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Phosphorus (P) is an essential element for sustaining human life, but its current management is unsustainable. Scientists are currently developing novel scientific and technological innovations to improve P management. By engaging stakeholders to understand their perceptions and concerns, researchers can address concerns and improve the chances that their innovations will be adopted. In this paper, we conducted thirty-seven interviews with U.S. stakeholders to develop three case studies of technologies in P recovery. The cases investigated are i) urine diversion for P recovery, ii) biological P removal from wastewater, and iii) analysis of stable isotopes for source tracking in natural water bodies. Stakeholders highlighted an array of economic, regulatory, and social barriers to adoption that were similar across all three cases. The findings presented in this study provide proof of concept for the efficacy of comparative methods to identify shared challenges in adoptions of new innovations within a research area. [ABSTRACT FROM AUTHOR]

Objective: The authors compared the performance of a novel self-collect device with clinician-collected samples for detection of high-risk human papillomavirus (hrHPV)., Materials and Methods: Eighty-two (82) participants were recruited from 5 clinical sites in the United States. Each participant performed self-collect sampling using the self-collect device followed by a standard of care clinician-collected sample. Both samples were evaluated for hrHPV using polymerase chain reaction (PCR)-based HPV assays. A subset of HPV-positive samples underwent dual staining (p16/Ki-67), and concordance was evaluated. Biopsy results collected per standard of care were recorded., Results: On the Roche cobas assay, the preliminary positive percent agreement (PPA) and negative percent agreement (NPA) was 91%. Agreement for hrHPV using the BD OnClarity in PreservCyt was 100% PPA (n = 10), and 100% PPA, 93% NPA in SurePath. Dual-stain concordance was 93% (n = 16) overall, and 100% for HPV other genotypes. Seventy-one participants (n = 71; 89%) indicated they would feel confident using the self-collect device for screening if they knew they could get equal results, and 86% (n = 69) indicated that they would be more likely to get screened with this option., Conclusions: The self-collect device shows high (>92%) positive and negative agreement for detection of HPV when compared with reference clinician-collected samples, with very high acceptability and preference. Furthermore, the self-samples collected with the self-collect device showed highly concordant results by dual stain, which is a novel and emerging application for a self-collected sampling device, thus enabling potential triage from 1 sample., Competing Interests: Role of funding source: The study was funded by Teal Health, Inc, which is a biotechnology startup company. The funding source was involved in the study design, collection, analysis, and interpretation of data, as well as the writing of the report and decision to submit the article for publication. All authors have access to the data and take responsibility for the integrity of the data and accuracy of data analysis. All potential conflicts of interest have been disclosed. MBF is a current employee at Teal Health. No other relationships or activities have influenced the submitted work. The other authors have declared they have no conflicts of interest., (Copyright © 2024, ASCCP.)

Background: Given the continued increases in rates of both Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) infection, additional diagnostic assays may be useful in increasing access to testing for these sexually transmitted infections. We evaluated the performance of the NeuMoDx™ CT/NG Assay 2.0 on the NeuMoDx-96 and NeuMoDx-288 Molecular Systems., Methods: The clinical sensitivity and specificity of the assay was assessed when used with: 1) endocervical swabs; 2) self-, and clinician-collected vaginal swabs; and 3) first-catch urine specimens (female and male). Results were compared to a patient infection status based on US Food and Drug Administration (FDA)-cleared assays., Results: The NeuMoDx CT/NG Assay 2.0 demonstrated high sensitivity and specificity in both symptomatic and asymptomatic participants. All specimen types other than endocervical swabs had >95% sensitivity and > 99% specificity for both pathogens. For endocervical samples, sensitivity was 93.2% and 93.3% for CT and NG, respectively. There was no difference in performance based on platform. The frequency of invalid results was low (<1%)., Conclusions: The NeuMoDx CT/NG Assay 2.0 demonstrated performance similar to currently FDA-cleared assays, with the added choice of a moderate- (96-sample) or a high-throughput (288-sample) platform. The system therefore offers solutions to laboratories running lower volumes of testing that may obviate the need for outsourcing to larger reference laboratories., Competing Interests: Conflicts of interest and sources of funding: BVDP reports receiving, over the last two years, grant funding to her institution or personal consulting fees/honorarium from Abbott, Becton Dickinson, BioFire Diagnostics, Cepheid, Cue Health, Detect, FIND, Hologic, Preventx, Rheonix, Roche, and Visby Medical. AA, LC, SC, SY, VR, and DY report no conflict of interests., (Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the American Sexually Transmitted Diseases Association.)

