0.00005 and 0.01277 for flagellin and Poly (I: C), respectively).Limitations, Reasons For Caution: This was a descriptive and experimental study which suggests that the TLR system is active in human embryos and capable of function, but does not confirm any particular role. Although we identified embryonic transcripts for a range of TLR genes, the expression patterns were not always consistent across published studies and expression levels of some genes were low, leaving open the possibility that these were expressed from the maternal rather than embryonic genome.Wider Implications Of the Findings: This is the first report of the expression and activity of a number of components of the innate immunity TLR system in human embryos. Understanding the role of TLRs during preimplantation human development may be important to reveal immunological mechanisms and potential clinical markers of embryo quality and pregnancy initiation during natural conception and in ART.Study Funding/competing Interest(s): This work was funded by the Ministry of Higher Education, The State of Libya, the UK Medical Research Council, and the NIHR Local Comprehensive Research Network and NIHR Manchester Clinical Research Facility and the European Union's Horizon 2020 Research and Innovation Programmes under the Marie Skłodowska-Curie Grant Agreement No. 812660 (DohART-NET). In accordance with H2020 rules, no new human embryos were sacrificed for research activities performed from the EU funding, which concerned only in silico analyses of recorded time-lapse and transcriptomics datasets. None of the authors has any conflict of interest to declare.Trial Registration Number: n/a. [ABSTRACT FROM AUTHOR]

Background: Low back pain is a leading cause of disability worldwide. Health literacy has been associated with pain intensity and pain control. However, there is a paucity of evidence regarding this association. In the field of low back pain research, inconsistent reporting of outcomes has been highlighted. To address this issue a Core Outcome Set has been developed.Objectives: The objectives of this scoping review were: (1) The health literacy measures currently employed for low back pain and the aspects of health literacy they include. (2) The low back pain health outcomes included in such work. (3) The extent to which these health outcomes reflect the Core Outcome Set for Clinical Trials in Non-Specific Low Back Pain.Methods: The search included thirteen bibliographic databases, using medical subject heading terms for low back pain and health literacy, and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. The eligibility criteria were defined by the Joanna Briggs Institute PCC mnemonic. A thematic framework approach was used for analysis.Results: The search yielded ten relevant studies for inclusion, amongst which a total of nine health literacy measures and 50 health outcome measures were used. Most health literacy measures focused on functional health literacy, with few assessing communicative and critical health literacy. The health outcomes assessed by the included studies could be broadly categorised into: Pain, Disability, Behaviour, Knowledge and Beliefs, and Resource Utilisation. Most of these outcome measures studied (36 out of 50) did not directly reflect the Core Outcome Set for Clinical Trials in Non-Specific Low Back Pain.Conclusions: To allow for comparison across findings and the development of a rigorous evidence base, future work should include the Core Outcome Set for Clinical Trials in Non-Specific Low Back Pain. There is an urgent need to broaden the evidence-base to include regions where low back pain morbidity is high, but data is lacking. Such work demands the incorporation of comprehensive measures of health literacy that have both generic and culturally sensitive components. [ABSTRACT FROM AUTHOR]

More than half of the webpages (64%) advised avoiding allergy-triggering foods, education about food allergies and informing friends and family about the diagnosis. In the problem-focussed category, the most frequently suggested approaches for the management of food allergies were making an emergency management plan (76% of webpages) and carrying an auto-injector (72%). Although the webpages were targeted at non-professionals, readability of the webpages spanned from sixth grade (age 11) to university degree level, making all but one webpage too complex for at least 15% of the general population.5 The FKGL scores ranged from 5.5 to 18.4 (median 11, mean 11.01, SD 2.62). [Extracted from the article]

Introduction: The Mental Welfare Commission for Scotland published a report into the death of a young person, with recommendations for the Royal College of Psychiatry in Scotland Child and Adolescent Faculty; to explore if there were barriers to the use of Clozapine in young people in Scotland. Methods: A mixed-methods study was performed using a cross-sectional survey of clinicians working in child and adolescent psychiatry across Scotland, to determine attitudes towards clozapine use and the perceived barriers and facilitators to clozapine treatment. Results: Results suggest that there may be a lack of clearly defined pathways within and between services, as well as a lack of resources provided for the necessary monitoring of a young person started on clozapine. Multiple respondents felt unskilled in clozapine initiation and had not accessed formal training. The most frequently mentioned themes for improving facilitation of clozapine prescription were that of increased resources and training. Discussion: National policymakers including the Mental Welfare Commission, NHS Education for Scotland, and NHS Scotland should consider these findings to address the potential underutilisation of clozapine for people aged under 18 in services across Scotland. A review of current service provision should take place, with consideration of whether the facilitators to clozapine prescription which our study has highlighted could be implemented more effectively. This may help reduce identified barriers and increase clozapine prescription to those who would benefit from it, potentially improving outcomes for young people with treatment-resistant psychosis. [ABSTRACT FROM AUTHOR]

