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Emerging evidence suggests that social identities are an important determinant of adaptation following traumatic life experiences. In this paper, we analyse accounts of people who experienced child sexual abuse. Using publicly available talk of people who waived their right to anonymity following successful conviction of perpetrators, we conducted a thematic analysis focusing on trauma‐related changes in their social identities. Analysis of these accounts highlighted two themes. The first highlights the acquisition in these accounts of unwanted and damaging identity labels. The second presents child sexual abuse as a key destructive force in terms of important identity work during childhood. Discussion of this analysis centres on the pathological consequences of social identity change. Both the loss of valued identities and the acquisition of aberrant and isolating identities are experienced and constructed as devastating by those affected by child sexual abuse. This has important implications, not only for those impacted by child sexual abuse but for how abuse is discussed in society, and how it is approached by policy makers, educators and individuals working with survivors and their families. [ABSTRACT FROM AUTHOR]

Purpose: Financial hardship as a result of cancer treatment can have a significant and lasting negative impact on adolescents and young adults (AYAs) and their families. To address a lack of developmentally informed and psychometrically sound measures of financial hardship for AYAs and their caregivers, we used rigorous measurement development methods recommended by the National Institutes of Health's Patient-Reported Outcomes Measurement Information System® (PROMIS®) to determine comprehensibility and relevance of measure content. Methods: Our multi-step approach involved item identification, refinement, and generation; translatability and reading level review; and cognitive interviews. A purposive sample of 25 AYAs and 10 caregivers participated, ensuring representation across age, education, gender, race/ethnicity, and cancer type. Results: Fifty patient-reported and caregiver-reported items were developed across material, psychosocial, and behavioral subdomains of financial hardship. Translatability and reading level reviews resulted in 22 patient-reported and 25 caregiver-reported items being rewritten. Eighty-eight percent of patients and all caregivers described the items as easy to answer. Younger AYAs (15 to 25 years of age) were more likely to say the items were less relevant for them. Forty-six patient-reported and 48 caregiver-reported items were recommended for further testing. Conclusion: This study is the first to use in-depth qualitative methods to center AYA patient and caregiver experiences in the creation of new measures of financial hardship. Data support the comprehensibility and content validity of these preliminary item banks. Future large-scale, quantitative testing will lead to additional refinements and support the use of short forms and computer-adaptive testing for a diverse sample of AYAs and their caregivers. [ABSTRACT FROM AUTHOR]

Introduction: Many stroke survivors do not receive optimal levels of personalised therapy to support their recovery. Use of technology for stroke rehabilitation has increased in recent years to help minimise gaps in service provision. Markerless motion capture technology is currently being used for musculoskeletal and occupational health screening and could offer a means to provide personalised guidance to stroke survivors struggling to access rehabilitation. Aims: This study considered context, stakeholders, and key uncertainties surrounding the use of markerless motion capture technology in community stroke rehabilitation from the perspectives of stroke survivors and physiotherapists with a view to adapting an existing intervention in a new context. Methods: Three focus groups were conducted with eight stroke survivors and five therapists. Data were analysed using reflexive thematic analysis. Results: Five themes were identified: limited access to community care; personal motivation; pandemic changed rehabilitation practice; perceptions of technology; and role of markerless technology for providing feedback. Conclusions: Participants identified problems associated with the access of community stroke rehabilitation, exacerbated by Covid-19 restrictions. Participants were positive about the potential for the use of markerless motion capture technology to support personalised, effective stroke rehabilitation in the future, providing it is developed to meet stroke survivor specific needs. [ABSTRACT FROM AUTHOR]

Background Methods Results Discussion Prenatal ultrasounds form an important part of routine maternity care in Australia and indeed internationally. The COVID‐19 pandemic necessitated rapid changes in society and healthcare to curb transmission, with evidence demonstrating detrimental impacts on childbearing women associated with these restrictions. However, experiences with pandemic restrictions for prenatal ultrasounds in relation to distress, patient expectations, and satisfaction are largely unknown. This study aimed to explore the experiences of pregnant women attending prenatal ultrasound during the pandemic in Australia.A cross‐sectional online survey of people in Australia who had undergone at least one prenatal ultrasound during the period of maternity care restrictions was performed. The survey included validated tools for assessing post‐traumatic stress, satisfaction, and expectations with maternity care.A total of 1280 responses were obtained. Almost 37% of respondents returned a PCL‐C score consistent with probable post‐traumatic stress disorder. Unexpected ultrasound findings or a high PCL‐C score were more likely to have higher expectations and lower levels of satisfaction with their maternity care experience. Having an ultrasound for pregnancy loss, fetal abnormality, and/or a prior post‐traumatic stress disorder diagnosis were the strongest factors correlating with a high PCL‐C score.The prevalence of post‐traumatic stress symptoms in the study population is concerning and elucidates the distress experienced in association with prenatal ultrasounds during pandemic restrictions in Australia. Maternity services should acknowledge the high levels of service consumers with post‐trauma symptoms and consider trauma‐responsive maternity care adaptations in response to adverse perinatal outcomes for those afflicted with post‐trauma and distress‐related symptoms. [ABSTRACT FROM AUTHOR]

Sexual assault is a persistent problem on college campuses that disproportionately impacts sexual and gender minority identified students. Objective: This study explores how circumstances of the crime, disclosure to informal sources, training and campus climate are associated with reporting sexual assault to college officials by these students. Participants: A total of 409 lesbian, gay, bisexual, transgender and queer/questioning college students who experienced sexual assault while attending their current four-year college. Results: Chi-square and t-test analysis found that reporting to college officials was significantly associated with the type of assault experienced, disclosure to a campus advocates, disclosure to a parent/guardian, and the campus climate for LGBTQ students. Conclusion: These findings suggest that practitioners and college officials may support reporting behavior amongst sexual and gender minority identified students through enhanced campus support systems and strategic educational efforts. [ABSTRACT FROM AUTHOR]

Objective: There is substantial practice variation in the management of cellulitis with limited prospective studies describing the course of cellulitis after diagnosis. We aimed to describe the demographics, clinical features (erythema, warmth, swelling and pain), patient‐reported disease trajectory and medium‐term follow‐up for ED patients with cellulitis. Methods: Prospective observational cohort study of adults diagnosed with cellulitis in two EDs in Southeast Queensland, Australia. Patients with (peri)orbital cellulitis and abscess were excluded. Data were obtained from a baseline questionnaire, electronic medical records and follow‐up questionnaires at 3, 7 and 14 days. Clinician adjudication of day 14 cellulitis cure was compared to patient assessment. Descriptive analyses were conducted. Results: Three‐hundred patients (mean age 50 years, SD 19.9) with cellulitis were enrolled, predominantly affecting the lower limb (75%). Cellulitis features showed greatest improvement between enrolment and day 3. Clinical improvement continued gradually at days 7 and 14 with persistent skin erythema (41%) and swelling (37%) at day 14. Skin warmth was the feature most likely to be resolved at each time point. There was a discrepancy in clinician and patient assessment of cellulitis cure at day 14 (85.8% vs. 52.8% cured). Conclusions: A clinical response of cellulitis features can be expected at day 3 with ongoing slower improvement over time. Over one third of patients had erythema or swelling at day 14. Patients are less likely than clinicians to deem their cellulitis cured at day 14. Future research should include parallel patient and clinician evaluation of cellulitis to help develop clearer definitions of treatment failure and cure. [ABSTRACT FROM AUTHOR]

