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Ahmed Handhle, 1 Adie Viljoen, 2 Anthony S Wierzbicki 3 1Department of Metabolic Medicine/Chemical Pathology, Addenbrookes Hospital, Cambridge, UK; 2Department of Metabolic Medicine/Chemical Pathology, North & East Hertfordshire Hospitals Trust, Lister Hospital, Hertfordshire, UK; 3Department of Metabolic Medicine/Chemical Pathology, Guy’s & St Thomas’, Hospitals, London, SE1 7EH, UKCorrespondence: Anthony S WierzbickiMetabolic Medicine/Chemical Pathology, St Thomas Hospital, Lambeth Palace Road, London, SE1 7EH, UKTel +44 207 188 1256Email Anthony.Wierzbicki@kcl.ac.UkAbstract: Lipoprotein(a) forms a subfraction of the lipid profile and is characterized by the addition of apolipprotein(a) (apo(a)) to apoB100 derived particles. Its levels are mostly genetically determined inversely related to the number of protein domain (kringle) repeats in apo(a). In epidemiological studies, it shows consistent association with cardiovascular disease (CVD) and most recently with extent of aortic stenosis. Issues with standardizing the measurement of Lp(a) are being resolved and consensus statements favor its measurement in patients at high risk of, or with family histories of CVD events. Major lipid-lowering therapies such as statin, fibrates, and ezetimibe have little effect on Lp(a) levels. Therapies such as niacin or cholesterol ester transfer protein (CETP) inhibitors lower Lp(a) as well as reducing other lipid-related risk factors but have failed to clearly reduce CVD events. Proprotein convertase subtilisin kexin-9 (PCSK9) inhibitors reduce cholesterol and Lp(a) as well as reducing CVD events. New antisense therapies specifically targeting apo(a) and hence Lp(a) have greater and more specific effects and will help clarify the extent to which intervention in Lp(a) levels will reduce CVD events.Keywords: lipoprotein (a), cardiovascular disease, aortic stenosis, apheresis, genetics, lipoprotein turnover, statin, PCSK9, antisense therapy

Esafoxolaner is a purified enantiomer of afoxolaner with insecticidal and acaricidal properties. It is combined with eprinomectin and praziquantel in a novel topical endectoparasiticide formulation for cats. The efficacy of this novel formulation was assessed in an experimental study against induced infestation of Rhipicephalus sanguineus ticks. Twenty cats were randomly allocated to either a placebo control group or a treated group in a 1:1 ratio. Infested cats were treated topically once at the minimum recommended dose. The study was designed to assess curative efficacy 48 h after treatment and to test preventive efficacy 48 h after weekly infestations for 2 months. At each weekly infestation, all cats were infested with 25 male and 25 unfed female R. sanguineus ticks. At each tick count, at least 6 in 10 control cats had a retention of 13 (26%) or more live ticks, demonstrating adequate infestation throughout the study. Curative efficacy on existing tick infestation was 90%; preventive efficacy over the following 6 weeks was at least 96%.

Esafoxolaner, a purified enantiomer of afoxolaner with insecticidal and acaricidal properties, is combined with eprinomectin and praziquantel in NexGard® Combo, a novel topical endectoparasiticide formulation for cats. The efficacy of this novel formulation against adult and immature stages of Ctenocephalides felis fleas was tested in four experimental studies. Two studies were designed to test adulticide efficacy, one to test inhibition of immature stages, and one to test both adulticide efficacy and inhibition of immature stages. In each study, cats were randomly allocated to a placebo control group or to a novel formulation group treated once at the minimum recommended dose. Cats were experimentally infested weekly for one to two months with unfed C. felis originating from North America or Europe. For adulticide efficacy evaluations, live fleas were counted 24 h after treatment and after subsequent weekly infestations. For immature stages, flea eggs were collected and counted weekly for evaluation of egg production inhibition and incubated for larval hatching evaluation. In the three studies testing adult fleas, curative efficacies, 24 h after treatment, were 92.1%, 98.3% and 99.7%; preventive weekly efficacies, 24 h after weekly infestations, remained higher than 95.5% for at least one month. In the two studies testing immature stages, egg production and larval hatching was significantly reduced for at least one month. These studies provide robust evidence of efficacy of the novel formulation against experimental adult flea infestations and for the prevention of environmental contamination by immature flea stages, for at least one month.