With a view to developing a much-needed non-invasive method for monitoring the healthy pluripotent state of human stem cells in culture, we undertook proteomic analysis of the waste medium from cultured embryonic (Man-13) and induced (Rebl.PAT) human pluripotent stem cells (hPSCs). Cells were grown in E8 medium to maintain pluripotency, and then transferred to FGF2 and TGFβ deficient E6 media for 48 hours to replicate an early, undirected dissolution of pluripotency. We identified a distinct proteomic footprint associated with early loss of pluripotency in both hPSC lines, and a strong correlation with changes in the transcriptome. We demonstrate that multiplexing of four E8- against four E6- enriched secretome biomarkers provides a robust, diagnostic metric for the pluripotent state. These biomarkers were further confirmed by Western blotting which demonstrated consistent correlation with the pluripotent state across cell lines, and in response to a recovery assay. [ABSTRACT FROM AUTHOR]

Background Objectives Methods Results Discussion Conclusion Clinicians' information‐seeking behaviours impact patient care quality. Earlier studies indicated that barriers to accessing information deter clinicians from seeking answers to clinical questions.To explore primary care clinicians' information‐seeking behaviour at point‐of‐care, focusing on when and how they seek answers to clinical questions.Semi‐structured interviews were conducted with 45 clinicians after clinical sessions to investigate their information‐seeking habits. Follow‐up interviews were conducted after a week for those intending to address unanswered queries.Two thirds of clinicians encountered questions during care, with nearly three quarters resolving them during the session. Colleagues, guidelines and online platforms were common information sources, with smartphones being used to access Google, WhatsApp or UpToDate®. Facilitators included reliable sources and the drive to confirm knowledge, while barriers included ineffective search methods and high workload. Despite challenges, most clinicians expressed satisfaction with their information‐seeking process.The findings underscore the increasing use of smartphones for accessing clinical information among Singaporean primary care clinicians and suggest the need for tailored training programmes and guidelines to optimise information‐seeking practices.Insights from this study can inform the development of training programmes and guidelines aimed at improving information‐seeking practices among primary care clinicians, potentially enhancing patient care quality. [ABSTRACT FROM AUTHOR]

Background: The growth of medical knowledge and patient care complexity calls for improved clinician access to evidence-based resources. This study aimed to explore the primary care clinicians' preferences for, barriers to, and facilitators of information-seeking in clinical practice in Singapore. Methods: A convenience sample of ten doctors and ten nurses was recruited. We conducted semi-structured face-to-face in-depth interviews. The interviews were recorded, transcribed verbatim, and analysed using thematic content analysis. Results: Of the 20 participants, eight doctors and ten nurses worked at government-funded polyclinics and two doctors worked in private practice. Most clinicians sought clinical information daily at the point-of-care. The most searched-for information by clinicians in practice was less common conditions. Clinicians preferred evidence-based resources such as clinical practice guidelines and UpToDate®. Clinical practice guidelines were mostly used when they were updated or based on memory. Clinicians also commonly sought answers from their peers. Furthermore, clinicians frequently use smartphones to access the Google search engine and UpToDate® app. The barriers to accessing clinical information included the lack of time, internet surfing separation of work computers, limited search functions in the organisation's server, and limited access to medical literature databases. The facilitators of accessing clinical information included convenience, easy access, and trustworthiness of information sources. Conclusion: Most primary care clinicians in our study sought clinical information at the point-of-care daily and reported increasing use of smartphones for information-seeking. Future research focusing on interventions to improve access to credible clinical information for primary care clinicians at the point-of-care is recommended. Trial registration: This study has been reviewed by NHG Domain Specific Review Board (NHG DSRB) (the central ethics committee) for ethics approval. NHG DSRB Reference Number: 2018/01355 (31/07/2019). [ABSTRACT FROM AUTHOR]

The aim of this literature review was to compose a narrative review supported by a systematic approach to critically identify and examine concerns about accountability and the allocation of responsibility and legal liability as applied to the clinician and the technologist as applied the use of opaque AI-powered systems in clinical decision making. This review questions (a) if it is permissible for a clinician to use an opaque AI system (AIS) in clinical decision making and (b) if a patient was harmed as a result of using a clinician using an AIS's suggestion, how would responsibility and legal liability be allocated? Literature was systematically searched, retrieved, and reviewed from nine databases, which also included items from three clinical professional regulators, as well as relevant grey literature from governmental and non-governmental organisations. This literature was subjected to inclusion/exclusion criteria; those items found relevant to this review underwent data extraction. This review found that there are multiple concerns about opacity, accountability, responsibility and liability when considering the stakeholders of technologists and clinicians in the creation and use of AIS in clinical decision making. Accountability is challenged when the AIS used is opaque, and allocation of responsibility is somewhat unclear. Legal analysis would help stakeholders to understand their obligations and prepare should an undesirable scenario of patient harm eventuate when AIS were used. [ABSTRACT FROM AUTHOR]

