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Background: An increase in opioid-related overdoses, notably from potent synthetic opioids like fentanyl, prompted this consideration of characteristics of emergency department (ED) patients with evidence for illicit fentanyl use or exposure, the correlation with intentional opioid misuse, and subsequent ED management. Methods: A retrospective review was performed of patients presenting to an urban academic medical center ED with evidence for illicit fentanyl use, determined by positive urine drug screens (UDS), from 6/2021 through 11/2021. Participant demographics, comorbidities, ED chief complaint and disposition, and evidence of intentional opioid misuse were considered. Secondary outcomes included provision of buprenorphine/naloxone and/or naloxone kits at discharge, ED recidivism, and six-month mortality. Bivariate comparisons and logistic regression models were performed. Results: Among 409 unique patients, most were white and male with a mean age of 39.4. Approximately half presented with opioid-related complaints. Evidence of intentional opioid misuse was identified in 72.6 % of patients. Black patients had 79 % lower odds of intentional opioid misuse compared to white patients. Regarding ED management, 28.8 % were discharged with buprenorphine/naloxone and 14.0 % with a naloxone kit. Black patients had 63 % lower odds of receiving buprenorphine/naloxone compared to white patients after controlling for covariates. Nearly 6 % of the study population died within six months of the initial ED visit. Conclusion: This fentanyl-focused review describes patient characteristics which largely mirror the epidemiology of the current opioid epidemic; however, despite evidence of objective exposure, it also suggests that Black patients may be less likely to use fentanyl intentionally. It also highlights potential disparities related to ED-based opioid misuse patient management.

Introduction The growing population of older drivers presents challenges for road safety attributed to age-related declines and increased crash fatality rates. However, enabling older people to maintain their health and independence through continued safe driving is important. This study focuses on the urgent need for cost-effective interventions that reduce crash risk while supporting older drivers to remain driving safely for longer. Our study aims to evaluate the effectiveness of three behavioural interventions for older driver safety. These include an online road-rules refresher workshop, tailored feedback on driving performance and two tailored driving lessons.Methods and analysis A single-blind three-parallel group superiority randomised controlled trial will be conducted with 198 urban licensed drivers aged 65 years and older, allowing for 4% attrition. This sample size provides 80% power to detect a difference with an alpha of 0.05. Participants will be selected based on a standardised on-road test that identifies them as moderately unsafe drivers. Interventions, spanning a 3-month period, aim to improve driving safety. Their effectiveness will be assessed through a standardised on-road assessment of driving safety at 3 months (T1) and 12 months postintervention (T2). Additionally, monthly self-reported driving diaries will provide data on crashes and incidents.This trial has the potential to identify cost-effective approaches for improving safety for older drivers and contribute to evidence-based health policy, clinical practice and guidelines.Ethics and dissemination Ethical approval was obtained by the University of New South Wales Human Research Ethics Committee (HC190439, 22 August 2019). The results of the study will be disseminated in peer-reviewed journals and research conferences.Trial registration number ACTRN12622001515785.

BackgroundFalls are the most common hospitalized injury mechanism in children aged ≤1 years, and currently, there are no targeted prevention interventions. The prevention of falls in children of this age requires changes in the behavior of their caregivers, and theoretically informed digital behavior change interventions (DBCIs) may provide a unique mechanism for achieving effective intervention. However, user acceptance and the ability of DBCIs to effect the required changes in behavior are critical to their likelihood of success. ObjectiveThis study aims to evaluate a behavior theory–informed digital intervention developed following a user-centered approach for user experience, the potential for this intervention to prevent infant falls, and its impact on behavioral drivers underpinning fall risk in young children. MethodsParents of infants aged

Introduction/background: COVID-19 vaccination uptake rates and responses by Canadian respiratory therapists (RTs) were investigated along with factors that may be shown to play a role in vaccination hesitancy. Methods: An anonymous survey using SurveyMonkey® on vaccination uptake rates, responses and attitudes was made available to student RTs, graduate RTs and registered RTs in Canada from July to October of 2021. Pearson’s chi-square tests were performed to evaluate association between vaccination status and the other categorical parameters evaluated. Results: A total of 1013 surveys (8.0% of target population) were completed fully and included in the data analysis. Of the surveyed RT population, 90.42% received their vaccination as soon as it was made available compared to Canada’s Ministry of Health’s published rate at the time of 86.27% for all Canadian healthcare workers. There was a significant (p = 0.013) association between early vaccination and age and a significant (p = 0.036) association between vaccination status and a participant’s response on whether or not they have a family member or know someone who has had COVID-19. There was also a significant (p < 0.001) association between vaccination status and attitudes towards trusting science to develop safe, effective, new vaccines and trusting the Ministry of Health to ensure that vaccines are safe. There was no significant association between vaccination status and gender, province/territory of residency/work, level of education and level of involvement with COVID-19 patients. Conclusion: The results suggest that RT groups across Canada had higher early vaccination uptake rates than general healthcare worker groups and that age, relationship to people with COVID-19 and trust in science played a significant role in their vaccination uptake rates.