In a strong gravitational lensing system, the distorted light from a source is analysed to infer the properties of the lens. However, light emitted by the lens itself can contaminate the image of the source, introducing systematic errors in the analysis. We present a simple and efficient lens light model based on the well-tested multi-Gaussian expansion (MGE) method for representing galaxy surface brightness profiles, which we combine with a semi-linear inversion scheme for pixelized source modelling. Testing it against realistic mock lensing images, we show that our scheme can fit the lensed images to the noise level, with relative differences between the true input and best-fitting lens light model remaining below 5 per cent. We apply the MGE lens light model to 38 lenses from the HST SLACS sample. We find that the new scheme provides a good fit for the majority of the sample with only 3 exceptions – these show clear asymmetric residuals in the lens light. We examine the radial dependence of the ellipticity and position angles and confirm that it is common for a typical lens galaxy to exhibit twisting non-elliptical isophotes and boxy / disky isophotes. Our MGE lens light model will be a valuable tool for understanding the hidden complexity of the lens mass distribution. [ABSTRACT FROM AUTHOR]

The distribution of mass in galaxy-scale strong gravitational lenses is often modelled as an elliptical power-law plus 'external shear', which notionally accounts for neighbouring galaxies and cosmic shear along our line of sight. A small amount of external shear could come from these sources, but we show that the vast majority does not. Except in a handful of rare systems, the best-fitting values do not correlate with independent measurements of line-of-sight shear: from weak lensing in 45 Hubble Space Telescope images, or in 50 mock images of lenses with complex distributions of mass. Instead, the best-fit external shear is aligned with the major or minor axis of 88 per cent of lens galaxies; and the amplitude of the external shear increases if that galaxy is discy. We conclude that 'external shear' attached to a power-law model is not physically meaningful, but a fudge to compensate for lack of model complexity. Since it biases other model parameters that are interpreted as physically meaningful in several science analyses (e.g. measuring galaxy evolution, dark matter physics or cosmological parameters), we recommend that future studies of galaxy-scale strong lensing should employ more flexible mass models. [ABSTRACT FROM AUTHOR]

Background: This paper describes and critically reflects on how children and young people (CYP) acted as public advisors to coproduce health information materials about Long Covid for younger audiences. This work was underpinned by the Lundy model, a framework which provides guidance on facilitating CYP to actively contribute to matters which affect them. Methods: Coproduction activity sessions took place with CYP in schools as well as video conferences with a CYP stakeholder group and CYP with Long Covid. Activities encouraged CYP to focus on the content, format, and design of materials and used problem‐based and collaborative learning to encourage engagement with the project. Using a range of methods and open discussion, CYP codesigned a series of Long Covid health information materials for younger audiences. Results: Sixty‐six CYP (aged 10–18), and two young adults were involved. CYP codesigned specifications for the final materials and provided feedback on early designs. The project led to the development of a series of health information materials targeted at CYP: a short social media campaign with six short videos and a 12‐page illustrated leaflet about Long Covid; released on social media and distributed in local area. All the CYP were positive about the project and their involvement. Discussion: Involving CYP led to the development of innovative and engaging information materials (influence). Developing rapport was important when working with CYP and this was facilitated by using approaches and activities to establish an environment (space) where the CYP felt comfortable sharing their views (voice) and being listened to (audience) by the adults in the project. Working with external groups who are willing to share their expertise can help the meaningful involvement of voices 'less heard'. Public Contribution: One CYP coapplicant contributed to the project design and facilitation of PPIE sessions, 64 CYP were involved in the PPIE sessions to design and feedback on materials. Two young adult media producers worked with CYP to produce these materials, another CYP supported this process. Three public contributors were involved in the preparation of this manuscript. [ABSTRACT FROM AUTHOR]

The articles in this special section employ histories of cities to examine the relationship between human ambitions and the transformation of space, the development of power discrepancies, and unequal access to material and natural resources. They also reveal the relevance of this quintessential human creation to global dynamics on our planet by unveiling the complex and often messy intersection between urban trajectories, local, imperial, or national histories and longue durée global developments. More than a case study, each article delves into the details of the materiality of the urban history they examine to explain how cities exist in the world, or in Richard Harris's words, "how cities matter" to our shared planetary past and present. In this manner, they answer the call for new conversations about the historical relationship between our urban past and our broader global reality. [ABSTRACT FROM AUTHOR]

Peritoneal inclusion cysts (PICs) are a rare and benign condition of uncertain pathogenesis. The fluid-filled, mesothelial-lined cysts manifest within the abdominopelvic cavity. This case report details an unusual occurrence of a 97 mm PIC- presenting as an umbilical hernia- in a 26-year-old male patient with no prior surgical history. Following pre-operative cross-sectional imaging, this was managed through open excision without complication. A systematic review of the literature highlighted 30 previous cases [26F, 4M] with a mean age of 34 years (std ±15.4) and a median diameter of 93 mm [IQR, 109 mm]. A total of 53% (n = 16) of cases had a history of previous abdominal surgery. Surgical excision is safe and laparoscopic modality should be considered (<1% recurrence). Accepting the limited evidence base, image guided drainage should be avoided (50% recurrence, n = 2). [ABSTRACT FROM AUTHOR]

During the pandemic of coronavirus disease 2019 (COVID-19), many jurisdictions around the world introduced a "social distance" rule under which people are instructed to keep a certain distance from others. Generally, this rule is implemented simply by telling people how many metres or feet of separation should be kept, without giving them precise instructions as to how the specified distance can be measured. Consequently, the rule is effective only to the extent that people are able to gauge this distance through their space perception. To examine the effectiveness of the rule from this point of view, this study empirically investigated how much distance people would leave from another person when they relied on their perception of this distance. Participants (N = 153) were asked to stand exactly 1.5 m away from a researcher, and resultant interpersonal distances showed that while their mean was close to the correct 1.5 m distance, they exhibited large individual differences. These results suggest that a number of people would not stay sufficiently away from others even when they intend to do proper social distancing. Given this outcome, it is suggested that official health advice include measures that compensate for this tendency. [ABSTRACT FROM AUTHOR]

BackgroundMethodsResultsConclusionChildren with visual impairment very often have additional motor disorders and developmental delays. They are less active than typical children of a similar age, even though physical activity is essential for their well-being.A weekly dance class for 1 year was offered to 4 visually impaired and 5 sighted children in a conservatory.The children’s satisfaction was excellent, and they perceived an improvement in their mood, walking, balance and coordination, and felt more physically active. The walking speed, balance and posture were improved.This original project, with its full integration in a dance conservatory and by mixing children with and without visual impairment, showed excellent feasibility. [ABSTRACT FROM AUTHOR]

This article explores the meanings and uses of a hospital corridor through 98 diary entries produced by the staff of an English specialist hospital during the early stages of the COVID‐19 pandemic. Drawing on Lefebvre's (1991, The production of space. Blackwell) threefold theorisation of space, corridors are seen as conceived, perceived and lived spaces, produced through and enabling the reconfiguration and reinterpretation of social interactions. The diaries depict two distinct versions of the central hospital corridor: its ‘normal’ operation prior to the pandemic when it was perceived as a social and symbolic space for collective sensemaking and the ‘COVID‐19 empty corridor’ described as a haunting place that divided hospital staff along ostensibly new social and moral boundaries that impacted negatively on lived work experiences and staff relationships. The mobilisation of the central hospital corridor in the daily social construction of meaning and experience during a period of organisational and societal crisis suggests that corridors should not be only seen as a material backdrop for work relationships but as social entities that come into being and are maintained and reproduced through the (lack of) performance of social relations. [ABSTRACT FROM AUTHOR]