Issue Addressed: In response to high rates of gender-based violence and poor sexual and reproductive health indicators in Timor-Leste, a 'Men's Health Project' was implemented in two rural communities in 2013. A peer education model was utilised to engage men in issues regarding health, relationships and well-being.Methods: Community-based baseline and endline surveys were undertaken to evaluate the project in the two communities.Results: In 2013, 401 men and boys completed a baseline survey, and 400 completed an endline survey in 2016. Significant differences were found in a number of areas, with more men in the endline survey aware of the negative impacts of alcohol, safe pregnancy practices, family planning and sexually transmitted infections. Many men reported making the major decisions in their family in both surveys.Conclusions: The peer education approach engaged men in health awareness and contributed to increasing knowledge of sexual and reproductive health and other health issues. However, while education and positive attitudes are an important foundation for change, other enabling mechanisms including vital infrastructure, services and health personnel must be in place to facilitate change and increase access to information and healthcare. Findings highlight the importance of engaging both women and men in processes of challenging behaviours and structures that reinforce gender inequalities. SO WHAT?: Peer education appears to be an effective model for engaging community members in gender and health issues in Timor-Leste. The Men's Health Project enabled men to participate in health awareness and issues regarding health, relationships and well-being. [ABSTRACT FROM AUTHOR]

Polyketide synthase (PKS) and non-ribosomal peptide synthetase (NRPS) multienzymes produce numerous high value metabolites. The protein subunits which constitute these megasynth(et)ases must undergo ordered self-assembly to ensure correct organisation of catalytic domains for the biosynthesis of a given natural product. Short amino acid regions at the N- and C-termini of each subunit, termed docking domains (DDs), often occur in complementary pairs, which interact to facilitate substrate transfer and maintain pathway fidelity. This review details all structurally characterised examples of NRPS and PKS DDs to date and summarises efforts to utilise DDs for the engineering of biosynthetic pathways. [ABSTRACT FROM AUTHOR]

This study builds upon the previous research that recognised coaching as a triangular political space generating power relationships. We integrate social identity theory into this power negotiation process and consider that the ultimate purpose of coaching is to facilitate a shared coaching identity among all related collaborators. To gain in‐depth understanding of factors that promote a three‐way joint coaching identity, we conducted 25 critical incident interviews and two levels of Q‐sorting (n = 10) with coaches, coachees, and organisational stakeholders. The research results indicated that a workplace coaching identity is a flexible space underpinned by coaches' attitude, all collaborators' positions, and the contracting process. Coaches' accommodated communication techniques determine the relationship climate (instrumental or influential). Coaches' position in the coaching space regulates their self‐interests and motivation to change. Moreover, a transparent contracting process encourages communication flows and psychological exchanges among all collaborators that may gain more support from stakeholders. [ABSTRACT FROM AUTHOR]

Polyketide synthase (PKS) and non-ribosomal peptide synthetase (NRPS) multienzymes produce numerous high value metabolites. The protein subunits which constitute these megasynth(et)ases must undergo ordered self-assembly to ensure correct organisation of catalytic domains for the biosynthesis of a given natural product. Short amino acid regions at the N- and C-termini of each subunit, termed docking domains (DDs), often occur in complementary pairs, which interact to facilitate substrate transfer and maintain pathway fidelity. This review details all structurally characterised examples of NRPS and PKS DDs to date and summarises efforts to utilise DDs for the engineering of biosynthetic pathways. [ABSTRACT FROM AUTHOR]

This article will highlight various uses for historical soil survey publications of the United States, discuss their management in libraries, and introduce an inventory to simplify their discovery. This inventory, provided as freely available supplementary material to this article, is a searchable list of publications organized by state. It can be adapted to the needs of individual libraries. [ABSTRACT FROM AUTHOR]

Now more than ever there is a demand to understand the mechanisms surrounding antibiotic resistance and look for alternative ways to impact phenotypic antibiotic outcome. Cellular energetics can be impacted by many bacteriostatic and bactericidal antibiotics, which affect metabolism and energy output, resulting in a reduction of cell growth or induction of cell death respectively. In this study, we provide evidence that a mannan rich fraction (MRF) from the cell wall of Saccharomyces cerevisiae modulates growth of antibiotic susceptible and resistant Escherichia coli and potentiates bactericidal antibiotic efficiency through modulation of bacterial cellular respiration. The role of MRF in modulating bactericidal impact and cellular metabolic state were assessed in E. coli by monitoring microbial growth and by measuring oxygen consumption rate (OCR) and extracellular acidification rate (ECAR) using the Seahorse XFe96 Analyser, respectively. This work further illustrates the link between bacterial susceptibility to antibiotics (phenotypic resistance) and resistance through modulation of bacterial metabolism. This is the first example of yeast MRF enabling collateral sensitivity to antibiotics in vitro and supports the search for alternative strategies to promote animal health without contributing to the growing issue of antimicrobial resistance. [ABSTRACT FROM AUTHOR]