Background: Carbapenem-resistant Enterobacterales (CRE) are an urgent threat to healthcare, but the epidemiology of these antimicrobial-resistant organisms may be evolving in some settings since the COVID-19 pandemic. An updated analysis of hospital-acquired CRE (HA-CRE) incidence in community hospitals is needed., Methods: We retrospectively analyzed data on HA-CRE cases and antimicrobial utilization (AU) from two community hospital networks, the Duke Infection Control Outreach Network (DICON) and the Duke Antimicrobial Stewardship Outreach Network (DASON) from January 2013 to June 2023. The zero-inflated negative binomial regression model was used owing to excess zeros., Results: 126 HA-CRE cases from 36 hospitals were included in the longitudinal analysis. The pooled incidence of HA CRE was 0.69 per 100,000 patient days (95% confidence interval [95% CI], 0.57-0.82 HA-CRE rate significantly decreased over time before COVID-19 (rate ratio [RR], 0.94 [95% CI, 0.89-0.99]; p = 0.02), but there was a significant slope change indicating a trend increase in HA-CRE after COVID-19 (RR, 1.32 [95% CI, 1.06-1.66]; p = 0.01). In 21 hospitals participating in both DICON and DASON from January 2018 to June 2023, there was a correlation between HA-CRE rates and AU for CRE treatment (Spearman's coefficient = 0.176; p < 0.01). Anti-CRE AU did not change over time, and there was no level or slope change after COVID., Conclusions: The incidence of HA-CRE decreased before COVID-19 in a network of community hospitals in the southeastern United States, but this trend was disrupted by the COVID-19 pandemic.

Competing Interests: The author has declared that they have no competing or potential conflicts of interest.

Introduction: Autism is a lifelong neurodevelopmental condition diagnosed on the basis of differences in social communication, interaction and repetitive behaviours, including sensory sensitivities. Autistic individuals without intellectual disabilities often face barriers to positive adult outcomes and are at high risk for poor health, including mental health issues, which could be mitigated by improving well-being. Young people should receive support to increase their well-being during the transition to adulthood, when social and family support often reduces. This is the protocol for a feasibility randomised controlled trial (RCT) of an online peer-group intervention, 'Understanding You, Discovering You' (UYDY). Objectives included assessing recruitment and retention rates, acceptability of procedures, characterising usual care, assessing the acceptability of UYDY and care as usual (CAU) and calculating outcome measure variances for a full trial., Methods and Analysis: This two-arm parallel feasibility RCT includes a nested qualitative evaluation. Seventy participants aged 16-25 years old with a clinical autism diagnosis will be randomised on a 1:1 basis to UYDY or CAU. Exclusion criteria include risk of harm to self or others, receipt of postdiagnostic support in the past 12 months, and literacy levels such that the written session materials are not accessible. UYDY, a 6-week online peer-group intervention, will cover topics such as understanding autism, problem-solving and accessing services, and is facilitated by an autistic person and social care professionals. The main outcomes from the feasibility trial will be collecting data on (1) recruitment and retention rates; (2) the acceptability of randomisation and outcome measurement procedures; (3) CAU accessed by participants; (4) acceptability of the interventions; (5) clinical outcome measure variances (see below). See the Statistical methods section below for how this will be assessed in the current study. Clinical outcomes will be measured at baseline, and 8, 16 and 24 weeks post-randomisation. The primary clinical outcome is well-being, assessed using the Warwick Edinburgh Mental Wellbeing Scale. Secondary clinical outcomes include autism social identification, quality of life, social support and loneliness. Adverse events will be monitored and reported. Carer impact will also be measured. Participants will be recruited from England and Wales via charities and NHS services. Qualitative interviews will be conducted to explore the acceptability of trial participation including randomisation and the interventions., Ethics and Dissemination: Ethical approval has been obtained from the HRA and NHS REC (23/WA/0113). Informed consent will be collected from all participants (see online supplemental material for an example consent form). Results will inform the design of a full RCT and will be disseminated through peer-reviewed journals, conferences, and stakeholder events., Trial Registration Number: ISRCTN10513626., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