Campus-based victim advocates provide support and assistance to victims of interpersonal violence in the college context. In this study of professional campus-based victim advocates, structural equation modeling (SEM) was used to assess the direct and indirect effects of factors related to burnout. A total of 208 full-time victim advocates employed at four-year college campuses across the United States participated in an online survey in the summer of 2021. SEM analysis found that secondary traumatic stress and organizational support had significant direct effects on the level of burnout in this population. Also, organizational support served as a mediating factor between perceptions of leadership and burnout, and secondary traumatic stress served as a mediating factor between organizational support and burnout. Higher education institutions can make changes at the organizational level to address burnout of victim advocates through manageable work hours, control over workload, fair compensation, and increased sense of community investment in interpersonal violence response. [ABSTRACT FROM AUTHOR]

Background Despite their vital roles, informal caregivers of adult cancer patients are commonly overlooked in cancer care. This study describes processes for identifying cancer caregivers and processes for distress screening and management among caregivers and patients in the understudied community oncology setting. Methods Supportive care leaders from the National Cancer Institute Community Oncology Research Program practices completed online survey questions regarding caregiver identification, caregiver and patient distress screening, and distress management strategies. We described practice group characteristics and prevalence of study outcomes. Multivariable logistic regression explored associations between practice group characteristics and caregiver identification in the electronic health record (EHR). Results Most (64.9%, 72 of 111) supportive care leaders reported routine identification and documentation of informal caregivers; 63.8% record this information in the EHR. Only 16% routinely screen caregivers for distress, though 92.5% screen patients. Distress management strategies for caregivers and patients are widely available, yet only 12.6% are routinely identified and screened and had at least 1 referral strategy for caregivers with distress; 90.6% are routinely screened and had at least 1 referral strategy for patients. Practices with a free-standing outpatient clinic (odds ratio [OR] = 0.29, P  = .0106) and academic affiliation (OR = 0.01, P  = .04) were less likely to identify and document caregivers in the EHR. However, higher oncologist volume was associated with an increased likelihood of recording caregiver information in the EHR (OR = 1.04, P  = .02). Conclusions Despite high levels of patient distress screening and management, few practices provide comprehensive caregiver engagement practices. Existing patient engagement protocols may provide a promising platform to build capacity to better address caregiver needs. [ABSTRACT FROM AUTHOR]

Young adults entering college are exposed to new and ever-changing stressors that powerfully affect health and academic achievement. While engaging in physical activity can help to manage the experience of stress, stress itself is an important barrier to activity. The purpose of this study is to examine the bidirectional relationships between physical activity and momentary stress among college students. We further examined whether these relationships were modified by trait mindfulness. Undergraduate students (N = 61) completed a single measure of trait mindfulness and up to 6 daily ecological momentary assessments of stress for one week while wearing an ActivPAL accelerometer. Activity variables were aggregated in the 30, 60, and 90 min before and following each stress survey. Multilevel models revealed significant negative relationships between stress ratings and total volume of activity both preceding and following the survey. Mindfulness did not modify these relationships but was independently and negatively related to momentary reports of stress. These results underscore the importance of developing activity programming for college students that addresses stress as a powerful and dynamic barrier to behavior change. [ABSTRACT FROM AUTHOR]

The cold dark matter (DM) model predicts that every galaxy contains thousands of DM subhaloes; almost all other DM models include a physical process that smooths away the subhaloes. The subhaloes are invisible, but could be detected via strong gravitational lensing, if they lie on the line of sight to a multiply imaged background source, and perturb its apparent shape. We present a predominantly automated strong lens analysis framework, and scan for DM subhaloes in Hubble Space Telescope imaging of 54 strong lenses. We identify five DM subhalo candidates, including two especially compelling candidates (one previously known in SLACS0946 + 1006) where a subhalo is favoured after all of our tests for systematics. We find that the detectability of subhaloes depends upon the assumed parametric form for the lens galaxy's mass distribution, especially its degree of azimuthal freedom. Using separate components for DM and stellar mass reveals two DM subhalo candidates and removes four false positives compared to the single power-law mass model that is common in the literature. We identify 45 lenses without substructures, the number of which is key to statistical tests able to rule out models of, for example, warm or self-interacting DM. Our full analysis results are available at https://github.com/Jammy2211/autolens_subhalo. [ABSTRACT FROM AUTHOR]

Students must be able to produce legible and fluent text when completing classwork and for exam purposes. Some students, however, present with handwriting difficulties in secondary school. When these are significant, intervention may be necessary or alternatives to handwriting may be offered (e.g. use of a word processor). Little is known about current practice of supporting secondary students with handwriting difficulties in England and how recommendations are made to transition to typing. Semi‐structured interviews were conducted with 13 practitioners with a responsibility for supporting students with handwriting difficulties. Two themes were identified. The first theme, 'doing the right thing', illustrated the tension between practitioners' commitment to supporting students with handwriting difficulties and their uncertainty around what is the 'right' approach. The second theme, 'influencing practice', described the contextual factors (student and family, school environment and national context) that impact on practitioners' practice and their decision to transition from handwriting to typing. Findings highlight the complexities of supporting this group of students and an urgent need for guidance at a national level to assist best practice. Implications for practice are discussed. Further research examining the effectiveness of handwriting interventions with secondary students and the optimum time to start typing is warranted. [ABSTRACT FROM AUTHOR]

Protected areas (PAs) are a core component of conservation policy and practice. However, many species for which they are designated are highly mobile, and may move among sites within and beyond PA boundaries. Environmental impacts on sites beyond those boundaries could thus impact the PA's protected populations, with the risk of adversely affecting its conservation objectives. Conservationists therefore urgently need tools to assess impacts on PAs and their populations of developments beyond their boundaries. We present a framework for using network analysis of observations of marked individuals to assess the protection footprint of PAs in the wider landscape and the impact footprint of developments within or neighboring PAs. We illustrate the use of this framework by assessing the impact of a current airport development proposal on a partially protected wetland, the Tagus estuary in Portugal, specifically by evaluating the extent of noise disturbance on the PA's population of Black‐tailed Godwits, a protected migratory wader species. By analyzing individual movements between sites and across seasons, we find disturbance impacts on up to 68.3% of individual Black‐tailed Godwits overall, greatly exceeding the estimates of 0.46–5.5% in the airport's Environmental Impact Assessments which derived from count data. We then compared the pre‐development network with simulated networks that represented two levels of site avoidance by removing sites predicted to receive noise in excess of two thresholds, 55 or 65 dB(A). Avoidance by Godwits of the potentially‐impacted sites is predicted to have a larger effect on network structure than removing the same number of sites at random, suggesting that an airport in the proposed location would operate as a barrier to connectivity in this wetland. We also highlight the role that network analyses of locations of marked individuals can play in assessing environmental impacts on protected sites and populations. [ABSTRACT FROM AUTHOR]

Recent research indicates that social identities play a crucial role in the connection between adversity, post‐traumatic stress, and overall psychological well‐being. Understanding of how trauma influences collective dimensions of the self, positively or negatively, is limited. This study focuses on analysing publicly accessible narratives of four women who chose to waive their anonymity after the conviction of the men who had attacked and sexually assaulted them in Ireland. Thematic analysis highlighted two themes that signal (i) collective dimensions to this personal trauma, (ii) attempts to reconstruct social identities in the aftermath of trauma. Women presented their experiences as having the potential to amplify positive connections with others despite the wider embedded sociocultural understanding of sexual assault. These changes were associated with redefinition of social identities. Discussion highlights the potential for personal and intimate trauma to result in positive social identity change; a phenomenon that we label collective post‐traumatic growth. [ABSTRACT FROM AUTHOR]