BackgroundWhile early autism intervention can significantly improve outcomes, gaps in implementation exist globally. These gaps are clearest in Africa, where forty percent of the world's children will live by 2050. Task-sharing early intervention to non-specialists is a key implementation strategy, given the lack of specialists in Africa. Naturalistic Developmental Behavioral Interventions (NDBI) are a class of early autism intervention that can be delivered by caregivers. As a foundational step to address the early autism intervention gap, we adapted a non-specialist delivered caregiver coaching NDBI for the South African context, and pre-piloted this cascaded task-sharing approach in an existing system of care.ObjectivesFirst, we will test the effectiveness of the caregiver coaching NDBI compared to usual care. Second, we will describe coaching implementation factors within the Western Cape Department of Education in South Africa.MethodsThis is a type 1 effectiveness-implementation hybrid design; assessor-blinded, group randomized controlled trial. Participants include 150 autistic children (18-72 months) and their caregivers who live in Cape Town, South Africa, and those involved in intervention implementation. Early Childhood Development practitioners, employed by the Department of Education, will deliver 12, one hour, coaching sessions to the intervention group. The control group will receive usual care. Distal co-primary outcomes include the Communication Domain Standard Score (Vineland Adaptive Behavior Scales, Third Edition) and the Language and Communication Developmental Quotient (Griffiths Scales of Child Development, Third Edition). Proximal secondary outcome include caregiver strategies measured by the sum of five items from the Joint Engagement Rating Inventory. We will describe key implementation determinants.ResultsParticipant enrolment started in April 2023. Estimated primary completion date is March 2027.ConclusionThe ACACIA trial will determine whether a cascaded task-sharing intervention delivered in an educational setting leads to meaningful improvements in communication abilities of autistic children, and identify implementation barriers and facilitators.Trial registrationNCT05551728 in Clinical Trial Registry (https://clinicaltrials.gov).

Abstract Background This case study examines the application of Integrated Enhanced Cognitive Behavioural Therapy (I-CBTE) for a patient with severe, longstanding anorexia nervosa and multiple comorbidities, including organic hallucinosis, complex post-traumatic stress disorder (CPTSD), and severe self-harm. Such complex presentations often result in patients falling between services, which can lead to high chronicity and increased mortality risk. Commentaries from two additional patients who have recovered from severe and longstanding anorexia nervosa are included. Case study The patient developed severe anorexia nervosa and hallucinosis after a traumatic brain injury in 2000. Despite numerous hospitalisations and various psychotropic medications in the UK and France, standard treatments were ineffective for 17 years. However, Integrated Enhanced Cognitive Behaviour Therapy (I-CBTE) using a whole-team approach and intensive, personalised psychological treatment alongside nutritional rehabilitation proved effective. Methods In this paper, we describe the application of the I-CBTE model for individuals with severe, longstanding, and complex anorexia nervosa, using lived experience perspectives from three patients to inform clinicians. We also outline the methodology for adapting the model to different presentations of the disorder. Outcomes The patient achieved and maintained full remission from her eating disorder over the last 6 years, highlighting the benefit of the I-CBTE approach in patients with complex, longstanding eating disorder histories. Successful treatment also saved in excess of £360 k just by preventing further hospitalisations and not accounting for the improvement in her quality of life. This suggests that this method can improve outcomes and reduce healthcare costs. Conclusion This case study, with commentaries from two patients with histories of severe and longstanding anorexia nervosa, provides a detailed description of the practical application of I-CBTE for patients with severe and longstanding eating disorders with complex comorbidities, and extensive treatment histories. This offers hope for patients and a framework for clinicians to enhance existing treatment frameworks, potentially transforming the trajectory of those traditionally deemed treatment resistant. Recommendations We advocate the broader integration of CBT for EDs into specialist services across the care pathway to help improve outcomes for patients with complex eating disorders. Systematic training and supervision for multidisciplinary teams in this specialised therapeutic approach is recommended. Future research should investigate the long-term effectiveness of I-CBTE through longitudinal studies. Patient feedback on experiences of integrated models of care such as I-CBTE is also needed. In addition, systematic health economics studies should be conducted.