Objectives To systematically investigate the associations between vision impairment and risk of motor vehicle crash (MVC) involvement, and evaluate vision-related interventions to reduce MVCs.Design Medline (Ovid), EMBASE and Global Health electronic databases were systematically searched from inception to March 2022 for observational and interventional English-language studies. Screening, data extraction and appraisals using the Joanna Briggs Institute appraisal tools were completed by two reviewers independently. Where appropriate, measures of association were converted into risk ratios (RRs) or ORs for meta-analysis.Participants Drivers of four-wheeled vehicles of all ages with no cognitive declines.Primary and secondary outcomes MVC involvement (primary) and driving cessation (secondary).Results 101 studies (n=778 052) were included after full-text review. 57 studies only involved older drivers (≥65 years) and 85 were in high-income settings. Heterogeneity in the data meant that most meta-analyses were underpowered as only 25 studies, further split into different groups of eye diseases and measures of vision, could be meta-analysed. The limited evidence from the meta-analyses suggests that visual field defects (four studies; RR 1.51 (95% CI 1.23, 1.85); p

Introduction: This systematic review aims to (1) investigate the associations between vision impairment and driving performance, and (2) evaluate the effectiveness of vision-related interventions to improve driving performance. Method: Medline (Ovid), EMBASE and Global Health electronic databases were searched from their inception to March 2022 for observational and interventional English-language studies. The population of focus were licensed drivers of all ages of four-wheeled motorised vehicles. The primary outcome was measures of driving performance from naturalistic driving and/or on-road closed circuits. All screening, data extraction and critical appraisals were completed independently by two authors. Results: 27 studies (n = 6358 participants) from the 4281 identified in the search were included in this review. All but one study, an RCT, were observational. Only 2 cross-sectional studies were rated as high risk of bias. The majority of papers (80 %) were limited to older drivers. There were 33 different performance measures reported. Poor driving performance was associated with glaucoma, AMD and monocularity, and measures of vision function including contrast sensitivity, visual acuity and visual fields. From the vision-related interventions identified only cataract surgery and toric refractive correction for astigmatism were shown to improve driving performance on selected measures. Conclusion: Despite differences in outcome measures, there is consistent evidence for associations between vision impairments and poor driving performance. This review highlights the importance vision has on an individual’s ability to safely drive and complete common manoeuvres. Early detection and management of eye conditions may help decrease the likelihood of crashing and road traffic injuries.

BackgroundTreatment for gestational diabetes mellitus (GDM) aims to reduce maternal hyperglycaemia. The TARGET Trial assessed whether tighter compared with less tight glycaemic control reduced maternal and perinatal morbidity.Methods and findingsIn this stepped-wedge, cluster-randomised trial, identification number ACTRN12615000282583, 10 hospitals in New Zealand were randomised to 1 of 5 implementation dates. The trial was registered before the first participant was enrolled. All hospitals initially used less tight targets (fasting plasma glucose (FPG) ConclusionsTighter glycaemic targets in women with GDM compared to less tight targets did not reduce the risk of a large for gestational age infant, but did reduce serious infant morbidity, although serious maternal morbidity was increased. These findings can be used to aid decisions on the glycaemic targets women with GDM should use.Trial registrationThe Australian New Zealand Clinical Trials Registry (ANZCTR). ACTRN12615000282583.

BackgroundFalls represent the most common mechanism of injury requiring hospitalization among children under 12 months, and they commonly result in traumatic brain injury. Epidemiological studies exploring infant falls demonstrate the experienced burden, but they lack contextual information vital to the development of preventive interventions. ObjectiveThe objective of this study was to examine contextual information for falls involving children under 12 months, using online parenting discussion forums. MethodsOnline parenting forums provide an unobtrusive rich data source for collecting detailed information about fall events. Relevant discussions related to fall incidents were identified and downloaded using site-specific Google Search queries and a programming script. A qualitative descriptive approach was used to analyze the incidents and categorize contextual information into “precursor events” and “influencing factors” for infant falls. ResultsWe identified 461 infant fall incidents. Common fall mechanisms included falls from furniture, falls when being carried or supported by someone, falls from baby products, and falls on the same level. Across the spectrum of fall mechanisms, common precursor events were infant rolling off, infant being alone on furniture, product misuse, caretaker falling asleep while holding the infant, and caretaker tripping/slipping while carrying the infant. Common influencing factors were infant’s rapid motor development, lapses in caretaker attention, and trip hazards. ConclusionsThe findings define targets for interventions to prevent infant falls and suggest that the most viable intervention approach may be to target parental behavior change. Online forums can provide rich information critical for preventive interventions aimed at changing behavior.