Small unmanned aircraft (SUA) have the potential to be used as platforms for the measurement of atmospheric particulates. The use of an SUA platform for these measurements provides benefits such as high manoeuvrability, reusability, and low cost when compared with traditional techniques. However, the complex aerodynamics of an SUA – particularly for multi-rotor airframes – pose difficulties for accurate and representative sampling of particulates. The use of a miniaturised, lightweight optical particle instrument also presents reliability problems since most optical components in a lightweight system (for example laser diodes, plastic optics, and photodiodes) are less stable than their larger, heavier, and more expensive equivalents (temperature-regulated lasers, glass optics, and photomultiplier tubes). The work presented here relies on computational fluid dynamics with Lagrangian particle tracking (CFD–LPT) simulations to influence the design of a bespoke meteorological sampling system: the UH-AeroSAM. This consists of a custom-built airframe, designed to reduce sampling artefacts due to the propellers, and a purpose-built open-path optical particle counter (OPC) – the Ruggedised Cloud and Aerosol Sounding System (RCASS). OPC size distribution measurements from the UH-AeroSAM are compared with the cloud, aerosol, and precipitation spectrometer (CAPS) for measurements of stratus clouds during the Pallas Cloud Experiment (PaCE) in 2019. Good agreement is demonstrated between the two instruments. The integrated dN/dlog⁡(Dp) is shown to have a coefficient of determination of 0.8 and a regression slope of 0.9 when plotted 1:1. [ABSTRACT FROM AUTHOR]

Small unmanned aircraft (SUA) have the potential to be used as platforms for the measurement of atmospheric particulates. The use of an SUA platform for these measurements provides benefits such as high manoeuvrability, re-usability, and low-cost when compared with traditional techniques. However, the complex aerodynamics of an SUA (particularly for multirotor airframes), combined with the miniaturisation of particle instruments poses difficulties for accurate and representative sampling of particulates. The work presented here relies on computational fluid dynamics with Lagrangian particle tracking (CFD-LPT) simulations to influence the design of a bespoke meteorological sampling system: the UH-AeroSAM. This consists of a custom built airframe, designed to reduce sampling artefacts due to the propellers, and a purpose built open-path optical particle counter- the Ruggedised Cloud and Aerosol Sounding System (RCASS). OPC size distribution measurements from the UH-AeroSAM are compared with the Cloud and Aerosol Precipitation Spectrometer (CAPS) for measurements of Stratus cloud during the Pallas Cloud Experiment (PaCE) in 2019. Good agreement is demonstrated between the two instruments. The integrated dN/dlog(Dp) is shown to have a coefficient of determination of 0.8, and a regression slope of 0.9 when plotted 1:1. [ABSTRACT FROM AUTHOR]

A low-cost miniaturized particle counter has been developed by The University of Hertfordshire (UH) for the measurement of aerosol and droplet concentrations and size distributions. The Universal Cloud and Aerosol Sounding System (UCASS) is an optical particle counter (OPC), which uses wide-angle elastic light scattering for the high-precision sizing of fluid-borne particulates. The UCASS has up to 16 configurable size bins, capable of sizing particles in the range 0.4–40 µm in diameter. Unlike traditional particle counters, the UCASS is an open-geometry system that relies on an external air flow. Therefore, the instrument is suited for use as part of a dropsonde, balloon-borne sounding system, as part of an unmanned aerial vehicle (UAV), or on any measurement platform with a known air flow. Data can be logged autonomously using an on-board SD card, or the device can be interfaced with commercially available meteorological sondes to transmit data in real time. The device has been deployed on various research platforms to take measurements of both droplets and dry aerosol particles. Comparative results with co-located instrumentation in both laboratory and field settings show good agreement for the sizing and counting ability of the UCASS. [ABSTRACT FROM AUTHOR]

Disulfiram (DSF) can help treat alcohol dependency by inhibiting aldehyde dehydrogenase (ALDH). Genomic analysis revealed that Francisella tularensis , the causative agent of tularemia, has lost all but one ALDH-like domain and that this domain retains the target of DSF. In this study, minimum inhibitory concentration (MIC) assays demonstrated that both DSF and its primary metabolite diethyldithiocarbamate (DDC) have strong antimicrobial activity against F. tularensis strain SCHU S4, with the MIC of DSF determined as 2 µg/mL in comparison with 8 µg/mL for DDC. The activity of DSF was further confirmed using an in vitro human macrophage infection assay. Francisella tularensis bacteria in DSF-treated cells were reduced in comparison with untreated and DDC-treated cells, comparable with that observed in doxycycline-treated cells. This suggests that DSF may be suitable for further investigation as an in vivo therapy for tularemia. [ABSTRACT FROM AUTHOR]