Abstract Introduction To ensure that pre-final year medical students at Stellenbosch University were able to resume clinical training during the COVID-19 pandemic, a 12-week integrated rotation was introduced, during which students were distributed across a widespread training platform in two provinces of South Africa, utilizing a range of health care facilities in both rural and urban areas, rather than the central academic hospital (CAH) in which they would have been doing clerkships. Called the Integrated Distributed Engagement to Advance Learning (IDEAL) rotation, this clerkship was based on supervised engagement in healthcare services, focusing on patient-based clinical training, self-regulated learning and student participation as integral members of clinical teams. The success of this emergency intervention has led to its formal incorporation into the medical curriculum. This study aimed to understand the factors that influenced learning among students undertaking the IDEAL rotation at multiple sites on a distributed training platform. Methods Using an interpretive paradigm, we sought to conduct focus group interviews with students who completed the first iteration of the IDEAL rotation in the year after they had undertaken it to understand their experiences. All 252 students who were eligible were invited to participate by email on several occasions. Ultimately three focus group discussions and two individual interviews were undertaken, based on volunteers. Using a semi-structured interview guide, these explored student perceptions of their learning and growth through the rotation. Inductive and deductive analysis was carried out to identify themes. Findings Student descriptions of their learning experiences coalesced in 6 themes. The rotation was an enabling learning experience, which was more practically focused and assisted students in developing confidence in their clinical skills. It was seen to be a humanizing learning experience with greater opportunities for the development of relationships with patients and families, as well as with health professionals, who made them feel part of the team, so it was also a more collegial learning experience. At the same time, it was a variable learning experience with a lack of standardization on a number of levels and challenges being experienced at particular sites regarding both logistics and the nature of the exposure. Students perceived it to be a very different learning experience from what they had encountered in the CAH in terms of relationships, the kinds of patients and problems they saw, and their active participation. Through this, they also learned more about themselves and their roles, making it a personal learning journey. The findings confirm the importance of the dimensions of person, participation and place for being and becoming a doctor in a clinical environment. Conclusions Student learning experiences in the IDEAL rotation emphasize the importance of context, reinforcing the value of a distributed training platform in developing health professionals who are responsive to their environment. They emphasize the vital role of active participation in learning and the centrality of relationships in medical training, helping to develop graduates who are human beings and not only human doings.

Abstract Over the past five decades, a large number of wild animals have been individually identified by various observation systems and/or temporary tracking methods, providing unparalleled insights into their lives over both time and space. However, so far there is no comprehensive record of uniquely individually identified animals nor where their data and metadata are stored, for example photos, physiological and genetic samples, disease screens, information on social relationships. Databases currently do not offer unique identifiers for living, individual wild animals, similar to the permanent ID labelling for deceased museum specimens. To address this problem, we introduce two new concepts: (1) a globally unique animal ID (UAID) available to define uniquely and individually identified animals archived in any database, including metadata archived at the time of publication; and (2) the digital ‘home’ for UAIDs, the Movebank Life History Museum (MoMu), storing and linking metadata, media, communications and other files associated with animals individually identified in the wild. MoMu will ensure that metadata are available for future generations, allowing permanent linkages to information in other databases. MoMu allows researchers to collect and store photos, behavioural records, genome data and/or resightings of UAIDed animals, encompassing information not easily included in structured datasets supported by existing databases. Metadata is uploaded through the Animal Tracker app, the MoMu website, by email from registered users or through an Application Programming Interface (API) from any database. Initially, records can be stored in a temporary folder similar to a field drawer, as naturalists routinely do. Later, researchers and specialists can curate these materials for individual animals, manage the secure sharing of sensitive information and, where appropriate, publish individual life histories with DOIs. The storage of such synthesized lifetime stories of wild animals under a UAID (unique identifier or ‘animal passport’) will support basic science, conservation efforts and public participation.