BackgroundTighter glycaemic targets may be of benefit for women with GDM and their infants. Barrier and enabler identification prior to implementation of tighter glycaemic targets for women with GDM may support a successful transition.MethodsA cross-sectional questionnaire survey was conducted among Key Informant Health Professionals in ten hospitals in New Zealand. The survey assessed what was currently working using less tight glycaemic targets; what barriers and enablers were considered likely when introducing tighter glycaemic targets and whether these perceptions differed by health professional groups.ResultsSixty Key Health Informant Health Professionals completed the survey. When using the lower glycaemic targets, participants considered that women with GDM found the targets easy to use and that collaborative collegial support was effective. No significant barriers were identified. Perceived enablers identified prior to implementation of tighter targets included receiving collegial support (40, 67%), attending education sessions (38, 63%), use of pocket prompt cards (31, 52%), availability of wall charts (25, 42%) and glycaemic target reminder stickers (24, 40%). For health professionals referring into the Diabetes in Pregnancy Service effective communication (50, 83%) was considered important. Perceived barriers were confusion over glycaemic targets use (27 (45%), not being informed of the glycaemic target change (31, 52%), non-involvement with multidisciplinary decisions (29, 48%) and increased difficulty of blood glucose control for women (48, 80%). Overall, barriers and enablers between Health Professional groups did not differ.DiscussionKey Informant Health Professionals reported effective communication as a key perceived enabler and that woman would find it more difficult to control their blood glucose concentrations. Education sessions, multidisciplinary engagement, wall charts and stickers were considered effective to overcome the perceived barriers. Further research is needed to assess if the barriers perceived were realised and if the perceived enablers supported the implementation of the tighter glycaemic targets effectively.

BackgroundFalls account for approximately 50% of infant injury hospitalizations, and caretaker behavior is central to preventing infant falls. Behavior theory–informed interventions for injury prevention have been suggested, but to date, few have been reported. The potential of using smartphones for injury prevention intervention delivery is also underexploited. ObjectiveThis study aims to develop a behavior theory– and evidence-based as well as user-centered digital intervention as a mobile app for parents to prevent infant falls following agile development practices. MethodsInfant falls while feeding was selected as the fall mechanism to demonstrate the approach being taken to develop this intervention. In phase 1, the Behaviour Change Wheel was used as a theoretical framework supported by a literature review to define intervention components that were then implemented as a mobile app. In phase 2, after the person-based approach, user testing through think-aloud interviews and comprehension assessments were used to refine the content and implementation of the intervention. ResultsThe target behaviors identified in phase 1 were adequate rest for the newborn’s mother and safe feeding practices defined as prepare, position, and place. From behavioral determinants and the Behaviour Change Wheel, the behavior change functions selected to achieve these target behaviors were psychological capability, social opportunity, and reflective motivation. The selected behavior change techniques aligned with these functions were providing information on health consequences, using a credible source, instruction on performing each behavior, and social support. The defined intervention was implemented in a draft Android app. In phase 2, 4 rounds of user testing were required to achieve the predefined target comprehension level. The results from the think-aloud interviews were used to refine the intervention content and app features. Overall, the results from phase 2 revealed that users found the information provided to be helpful. Features such as self-tracking and inclusion of the social and environmental aspects of falls prevention were liked by the participants. Important feedback for the successful implementation of the digital intervention was also obtained from the user testing. ConclusionsTo our knowledge, this is the first study to apply the Behaviour Change Wheel to develop a digital intervention for child injury prevention. This study provides a detailed example of evidence-based development of a behavior theory–informed mobile intervention for injury prevention refined using the person-based approach.

Abstract Background Prehospital undertriage occurs when the required level of care for a major trauma patient is underestimated and the patient is transported to a lower-level emergency care facility. One possible reason is that the pattern of injuries exceeding a certain severity threshold is not easily recognizable in the field. The present study aims to examine whether the injury patterns of major road trauma patients are associated with trauma centre transport decisions in Sweden, controlling for the distance from the crash to the nearest trauma centre and other patient characteristics. Methods The Swedish Traffic Accident Data Acquisition (STRADA) database was queried from April 2011 to March 2017. Teaching hospitals with neurosurgery capabilities were classified as trauma centres (TC), all other hospitals were classified as other emergency departments (ED). Injury Severity Score ≥ 13 was used as the threshold for major trauma. Ten common injury patterns were derived from the STRADA data; six patterns included serious neuro trauma to the head or spine. The remaining four patterns were: other severe injuries, moderate to serious abdomen injuries, serious thorax injuries and all other remaining injury patterns. Logistic regression was used to analyse the effect of injury patterns, age, sex and distance from crash to nearest TC on transport decision (TC or ED). Results Of the 2542 patients, 38.0% were transported to a TC, equating to a prehospital undertriage of 62%. Over half (59.4%) of the patients had four or more Abbreviated Injury Scale (AIS) 2+ injuries. After controlling for age, sex and distance to nearest TC, only patients sustaining serious head injuries together with other severe injuries had significantly higher odds of being transported to a TC (OR = 4.18, 95% CI: 2.03, 8.73). The odds of being transported to a TC decreased by 5% with every kilometre further away the crash location was to the nearest TC. Conclusion These results highlight that there is considerable prehospital undertriage in Sweden and suggest that distance to nearest TC is more influential in transport decisions than injury pattern. These results can be used to further develop prehospital transportation guidelines and designation of trauma centres.