A low-cost miniaturized particle counter has been developed by The University of Hertfordshire (UH) for the measurement of aerosol/droplet concentrations and size distributions. The Universal Cloud and Aerosol Sounding System (UCASS) is an Optical Particle Counter (OPC), which uses wide-angle elastic light scattering for the high precision sizing of fluid-borne particulates. The UCASS has up to 16 configurable size bins, capable of sizing particles in the range 0.4–40 micrometer in diameter. Unlike traditional particle counters, the UCASS is an open-geometry system which relies on an external air flow. Therefore the instrument is suited for use as part of a dropsonde, balloon-borne sounding system, as part of an Unmanned Aerial Vehicle (UAV), or on any measurement platform with a known air flow. Data can be logged autonomously using an on-board SD card,or the device can be interfaced with commercially available meteorological sondes to transmit data in real time. The device has been deployed on various research platforms to take measurements of both droplets and dry aerosol particles. Comparative results with co-located instrumentation in both laboratory and field settings are used to assess the performance of the UCASS. [ABSTRACT FROM AUTHOR]

Francisella tularensis is an intracellular pathogen causing the disease tularemia, and an organism of concern to biodefence. There is no licensed vaccine available. Subunit approaches have failed to induce protection, which requires both humoral and cellular immune memory responses, and have been hampered by a lack of understanding as to which antigens are immunoprotective. We undertook a preliminary in silico analysis to identify candidate protein antigens. These antigens were then recombinantly expressed and encapsulated into glucan particles (GPs), purified Saccharomyces cerevisiae cell walls composed primarily of β-1,3-glucans. Immunological profiling in the mouse was used to down-selection to seven lead antigens: FTT1043 (Mip), IglC, FTT0814, FTT0438, FTT0071 (GltA), FTT0289, FTT0890 (PilA) prior to transitioning their evaluation to a Fischer 344 rat model for efficacy evaluation. F344 rats were vaccinated with the GP protein antigens co-delivered with GP-loaded with Francisella LPS. Measurement of cell mediated immune responses and computational epitope analysis allowed down-selection to three promising candidates: FTT0438, FTT1043 and FTT0814. Of these, a GP vaccine delivering Francisella LPS and the FTT0814 protein was able to induce protection in rats against an aerosol challenge of F. tularensis SchuS4, and reduced organ colonisation and clinical signs below that which immunisation with a GP-LPS alone vaccine provided. This is the first report of a protein supplementing protection induced by LPS in a Francisella vaccine. This paves the way for developing an effective, safe subunit vaccine for the prevention of inhalational tularemia, and validates the GP platform for vaccine delivery where complex immune responses are required for prevention of infections by intracellular pathogens. [ABSTRACT FROM AUTHOR]

This paper examines place-specific factors affecting geographies of innovation, that is, the transfer of research from the laboratory to bedside in the healthcare sector in four European bioscience regions. These regions are Medical Delta (MD; Leiden, Rotterdam and Delft, Netherlands) Oxford and the Thames Valley (OTV; UK), Biocat (Catalonia, Spain) and Life Science Zurich (LSZ; Switzerland). Evidence is drawn from the European Union-funded Healthcare Technology and Innovation for Economic Success (HealthTIES) project (2010–2013). The analytical framework, the HealthTIES Innovation Cycle, is organised into resources (inputs), innovation system elements and outcomes. The paper shows that each region represents different positions within international value chains of innovation in the healthcare sector. They range from the highly research intensive but with relatively less in the way of commercial exploitation location (OTV) to the less research intensive but with more commercialisation (LSZ). [ABSTRACT FROM AUTHOR]

