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Introduction: Clinical trial designs based on the assumption of independent observations are well established. Clustered clinical trial designs, where all observational units belong to a cluster and outcomes within clusters are expected to be correlated, have also received considerable attention. However, many clinical trials involve partially clustered data, where only some observational units belong to a cluster. Examples of such trials occur in neonatology, where participants include infants from both singleton and multiple births, and ophthalmology, where one or two eyes per participant may need treatment. Partial clustering can also arise in trials of group-based treatments (e.g. group education or counselling sessions) or treatments administered individually by a discrete number of health care professionals (e.g. surgeons or physical therapists), when this is compared to an unclustered control arm. Trials involving partially clustered data have received limited attention in the literature and the current lack of standardised terminology may be hampering the development and dissemination of methods for designing and analysing these trials. Methods and examples: In this article, we present an overarching definition of partially clustered trials, bringing together several existing trial designs including those for group-based treatments, clustering due to facilitator effects and the re-randomisation design. We define and describe four types of partially clustered trial designs, characterised by whether the clustering occurs pre-randomisation or post-randomisation and, in the case of pre-randomisation clustering, by the method of randomisation that is used for the clustered observations (individual randomisation, cluster randomisation or balanced randomisation within clusters). Real life examples are provided to highlight the occurrence of partially clustered trials across a variety of fields. To assess how partially clustered trials are currently reported, we review published reports of partially clustered trials. Discussion: Our findings demonstrate that the description of these trials is often incomplete and the terminology used to describe the trial designs is inconsistent, restricting the ability to identify these trials in the literature. By adopting the definitions and terminology presented in this article, the reporting of partially clustered trials can be substantially improved, and we present several recommendations for reporting these trial designs in practice. Greater awareness of partially clustered trials will facilitate more methodological research into their design and analysis, ultimately improving the quality of these trials.

While several studies have assessed quality and completeness of recording acute medical events in Clinical Practice Research Datalink (CPRD) Aurum, evaluation of additional chronic conditions is warranted.We selected patients with a first diagnosis of rheumatoid arthritis (RA) coded in their CPRD Aurum record between 2005 and 2019. We assessed quality of RA diagnosis by evaluating additional information in the patient record that would corroborate the diagnosis. We report recording of diagnoses, prescriptions, labs, and referrals expected to be present based on NICE guidelines for RA management.There were 53 083 patients with a first recorded RA diagnosis during the study period: 43606 (82%) patients had RA drug treatments in their record, 7596 (14%) had supporting codes without drug treatment, and 1881 (4%) patients had only a RA diagnoses recorded in their medical record with no supporting codes or RA treatments. Patients with RA diagnosis only were more likely to be first diagnosed in the earliest time period of study. Labs for diagnosing and monitoring RA were most common among patients with RA treatment. Analgesic and glucocorticoid prescriptions were common in all study patients but were highest among patients with RA treatment. Among patients with RA diagnosis only, the overwhelming majority had only one RA diagnosis recorded (76%).Our findings suggest that codes expected for monitoring and treatment of RA are routinely recorded in CPRD Aurum. These results support previous assessments, which found data recorded in CPRD Aurum to be of good quality for use in research.

There is growing recognition of the critical role that refugee fathers have in helping their children and families adjust to starting life in a new country, and the contribution of their mental and physical health to settlement and family health outcomes. The aims of this systematic review were to summarize and critically appraise the quality of research reporting on estimates of mental and physical health conditions among refugee fathers. Electronic databases were systematically searched to identify peer-reviewed studies reporting on the mental and/or physical health of refugee fathers of children aged 0–18 years, who had settled in a host country. Study details and estimates of mental and/or physical health conditions were extracted, and a critical appraisal of study quality conducted. Ten studies reporting estimates of post-traumatic stress (2–86%) and general psychological distress, anxiety, depression, stress and prolonged grief (25–50%) were identified. Only one study reported on physical health. Study quality and variability in recruitment, samples, data collection methods and outcomes across studies made it difficult to estimate the overall prevalence of mental and physical health difficulties. Despite marked heterogeneity across studies, this review highlights that mental health difficulties among refugee fathers are common, identifying them as a specific cohort of socially and culturally diverse fathers at risk of poor health. The findings underscore the need for health and social policy and service delivery specifically focussed on promoting the mental health of refugee fathers and their families.