Background: Young men have long been known to be disproportionately impacted by road crash and crash-related injury compared to young women and older drivers. However, there is limited insight into how sex differences in crash and crash-related injury changes over time as men and women get older and gain more driving experience. To explore sex differences in crash and crash-related injury, we undertook a sex disaggregated analysis in a large longitudinal cohort of over 20,000 young drivers in New South Wales, Australia, for up to 13 years after they first attained their independent car driver licence. Methods: DRIVE Study survey data from 2003–04 were linked with police, hospital and deaths data up to 2016. Sex differences were analysed using cumulative incidence curves investigating time to first crash and in negative binominal regression models adjusted for driver demographics and crash risk factors. Results: After adjusting for demographics and driving exposure, compared with women, men had 1.25 (95% CI 1.18–1.33), 2.07 (1.75–2.45), 1.28 (95% CI 1.13–1.46), 1.32 (95% CI 1.17–1.50) and 1.59 (95% CI 1.43–1.78) times higher rates of any crash, single vehicle crash, crash on streets with a speed limit of 80 km/h or above, crash in wet conditions and crash in the dark, respectively. By contrast, men were less likely to be involved in crashes that resulted in hospitalisation compared to women 0.73 (95% CI 0.55–0.96). Conclusions: Young men are at increased risk of crash, and this risk persists as they get older and gain more driving experience. Despite lower risk of crash, women are at higher risk of crash related injury requiring hospitalisation. These differences in men's and women's risk of crash and injury signal the need for better understanding of how sex and/or gender may contribute to risk of crash and injury across the life-course.

Evidence-based teaching practices (EBTP) – like inquiry-based learning, inclusive teaching, and active learning – have been shown to benefit all students, especially women, first-generation, and traditionally minoritized students in science fields. However, little research has focused on how best to train teaching assistants (TAs) to use EBTPs or on which components of professional development are most important. We designed and experimentally manipulated a series of pre-semester workshops on active learning where an Activity group worked in teams to learn an AL technique with a workshop facilitator, then these teams modeled the activity with their peers acting as students. In the Evidence group, facilitators modeled the activities with all TAs acting as students. We used a mixed-methods research design (specifically, concurrent triangulation) to interpret pre- and post-workshop and post-semester survey responses. We found that Evidence group participants reported greater knowledge of AL after the workshop than Activity group participants. Activity group participants found all of the AL techniques more useful than Evidence group participants. These results suggested that actually modeling AL made them more useful to TAs than simply experiencing the same techniques as students—even with the accompanying evidence. This outcome has broad implications for how we provide professional development sessions to TAs and potentially to faculty.

Studies have shown the importance of submarine canyons as conduits of land-derived organic carbon beyond the coastal shelf into the deep-sea where a single obvious river source can be identified. When there is more than one river source, identifying which rivers contribute to canyon sediment organic matter is technically challenging. Here, we compare two contrasting submarine canyons: the Hokitika Canyon, a long, narrow, and gently sloping canyon on the west coast of New Zealand; and the Kaikōura Canyon, a high productivity, short, steep canyon close to shore on the east coast of New Zealand. Both canyons have multiple potential river sources, so we applied a compound specific stable isotope (CSSI) tracking technique to identify and apportion the contribution from each river at locations along the length of each canyon axis. We found that land-derived organic matter contributed between 74 and 100% of the total organic matter in the sediment of the Hokitika Canyon as far as 200 km from shore and to depths of 2000 m. However, less than 50% of the land-derived organic carbon came from the largest river closest to the canyon head. We hypothesize that longshore drift transported much of the sediment from that river past the Hokitika Canyon, while river inflows farther up-current supplied the bulk of the land-derived organic carbon. In contrast, land-derived organic matter contributed less than 50% of the total organic matter in Kaikōura Canyon sediments with land-derived organic sediment contribution decreasing steeply to less than 15% at about 24 km from shore in 1500 m water depth. Most of the land-derived organic matter (ca. 80%) came from the river with the largest suspended sediment yield, despite another (smaller) river discharging closer to the canyon head. We hypothesize that this difference in carbon source is partly due to the comparatively short and steep, and therefore dynamic, nature of Kaikōura Canyon resulting in efficient sediment through-put. The efficiency with which organic matter is captured and transferred to the deep-sea by canyons demonstrates the potential for such systems to act as natural carbon sinks driven by both geologically episodic and more regular oceanographic processes.

Abstract Background There is concern about recent increase and severity of sports-related injuries in children. Despite the benefits of sports participation, injuries may carry long-term health consequences. We aimed to evaluate the prevalence, characteristics and types of hospitalized sports-related injuries in children. Methods Population-based study of all acute sports-related injuries requiring hospitalization in children 5 to 15 years of age in New South Wales (NSW), Australia, 2005–2013. Health information was obtained from the NSW Admitted Patient Data Collection, a census of all hospital admissions from public and private hospitals. Children with a recorded ICD10-AM injury code (S00-T79) and sport-related activity code (U50-U70) were included. Prevalence and trend in injuries by age group, sporting code, body region affected and type of injury were assessed. Results There was a total of 20,034 hospitalizations for sports-related injuries (2.7% of all hospitalizations in children aged 5–15 years), involving 21,346 recorded injuries in 19,576 children. The overall population hospitalization period prevalence was 227 per 100,000 children aged 5–15 years in 2005–2013, remaining stable over time (RR 0.99; 95% CI 0.98–1.00). Football codes such as rugby league/union and soccer combined represented nearly two thirds of the total (60%). The most common body regions affected were the forearm (31%) head (15%) and hand injuries (13%). Fractures accounted for 65% of injuries followed by dislocations (10%) and traumatic brain injury (10%). Compared to other age groups, children aged 5–8 years had double the proportion of shoulder (15% vs. 7%) while 13–15 year olds had higher proportion of lower-leg (14% vs. 8%) and knee (6% vs.2%) injuries. One in seven injuries sustained while playing rugby league/union, baseball and hockey were traumatic brain injuries. A total of 444 (2.2%) of children had more than one hospitalization for sports-related injuries. Conclusion On average, six children were hospitalized every day for sports-related injuries in the last decade with trends remaining stable. The most common sports involved were football codes, one in three injuries involved the forearm and two thirds were fractures. These findings can be used to inform health policy and sporting governing bodies to target preventive interventions and promote safe sports participation in children.