The impact of the COVID-19 pandemic on University students has been a topic of fiery debate and of public health research. This study demonstrates the use of a combination of spatiotemporal epidemiological models to describe the trends in COVID-19 positive cases on spatial, temporal and spatiotemporal scales. In addition, this study proposes new epidemiological metrics to describe the connectivity between observed positivity; an analogous metric to the R number in conventional epidemiology. The proposed indices, Rspatial, Rspatiotemporal and Rscaling will aim to improve the characterisation of the spread of infectious disease beyond that of the COVID-19 framework and as a result inform relevant public health policy. Apart from demonstrating the application of the novel epidemiological indices, the key findings in this study are: firstly, there were some Intermediate Zones in Edinburgh with noticeably high levels of COVID-19 positivity, and that the first outbreak during the study period was observed in Dalry and Fountainbridge. Secondly, the estimation of the distance over which the COVID-19 counts at the halls of residence are spatially correlated (or related to each other) was found to be 0.19km (0.13km to 0.27km) and is denoted by the index, Rspatial. This estimate is useful for public health policy in this setting, especially with contact tracing. Thirdly, the study indicates that the association between the surrounding community level of COVID-19 positivity (Intermediate Zones in Edinburgh) and that of the University of Edinburgh's halls of residence was not statistically significant. Fourthly, this study reveals that relatively high levels of COVID-19 positivity were observed for halls for which higher COVID-19 fines were issued (Spearman's correlation coefficient = 0.34), and separately, for halls which were non-ensuite relatively to those which were not (Spearman's correlation coefficient = 0.16). Finally, Intermediate Zones with the highest positivity were associated with student residences that experienced relatively high COVID-19 positivity (Spearman's correlation coefficient = 0.27). [ABSTRACT FROM AUTHOR]

Introduction: To examine electroencephalogram (EEG) as a diagnostic tool for late-onset efavirenz (EFV) neurotoxicity syndrome (LENS), an uncommon but severe and potentially fatal complication of EFV therapy. Methods: We conducted a Retrospective case-control study. EEGs from confirmed cases of LENS (clinical syndrome and plasma EFV >4ug/mL) recorded from June 2016 to May 2021 were compared with control EEGs from the same time-period. Controls were adults (18–70 years) with a similar indication for EEG (eg. encephalopathy or confusion), dysrhythmia generalised grade II, and LENS excluded. EEGs were reviewed by two blinded interpreters given a description of the characteristic EEG changes, ie. persistent, diffuse, high voltage, bisynchronous, monomorphic 4–7 Hz theta frequency waveforms with transient attenuation on eye opening. Interpreters were asked to determine whether EEGs showed definite, probable or no changes. Results: Thirteen LENS cases were compared with 50 control EEGs. Interpreter 1 labelled 11/13 LENS cases as having define or probable changes, and interpreter 2 labelled 10/13. Interpreter 1 labelled probable changes in 1/50 controls and interpreter 2 in 3/50. Neither interpreter labelled any controls as having definite changes. Interrater reliability was good with 95% agreement and a Cohen's kappa of 0.83. Sensitivity of EEG under these conditions for the diagnosis of LENS was 85% and 77% for interpreters 1 and 2 respectively, and specificity was 98% and 94%. Conclusions: EEG is a useful tool in the diagnosis of LENS which can be used to aid clinical decisions while awaiting EFV levels, or in low-resource settings where EFV levels are not available. [ABSTRACT FROM AUTHOR]

Federal law in the United States mandates that institutions of higher education address sexual assault within their communities. Colleges and universities have increasingly hired full-time professionals to manage response efforts, including campus-based victim advocates. Campus-based advocates provide emotional support, help students access and understand report options, and ensure students receive appropriate accommodations. Very little is known about the experience or perceptions of campus-based victim advocates. In this study, 208 professional campus-based advocates from across the United States completed an anonymous online survey focused on their perceptions of campus response to sexual assault. Multiple regression analysis was applied to investigate how psychosocial factors (burnout, secondary trauma, and compassion satisfaction) and organizational factors (perceptions of leadership, organizational support, and community relational health) were associated with advocate perceptions of institutional response to sexual assault. Findings indicate that while advocates experience burnout and secondary trauma, and have lower than average compassion satisfaction scores, these psychosocial outcomes do not influence their perception of response efforts. However, all the organizational factors significantly contribute to how advocates view response. The more positively advocates viewed leadership, campus support, and relational health, the more positive they viewed the response efforts on campus. In order to improve response efforts, administrators should engage in meaningful training on sexual assault, include campus advocates in high-level discussions of campus sexual assault and ensure appropriate resources are provided to advocacy services. [ABSTRACT FROM AUTHOR]

Background: Cellulitis is a clinical diagnosis with several mimics and no gold standard diagnostic criteria. Misdiagnosis is common. This review aims to quantify the proportion of cellulitis misdiagnosis in primary or unscheduled care settings based on a second clinical assessment and describe the proportion and types of alternative diagnoses. Methods: Electronic searches of Medline, Embase and Cochrane library (including CENTRAL) using MeSH and other subject terms identified 887 randomised and non-randomised clinical trials, and cohort studies. Included articles assessed the proportion of cellulitis misdiagnosis in primary or unscheduled care settings through a second clinical assessment up to 14 days post initial diagnosis of uncomplicated cellulitis. Studies on infants and patients with (peri-)orbital, purulent and severe or complex cellulitis were excluded. Screening and data extraction was conducted independently in pairs. Risk of bias was assessed using a modified risk of bias tool from Hoy et al. Meta-analyses were undertaken where ≥ 3 studies reported the same outcome. Results: Nine studies conducted in the USA, UK and Canada, including a total of 1600 participants, were eligible for inclusion. Six studies were conducted in the inpatient setting; three were in outpatient clinics. All nine included studies provided estimates of the proportion cellulitis misdiagnosis, with a range from 19 to 83%. The mean proportion misdiagnosed was 41% (95% CI 28 to 56% for random effects model). Heterogeneity between studies was very high both statistically (I2 96%, p-value for heterogeneity < 0.001) and clinically. Of the misdiagnoses, 54% were attributed to three conditions (stasis dermatitis, eczematous dermatitis and edema/lymphedema). Discussion: The proportion of cellulitis misdiagnosis when reviewed within 14 days was substantial though highly variable, with the majority attributable to three diagnoses. This highlights the need for timely clinical reassessment and system initiatives to improve diagnostic accuracy of cellulitis and its most common mimics. Trial Registration: Open Science Framework (https://osf.io/9zt72). [ABSTRACT FROM AUTHOR]

Organisms have evolved elaborate physiological pathways that regulate growth, proliferation, metabolism, and stress response. These pathways must be properly coordinated to elicit the appropriate response to an ever-changing environment. While individual pathways have been well studied in a variety of model systems, there remains much to uncover about how pathways are integrated to produce systemic changes in a cell, especially in dynamic conditions. We previously showed that deletion of Protein Kinase A (PKA) regulatory subunit BCY1 can decouple growth and metabolism in Saccharomyces cerevisiae engineered for anaerobic xylose fermentation, allowing for robust fermentation in the absence of division. This provides an opportunity to understand how PKA signaling normally coordinates these processes. Here, we integrated transcriptomic, lipidomic, and phospho-proteomic responses upon a glucose to xylose shift across a series of strains with different genetic mutations promoting either coupled or decoupled xylose-dependent growth and metabolism. Together, results suggested that defects in lipid homeostasis limit growth in the bcy1Δ strain despite robust metabolism. To further understand this mechanism, we performed adaptive laboratory evolutions to re-evolve coupled growth and metabolism in the bcy1Δ parental strain. The evolved strain harbored mutations in PKA subunit TPK1 and lipid regulator OPI1, among other genes, and evolved changes in lipid profiles and gene expression. Deletion of the evolved opi1 gene partially reverted the strain's phenotype to the bcy1Δ parent, with reduced growth and robust xylose fermentation. We suggest several models for how cells coordinate growth, metabolism, and other responses in budding yeast and how restructuring these processes enables anaerobic xylose utilization. Author summary: All organisms utilize an energy source to generate the cellular resources needed to grow and divide. Individual processes have been well studied, but the coordination and crosstalk between the process is not well understood. To study growth and metabolism coupling, we used a yeast strain that was genetically engineered to ferment the sugar xylose but lacked growth on the sugar. The decoupled growth and metabolism was caused by a deletion of a single gene in a highly conserved signaling pathway found in all eukaryotes. While our work is focused on xylose metabolism, we address the fundamental question of how cells coordinate growth with metabolism under non-ideal conditions. We identified changes in gene expression that implicated altered regulatory mechanisms involved in lipid metabolism correlating with decoupled growth and metabolism. Our work highlights the complexity of engineering new cellular functions and that global regulatory modifications, rather than altering individual pathways, may be required for broad cellular changes. [ABSTRACT FROM AUTHOR]