Abstract Background Epidemiological and toxicological studies indicate that increased exposure to air pollutants can lead to neurodegenerative diseases. To further confirm this relationship, we evaluated the association between exposure to ambient air pollutants and corneal nerve measures as a surrogate for neurodegeneration, using corneal confocal microscopy. Methods We used population-based observational cross-sectional data from The Maastricht Study including N = 3635 participants (mean age 59.3 years, 51.6% were women, and 19.9% had type 2 diabetes) living in the Maastricht area. Using the Geoscience and hEalth Cohort COnsortium (GECCO) data we linked the yearly average exposure levels of ambient air pollutants at home address-level [particulate matter with diameters of ≤ 2.5 µm (PM2.5), and ≤ 10.0 µm (PM10), nitrogen dioxide (NO2), and elemental carbon (EC)]. We used linear regression analysis to study the associations between Z-score for ambient air pollutants concentrations (PM2.5, PM10, NO2, and EC) and Z-score for individual corneal nerve measures (corneal nerve bifurcation density, corneal nerve density, corneal nerve length, and fractal dimension). Results After adjustment for potential confounders (age, sex, level of education, glucose metabolism status, corneal confocal microscopy lag time, inclusion year of participants, smoking status, and alcohol consumption), higher Z-scores for PM2.5 and PM10 were associated with lower Z-scores for corneal nerve bifurcation density, nerve density, nerve length, and nerve fractal dimension [stβ (95% CI): PM2.5 -0.10 (-0.14; -0.05), -0.04 (-0.09; 0.01), -0.11 (-0.16; -0.06), -0.20 (-0.24; -0.15); and PM10 -0.08 (-0.13; -0.03), -0.04 (-0.09; 0.01), -0.08 (-0.13; -0.04), -0.17 (-0.21; -0.12)], respectively. No associations were found between NO2 and EC and corneal nerve measures. Conclusions Our population-based study demonstrated that exposure to higher levels of PM2.5 and PM10 are associated with higher levels of corneal neurodegeneration, estimated from lower corneal nerve measures. Our results suggest that air pollution may be a determinant for neurodegeneration assessed in the cornea and may impact the ocular surface health as well.

Abstract Background Population mail-out bowel cancer screening programs save lives through prevention and early detection; however, their effectiveness is constrained by low participation rates. Many non-participants are “intenders”; that is, they intend to screen but fail to do so, often forgetting or procrastinating. This study aimed to co-design interventions to increase screening participation among intenders in the Australian National Bowel Cancer Screening Program. Methods Three semi-structured interviews, and one online cross-sectional survey, were conducted between August 2021 and December 2022. Interviews with people who had completed and returned their latest screening kit (“completers”) were first conducted to identify the planning strategies they had used. Using survey data, logistic regressions were conducted to analyse strategies predictive of participants having returned their latest bowel cancer screening kit. Then, intenders were interviewed to explore their opinions of these strategies and worked with researchers to adapt these strategies into prototype interventions to facilitate screening participation. All interviews were analysed using the framework approach of codebook thematic analysis. Results Interview participants who returned their kit shared their effective planning strategies, such as putting the kit in a visible place or by the toilet, planning a time at home to complete the kit, and using reminders. Survey participants who reported using such strategies were more likely to have completed their screening kit compared to those who did not. Prototype interventions developed and endorsed by intenders included providing a prompt to place the kit or a sticker near the toilet as a reminder, a deadline for kit return, the option to sign up for reminders, and a bag to store the sample in the fridge. Conclusions These novel, consumer-led interventions that are built upon the needs and experience of screening invitees provide potential solutions to improve participation in population bowel cancer screening.

BACKGROUND: While early autism intervention can significantly improve outcomes, gaps in implementation exist globally. These gaps are clearest in Africa, where forty percent of the world's children will live by 2050. Task-sharing early intervention to non-specialists is a key implementation strategy, given the lack of specialists in Africa. Naturalistic Developmental Behavioral Interventions (NDBI) are a class of early autism intervention that can be delivered by caregivers. As a foundational step to address the early autism intervention gap, we adapted a non-specialist delivered caregiver coaching NDBI for the South African context, and pre-piloted this cascaded task-sharing approach in an existing system of care. OBJECTIVES: First, we will test the effectiveness of the caregiver coaching NDBI compared to usual care. Second, we will describe coaching implementation factors within the Western Cape Department of Education in South Africa. METHODS: This is a type 1 effectiveness-implementation hybrid design; assessor-blinded, group randomized controlled trial. Participants include 150 autistic children (18-72 months) and their caregivers who live in Cape Town, South Africa, and those involved in intervention implementation. Early Childhood Development practitioners, employed by the Department of Education, will deliver 12, one hour, coaching sessions to the intervention group. The control group will receive usual care. Distal co-primary outcomes include the Communication Domain Standard Score (Vineland Adaptive Behavior Scales, Third Edition) and the Language and Communication Developmental Quotient (Griffiths Scales of Child Development, Third Edition). Proximal secondary outcome include caregiver strategies measured by the sum of five items from the Joint Engagement Rating Inventory. We will describe key implementation determinants. RESULTS: Participant enrolment started in April 2023. Estimated primary completion date is March 2027. CONCLUSION: The ACACIA trial will determine whether a cascaded task-sharing intervention delivered in an educational setting leads to meaningful improvements in communication abilities of autistic children, and identify implementation barriers and facilitators. TRIAL REGISTRATION: NCT05551728 in Clinical Trial Registry ( https://clinicaltrials.gov ).