Abstract Background Gestational diabetes mellitus (GDM) is strongly associated with significant adverse maternal and perinatal health outcomes that have lifelong consequences. Treatment for women with GDM aims to normalise maternal blood glucose concentrations to reduce these adverse health risks. Target recommendations for glycaemic control in women with GDM vary amongst international organisations. All their recommendations rely on consensus, as there have been no published randomised trials that compare different intensities of glucose control in women with GDM. The TARGET Trial aims to determine whether tighter targets for glycaemic control in women with GDM compared with less tight targets, reduce maternal and perinatal morbidity without adverse health consequences. Methods/design Using a stepped wedge, cluster randomised trial the 10 participating hospitals will be randomised to the timing of the change from the less tight to the tighter glycaemic target period. During the less tight target period, all health professionals at the hospital will aim to use the less tight glycaemic targets for treatment of women with GDM (fasting plasma glucose 90th centile). A sample size of 1080 participants will detect a treatment difference of 6% in the proportion of large for gestational age babies from 13% with less tight glycaemic targets to 7% with tighter targets, assuming an intra-cluster correlation coefficient of 0.05. Discussion The TARGET Trial will provide high-level evidence of direct relevance for clinical practice. If tighter treatment targets for women with GDM clearly result in significantly fewer large for gestational age infants and less adverse maternal and perinatal outcomes then they should be recommended for women with GDM. This would be of great importance to these women, their children, health services and communities. Trial registration Australian New Zealand Clinical Trials Registry - ACTRN 12615000282583.

Abstract Background Glycaemic target recommendations vary widely between international professional organisations for women with gestational diabetes mellitus (GDM). Some studies have reported women’s experiences of having GDM, but little is known how this relates to their glycaemic targets. The aim of this study was to identify enablers and barriers for women with GDM to achieve optimal glycaemic control. Methods Women with GDM were recruited from two large, geographically different, hospitals in New Zealand to participate in a semi-structured interview to explore their views and experiences focusing on enablers and barriers to achieving optimal glycaemic control. Final thematic analysis was performed using the Theoretical Domains Framework. Results Sixty women participated in the study. Women reported a shift from their initial negative response to accepting their diagnosis but disliked the constant focus on numbers. Enablers and barriers were categorised into ten domains across the three study questions. Enablers included: the ability to attend group teaching sessions with family and hear from women who have had GDM; easy access to a diabetes dietitian with diet recommendations tailored to a woman’s context including ethnic food and financial considerations; free capillary blood glucose (CBG) monitoring equipment, health shuttles to take women to appointments; child care when attending clinic appointments; and being taught CBG testing by a community pharmacist. Barriers included: lack of health information, teaching sessions, consultations, and food diaries in a woman’s first language; long waiting times at clinic appointments; seeing a different health professional every clinic visit; inconsistent advice; no tailored physical activities assessments; not knowing where to access appropriate information on the internet; unsupportive partners, families, and workplaces; and unavailability of social media or support groups for women with GDM. Perceived judgement by others led some women only to share their GDM diagnosis with their partners. This created social isolation. Conclusion Women with GDM report multiple enablers and barriers to achieving optimal glycaemic control. The findings of this study may assist health professionals and diabetes in pregnancy services to improve their care for women with GDM and support them to achieve optimal glycaemic control.

The data presented in this article are related to the research manuscript “Predictors of older drivers’ involvement in rapid deceleration events”, which investigates potential predictors of older drivers’ involvement in rapid deceleration events including measures of vision, cognitive function and driving confidence (A. Chevalier et al., 2016) [1]. In naturalistic driving studies such as this, when sample size is not large enough to allow crashes to be used to investigate driver safety, rapid deceleration events may be used as a surrogate safety measure. Naturalistic driving data were collected for up to 52 weeks from 182 volunteer drivers aged 75–94 years (median 80 years, 52% male) living in the suburban outskirts of Sydney. Driving data were collected using an in-vehicle monitoring device. Accelerometer data were recorded 32 times per second and Global Positioning System (GPS) data each second. To measure rapid deceleration behavior, rapid deceleration events (RDEs) were defined as having at least one data point at or above the deceleration threshold of 750 milli-g (7.35 m/s2). All events were constrained to a maximum 5 s duration. The dataset provided with this article contains 473 events, with a row per RDE. This article also contains information about data processing, treatment and quality control. The methods and data presented here may assist with planning and analysis of future studies into rapid deceleration behaviour using in-vehicle monitoring.