The 5-year Ocean Regulation of Climate by Heat and Carbon Sequestration and Transports (ORCHESTRA) programme and its 1-year extension ENCORE (ENCORE is the National Capability ORCHESTRA Extension) was an approximately 11-million-pound programme involving seven UK research centres that finished in March 2022. The project sought to radically improve our ability to measure, understand and predict the exchange, storage and export of heat and carbon by the Southern Ocean. It achieved this through a series of milestone observational campaigns in combination with model development and analysis. Twelve cruises in the Weddell Sea and South Atlantic were undertaken, along with mooring, glider and profiler deployments and aircraft missions, all contributing to measurements of internal ocean and air–sea heat and carbon fluxes. Numerous forward and adjoint numerical experiments were developed and supported by the analysis of coupled climate models. The programme has resulted in over 100 peer-reviewed publications to date as well as significant impacts on climate assessments and policy and science coordination groups. Here, we summarize the research highlights of the programme and assess the progress achieved by ORCHESTRA/ENCORE and the questions it raises for the future. This article is part of a discussion meeting issue ‘Heat and carbon uptake in the Southern Ocean: the state of the art and future priorities’.

ObjectivesWe aimed to compare the effects of nutrient-enriched formula with standard term formula on rate of body weight gain of late preterm infants appropriately grown for gestational age.Study designA multi-center, randomized, controlled trial. Late preterm infants (34–37 weeks' gestation), with weight appropriate for gestational age (AGA), were randomized to nutrient enriched formula (NEF) with increased calories (22 kcal/30 ml) from protein, added bovine milk fat globule membrane, vitamin D and butyrate or standard term formula 20 kcal/30 ml (STF). Breastfed term infants were enrolled as an observational reference group (BFR). Primary outcome was rate of body weight gain from enrollment to 120 days corrected age (d/CA). Planned sample size was 100 infants per group. Secondary outcomes included body composition, weight, head circumference and length gain, and medically confirmed adverse events to 365 d/CA.ResultsThe trial was terminated early due to recruitment challenges and sample size was substantially reduced. 40 infants were randomized to NEF (n = 22) and STF (n = 18). 39 infants were enrolled in the BFR group. At 120 d/CA there was no evidence of a difference in weight gain between randomized groups (mean difference 1.77 g/day, 95% CI, −1.63 to 5.18, P = 0.31). Secondary outcomes showed a significant reduction in risk of infectious illness in the NEF group at 120 d/CA [relative risk 0.37 (95% CI, 0.16–0.85), P = 0.02].ConclusionWe saw no difference in rate of body weight gain between AGA late preterm infants fed NEF compared to STF. Results should be interpreted with caution due to small sample size.Clinical Trial RegistrationThe Australia New Zealand Clinical Trials Registry (ACTRN 12618000092291). “mailto:maria.makrides@sahmri.com” maria.makrides@sahmri.com.