Phosphorus (P) removal from water and recovery into useable forms is a critical component of creating a sustainable P cycle, although mature technologies for P removal and recovery are still lacking. The goal of this paper was to advance the testing of novel materials for P removal and recovery from water by providing guidance on the development of more realistic aqueous matrices used during materials development. Literature reports of "new" materials to remove P from water are often difficult to compare in terms of performance because authors use a myriad of water chemistries containing P concentrations, pH, and competing ions. Moreover, many tests are conducted in simplified matrices that do not reflect conditions in real systems. To address this critical gap, the research herein developed a systematic approach of identifying aqueous matrices relevant to P recovery, including key components in the aqueous matrices having the greatest influence on the mechanisms of P removal with emphasis on phosphate precipitation and phosphate adsorption, and providing guidelines on relevant "recipes" for aqueous solutions for testing novel materials. Key components in the aqueous matrices included hydrogen ion (i.e., pH), multivalent metal cations, and dissolved organic matter due to their influence on phosphate precipitation and adsorption mechanisms. Recipes for buffer solution and synthetic groundwater, surface water, anaerobic digestate, and stored urine are discussed in the context of P removal and recovery processes. Wherein the adoption of standard matrices in other fields have permitted direct comparison of processes or materials, it is anticipated that adoption of relevant aqueous matrix recipes for P removal and recovery will improve the ability to directly compare novel materials and processes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Lay Abstract: Autistic people are more likely to have health problems than the general population. They, and people who care about them, have said mental health research is very important, and some autistic adults have said quality of life is the most helpful area to research when focusing on mental health. Autistic people should also be more deeply involved in making decisions in research. Our review aimed to find out if and how quality of life is being measured when mental health treatments are being tested, and how autistic people and the wider autism community are involved in these studies. We searched four databases and other sources and found over 10,000 records. But just 19 research studies were testing mental health treatments for autistic adults, and only five of those measured quality of life. When they did measure quality of life, it was measured in different ways and there was not much information given on how communities were involved. We suggest mental health research should measure quality of life more often and in ways that are more helpful for autistic people. Our analysis found that mental health research needs to include a wider variety of autistic people, and autistic people should be more involved in the various parts of research., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Lay Abstract: There has been much research about the experiences of families of autistic children as they navigate the process of accessing a diagnosis and associated support. However, most of this work has been conducted in Europe, the United States, and Australia. In this study, we examined the experiences of 767 families in Ecuador via an in-depth survey. Of the families we surveyed, 651 had children whose journeys resulted in them receiving a formal autism diagnosis. Most families realized that their children might have developmental differences when they were between the ages of 6 and 48 months, after which they tended to seek support from a professional fairly quickly (i.e. within 6 months). Most families consulted with several different professionals before they accessed a diagnosis for their children, with children tending to receive a diagnosis before the age of 48 months. Families often reported negative emotions around their children's diagnostic and post-diagnostic journeys, which were commonly related to the lack of information and services available to them. We hope that through gaining a greater understanding of the experiences of families of autistic children in Ecuador, these findings can be used to inform public policies that lead to the development of supports and services that better meet the needs of autistic people and their families in this context., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Lay Abstract: There has been a growing push for the Autistic and autism communities to be more actively involved in autism research. From January 2021, the journal Autism made it a rule for authors to report whether they involved community members in their work; and if they did, how they had done so. In this study, we wanted to see how this new rule has changed things. Our team of Autistic and non-autistic researchers read all 283 articles published in Autism in 2019, about 2 years before the rule was in place, and in 2022, about 1 year after. We recorded what each article was about and how the community was involved. We found there was an increase in how often articles talked about community involvement - from about 10% before the rule to over 50% after. Most of these studies, however, only involved community members giving advice, with the researchers making most decisions about the research. This was especially true for applied research (like wellbeing) rather than basic science (like causes of autism). Also, some of these articles were unclear or did not give enough information for us to understand how the community was involved. This tells us that while it is promising that more community involvement is reported, researchers need to describe this involvement more clearly. It is also important for community members to have a bigger say in research by sharing power with the researchers or even leading the research themselves., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship and/or publication of this article: E.P. was an Editor of Autism from 2012–2022, and was instrumental in the Journal’s adoption of the community involvement statement. L.C. was the Social Media Editor at Autism from 2010–2020, and was involved in discussions around the Journal’s adoption of the community involvement statement. The other authors have no competing interests of which they are aware.