The data presented in this article are related to the research article entitled “A longitudinal investigation of the predictors of older drivers׳ speeding behavior” (Chevalier et al., 2016) [1], wherein these speed events were used to investigate older drivers speeding behavior and the influence of cognition, vision, functional decline, and self-reported citations and crashes on speeding behavior over a year of driving. Naturalistic speeding behavior data were collected for up to 52 weeks from volunteer drivers aged 75–94 years (median 80 years, 52% male) living in the suburban outskirts of Sydney. Driving data were collected using an in-vehicle monitoring device. Global Positioning System (GPS) data were recorded at each second and determined driving speed through triangulation of satellite collected location data. Driving speed data were linked with mapped speed zone data based on a service-provider database. To measure speeding behavior, speed events were defined as driving 1 km/h or more, with a 3% tolerance, above a single speed limit, averaged over 30 s. The data contains a row per 124,374 speed events. This article contains information about data processing and quality control. Keywords: Older drivers, Speed, Road safety, Naturalistic, In-vehicle monitoring, Device

Abstract Objectives : To examine changes in child car restraint practices in low socioeconomic areas following the introduction of mandatory child car restraint legislation in New South Wales (NSW), Australia. Methods : Data from two cross‐sectional studies of child car restraint use at pre‐schools, early childhood centres and primary schools before and after the introduction of legislating mandatory age‐appropriate car restraint use for children up to the age of seven years was used in this analysis. All included observations were from local government areas with socioeconomic status in the lowest 30% of urban Sydney. Children aged 2–5 years were observed in their vehicles as they arrived at observation sites (107 pre‐legislation, 360 post‐legislation). Multilevel logistic regression was used to examine changes in observed age‐appropriate and correct use of car restraints. Results : Age‐appropriate car restraint use was higher post‐legislation than pre‐legislation. After controlling for child's age, parental income, language spoken at home and adjusting for clustering, the odds of children being appropriately restrained post‐legislation were 2.3 times higher than in the pre‐legislation sample, and the odds of them being correctly restrained were 1.6 times greater. Conclusions : Results indicate an improvement in car restraint practices among children aged 2–5 in low socioeconomic areas after introduction of child restraint laws. Implications : Despite improvements observed with enhanced legislation, further efforts are required to increase optimal child car restraint use.

Introduction. Optimal glycaemic control in women with gestational diabetes mellitus (GDM) reduces maternal and infant morbidity. Method. A survey was administered to women diagnosed with GDM to explore their views and experiences in achieving optimal glycaemic control. Results. Sixty women participated. Enablers included being taught to test capillary blood glucose in group settings where the health professional demonstrated this on themselves first (60, 100%); health professionals listening (41, 68%); being reminded to perform blood glucose testing (33, 55%); and being provided healthy meals by friends and family (28, 47%). Barriers included not having information in a woman’s first language (33, 55%); being offered unhealthy food (19, 31%); not being believed by health professionals (13, 21%); receiving inconsistent information by health professionals (10, 16%); never being seen twice by the same health professional (8, 13%); and long waiting hours at clinics (7, 11%). Two-thirds of women (37, 62%) reported that food costs were not a barrier, but that they were always or frequently hungry. Conclusion. Optimising experiences for women with GDM for achieving glycaemic control and overcoming barriers, regardless of glycaemic targets, requires further focus on providing meaningful health literacy and support from health professionals, family, friends, and work colleagues.

Child restraint system misuse is a global public health issue leading to increased risk of injury and death in motor vehicle crashes. Although some interventions are effective at reducing misuse, they are prohibitively costly to adopt at a population-level. We aim to develop a novel, consumer-driven intervention to counter misuse embedded in product information supplied with child restraints. If effective, this cost efficient measure can be broadly implemented via product standards. The first stage of this project involved using a semi-structured discussion guide to conduct six in-depth focus groups (N = 44; 95% female) to elicit problems and preferences with current product information.

This practice report presents a university-wide strategic approach to enhancing the first-year student experience and to improving transition, progression and retention, called Moving Forward. Glasgow Caledonian University is a so-called post-1992 university with a high percentage of students from non-traditional, low-participation backgrounds, often coming into university as direct entrants onto levels two and three (of a four-level Scottish undergraduate degree). Its aim is to support a transformational approach to widening participation and the development of a transition pedagogy. Partnership working stands at its centre and underpins all activities from developing a Transition and Progression Framework, establishing a large Community of Practice and six Mini Communities of Practice, to negotiating formal partnership agreements with academic schools, Learner Support and the Students’ Association. The report charts the reasons for introducing Moving Forward, its development, activities, interim evaluation outcomes, achievements, as well as the challenges of sustaining such an initiative long term.

Child occupants require special consideration in the motor vehicle, where the environment is largely engineered for adults. This paper reviews the issues that place child occupants in a special category and how these have been dealt with in Australia, as well as the history of legislation covering children in cars and its effectiveness in enhancing crash protection. Recent research highlighting current problem areas for Australian child occupants is also reviewed. This review illustrates that the general principles of occupant protection can be applied to children but that this application also requires knowledge of the developmental stages of children. Legislation has been effective in getting children into restraints when travelling in cars, and recent changes to Australian law mandating the types of restraint used appears to have improved restraint choice in the short term. The history of legislation effectiveness suggests that it is likely that ongoing educational and enforcement activities will be required to sustain and maximise the effect of the new laws. Ensuring that restraints are used correctly is as important as getting children into the right type of restraint. Increasing correct use among child occupants requires additional strategies. To date, the only strategies shown to be associated with increased levels of correct restraint use are hands-on demonstration and the use of services like the New South Wales Authorised Restraint Fitting Station network. There is a need for continued focus on reducing the complexity of child restraint systems to enable correct use. Other issues of current importance for child occupants include the need to ensure interventions targeting optimal child restraint practices are made available to all members of the Australian community and that messages used in these interventions are consistent. Finally, there is currently a gap in protection for children too big for boosters but too small to be optimally protected by the adult seatbelt. This gap highlights the need for booster seats that can accommodate children beyond their 7th birthday and more focused attention to the safety performance of the rear seat of modern vehicles.