Background Men who have sex with men (MSM) are recommended the Human Papillomavirus (HPV) vaccination due to their higher risk of genital warts and anal cancer. Purpose To examine HPV vaccine acceptability amongst MSM in the UK. Methods Using advertisements via Facebook, MSM were recruited to an online survey measuring motivations for HPV vaccination. Logistic regression was performed to identify predictors of HPV vaccine acceptability. Results Out of 1508 MSM (median age = 22, range: 14–63 years) only 19% knew about HPV. Overall, 55% of MSM were willing to ask for the HPV vaccine and 89% would accept it if offered by a healthcare professional (HCP). Access to sexual health clinics (SHCs) [OR = 1.82, 95% CI 1.29–2.89], the disclosure of sexual orientation to a HCP [OR = 2.02, CI 1.39–3.14] and HIV-positive status [OR = 1.96, CI 1.09–3.53] positively predicted HPV vaccine acceptability. After receiving information about HPV, perceptions of HPV risk [OR = 1.31, CI 1.05–1.63], HPV infection severity [OR = 1.89, CI 1.16–3.01), HPV vaccination benefits [OR = 1.61, CI 1.14–3.01], HPV vaccine effectiveness [OR = 1.54, CI 1.14–2.08], and the lack of perceived barriers to HPV vaccination [OR = 4.46, CI 2.95–6.73] were also associated with acceptability. Conclusions Although nearly half of MSM would not actively pursue HPV vaccination, the vast majority would accept the vaccine if recommended by HCPs. In order to achieve optimal uptake, vaccine promotion campaigns should focus on MSM who do not access SHCs and those unwilling to disclose their sexual orientation. [ABSTRACT FROM AUTHOR]

Abstract: Multiple perioperative variables have been shown in existing literature to influence long‐term outcomes of pediatric RTx, such as allograft survival. Their impact on short‐term outcomes is not as well‐documented. This case series aims to investigate the effects of nine perioperative variables on two short‐term outcomes in pRTR: 1‐week post‐operative eGFR and post‐operative LOS. A total of 73 pRTR transplanted over 3 years from 2012 to 2014 at a single center were studied retrospectively and statistical analyses were performed. There was higher 1‐week post‐operative eGFR in pRTR who received living donor transplants compared to those who received deceased donor transplants (P=.01), with mean eGFR of 135 mL/min/1.73 m2 and 82 mL/min/1.73 m2, respectively. Aorta‐IVC anastomosis was associated with longer LOS compared to iliac vessel anastomosis (P=.03), with median LOS of 19 and 13 days, respectively. There were no significant effects on 1‐week eGFR or LOS of the seven other variables: pRTR age and gender, donor age, preoperative donor SBP, intraoperative mean CVP before graft perfusion, intraoperative median SBP z score after graft perfusion, and intraoperative fluid volume. Living donor transplants were associated with higher 1‐week post‐operative eGFR compared to deceased donor transplants. Aorta‐IVC anastomosis was significantly associated with longer LOS compared to iliac vessel anastomosis. [ABSTRACT FROM AUTHOR]

Stroke continues to be a leading cause of death and disability worldwide, yet effective treatments are lacking. Previous studies have indicated that stem-cell transplantation could be an effective treatment. However, little is known about the direct impact of transplanted cells on injured brain tissue. We wanted to help fill this knowledge gap and investigated effects of hematopoietic stem/progenitor cells (HSPCs) on the cerebral microcirculation after ischemia-reperfusion injury (I/RI). Treatment of HSPCs in I/RI for up to 2 wk after cerebral I/RI led to decreased mortality rate, decreased infarct volume, improved functional outcome, reduced microglial activation, and reduced cerebral leukocyte adhesion. Confocal microscopy and fluorescence-activated cell sorting analyses showed transplanted HSPCs emigrate preferentially into ischemic cortex brain parenchyma. We isolated migrated HSPCs from the brain; using RNA sequencing to investigate the transcriptome, we found metallothionein (MT, particularly MT-I) transcripts were dramatically up-regulated. Finally, to confirm the significance of MT, we exogenously administered MT-I after cerebral I/RI and found that it produced neuroprotection in a manner similar to HSPC treatment. These findings provide novel evidence that the mechanism through which HSPCs promote repair after stroke maybe via direct action of HSPC-derived MT-I and could therefore be exploited as a useful therapeutic strategy for stroke. [ABSTRACT FROM AUTHOR]

Tidal lagoons are an attractive renewable energy option that could aid the UK in meeting its ambitious renewable energy targets. One of the main barriers to tidal range development in the UK to date has been regulatory environmental concern. In order for the nascent lagoon industry to move forward into development, the views of the developers and other influential stakeholders such as government bodies, regulators, conservationists and practitioners (herein referred to as ‘influencing stakeholders’ or ‘influencers’) need to be aligned. This study is the first of its kind using online questionnaires and semi-structured interviews to present and compare the views of both developers and influencing stakeholders on the environmental interactions of tidal lagoons. We find that, whilst both influencers and developers are working towards the common goal of a good environmental outcome for tidal lagoons, there are mismatches in their views in terms of the priorities given to the key environmental impacts, benefits and potential solution options. The work provides insight into what is at the forefront of developers' and influencers' minds, highlighting the key themes within their views and transforming this information into policy recommendations that will help the industry's development move forward. [ABSTRACT FROM AUTHOR]