Background Patients with cognitive impairment are at greater risk of hospital acquired complications, longer hospital stays, and poor health outcomes compared to patients without cognitive impairment. The Cognitive Impairment Support Program is a multi-disciplinary approach to improve screening rates and awareness of patients with cognitive impairment and guide clinician response and communication during their hospitalisation to improve health outcomes. Objective This study evaluated the impact of implementing the Cognitive Impairment Support Program on patient hospital acquired complications, patient reported quality of life and staff satisfaction in an outer metropolitan hospital. Design A pre-test post-test design was used to collect data in two 6-month time periods between March 2020 and November 2021. Participants Patients aged ≥ 65 years, admitted to a participating ward for > 24 h. Intervention The Cognitive Impairment Support Program consisted of four components: cognitive impairment screening, initiation of a Cognitive Impairment Care Plan, use of a Cognitive Impairment Identifier and associated staff education. Measures The primary outcome was hospital acquired complications experienced by patients with cognitive impairment identified using clinical coding data. Secondary outcomes were patient quality of life and a staff confidence and perceived organisational support to care for patients with cognitive impairment. Results Hospital acquired complication rates did not vary significantly between the two data collection periods for patients experiencing cognitive impairment with a 0.2% (95% confidence interval: -5.7–6.1%) reduction in admissions with at least one hospital acquired complication. Patients in the post intervention period demonstrated statistically significant improvements in many items in two of the Dementia Quality of Life Measure domains: memory and everyday life. The staff survey indicated statistically significant improvement in clinical staff confidence to care for patients with cognitive impairment (p = 0.003), satisfaction with organisational support for patients (p = 0.004) and job satisfaction (p ≤ 0.001). Conclusion This study provides evidence that a multicomponent Cognitive Impairment Support Program had a positive impact on staff confidence and satisfaction and patient quality of life. Broader implementation with further evaluation of the multicomponent cognitive impairment intervention across a range of settings using varied patient outcomes is recommended.

We report the properties of primary cosmic-ray sulfur (S) in the rigidity range 2.15 GV to 3.0 TV based on 0.38 × 106 sulfur nuclei collected by the Alpha Magnetic Spectrometer experiment (AMS). We observed that above 90 GV the rigidity dependence of the S flux is identical to the rigidity dependence of Ne-Mg-Si fluxes, which is different from the rigidity dependence of the He-C-O-Fe fluxes. We found that, similar to N, Na, and Al cosmic rays, over the entire rigidity range, the traditional primary cosmic rays S, Ne, Mg, and C all have sizeable secondary components, and the S, Ne, and Mg fluxes are well described by the weighted sum of the primary silicon flux and the secondary fluorine flux, and the C flux is well described by the weighted sum of the primary oxygen flux and the secondary boron flux. The primary and secondary contributions of the traditional primary cosmic-ray fluxes of C, Ne, Mg, and S (even Z elements) are distinctly different from the primary and secondary contributions of the N, Na, and Al (odd Z elements) fluxes. The abundance ratio at the source for S/Si is 0.167±0.006, for Ne/Si is 0.833±0.025, for Mg/Si is 0.994±0.029, and for C/O is 0.836±0.025. These values are determined independent of cosmic-ray propagation.

PurposeThis article reflects on the adaption of Sarah Pink's video re-enactment methodology for exploring children's out-of-school lifeworlds.Design/methodology/approachVideo re-enactments originate in the work of Sarah Pink who developed the methodology to study everyday routines, including activities associated with people's energy consumption at home. This article discusses the adaption of this methodology for exploring 9–10-year-old children's out-of-school lifeworlds in their homes in the global cities of Hong Kong, Melbourne and Singapore.FindingsThe article reflects on the practical ways in which the video re-enactment methodology was adapted to explore children's out-of-school activities in the three different locations. In terms of activities, the findings highlight that children's out-of-school lifeworlds included regular routines across a week that contribute to and constitute their everyday activities, with varying time spent on leisure, homework and scheduled activities.Originality/valueThe authors discuss and reflect on the implications of adapting a methodology in order to make it relevant and innovative in a new research context. The use of video re-enactments with children to explore their out-of-school activities gives greater insights into their lifeworlds and their engagement in various activities and the opportunity for children to reflect on their everyday lives.

Wave overtopping of sea defences poses a hazard to people and infrastructure. Rising sea levels and limited resources mean accurate prediction tools are needed to deliver cost-effective shoreline management plans. A dearth of in-situ data means that the numerical tools used for flood forecasting and coastal scheme design are based largely on data from idealised flume studies, and the resulting overtopping predictions may have orders of magnitude uncertainty for complicated structures and some environmental conditions. Furthermore, such studies usually only provide data on the total volume of overtopping water, and no data on the speed of the water. Here we present WireWall, an array of capacitance-based sensors which measure the speed and volume of overtopping water on a wave-by-wave basis. We describe the successful validation of WireWall against traditional flume methods and present results from the first trial deployments at a sea wall in the UK. WireWall results are also compared with numerical predictions based on EurOtop guidance. WireWall technology offers an approach for reliable acquisition of the data needed to develop resilient coastal protections schemes.