It is well known that restraining children in cars reduces their risk of injury in a crash. However, sub-optimal restraint use reduces restraint effectiveness. While the most common form of sub-optimal use is inappropriate use, incorrect use of a restraint has potential for more severe outcomes. This paper draws on field data and studies injury mechanisms through laboratory simulations. Field data is drawn from a dataset of children aged 2-8 in crashes. Laboratory simulations of a number of these crashes were used to study injury mechanisms. Only a small proportion of children in the field sample (5%) were incorrectly using a restraint system, however most of these children (5 out of 7) sustained moderate to severe injuries. This was significantly different to what occurred in the children correctly using restraints. Most incorrect use was seen in children under 5. Most cases involved misuse of the internal harness system of forward facing restraints or the adult belt (with or without a booster). The laboratory study showed an increased injury potential resulting from excessive head and torso excursion in incorrectly used restraint systems. This paper discusses these findings with respect to current restraint system design and calls for an increase in the amount of attention paid to this issue.

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If a Renaissance-themed wedding keeps popping up in your dreams, perhaps it's time to listen to your heart and plan a romantic, enlightening ceremony. Additionally, couples across the United States [...]

Abstract Background We previously reported in the “Vitamin C to Decrease the Effects of Smoking in Pregnancy on Infant Lung Function” randomized clinical trial (RCT) that vitamin C (500 mg/day) supplementation to pregnant smokers is associated with improved respiratory outcomes that persist through 5 years of age. The objective of this study was to assess whether buccal cell DNA methylation (DNAm), as a surrogate for airway epithelium, is associated with vitamin C supplementation, improved lung function, and decreased occurrence of wheeze. Methods We conducted epigenome-wide association studies (EWAS) using Infinium MethylationEPIC arrays and buccal DNAm from 158 subjects (80 placebo; 78 vitamin C) with pulmonary function testing (PFT) performed at the 5-year visit. EWAS were performed on (1) vitamin C treatment, (2) forced expiratory flow between 25 and 75% of expired volume (FEF25–75), and (3) offspring wheeze. Models were adjusted for sex, race, study site, gestational age at randomization (≤ OR > 18 weeks), proportion of epithelial cells, and latent covariates in addition to child length at PFT in EWAS for FEF25–75. We considered FDR p

For a few glorious weekends each year, one Missouri province turns into a storybook town of yesteryear by embodying a 1550 Ireland village whose visitors celebrate an intimate, endearing Renaissance [...]

Abstract Background and aims Over the last decade, regulators have taken significant steps towards tackling perceptions that regulatory systems are burdensome. There has been much international research activity in the regulation of health and care professionals. This article reports a review of studies on health professions regulation between January 2011 and March 2020. Its chief object was to provide robust and up-to-date evidence to assist regulators in policy development and implementation. The main objectives of this study were to: 1. Identify and retrieve research in the field of health and care professions regulation in English since 2011; 2. Evaluate the published research, exploring its utility to regulators and practitioners, and drawing out any key messages; 3. Draw conclusions concerning the scope and limitations of the research literature and identify areas for further research. Methods We undertook a rapid evidence assessment (REA) of the international literature on health and care professions regulation, including reviewing ten UK regulators’ websites to identify issues of concern and strategic priorities. We retrieved 3833 references, using a four-stage screening process to select the 81 most relevant. Results Results are reported within six key themes: harm prevention and patient safety; fitness to practise; quality assurance of education and training; registration including maintenance of registers; guidelines and standards and relations with regulatory bodies. Conclusions Regulation of professionals in health and care is comparatively undeveloped as a field of academic study. Consequently, the published evidence is diffuse and small-scale. Most work presents relatively weak data of low relevance to regulators, mainly reporting or describing the current position. Few studies are able to show the impact of regulation or demonstrate a causal link between regulation and its effects. To inform their research and policy agendas health and social care regulators need to commission, interpret and apply the scholarly literature more effectively; academics need to engage with regulators to ensure that their research provides high-quality evidence with practical relevance to the regulators’ agendas. Further study is needed to explore how effective academic collaborations between regulators and researchers may be created and sustained.