This article will explore region as a category of analysis for understanding gender, sexual cultures, and the expression of same-sex desire. In unpicking the notion of regional difference in both its tangible and intangible forms, it outlines the corresponding impact on how sexual cultures developed and were experienced in twentieth-century Britain. By recognizing that the area in which an individual lived could have as much impact on their sense of self and their sexual experiences as issues of race, gender, and class, a new and fruitful avenue of interpretation is opened up for the history of sexuality and twentieth-century British history more broadly. Such a methodology has the potential to add a new dimension to all histories of non-state-sanctioned sexual experience such as illegitimacy, premarital sex, extramarital affairs, and prostitution. In using regional case studies and interrogating ideas of sexual taboo, this article offers a unique interpretation of sexual experience that destabilizes current Londoncentric narratives and offers a more democratic and nuanced history of sex. [ABSTRACT FROM AUTHOR]

Abstract: At a time when government funding cuts mean that public libraries face an uncertain future and need to make sure they stay relevant to young users and their families, this paper explores what counts as literacy for young children in a public library in a town in the East Midlands, UK. It is based on a study which adopted an ethnographic approach, drawing on Lefebvre's spatial theory to understand how a library space presents literacy to young children and their carers, and how this then shapes the literacy practices and events that happen in this space. The study shows that dominant discourses are bound up in what the library staff understand to be their role in promoting and supporting young children's literacy, and that, often, they organise the space and literacy events in ways that reflect these discourses. However this paper argues that it is not only the library staff that create space in the library, as carers and their children are sometimes seen to create alternative spaces which challenge and subvert the way the librarians would like the space to be used and understood. [ABSTRACT FROM AUTHOR]

Background: Recent World Health Organization recommendations recognize the important role Traditional Birth Attendants (TBAs) can play in supporting the health of women and newborns. This paper provides an analysis of key factors that affect the implementation of interventions to develop partnerships with TBAs to promote improved access to skilled care at birth.Methods: We conducted a secondary analysis of 20 papers identified through two systematic reviews that examined the effectiveness of interventions to find new roles for TBAs on maternal and newborn health outcomes, as well as papers identified through a systematic mapping of the maternal health literature. The Supporting the Use of Research Evidence framework (SURE) guided the thematic analysis to explore the perceptions of various stakeholders and implementation barriers and facilitators, as well as other contextual issues.Results: This analysis identified countries that have implemented interventions to support the transition from birth with a TBA to birth with a skilled birth attendant. Drawing on the experiences of these countries, the analysis highlights factors that are important to consider when designing and implementing such interventions. Barriers to implementation included resistance to change in more traditional communities, negative attitudes between TBAs and skilled attendants and TBAs concerns about the financial implications of assuming new roles. Facilitating factors included stakeholder involvement in devising and implementing interventions, knowledge sharing between TBAs and skilled birth attendants, and formalised roles and responsibilities and remuneration for TBAs.Conclusions: The implementation barriers identified in this analysis could, if not addressed, prevent or discourage TBAs from carrying out newly defined roles supporting women in pregnancy and childbirth and linking them to the formal health system. This paper also identifies the factors that seem critical to success, which new programmes could consider adopting from the outset. In most cases a multi-faceted approach is needed to prepare TBAs and others for new roles, including the training of TBAs to strengthen their knowledge and skills to enable them to be able to assume new roles, alongside the sensitization of healthcare providers, communities, women and their families. Further research is required to map the transition process and stakeholder experiences in more detailed ways and to provide longer-term monitoring of existing interventions. [ABSTRACT FROM AUTHOR]

Background: In 2014 the World Health Organization (WHO) developed a new tool to be used to assess the quality of care for mothers, newborns and children provided at healthcare facility level. This paper reports on the feasibility of using the tool, its limitations and strengths.Methods: Across 5 districts in Malawi, 35 healthcare facilities were assessed. The WHO tool includes checklists, interviews and observation of case management by which care is assessed against agreed standards using a Likert scale (1 lowest: not meeting standard, 5 highest: compliant with standard). Descriptive statistics were used to provide summary scores for each standard. A 'dashboard' system was developed to display the results.Results: For maternal care three areas met standards; 1) supportive care for admitted patients (71% of healthcare facilities scored 4 or 5); 2) prevention and management of infections during pregnancy (71% scored 4 or 5); and 3) management of unsatisfactory progress of labour (84% scored 4 or 5). Availability of essential equipment and supplies was noted to be a critical barrier to achieving satisfactory standards of paediatric care (mean score; standard deviation: 2.9; SD 0.95) and child care (2.7; SD 1.1). Infection control is inadequate across all districts for maternal, newborn and paediatric care. Quality of care varies across districts with a mean (SD) score for all standards combined of 3 (SD 0.19) for the worst performing district and 4 (SD 0.27) for the best. The best performing district has an average score of 4 (SD 0.27). Hospitals had good scores for overall infrastructure, essential drugs, organisation of care and management of preterm labour. However, health centres were better at case management of HIV/AIDS patients and follow-up of sick children.Conclusions: There is a need to develop an expanded framework of standards which is inclusive of all areas of care. In addition, it is important to ensure structure, process and outcomes of health care are reflected. [ABSTRACT FROM AUTHOR]