Aims/method This national pre-pandemic survey compared demand and capacity of adult community eating disorder services (ACEDS) with NHS England (NHSE) commissioning guidance. Results Thirteen services in England and Scotland responded (covering 10.7 million population). Between 2016–2017 and 2019–2020 mean referral rates increased by 18.8%, from 378 to 449/million population. Only 3.7% of referrals were from child and adolescent eating disorder services (CEDS-CYP), but 46% of patients were aged 18–25 and 54% were aged >25. Most ACEDS had waiting lists and rationed access. Many could not provide full medical monitoring, adapt treatment for comorbidities, offer assertive outreach or provide seamless transitions. For patient volume, the ACEDS workforce budget was 15%, compared with the NHSE workforce calculator recommendations for CEDS-CYP. Parity required £7 million investment/million population for the ACEDS. Clinical implications This study highlights the severe pressure in ACEDS, which has increased since the COVID-19 pandemic. Substantial investment is required to ensure NHS ACEDS meet national guidance, offer evidence-based treatment, reduce risk and preventable deaths, and achieve parity with CEDS-CYP.

Abstract Background Amyotrophic lateral sclerosis (ALS) is a rapidly progressing neurodegenerative disorder with minimally effective treatment options. An important hurdle in ALS drug development is the non-invasive therapeutic access to the motor cortex currently limited by the presence of the blood-brain barrier (BBB). Focused ultrasound and microbubble (FUS+ MB) treatment is an emerging technology that was successfully used in ALS patients to temporarily open the cortical BBB. However, FUS+ MB-mediated drug delivery across ALS patients’ BBB has not yet been reported. Similarly, the effects of FUS+ MB on human ALS BBB cells remain unexplored. Methods Here we established the first FUS+ MB-compatible, fully-human ALS patient-cell-derived BBB model based on induced brain endothelial-like cells (iBECs) to study anti-TDP-43 antibody delivery and FUS+ MB bioeffects in vitro. Results Generated ALS iBECs recapitulated disease-specific hallmarks of BBB pathology, including reduced BBB integrity and permeability, and TDP-43 proteinopathy. The results also identified differences between sporadic ALS and familial (C9orf72 expansion carrying) ALS iBECs reflecting patient heterogeneity associated with disease subgroups. Studies in these models revealed successful ALS iBEC monolayer opening in vitro with no adverse cellular effects of FUS+ MB as reflected by lactate dehydrogenase (LDH) release viability assay and the lack of visible monolayer damage or morphology change in FUS+ MB treated cells. This was accompanied by the molecular bioeffects of FUS+ MB in ALS iBECs including changes in expression of tight and adherens junction markers, and drug transporter and inflammatory mediators, with sporadic and C9orf72 ALS iBECs generating transient specific responses. Additionally, we demonstrated an effective increase in the delivery of anti-TDP-43 antibody with FUS+ MB in C9orf72 (2.7-fold) and sporadic (1.9-fold) ALS iBECs providing the first proof-of-concept evidence that FUS+ MB can be used to enhance the permeability of large molecule therapeutics across the BBB in a human ALS in vitro model. Conclusions Together, this study describes the first characterisation of cellular and molecular responses of ALS iBECs to FUS+ MB and provides a fully-human platform for FUS+ MB-mediated drug delivery screening on an ALS BBB in vitro model.