Objectives While institutional and systemic attempts to increase women’s participation in medical education have enabled increasing numbers to enter the field and achieve more senior positions, little is known about lived experiences of female clinical educators. Women clinicians are more likely to change careers and work less than full time. This study focuses on women medical educators’ narratives of career change, with the aim of exploring the interplay between factors affecting career decision-making, career trajectory and professional development. Methods We employed narrative enquiry approaches to two data sources (55 written accounts of turning points; 9 semistructured interviews reflecting on periods of career transition). Through analysing themes within each dataset before comparing and contrasting datasets simultaneously, we identified three areas of inconsistency and tension.Results Participants reported feeling both drawn and pushed into medical education. Some respondents reported that they were compelled by circumstances to enter medical education. Participants’ narratives were ambiguous regarding personal and professional identities. Additionally, participants asserted their position as autonomous agents while acknowledging their powerlessness when encountering organisational, social and cultural expectations limiting the ability to make independent choices. Even where primary decisions to pursue medical education were positive and motivated by interest, subsequent disappointments and challenges led some participants to doubt their choices.Conclusions Career advancement in medical education may involve women taking significant personal or career sacrifices, partly due to the continued existence of a medical culture allowing men to dominate senior ranks. Women medical educators achieving satisfying senior roles in the field may harbour lingering regret and resentment at the personal and career costs.

Background: Facebook is a well-established social networking platform that is commonly used by medical schools as an educational resource, but there are few studies assessing the roles of a non-academic Facebook page in medical education. Cardiff University uses Facebook primarily as a student support and engagement platform through its ‘C21’ Facebook Page; this study aimed to explore the use of the page by students, as well as their perceptions on the value of the page and the appropriateness of social media use by the medical school. Methods:Authors collected and analyzed C21 Facebook Page usage data to obtain descriptive information on reach, engagement and content. They also distributed an anonymized survey to evaluate and explore users’ interest in, experience of and engagement with the content. Results: Of the 1021 posts on the page in 2019, the highest post-engagement rate occurred in the?Student or Staff News?category (13.5%) and the lowest in?Medical Research News?(3.5%). Survey feedback on the page was overwhelmingly positive (n=89; 84.8%), and respondents reported a high degree of trust (n=95; 90.5%) in the page. Students would like to see more ‘Curriculum Vitae (CV)-building’ Opportunities advertised on the page. Conclusion:The C21 Facebook Page is an important resource in developing community within the medical school and facilitating student engagement with both the C21 course and wider medical opportunities. It is perceived as an appropriate channel of communication between the medical school and students.

Parent or guardian perceptions play a specialized role in the evaluation of school teachers. Parents are important stakeholders in teacher success, they are in some instances partners in the teachers' work, parents have unique personal information about student learning, and they can report on the teacher duties to inform parents about the classroom and child progress. This study analyzed the responses of parents to 12 survey items concerning teacher performance in 201 classrooms. The surveys were used as part of an innovative teacher evaluation program in which teachers elected to include parent feedback as one objective data source for annual review. In this study three factors emerged as important concerns for parents: humane treatment of students, support for pupil learning, and effective communication and collaboration with parents. Recommendations for use of specific survey items can be based on the empirical results of this sampling. The data gathered by parent surveys define one dimension of quality which may vary in importance from one teacher to another. [ABSTRACT FROM AUTHOR]

In our opening editorial we discussed our desire to receive a diverse range of submissions regarding peer teaching and learning. We are delighed to have received such a range of different submissions from healthcare education teams across the globe, focussing on peer education in very different settings. In this, our closing editorial, we discuss the key findings from the submissions that we have received, provide our own reflections on what authors have submitted and discuss our experiences of co-editing this themed edition of MedEdPublish.

In this special issue we would like to encourage authors to contribute as many diverse understandings as possible of how learning occurs in situations where the teacher is, as Osler so memorably put it, a senior student anxious to help his or her juniors. So although we expect to see plenty of work on peer assisted learning programmes within clinical skills units or hospitals we would like to invite authors to be creative in their interpretation of what Medical Students and Postgraduate Trainees as Medical Educators means. In particular we'd like to advance the definition to include "teaching and learning with flat hierarchies" - that is to say, teaching and learning that takes place between people who are fairly close in age, experience or stage of learning, as well as teaching and learning that occurs in the 'opposite direction' - such as when seniors are able to learn from juniors. We will be celebrating the remarkable potential of peer teaching and learning with flat hierarchies and look forward to the publication of a variety of articles, including those that would not normally find an outlet elsewhere, such as replication studies, negative findings, pilots and protocols, case reports, narrative studies and reflections.

Objectives: We sought to identify the program fidelity factors associated with successful implementation of the Buckle-Up Safely program, targeting correct use of age-appropriate child car restraints., Methods: In 2010, we conducted a cluster randomized controlled trial of 830 families with children attending preschools and long day care centers in South West Sydney, New South Wales, Australia. Families received the Buckle-Up Safely program in the intervention arm of the study (13 services). Independent observers assessed the type of restraint and whether it was used correctly., Results: This detailed process evaluation showed that the multifaceted program was implemented with high fidelity. Program protocols were adhered to and messaging was consistently delivered. Results from multilevel and logistic regression analyses show that age-appropriate restraint use was associated with attendance at a parent information session hosted at the center (adjusted odd ratio [AOR]=3.66; 95% confidence interval [CI]=1.61, 8.29) and adversely affected by the child being aged 2 to 3 years (AOR=0.14; 95% CI=0.07, 0.30) or being from a family with more than 2 children (AOR=0.34; 95% CI=0.17, 0.67)., Conclusions: Findings highlight the importance of parents receiving hands-on education regarding the proper use of age-appropriate child restraints.