Current approaches to classifying cognitive impairment in people living with HIV can overestimate disease burden and lead to ambiguity around disease mechanisms. The 2007 criteria for HIV-associated neurocognitive disorders (HAND), sometimes called the Frascati criteria, can falsely classify over 20% of cognitively healthy individuals as having cognitive impairment. Minimum criteria for HAND are met on the basis of performance on cognitive tests alone, which might not be appropriate for populations with diverse educational and socioeconomic backgrounds. Imprecise phenotyping of cognitive impairment can limit mechanistic research, biomarker discovery and treatment trials. Importantly, overestimation of cognitive impairment carries the risk of creating fear among people living with HIV and worsening stigma and discrimination towards these individuals. To address this issue, we established the International HIV-Cognition Working Group, which is globally representative and involves the community of people living with HIV. We reached consensus on six recommendations towards a new approach for diagnosis and classification of cognitive impairment in people living with HIV, intended to focus discussion and debate going forward. We propose the conceptual separation of HIV-associated brain injury — including active or pretreatment legacy damage — from other causes of brain injury occurring in people living with HIV. We suggest moving away from a quantitative neuropsychological approach towards an emphasis on clinical context. Our recommendations are intended to better represent the changing profile of cognitive impairment in people living with HIV in diverse global settings and to provide a clearer framework of classification for clinical management and research studies. Current approaches to classifying cognitive impairment in people living with HIV can overestimate disease burden and lead to ambiguity around disease mechanisms. In this Consensus Statement, the International HIV-Cognition Working Group have outlined six recommendations towards a new approach, intended to better represent changes in the spectrum of HIV disease in the modern era of antiretroviral therapy. [ABSTRACT FROM AUTHOR]

In this research, a pipeline was developed to assess the out‐of‐sample predictive capability of structure‐based constitutive models of ascending aortic aneurysmal tissue. The hypothesis being tested is that a biomarker can help establish similarities among tissues sharing the same level of a quantifiable property, thus enabling the development of biomarker‐specific constitutive models. Biomarker‐specific averaged material models were constructed from biaxial mechanical tests of specimens that shared similar biomarker properties such as level of blood‐wall shear stress or microfiber (elastin or collagen) degradation in the extracellular matrix. Using a cross‐validation strategy commonly used in classification algorithms, biomarker‐specific averaged material models were assessed in contrast to individual tissue mechanics of out of sample specimens that fell under the same category but did not contribute to the averaged model's generation. The normalized root means square errors (NRMSE) calculated on out‐of‐sample data were compared with average models when no categorization was performed versus biomarker‐specific models and among different level of a biomarker. Different biomarker levels exhibited statistically different NRMSE when compared among each other, indicating more common features shared by the specimens belonging to the lower error groups. However, no specific biomarkers reached a significant difference when compared to the average model created when No Categorization was performed, possibly on account of unbalanced number of specimens. The method developed could allow for the screening of different biomarkers or combinations/interactions in a systematic manner leading the way to larger datasets and to more individualized constitutive approaches. [ABSTRACT FROM AUTHOR]

Observations suggest that the dark matter and stars in early-type galaxies 'conspire' to produce a surprisingly simple distribution of total mass, ρ(r) ∝ ρ−γ, with γ ≈ 2. We measure the distribution of mass in 48 early-type galaxies that gravitationally lens a resolved background source. By fitting the source light in every pixel of images from the Hubble Space Telescope , we find a mean |$\langle \gamma \rangle =2.075_{-0.024}^{+0.023}$| with an intrinsic scatter between galaxies of |$\sigma _\gamma =0.172^{+0.022}_{-0.032}$| for the overall sample. This is consistent with and has similar precision to traditional techniques that employ spectroscopic observations to supplement lensing with mass estimates from stellar dynamics. Comparing measurements of γ for individual lenses using both techniques, we find a statistically insignificant correlation of |$-0.150^{+0.223}_{-0.217}$| between the two, indicating a lack of statistical power or deviations from a power-law density in certain lenses. At fixed surface mass density, we measure a redshift dependence, |$\partial \langle \gamma \rangle /\partial z=0.345^{+0.322}_{-0.296}$|⁠ , that is consistent with traditional techniques for the same sample of Sloan Lens ACS and GALaxy-Lyα EmitteR sYstems (GALLERY) lenses. Interestingly, the consistency breaks down when we measure the dependence of γ on the surface mass density of a lens galaxy. We argue that this is tentative evidence for an inflection point in the total mass-density profile at a few times the galaxy effective radius – breaking the conspiracy. [ABSTRACT FROM AUTHOR]

In an adolescent population receiving treatment of chlamydia, individuals having a prescription sent to a pharmacy were 49% less likely to return for retesting within 6 months than individuals receiving directly observed therapy. Background: Chlamydia trachomatis is the most common reportable sexually transmitted infection in the United States, with >60% of reported cases occurring in individuals aged 15 to 24 years. US practice guidelines recommend directly observed therapy (DOT) for the treatment of chlamydia in adolescents, but almost no research has been done to evaluate whether DOT results in improved outcomes. Methods: We conducted a retrospective cohort study of adolescents who sought care at 1 of 3 clinics within a large academic pediatric health system for a chlamydia infection. The study outcome was return for retesting within 6 months. Unadjusted analyses were performed using χ 2, Mann-Whitney U , and t tests, and adjusted analyses were performed using multivariable logistic regression. Results: Of the 1970 individuals included in the analysis, 1660 (84.3%) received DOT and 310 (15.7%) had a prescription sent to a pharmacy. The population was primarily Black/African American (95.7%) and female (78.2%). After controlling for confounders, individuals who had a prescription sent to a pharmacy were 49% (95% confidence interval, 31%–62%) less likely than individuals who received DOT to return for retesting within 6 months. Conclusions: Despite clinical guidelines recommending the use of DOT for chlamydia treatment in adolescents, this is the first study to describe the association between DOT and an increase in the number of adolescents and young adults who return for sexually transmitted infection retesting within 6 months. Further research is needed to confirm this finding in diverse populations and explore nontraditional settings for the provision of DOT. [ABSTRACT FROM AUTHOR]