Abstract Background Anticipated, internal, and enacted stigma are major barriers to tuberculosis (TB) care engagement and directly impact patient well-being. Unfortunately, targeted stigma interventions are lacking. We aimed to co-develop a person-centred stigma intervention with TB-affected community members and health workers in South Africa. Methods Using a community-based participatory research approach, we conducted ten group discussions with people diagnosed with TB (past or present), caregivers, and health workers (total n = 87) in Khayelitsha, Cape Town. Group discussions were facilitated by TB survivors. Discussion guides explored experiences and drivers of stigma and used human-centred design principles to co-develop solutions. Recordings were transcribed, coded, thematically analysed, and then further interpreted using the socio-ecological model and behaviour change wheel framework. Results Intervention components across socio-ecological levels shared common functions linked to effective behaviour change, namely education, training, enablement, persuasion, modelling, and environmental restructuring. At the individual level, participants recommended counselling to improve TB knowledge and provide ongoing support. TB survivors can guide messaging to nurture stigma resilience by highlighting that TB can affect anyone and is curable, and provide lived experiences of TB to decrease internal and anticipated stigma. At the interpersonal level, support clubs and family-centred counselling were suggested to dispel TB-related myths and foster support. At the institutional level, health worker stigma reduction training informed by TB survivor perspectives was recommended to decrease enacted stigma. Participants discussed how integration of TB/HIV care services may exacerbate TB/HIV intersectional stigma and ideas for restructured service delivery models were suggested. At the community level, participants recommended awareness-raising events led by TB survivors, including TB information in school curricula. At the policy level, solutions focused on reducing the visibility generated by a TB diagnosis and resultant stigma in health facilities and shifting tasks to community health workers. Conclusions Decreasing TB stigma requires a multi-level approach. Co-developing a person-centred intervention with affected communities is feasible and generates stigma intervention components that are directed and implementable. Such community-led multi-level intervention components should be prioritised by TB programs, including integrated TB/HIV care services.

Abstract Background Concussions in Rugby Union are common with an increased risk to adolescent players. Coaches are key to injury prevention and a greater understanding of their knowledge and sentiments may guide future initiatives. There is a lack of data on rugby coaches, especially in South Africa. This study aimed to investigate the knowledge and opinions of high school rugby coaches regarding concussion management. Methods This cross-sectional study of 37 high school rugby coaches in South Africa, was conducted via a self-reported questionnaire. Concussion knowledge was scored for correct answers only with closed-question scaling methods to measure the importance of items of concussion management using a graphical rating scale. An attitude scale (Likert) was used to assess self-reported opinions and behaviours. Associations were calculated for participant characteristics and overall concussion injury knowledge. Results More participants showed good overall knowledge of ≥ 75% (n = 22, 59% vs. n = 15, 40%), especially those with greater coaching experience (p = 0.021). Player welfare was perceived more important than player performance (185 vs. 164), with concussion prevention most important (184 of 185). Appealing characteristics of an injury prevention programme were the improvement of player skill (173, SD ± 0.75, mean 4.68), being adaptable (171, ± 0.86, 4.62), and being completed in the warm-up (167, ± 0.93, 4.51). The biggest perceived barriers were duration (138, ± 1.59, mean 3.73), effort (130, ± 1.56, 3.51), compliance and lack of knowledge (both 127, ± 1.68, 3.43). Conclusion These results support the implementation of ongoing concussion education for rugby coaches and identify areas for promoting awareness and knowledge of concussion injury prevention, identification, and specific management of younger athletes. Appealing characteristics and barriers are highlighted and may allow for improved implementation and adherence to concussion prevention programmes.