In human medicine, empathy contributes to enhanced patient satisfaction and trust, decreased litigation, and increased adherence to medical recommendations. Understanding client perspectives is crucial in the empathic process; failure to explore these perspectives has been linked to decreased client satisfaction in veterinary consultations. This article explores how veterinary clients verbally expressed emotional concerns during consultations and how veterinary students addressed them. The “Model of Empathic Communication in the Medical Interview” by Suchman et al., is the starting point for a thematic analysis of consultation transcripts. Clients expressed multiple emotional concerns both directly by using explicit words (coded as empathic opportunities-EO), and indirectly (coded as potential empathic opportunities-PEO), throughout the consultations. Indirect examples prevailed and included stories about previous experiences with pet illnesses and pet care received elsewhere. Clients used explicit words, including “fear” and “panic.” Students usually responded with a biomedical focus, including asking medical questions and giving medical explanations. Although students demonstrated various communication skills, they failed to demonstrate a complete verbal compassionate empathic response (a novel code) that includes exploring and verbalizing accurate understanding of the clients’ perspectives and offering help based on this understanding. These findings suggest that strategies to teach compassionate empathy and support its use in the clinical setting are not fully effective, and veterinary students risk entering practice unprepared to employ this vital competency. The authors also introduce an operational definition for compassionate empathy.

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Four supplementary figures and one table providing maps of flight paths and aircraft vs ship data comparisons, as well as cruise information

Realist interviews are a data collection method used in realist evaluations. There is little available guidance for realist interviewing in cross-cultural contexts. Few published realist evaluations have included cross-cultural interviews, providing limited analyses of the cross-cultural application of realist methodology. This study integrated realist and cross-cultural qualitative methods in a realist evaluation of an Australian doula support program. The interviews were conducted with Arabic speaking clients of the program. The process included collaboration with a bicultural researcher, philosophically situating the study for methodologically coherent integration, bicultural review of the appropriateness of realist ‘how’ and ‘why’ questions, decisions about language translation and interpretation, pilot interviews, and co-facilitation of the interviews. Integration of the methods was feasible and valuable. This study may support other realist evaluators to give voice to people from culturally diverse groups, in a manner that is culturally safe, methodologically coherent and rigorous, and that produces trustworthy results.

Although twins often participate in medical research, few clinical trials are conducted entirely in twin populations. The purpose of this review is to demonstrate the substantial benefits and address the key challenges of conducting clinical trials in twin populations, or ‘twin-only trials’. We consider the unique design, analysis, recruitment and ethical issues that arise in such trials. In particular, we describe the different approaches available for randomizing twin pairs, highlight the similarity or correlation that exists between outcomes of twins, and discuss the impact of this correlation on sample size calculations and statistical analysis methods for estimating treatment effects. We also consider the role of both monozygotic and dizygotic twins for studying variation in outcomes, the factors that may affect recruitment of twins, and the ethics of conducting trials entirely in twin populations. The advantages and disadvantages of conducting twin-only trials are also discussed. Finally, we recommend that twin-only trials should be considered more often.

In this colloquium we share stories from two schools located in Western Australia that were inspired from the Reggio Emilia education project. The focus is on a view of children as capable citizens of the now. The examples in practice describe learning scenarios in which educators work as researchers using the ordinary moments of daily classroom life. It is in these ordinary moments where a pedagogy of listening is enacted.