Supermassive black holes (SMBHs) are a key catalyst of galaxy formation and evolution, leading to an observed correlation between SMBH mass M BH and host galaxy velocity dispersion σe. Outside the local Universe, measurements of M BH are usually only possible for SMBHs in an active state: limiting sample size and introducing selection biases. Gravitational lensing makes it possible to measure the mass of non-active SMBHs. We present models of the |$z$|  = 0.169 galaxy-scale strong lens Abell 1201. A cD galaxy in a galaxy cluster, it has sufficient 'external shear' that a magnified image of a |$z$|  = 0.451 background galaxy is projected just ∼1 kpc from the galaxy centre. Using multiband Hubble Space Telescope imaging and the lens modelling software PYAUTOLENS , we reconstruct the distribution of mass along this line of sight. Bayesian model comparison favours a point mass with M BH = 3.27 ± 2.12 × 1010 M⊙ (3σ confidence limit); an ultramassive black hole. One model gives a comparable Bayesian evidence without an SMBH; however, we argue this model is nonphysical given its base assumptions. This model still provides an upper limit of M BH ≤ 5.3 × 1010 M⊙, because an SMBH above this mass deforms the lensed image ∼1 kpc from Abell 1201's centre. This builds on previous work using central images to place upper limits on M BH, but is the first to also place a lower limit and without a central image being observed. The success of this method suggests that surveys during the next decade could measure thousands more SMBH masses, and any redshift evolution of the M BH−σe relation. Results are available at https://github.com/Jammy2211/autolens_abell_1201. [ABSTRACT FROM AUTHOR]

Purpose: Limited research has examined the suitability of crowdsourced ratings to measure treatment effects in speakers with Parkinson’s disease (PD), particularly for constructs such as voice quality. This study obtained measures of reliability and validity for crowdsourced listeners’ ratings of voice quality in speech samples from a published study. We also investigated whether aggregated listener ratings would replicate the original study’s findings of treatment effects based on the Acoustic Voice Quality Index (AVQI) measure. Method: This study reports a secondary outcome measure of a randomized controlled trial with speakers with dysarthria associated with PD, including two active comparators (Lee Silverman Voice Treatment [LSVT LOUD] and LSVT ARTIC), an inactive comparator (untreated PD), and a healthy control group. Speech samples from three time points (pretreatment, posttreatment, and 6-month follow-up) were presented in random order for rating as “typical” or “atypical” with respect to voice quality. Untrained listeners were recruited through the Amazon Mechanical Turk crowdsourcing platform until each sample had at least 25 ratings. Results: Intrarater reliability for tokens presented repeatedly was substantial (Cohen’s κ = .65–.70), and interrater agreement significantly exceeded chance level. There was a significant correlation of moderate magnitude between the AVQI and the proportion of listeners classifying a given sample as “typical.” Consistent with the original study, we found a significant interaction between group and time point, with the LSVT LOUD group alone showing significantly higher perceptually rated voice quality at posttreatment and follow-up relative to the pretreatment time point. Conclusions: These results suggest that crowdsourcing can be a valid means to evaluate clinical speech samples, even for less familiar constructs such as voice quality. The findings also replicate the results of the study by Moya-Galé et al. (2022) and support their functional relevance by demonstrating that the effects of treatment measured acoustically in that study are perceptually apparent to everyday listeners. [ABSTRACT FROM AUTHOR]

Background: Women with gestational weight gain (GWG) that is below or above recommendations are at risk of adverse perinatal outcomes. Motivational interviewing and/or cognitive behaviour therapy have demonstrated efficacy in initiating and sustaining behaviour change, including weight control. The objective of this review was to investigate the effect of antenatal interventions that include components of motivational interviewing and/or cognitive behaviour therapy on gestational weight gain. Methods: This review was designed and reported in accordance with guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Five electronic databases were systematically searched to March 2022. Randomised controlled trials evaluating interventions with identified components of motivational interviewing and/or cognitive behaviour therapies were included. Pooled proportions of appropriate GWG and GWG above or below guidelines, and standardised mean difference for total gestational weight gain, were calculated. Risk of bias in included studies was evaluated using the Risk of Bias 2 tool, and the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) approach was used to evaluate the quality of evidence. Results: Twenty-one studies (8030 participants) were included. Overall, MI and/or CBT interventions had a small effect on the total gestational weight gain (SMD: -0.18, 95% confidence interval: -0.27 to -0.09, p < 0.001) and improved the proportion of women achieving recommended gestational weight gain (29% versus 23% in the comparison, p < 0.001). The GRADE assessment indicated that overall quality of evidence is very uncertain, however sensitivity analyses to account for high risk of bias produced similar results to original meta-analyses. The magnitude of effect was greater in women with overweight or obesity when compared to women with BMI < 25 kg/m2. Conclusion: Motivational interviewing and/or cognitive behaviour therapy techniques may be effective for promoting healthy gestational weight gain. Nevertheless, a high proportion of women do not achieve recommended gestational weight gain. Future interventions should consider factors, including clinician and consumer perspectives, in the design and delivery of psychosocial interventions that aim to support healthy gestational weight gain. Trial registration: The protocol for this review was registered with the PROSPERO International register of systematic reviews (registration number CRD42020156401). [ABSTRACT FROM AUTHOR]

Introduction: As children with long‐term conditions (LTCs) mature, they are usually expected to assume responsibility from their parents for self‐management of their condition. Little is known about what supports families with this handover of responsibility, including the role of healthcare professionals (HCPs). This study aimed to explore what supports young people with chronic kidney disease (CKD) to assume self‐management responsibility and parents to relinquish control. Methods: A qualitative study, using a grounded theory approach was conducted. Individual and dyadic interviews and focus groups were carried out with 16 young people aged 13–17 years old with CKD, 13 parents, and 20 HCPs. Participants were recruited from two UK children's renal units. Findings: Building and maintaining trust, fostering positivity, learning from mistakes, forming partnerships and individualized support, facilitated the transfer of self‐management responsibility. However, HCPs' focus on developing partnerships with young people meant some parents felt excluded, highlighting uncertainty around whether support should be child‐ or family‐centred. Although tailored support was identified as critical, aspects of local service provision appeared to impact on HCPs' capacity to implement individualized approaches. Conclusion: This study has identified what supports the handover of responsibility, and, importantly, HCPs' current, and potential role in helping young people to assume responsibility for managing their LTC. Further research is needed to explore how HCPs' involvement balances child‐ and family‐centred care, and how HCPs can adopt personalized, strengths‐based approaches to help ensure the support that families receive is tailored to their individual needs. Patient or Public Contribution: Patient and public involvement was integrated throughout the study, with young adults with CKD and parents who had a child with CKD actively involved in the study's design and delivery. [ABSTRACT FROM AUTHOR]

Introduction: Differentiating an acute from chronic compression fracture of the thoracolumbar (TL) spine can pose a dilemma for radiologists interpreting spinal imaging following trauma. Mild wedging of the vertebrae can be due to spondylosis or osteoporosis, whilst acute simple compression fractures may not always be associated with loss of body height. In this observational study, we hypothesize that the presence of a vertebral body cortical step is a reliable sign of an acute compression fracture on Computed Tomography (CT) scans. Methods: In a retrospective review of thoracolumbar CT scans following trauma, two observers analysed for the presence of a cortical step at the anterior or posterior vertebral body cortex, fracture morphology and associated injuries. A 'cortical step' is defined as a break of hyperdense cortex on CT scans, intervening non-sclerosed trabecular bone, and sharp overlap of the underlying cortex. MRI of the spine was used as gold standard. Results: 187 consecutive CT scans over 2 years were assessed. Sensitivity, specificity and accuracy of cortical step sign were 100%, 90.2% and 97% in diagnosing an acute thoracolumbar compression fracture, respectively. The interobserver reliability was high (kappa = 0.97). False positive cortical step was seen in Kummel's disease and large Schmorl's nodule. Conclusion: Our results demonstrate high sensitivity and specificity of 'cortical step sign' in diagnosing acute vertebral body compression fractures of TL spine on CT scans in patients with trauma. This sign can be useful to radiologists for safe clearance of the thoracolumbar spine following trauma, helping distinguish acute trauma from chronic causes of vertebral body height loss. [ABSTRACT FROM AUTHOR]