Abstract Aims Peripartum cardiomyopathy (PPCM) is characterized by left ventricular (LV) dysfunction developing towards the end of pregnancy or in the first months postpartum. Although about 60% of women with PPCM (the majority of which are prescribed evidence based heart failure [HF] medications) show LV recovery within 6 to 12 months, others remain with persistently impaired LV function. Poor adherence to medical therapy represents a major cause of avoidable hospitalizations, disability, and death in other cardiovascular conditions. In this study, we aimed to determine drug adherence to HF therapy among women with PPCM and to identify possible associations between drug adherence and LV recovery, functional status and psychological well‐being. Methods and results In this single‐centre, prospective, observational study, we included 36 consecutive women with PPCM. Adherence to HF treatment was assessed by (i) verifying the collection of pharmacy refills and (ii) using liquid chromatography high‐resolution mass spectrometry (LC‐HRMS). Participants were thereby classified as ‘adherent’ (i.e. all prescribed HF drugs were detectable by LC‐HRMS), ‘partially adherent’ (i.e. at least one prescribed drug detectable) or ‘non‐adherent’ (i.e. none of the prescribed drugs detectable). Health state index scores were assessed by EQ‐5D‐5L and HADS‐A/D (for anxiety/depression). Patients' median age was 32.4 years (IQR 27.6–36.1). At the adherence visit (which occurred at a median of 16 months [IQR 5–45] after PPCM diagnosis), prescription included beta‐blockers (77.8%), angiotensin‐converting enzyme inhibitors/angiotensin II receptor blockers (75%), mineralocorticoid receptor antagonists (47.2%) and loop diuretics (95.2%). Less than two thirds of patients (63.9%) collected all their pharmacy refills in the 6 months prior to adherence visit. According to LC‐HRMS, 23.5% participants were classified as adherent, 53.0% as partially adherent, and 23.5% as non‐adherent. Adherence was associated with significantly lower LVEDD at follow‐up (47 mm [IQR 46–52), vs. 56 mm [IQR 49–64] with partial adherence, and 62 mm [IQR 55–64] with non‐adherence, P = 0.022), and higher LVEF at follow‐up (60% [IQR 41–65]), vs. partially adherence (46% [IQR 34–50]) and non‐adherence (41.0% [IQR 29–47], P = 014). Adherent patients had a lower overall EQ‐ 5D score (5.5 [IQR 5–7.5], vs. 6 [IQR 5–7] in partially adherent, and 10 [IQR 8–15] in non‐adherent patients, P = 0.032) suggestive of a better self‐rated health status. Conclusions Adherence to HF therapy was associated with favourable LV reverse remodelling in PPCM and better self‐rated health status. Our study highlights the importance of drug adherence for functional recovery. Drug adherence should be an important component of patient communication and specific interventions in PPCM.

No abstract available.

Background: The radiology report is the primary means of conveying imaging findings between radiologists and clinicians. As a result, clinician satisfaction with the radiology report is an indicator of its quality and clinical relevance. It is crucial to identify factors that can enhance the radiology report in order to improve service delivery. Objectives: This study evaluates clinician and radiologist opinions, preferences and clinician utilisation of the radiology report. Method: Mixed quantitative and qualitative survey questionnaires were distributed in-person and online from December 2022 to February 2023 to a total of 287 clinicians and 43 independent medical practitioners specialising in radiology. Results: A total of 73.0% of radiologists and 56.5% of clinicians expressed satisfaction with the radiology reports. Additionally, 72.0% of radiologists expressed dissatisfaction with the history provided on the referral forms. It was found that 87.6% of clinicians read the radiology report, while 26.2% reviewed the radiological imaging without referring to it. Interestingly, 77.8% of clinicians preferred itemised listed reports, whereas 53.8% of radiologists preferred reports in paragraph format. It was discovered that 69.6% of radiologists and 65.4% of clinicians preferred a standardised reporting format. Conclusion: More than half of the clinicians and most of the radiologists expressed satisfaction with the radiology report. Both clinicians and radiologists showed a preference for a structured reporting format. A crucial element in constructing a good radiology report was having a relevant clinical history. The radiologist continued to be the preferred professional for interpreting radiological imaging. Contribution: This survey was a good starting point for improving communication between clinicians and radiologists. This will ultimately result in reports that are more useful to clinicians and radiologists who have a better understanding of what should be included in reports and how they should be structured.