IntroductionBreastmilk is considered the gold standard for infant nutrition. Breast feeding is recommended as the sole source of nutrition between birth until around 6 months of age and should be continued beyond this age as complementary foods are introduced. While breast feeding initiation is generally high in developed countries, continuation of breast feeding appears to drop rapidly. This is a prospective observational study of life that aims to characterise a current picture of infant feeding practices across the first year, and motivations for feeding practices, and to identify barriers and enablers for breast feeding.Methods and analysisCaregivers with newborn singleton infants of normal birth weight are approached on the postnatal units of three hospitals in South Australia, or through targeted online advertising campaigns promoting the study. Caregivers are asked to complete surveys when their infant reaches 3, 5 and 7 weeks’, and at 3, 4, 5, 6, 9 and 12 months of age. Initially, baseline characteristics, intentions and preferences for infant milk feeds, as well as reasons for preferences are captured. Latter surveys query how infants are being fed, difficulties or barriers to breast feeding, as well as any enablers (if breast feeding). Once infants reach 5 months of age, surveys capture complementary feeding. A large opportunistic sample from the Adelaide community with a minimum of 1000 mother–infant pairs will be enrolled. The data will be analysed descriptively and using regression models.Ethics and disseminationWomen’s and Children’s Health Network Human Research Ethics Committee reviewed and approved the study (approval no HREC/19/WCHN/140, approval date: 22 November 2019). Study results will be disseminated through academic meetings, peer-reviewed journals, in-services for postnatal healthcare services, results letters for participants and social media.Trial registration numberACTRN12620000529943.

AimThis cohort study investigates the extent to which variation in ulcer healing between services can be explained by demographic and clinical characteristics.MethodsThe National Diabetes Foot Care Audit (NDFA) collated data on people with diabetic foot ulcers presenting to specialist services in England and Wales between July 2014 and March 2018. Logistic regression models were created to describe associations between risk factors and a person being alive and ulcer-free 12 weeks from presentation, and to investigate whether variation between 120 participating services persisted after risk factor adjustment. ResultsOf 27,030 people with valid outcome data, 12,925 (47.8%) were alive and ulcer-free at12 weeks, 13,745 (50.9%) had an unhealed ulcer and 360 had died (1.3%). Factors associated with worse outcome were male sex, more severe ulcers, history of cardiac or renal disease and a longer time between first presentation to a non-specialist healthcare professional and first expert assessment. After adjustment for these factors, four services (3.3%) were more than 3SD above and seven services (5.8%) were more than 3SD below the national mean for proportions that were alive and ulcer-free at follow-up.Conclusions/interpretationsVariation in the healing of diabetic foot ulcers between specialist services in England and Wales persisted after adjusting for demographic characteristics, ulcer severity, smoking, body mass index and co-morbidities. We conclude that other factors contribute to variation in healing of diabetic foot ulcers and include the time to specialist assessment.

Wave overtopping of sea defences poses a hazard to people and infrastructure. Rising sea levels and limited resources mean accurate prediction tools are needed to deliver cost-effective shoreline management plans. A dearth of in-situ data means that the numerical tools used for flood forecasting and coastal scheme design are based largely on data from idealised flume studies, and the resulting overtopping predictions may have orders of magnitude uncertainty. Furthermore, such studies usually only provide data on the total volume of overtopping water, and no data on the speed of the water. Here we present a novel system "WireWall" that measures the speed and volume of overtopping water on a wave-by-wave basis. We describe the successful validation of WireWall against traditional flume methods and present results from the first trial deployments at a sea wall in the UK. WireWall results are also compared with numerical predictions from widely-used industry rules (EurOtop).

Borderline personality disorder (BPD) is increasingly diagnosed in perinatal and infant settings, and research suggests that as well as an escalation of BPD symptoms in this period, these symptoms may also be detrimental to infant development. Providing tailored treatments during the postnatal period may help women and prevent an intergenerational cycle of emotional and interpersonal symptoms in infants. Mother-infant dialectical behavior therapy (MI-DBT) has produced promising, yet inconsistent, improvements on quantitative scales of maternal mental health and the mother-infant relationship. The qualitative evaluation may provide complementary information.This study aimed to explore the subjective experiences of women who had completed MI-DBT.Thematic analysis of semistructured interviews conducted on 13 women undertaking MI-DBT before, post, and 12 months after MI-DBT were analyzed for themes.Five major themes were identified. Overall, the women expressed that their emotional literacy and regulation improved after MI-DBT, subsequently addressing key risks and challenges such as uncertainty around their child's cues, and low self-esteem, and potentially improving the women's mentalization capability.This study consolidates previous research on maternal BPD, and provides qualitative evidence of the benefits of MI-DBT for mothers as both individuals and as parents with likely flow-on effects for infants. Lived experience input for future adaptations was a valuable gain.