This article presents an analysis of personal diaries kept by health‐care staff within a specialist NHS Trust in England during the initial 3 months of the COVID‐19 pandemic. It adopts a moral sensemaking perspective to explore how NHS employees mobilised and reframed ideas of right and wrong in order to make sense of unprecedented uncertainty and displacement. By focussing on how the macro and micro politics of the pandemic were played out in the organisation, the study finds that polarised moral judgements were invoked in order to justify and rationalise a broad array of associated emergent emotions, intuitions, behaviours and practices. This polarisation of moral responses could be seen as a desire to bring order out of chaos and put matters back into place following displacement. This is inevitably an ongoing, complex and variegated enterprise whose results can be as often discomforting as they can be reassuring. Indeed, while moral sensemaking was partly beneficial for staff in that it promoted a greater sense of camaraderie and support for others, it also appeared to have darker consequences in terms of staff wellbeing and the development of more impermeable social boundaries across the organisation through processes of moral 'othering'. [ABSTRACT FROM AUTHOR]

Strong gravitational lensing offers a compelling test of the cold dark matter paradigm, as it allows for subhaloes with masses of ∼109 M⊙ and below to be detected. We test commonly used techniques for detecting subhaloes superposed in images of strongly lensed galaxies. For the lens we take a simulated galaxy in a ∼1013 M⊙ halo grown in a high-resolution cosmological hydrodynamical simulation, which we view from two different directions. Though the resolution is high, we note the simulated galaxy still has an artificial core which adds additional complexity to the baryon dominated region. To remove particle noise, we represent the projected galaxy mass distribution by a series of Gaussian profiles which precisely capture the features of the projected galaxy. We first model the lens mass as a (broken) power-law density profile and then search for small haloes. Of the two projections, one has a regular elliptical shape, while the other has distinct deviations from an elliptical shape. For the former, the broken power-law model gives no false positives and correctly recovers the mass of the superposed small halo; however, for the latter we find false positives and the inferred halo mass is overestimated by ∼4–5 times. We then use a more complex model in which the lens mass is decomposed into stellar and dark matter components. In this case, we show that we can capture the simulated galaxy's complex projected structures and correctly infer the input small halo. [ABSTRACT FROM AUTHOR]

The distribution of mass in galaxy-scale strong gravitational lenses is often modelled as an elliptical power law plus 'external shear', which notionally accounts for line-of-sight galaxies and cosmic shear. We argue that it does not, using three lines of evidence from the analysis of 54 galaxy-scale strong lenses: (i) strong lensing external shears do not correlate with weak lensing; (ii) the measured shear magnitudes in strong lenses (which are field galaxies) are too large (exceeding 0.05) for their environment and; (iii) the external shear position angle preferentially aligns or anti-aligns with the mass model position angle, indicating an internal origin. We argue the measured strong lensing shears are therefore systematically accounting for missing complexity in the canonical elliptical power-law mass model. If we can introduce this complexity into our lens models, this will further lensing studies of galaxy formation, dark matter and Cosmology. [ABSTRACT FROM AUTHOR]

Cognitive performance in people with HIV (PWH) may be affected by brain injury attributable to the infection itself, by other medical and psychiatric comorbidities (including major depressive disorder; MDD), and by psychosocial factors (e.g., education, food insecurity). We investigated effects of these variables on cognitive performance in a South African cohort of PWH with comorbid MDD and incomplete adherence to antiretroviral therapy (ART). We also examined (a) associations of depression severity with cognitive performance, and (b) whether improvement in depression led to improved cognitive performance. Participants (N = 105) completed baseline neuropsychological, psychiatric, and sociodemographic assessments. Subsequently, 33 were assigned to a cognitive-behavioural therapy for ART adherence and depression (CBT-AD) and 72 to standard-of-care treatment. Eight months post-baseline, 81 (nCBT-AD = 29) repeated the assessments. We investigated (a) baseline associations between sociodemographic, medical, and psychiatric variables and cognitive performance, (b) whether, from baseline to follow-up, depression and cognitive performance improved significantly more in CBT-AD participants, and (c) associations between post-intervention improvements in depression and cognitive performance. At baseline, less education (β = 0.62) and greater food insecurity (β = −0.20) predicted poorer overall cognitive performance; more severe depression predicted impairment in the attention/working memory domain only (β = −0.25). From baseline to follow-up, depression decreased significantly more in CBT-AD participants (p =.017). Improvement over time in depression and cognitive performance was not significantly associated except in the attention/working memory domain (p =.026). Overall, factors associated with cognitive performance were unrelated to brain injury. We conclude that clinicians examining PWH presenting with cognitive difficulties must assess depression, and that researchers investigating cognitive impairment in PWH must collect information on psychosocial factors. [ABSTRACT FROM AUTHOR]

Informal and unregulated work is the norm rather than the exception in emerging economies. This study was conducted in India where nine out of 10 women are occupied in informal, unregulated work, and are vulnerable to low‐wages, exploitation, and interconnected cultural and social‐economic injustices. The Self‐Employed Women's Association (SEWA) and their education wing the Indian Academy of Self‐Employed Women encourage their members to self‐define as "self‐employed workers" and facilitate identity‐based worker education and leadership training. Drawing on insights from the Social Identity Approach to Learning and the New Psychology of Leadership this cross‐sectional study (N = 300) explored if this shared social identity significantly predicted participants perceived identity‐leadership ability. We further explored if this relationship was partially explained by SEWA norms, values, and beliefs, developed during learning, and measured as "awareness of gendered inequality", "injustice consciousness", and "collective efficacy". A parallel mediation analysis found a direct relationship between "self‐employed women identity" and "identity‐leader ability" and indirect relationships through "awareness of gendered inequality" and "collective efficacy". No indirect path was evident through "injustice consciousness". The theoretical and practical implications of an identity‐based approach to worker education and leader training among vulnerable workers, are discussed. [ABSTRACT FROM AUTHOR]

The transcription factor EHF is highly expressed in the lactating mammary gland, but its role in mammary development and tumorigenesis is not fully understood. Utilizing a mouse model of Ehf deletion, herein, we demonstrate that loss of Ehf impairs mammary lobuloalveolar differentiation at late pregnancy, indicated by significantly reduced levels of milk genes and milk lipids, fewer differentiated alveolar cells, and an accumulation of alveolar progenitor cells. Further, deletion of Ehf increased proliferative capacity and attenuated prolactin-induced alveolar differentiation in mammary organoids. Ehf deletion also increased tumor incidence in the MMTV-PyMT mammary tumor model and increased the proliferative capacity of mammary tumor organoids, while low EHF expression was associated with higher tumor grade and poorer outcome in luminal A and basal human breast cancers. Collectively, these findings establish EHF as a non-redundant regulator of mammary alveolar differentiation and a putative suppressor of mammary tumorigenesis. [Display omitted] • The transcription factor EHF is essential for mammary development in pregnancy • Ehf drives differentiation of progenitor cells into milk-producing alveolar cells • Ehf deletion increased tumor development in the mouse mammary gland Nightingale and Reehorst et al. identify a key role for the transcription factor EHF in mouse mammary gland development and in controlling the differentiation of mammary epithelial cells into milk-producing cells during pregnancy. They also show that Ehf is an important suppressor of tumor development in this tissue. [ABSTRACT FROM AUTHOR]