Background: Maternal Death Surveillance and Response (MDSR) implementation is monitored globally, but not much is known about what works well, where and why in scaling up. We reviewed a series of country case studies in order to determine whether and to what extent these countries have implemented the four essential components of MDSR and identify lessons for improving implementation.Methods: A secondary analysis of ten case studies from countries at different stages of MDSR implementation, using a policy analysis framework to draw out lessons learnt and opportunities for improvement. We identify the consistent drivers of success in countries with well-established systems for MDSR, and common barriers in countries were Maternal Death Review (MDR) systems have been less successful.Results: MDR is accepted and ongoing at subnational level in many countries, but it is not adequately institutionalised and the shift from facility based MDR to continuous MDSR that informs the wider health system still needs to be made. Our secondary analysis of country experiences highlights the need for a) social and team processes at facility level, for example the existence of a 'no shame, no blame' culture, and the ability to reflect on practice and manage change as a team for recommendations to be acted upon, b) health system inputs including adequate funding and reliable health information systems to enable identification and analysis of cases c) national level coordination of dissemination, and monitoring implementation of recommendations at all levels and d) mandatory notification of maternal deaths (and enforcement of this) and a professional requirement to participate in MDRs.Conclusions: Case studies from countries with established MDSR systems can provide valuable guidance on ways to set up the processes and overcome some of the barriers; but the challenge, as with many health system interventions, is to find a way to provide catalytic assistance and strengthen capacity for MDSR such that this becomes embedded in the health system. [ABSTRACT FROM AUTHOR]

• Mycelial extracts inhibit growth of E.coli , Salmonella and Staphylococcus. • Liquid fermentation produced bioactive compounds of phenolic and lipid structure. • Novel UPLC method developed to quantify total phenolic composition. • Total phenolic content of the selected fungi ranged from 31.85 to 101.77 mg g−1. • Multiple constituents from filamentous fungi yielded antimicrobial activity. Some of the most powerful natural antimicrobial compounds originate from filamentous fungi. However, due to the diversity of compounds from plant and fungal origin, separation, isolation, and identification of bioactive constituents can be a long and tedious process. This study explores the effectiveness of thin layer chromatography (TLC) in combination with bioautography in the separation and identification of bioactive compounds from several filamentous fungi. Ultra-performance liquid chromatography coupled to photodiode array detector (UPLC-DAD) was employed to quantitatively identify phenolic composition. The total phenolic content of the selected filamentous fungi ranged from 31.85 mg g−1 to 101.77 mg g−1. Additionally, liquid chromatography mass spectrometry (LC/MS) determined the most abundant fatty acids were linoleic, palmitic, oleic, and stearic acid. Submerged cultivation of Grifola frondosa , Monascus purpureus , Lentinula edodes , Trametes versicolor and Pleurotus ostreatus proved to be an effective method to produce natural antimicrobial compounds. [ABSTRACT FROM AUTHOR]

Objective: To present the first national‐level report card on the state of women's preconception health in England. Design: Cross‐sectional population‐based study. Setting: Maternity services, England. Population: All pregnant women in England with a first antenatal (booking) appointment recorded in the national Maternity Services Dataset (MSDS) from April 2018 to March 2019 (n = 652 880). Methods: We analysed the prevalence of 32 preconception indicator measures in the overall population and across socio‐demographic subgroups. Ten of these indicators were prioritised for ongoing surveillance based on modifiability, prevalence, data quality and ranking by multidisciplinary UK experts. Results: The three most prevalent indicators were the proportion of the 22.9% of women who smoked 1 year before pregnancy who did not quit smoking before pregnancy (85.0%), those who had not taken folic acid supplementation before pregnancy (72.7%) and previous pregnancy loss (38.9%). Inequalities were observed by age, ethnicity and area‐based deprivation level. The ten indicators prioritised were not taking folic acid supplementation before pregnancy, obesity, complex social factors, living in the most deprived areas, smoking around the time of conception, overweight, pre‐existing mental health condition, pre‐existing physical health condition, previous pregnancy loss and previous obstetric complication. Conclusions: Our findings suggest important opportunities to improve the state of preconception health and reduce socio‐demographic inequalities for women in England. In addition to MSDS data, other national data sources that record further and possibly better quality indicators could be explored and linked to build a comprehensive surveillance infrastructure. Linked article: This article is commented on by Mairead Black, pp. 1196 in this issue. To view this mini commentary visit https://doi.org/10.1111/1471‐0528.17483. [ABSTRACT FROM AUTHOR]