Two paralogs of the guanine dissociation inhibitor-like solubilizing factors UNC119, UNC119A and UNC119B, are present in the human genome. UNC119 binds to N-myristoylated proteins and masks the hydrophobic lipid from the hydrophilic cytosol, facilitating trafficking between different membranes. Two classes of UNC119 cargo proteins have been classified: low affinity cargoes, released by the Arf-like proteins ARL2 and ARL3, and high affinity cargoes, which are specifically released by ARL3 and trafficked to either the primary cilium or the immunological synapse. The UNC119 homologues have reported differences in functionality, but the structural and biochemical bases for these differences are unknown. Using myristoylated peptide binding and release assays, we show that peptides sharing the previously identified UNC119A high affinity motif show significant variations of binding affinities to UNC119B of up to 427-fold. Furthermore, we solve the first two crystal structures of UNC119B, one in complex with the high affinity cargo peptide of LCK and a second one in complex with the release factor ARL3. Using these novel structures, we identify a stretch of negatively charged amino acids unique to UNC119B that may undergo a conformational change following binding of a release factor which we propose as an additional release mechanism specific to UNC119B. ispartof: BIOCHEMISTRY vol:60 issue:25 pages:1952-1963 ispartof: location:United States status: published

Aim This review will identify, critically appraise, and synthesise evidence on culturally competent approaches to the provision of primary care to women of immigrant and refugee backgrounds who experience family and domestic violence. Background Women from some immigrant and refugee backgrounds are known to be at a higher risk for harms from family and domestic violence. However, little is known about cultural competency in the provision of primary care for these women and how this enables, or hinders, clinicians in caring for them. Design/methods A systematic review using Critical Interpretive Synthesis of quantitative, qualitative, and mixed-methods studies and grey literature that report cultural competency in the provision of primary care for women over 16 years of age experiencing family and domestic violence. Our search strategy will include electronic database searches, citation tracking, and grey literature searches. Two reviewers will independently carry out title, abstract, and full text screening using the Covidence software, then quality assessment, and data extraction. We will appraise quality using the Crowe Critical Appraisal Tool for quantitative and mixed methods studies; Quality Framework for qualitative studies; and the Authority, Accuracy, Coverage, Objectivity, Date, Significance checklist for grey literature. A qualitative critical synthesis of the included studies and grey literature will be completed. Discussion Critical interpretive synthesis is an iterative method that allows reviewers to explore various foci of the concept in question and answer the research question posed at the outset comprehensively. The expected outcome of the review is an evidence-based model of culturally competent primary care related to family and domestic violence.

Problem Persisting disparities in maternal and child health outcomes in high income countries require new insights for health service response. Background Significant social hardship, including factors related to migration, are associated with perinatal morbidity and mortality. The universality of maternity and child health care offers opportunities to reduce health disparities. Process evaluation of health service initiatives to address refugee health inequalities in Melbourne, Australia, is the setting for the study. Aim To explore the views of health service leaders about health system and service capacity to tailor care to address social adversity and reduce disparities in maternal and child health outcomes. Methods In-depth interviews with leaders of maternity and maternal and child health services with questions guided by a diagram to promote discussion. Thematic analysis of transcribed interviews. Findings Health care leaders recognised the level of social complexity and diversity of their clientele. The analysis revealed three key themes: grappling with the complexity of social disadvantage; ‘clinical risk’ versus ‘social risk’; and taking steps for system change. Discussion Priority given to clinical requirements and routine practices together with the rising demand for services is limiting service response to families experiencing social hardship and hampering individualised care. System change was considered possible only if health service decision makers engaged with consumer and community perspectives and that of front-line staff. Conclusion Achieving equity in maternal and child health outcomes requires engagement of all key stakeholders (communities, clinicians, managers) to facilitate effective system re-design.