Nepal's transition to federalism in 2015 involved a significant redistribution of authority across three levels of government, with a greater level of autonomy granted to provincial and local levels. We examine multi-scale climate policy and politics in Nepal, focusing on three elements that are important for policy development and implementation: (a) the authority to make decisions; (b) the knowledge and expertise to develop and implement policies; and (c) the ability to access and mobilize resources, primarily external funding, by government bodies at different levels. Our findings show that the newly decentralized local governments are constrained in their ability to develop and implement climate change-related policies and practical responses by a mismatch between the authority granted to them and existing institutional capabilities. These governmental bodies have limited opportunities to develop, access and mobilize knowledge of climate and development and financial resources, which are needed to put new policies into action. Based on this analysis, we argue that decentralization of governmental authority is not likely to produce effective climate policy outcomes if this mismatch remains unaddressed. The ability of the provincial and local governments in federal Nepal to respond to climate change has been constrained by a pervasive mismatch between authority granted and institutional capabilities, in terms of opportunities to access and mobilize knowledge and financial resources. The devolution of power is not adequate for effective climate change responses; rather, there is a need to strengthen the institutional capabilities and opportunities of the decentralized local governments to address climate change. Formal allocation of authority is always blurred in practice, as agencies at different levels of governance engage in power struggles within and beyond formally delineated boundaries. This suggests the need for more operational clarity on policy implementation procedures. There is a need for a clear exchange of knowledge and a flow of resources to the level where responsibilities lie to respond to climate change. [ABSTRACT FROM AUTHOR]

Objective: Adolescent and young adult (AYA) cancer survivors are vulnerable to cancer‐related financial burden, which is likely shared by their caregivers. This study aims to enhance an existing conceptual model of financial burden by conducting concept elicitation interviews with caregivers to generate knowledge that can be translated to inform instrumental and psychosocial support in cancer care. Methods: Qualitative concept elicitation interviews were conducted with 24 caregivers of AYA cancer survivors (caregivers of adolescents, n = 12; caregivers of emerging adults, n = 12) recruited from four sites. Constant comparative methods were used to identify themes, and results were interpreted and organized into domains of the conceptual model. We also explored COVID‐19 related financial impacts among a subset (n = 12) of caregivers. Results: Seven themes emerged, which varied by age group and strengthened the conceptualization of the model. Themes centered on: (1) direct and indirect costs of cancer; (2) impact of socioeconomic status on financial burden; (3) caregiver desire to shield AYAs from distress due to financial burden; (4) strategies to manage cancer‐related costs; (5) worries about AYAs' financial future; (6) seeking and receiving financial support; and (7) navigating the healthcare system. Findings also revealed that COVID‐19 exacerbates financial burden for some caregivers. Conclusions: Building upon our prior work, we have adapted the conceptual model of financial burden to reflect perspectives of AYAs, oncology providers, and now, caregivers. An important next step is to develop a reliable and valid self‐report measure of financial burden among caregivers of AYA cancer survivors. [ABSTRACT FROM AUTHOR]

The prevalence of HIV-associated neurocognitive impairment (H-NCI) is concerning. Individuals on effective antiretroviral therapy (ART) may still be at risk for H-NCI as they experience longer life expectancies. There are, however, few professionals with knowledge and skills to identify H-NCI, in low- and middle-income countries. We explored qualitatively, primary healthcare workers' knowledge and views of H-NCI, in the era of effective ART, particularly their views toward task-sharing of H-NCI screening from specialists to mid-level or lay healthcare providers. The first phase of data collection involved two focus group discussions (FGDs) 23 primary healthcare workers from two facilities in the Western Cape participated in the FGDs. In the second phase of data collection12 individual, in-depth interviews were conducted in KwaZulu-Natal. Using thematic analysis, several key themes emerged. Although healthcare providers were unable to specifically identify H-NCI, they described several HIV disease and treatment related or mental health comorbidities that could be responsible for the symptoms. Despite healthcare workers reporting low frequencies of H-NCI, they favoured receiving training to screen for H-NCI with a view toward providing holistic care. [ABSTRACT FROM AUTHOR]

Background The late-onset efavirenz neurotoxicity syndrome (LENS) presents as ataxia and/or encephalopathy with supratherapeutic efavirenz plasma concentrations (>4 µg/mL). Efavirenz is primarily metabolized by cytochrome P450 2B6 (CYP2B6), with CYP2A6 as an accessory pathway. We hypothesized that participants with LENS would predominantly be CYP2B6 slow metabolizers. The aim of our study was to determine the frequency of CYP2B6 slow metabolizers in participants with LENS. Methods Adult HIV-positive participants on efavirenz-based antiretroviral therapy presenting with LENS were prospectively enrolled. Genetic polymorphisms known to be associated with increased efavirenz plasma concentrations in CYP2B6 (rs3745274, rs28399499, rs4803419) and CYP2A6 (rs28399433) were selected and used to determine proportions of slow metabolizers. Pharmacokinetic analyses were performed using liquid chromatography–tandem mass spectrometry. Median (IQR) plasma efavirenz and 8-hydroxyefavirenz were described. Results Fifteen participants were enrolled. Thirteen (13/15) were Black-African and 13 were female. Median weight was 49.9kg with a median duration on efavirenz of 2.2 years. All 15 participants were successfully genotyped as slow CYP2B6 metabolizers, with 6 participants additionally having CYP2A6 heterozygous genotype. Thirteen were receiving the CYP2A6 enzyme inhibitor isoniazid, and all 15 were genotypic NAT2 slow or intermediate acetylators. Efavirenz plasma concentration was markedly increased at 50.5 (47.0–65.4) µg/mL; 8-hydroxyefavirenz concentration was markedly decreased at 0.10 (0.07–0.15) µg/mL. Conclusions Our cohort provides definitive evidence that LENS is associated with the CYP2B6 slow metabolizer genotype, with a median efavirenz plasma concentration >12-fold higher than the defined upper limit of the therapeutic range. Isoniazid and low body weight are important contributors to LENS development. [ABSTRACT FROM AUTHOR]

Introduction: The responsibility for managing a long‐term condition (LTC) such as chronic kidney disease (CKD) typically transfers from parent to child, as children become older. However, children can find it challenging to become independent at managing their LTC, and evidence for how healthcare professionals (HCPs) support transfer of responsibility is limited. This study aimed to explore how young people with CKD assume responsibility for managing their condition and the HCP's role during this process. Methods: Sampling, qualitative data collection and analysis were guided by a constructivist grounded theory approach. Individual and dyadic interviews, and focus groups, were conducted with 16 young people aged 13–17 years with CKD, 13 parents and 20 HCPs. Findings: A grounded theory, shifting responsibilities, was developed that provides new insights into how young people's, parents' and HCPs' constructions of the transfer of responsibility differed. These diverse constructions contributed to multiple uncertainties around the role of HCPs, when the process started and was completed and whether the endpoint of the process was young people's self‐management or young person–parent shared management. Conclusion: Families would benefit from HCP support over a longer timeframe that integrates assuming self‐management responsibility with gaining independence in other areas of their lives and focuses on young people 'doing' self‐management. Patient or Public Contribution: Patient and public involvement was integrated throughout the study, with young adults with CKD and parents who had a child with CKD actively involved in the study's design and delivery. [ABSTRACT FROM AUTHOR]

This document is a reply to a letter discussing the consensus recommendations for a new approach to cognitive impairment in people living with HIV. The authors of the reply emphasize that their approach does not seek to undermine the experiences of individuals with HIV, but rather aims to accurately delineate the underlying mechanisms and provide clear prognostic information. They propose separating 'HIV-associated brain injury' caused directly by HIV from 'cognitive impairment in people living with HIV' which can have multiple causes. The authors also address concerns about distinguishing active from legacy HIV-associated brain injury and the use of advanced neuroimaging techniques. They express a desire for broader consensus on this topic and aim to improve care for people living with HIV. [Extracted from the article]