The article presents and validates an extensive multivariate dataset that offers insights into water–energy–food (WEF) nexus governance for social justice at the intrahousehold, household, and community levels. The lack of insights in the WEF nexus debate that take social justice and governance into account is what spurred the data collection. The initial process involved scoping the originally selected investigated sites and their suitability. Once the research areas were identified, the data were collected from 1184 households in the Matatiele, Magareng, and Greater Taung Local Municipalities in South Africa, using a semi-structured questionnaire and KoboCollect software. The freely available software was installed on Android Tablets which were used by the enumerators. The questionnaires were initially piloted in Matatiele Local Municipality, testing for internal validity and skip patterns, as well as time to complete the questionnaire. The reliability of the Likert responses from the questionnaire was evaluated using Cronbachʼs alpha. The questionnaire was then refined for data collection and utilized a total of twenty-two (22) locally trained enumerators who were employed at the investigated sites. These enumerators were trained in administering the questionnaire and the use of the KoboCollect software used in data collection. The enumerators also received training on how to conduct the survey ethically, including informed permission, confidentiality, and the option to withdraw from the interview. The design of the data collection process was a cross-sectional survey that was conducted between 6 June and 4 August 2022, using purposive sampling. At the end of each data collection day, the enumerators uploaded their collected data into the KoboTool cloud, which allowed the lead in the survey to assess the data and effect any correctional measures on the questionnaire if the need arose. The enumerators also used a WhatsApp chat group to communicate real time opportunities and challenges in the questionnaire, which allowed the lead in the survey to constantly update the questionnaire. The multivariate questionnaire was divided into sections of socioeconomic and demographic characteristics, community-level governance, decision-making, food, energy, and water security, social justice, legal knowledge, and rights to utilize these resources. The dataset will be of significance to multi-disciplinary researchers focusing on WEF security, governance, and social justice in Southern Africa. Furthermore, environmental and sustainability practitioners can find valuable insights from the provided data. The employed methodology is replicable and adaptable, enabling real-time monitoring of social justice and governance in the context of food, energy, and water security. The real time monitoring of governance and social justice in water, energy and food allows for the possibility of continual data collection and updating, and if a longitudinal design is adopted, it can be used for impact inquiry of any interventions or policies.

Measures of physical growth, such as weight and height have long been the predominant outcomes for monitoring child health and evaluating interventional outcomes in public health studies, including those that may impact neurodevelopment. While physical growth generally reflects overall health and nutritional status, it lacks sensitivity and specificity to brain growth and developing cognitive skills and abilities. Psychometric tools, e.g., the Bayley Scales of Infant and Toddler Development, may afford more direct assessment of cognitive development but they require language translation, cultural adaptation, and population norming. Further, they are not always reliable predictors of future outcomes when assessed within the first 12–18 months of a child’s life. Neuroimaging may provide more objective, sensitive, and predictive measures of neurodevelopment but tools such as magnetic resonance (MR) imaging are not readily available in many low and middle-income countries (LMICs). MRI systems that operate at lower magnetic fields (< 100mT) may offer increased accessibility, but their use for global health studies remains nascent. The UNITY project is envisaged as a global partnership to advance neuroimaging in global health studies. Here we describe the UNITY project, its goals, methods, operating procedures, and expected outcomes in characterizing neurodevelopment in sub-Saharan Africa and South Asia.

The Adult Autism Quotient (AQ), the Empathy Quotient (EQ) and the Relative's Questionnaire (RQ) were used as part of the Adult Asperger's Assessment (AAA) by a diagnostic service for adults without an intellectual disability with suspected autism spectrum disorder (ASD). This service is part of the National Health Service (NHS) in England. Little is known about the utility of these structured questionnaires despite wide use in clinical practice. It was investigated whether the questionnaires could discriminate between individuals with and without a diagnosis of ASD. Receiver Operating Curve analysis showed good levels of sensitivity to detect a positive diagnosis, but the specificity to exclude those without a diagnosis was poor. A binary logistic regression showed that a combination of the questionnaires also showed limited diagnostic validity. These findings have clinical implications in reviewing the efficiency of the assessment process.

A bimodal impact strength distribution was found in notched impact specimens of HDPE composites with calcium carbonate, carbon black, SEBS and stabilisers. The bimodal distribution was only found at moderate-to-high calcium carbonate loadings, with the likelihood of low impact strength increasing with increasing stabiliser loading and decreasing with increasing SEBS/CB masterbatch loading. Bayesian methods were used first to confirm bimodality and then to investigate the effects of formulation on the performance of the system, based on a hierarchical model with quadratic and interactive terms and switching based on the sampling of a Bernoulli distribution with a logistic regression informing the probability of high or low impact strength. The results are contextualised through micrograph fractography and, briefly, differential scanning calorimetry. Results are also reported for unnotched impact tests, with negative correlations for impact strength with calcium carbonate and stabilisers, a positive correlation with SEBS/CB and interactive effects.