While the bulk of Cooperative Extension’s (Extension) historical work has been with rural populations, its future work should also address the needs of those living in urban areas. The opportunity to live a long and healthy life is paramount among those needs. Cooperative Extension’ National Framework for Health Equity and Well-Being (Framework) provides a roadmap by which Cooperative Extension can help ensure that all people have that opportunity. The central premise of the Framework is that future work of Extension must include but extend beyond the promotion of healthy behaviors to place-based approaches for improving conditions in which people live, learn, work, and play. Recommendations for doing so include advancing health equity as a systemwide value, integrating data science with community voice to surface health inequities, investing in health-focused work, initiating new partnerships, and utilizing community development principles to influence social determinants of health. This article sequentially introduces the reader to the five recommendations and highlights how each of those recommendations is already being put into practice in urban areas of the United States.

How women are cared for while pregnant and having a new baby can have profound and lasting effects on their health and well-being. While mainstream maternity care systems aspire to provide care that is woman-centred, women with fewest social and economic resources often have reduced access. Community-based doula support programs offer complementary care for these women and are known to, on average, have positive outcomes. Less understood is how, when and why these programs work. A realist evaluation of an Australian volunteer doula program provided for women experiencing socioeconomic adversity explored these questions. The program provides free non-medical, social, emotional, and practical support by trained doulas during pregnancy, birth and new parenting. This paper reports the testing and refinement of one program theory from the larger study. The theory, previously developed from key informant interviews and rapid realist review of literature, hypothesised that the cultural matching of woman (client) and doula led to best outcomes. This was tested in realist interviews with women and focus groups with doulas, in January–February 2020. Seven English speaking, and six Arabic speaking clients were interviewed. Two focus groups were conducted with a total of eight doulas from diverse cultural and professional backgrounds. Data were analysed in NVivo. The study found cultural matching to be valued by some but not all women, and only when the doula was also genuinely interested, kind, timely and reliable. These approaches (with or without cultural matching) generate trust between the doula and woman. Trust theory, reflexivity theory and social relations theory supported explanatory understanding of the causal contribution of a doula knowing what it takes to build trust, to a woman deciding to trust her doula.

The Internet of Things is reshaping many households’ digital landscape and influencing children’s play and learning, especially in the form of toys that are named the Internet of Toys (IoToys). IoToys may generate a significant influence on children’s growth. While increasing attention is drawn to the IoToys, confusion around their conceptualization and use is evident. Without a thorough understanding of what the IoToys are, the progress of meaningful research on this topic will be greatly hindered. We, thus, conducted a systematic review to determine existing definitions of the IoToys using seven major databases over the past 20 years. After analyzing the definitions identified, we found that the previous definitions neglected the significance of defining “toys” in their work. The review led to a discussion around how to understand “toys” and then a more precise conceptualization of the IoToys, based on which implications for future research are offered.

A pilot study with women with borderline personality disorder (BPD) and their infants showed promising results. This clinical research program sought to discover whether ongoing implementation confirmed preliminary results in relation to maternal mental health and, in addition, whether parenting and the mother-infant relationship showed sufficient improvement. Women with BPD and their infants were referred to a 25-week group program of Mother-Infant Dialectical Behavior Therapy (MI-DBT). During groups, infants were provided care by childcare workers while mothers took part in a skills training session. Mothers and infants then reunited and took part in an activity together that incorporated skills taught in the teaching session. Sixty-nine of 98 women commencing MI-DBT completed the program, demonstrating a 71% completion rate. Women showed improvement on all measures of mental health including depression, anxiety, and BPD symptoms. While women reported improvement in parenting confidence, an objective measure of the mother-infant relationship showed continuation of concerning relationships in a significant percentage. MI-DBT was found to be effective at improving mothers' mental health, both at the initial site and in community settings, with different clinicians and with different childcare options. While there were some improvements found in measures of the mother's perception of the infant-parent relationship, there were no significant improvements in currently used observational measures of the interaction or the infant's social-emotional development, suggesting that additional intervention such as infant-parent therapy may be needed to augment the benefits of MI-DBT to improve outcomes in these areas.