Lay Abstract: Internships designed for autistic people can help them to find employment, but there is little research about the experiences of those involved with internship schemes. To learn more about a new paid internship scheme in the United Kingdom, the Employ Autism network, we interviewed 19 interns, who were autistic young adults without intellectual disability taking part in one of eight different internships. We also interviewed 22 employers (who worked with the interns), and 10 parents (who supported their children in the internship). The interns, employers and parents told us that the Employ Autism network was a valuable experience that helped the interns become more confident. Also, the parents said it helped the interns become more independent. All the groups said the Employ Autism network removed common barriers to employment, and interns and parents said it would help interns get a job in future. Employers and interns said they understood each other better during the internship, and employers said the internship made them think about how their organisations might have accidentally had barriers in place that could stop autistic people getting employed (barriers that they wanted to address in future). However, all groups said some expectations of the internship were not met. These findings suggest the Employ Autism network is helpful for autistic young adults without intellectual disability and employers, but that there are ways that the internships could be improved in future. We discuss the lessons we can learn from the Employ Autism network that might help others who are thinking about setting up, or getting involved in, similar internship schemes., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The PhD research leading to these results was funded by Ambitious about Autism, who also developed and delivered the internship scheme this study evaluated. Ambitious about Autism were not involved in data analysis or write-up of the study. Please refer to the conflict of interest form for more information.

Lay Abstract: There has been increasing interest in research on loneliness in autistic adults. Much of this research has involved giving autistic adults widely-used questionnaires that are thought to measure how lonely people are. However, these questionnaires have been developed for the general public. We do not know whether these questionnaires accurately measure how lonely autistic adults are. We asked 203 autistic adults to complete an online survey that included two widely-used loneliness questionnaires: (1) the University of California, Los Angeles (UCLA) Loneliness Scale Version 3 and (2) the Social and Emotional Loneliness Scale for Adults (SELSA). We also asked participants to rate how lonely they were from 1 (often/always) to 5 (never). Participants were then asked to give their views on the questionnaires (e.g. what they thought was good, and what they thought was not so good about them). We found that the scores on the UCLA scale and the SELSA aligned with participants' ratings of how lonely they were, which suggests that these two questionnaires accurately measure loneliness in autistic people. However, our participants also identified several ways to improve the questionnaires. This included (1) better distinguishing the characteristics/experiences of loneliness from those of being autistic; (2) better reflecting how loneliness may change at different times and in different contexts and (3) making the phrasing of the questions clearer. Overall, our autistic participants tended to prefer the UCLA scale to the SELSA. Therefore, we present some recommendations about how the UCLA scale could be changed to be more suitable for autistic people., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Lay Abstract: 'Who, When, How to Share' is a new programme that aims to support autistic adults in making decisions around sharing their autistic identity with others. The programme involves working through a self-help guide independently over 3 weeks with optional peer support. We wanted to find out if autistic adults would join the programme and find it useful. Thirty-two autistic adults took part in the programme and 19 of them completed it. Most participants who completed the programme liked the programme and found it helpful, but some felt that they needed more time and support to complete it. They suggested that the programme would be more accessible if it was more interactive, such as including videos and other ways to gain feedback on their progress. Surveys filled in by participants before and after the programme suggested that they became more confident and less stressed about sharing their autistic identity with others, but some felt they still needed to build more confidence in order to handle negative attitudes from others. More work is needed to improve and test the programme further., Competing Interests: Declaration of conflicting interestsThe author(s) declared the following potential conflicts of interest with respect to the research, authorship and/or publication of this article: The authors disclosed their involvement in both the development and evaluation of the programme reported in this article. They declare no other conflicts of interest.

Flow chemistry presents many advantages over batch processes for the fast and continuous production of polymers under more robust, safer, and easily scalable conditions. Although largely exploited for chain-growth polymerizations, it has rarely been applied to step-growth polymerizations (SGP) due to their inherent limitations. Here, we report the facile and fast preparation of an emerging class of nonisocyanate polyurethanes, i.e., CO 2 -based poly(oxazolidone)s, by SGP in continuous flow reactors. Importantly, we also demonstrate that functional poly(oxazolidone)s are easily prepared by telescoping a flow module where SGP occurs with reagents able to simultaneously promote two polymer derivatizations in a second module, i.e., dehydration followed by cationic thiol-ene to yield poly( N , S -acetal oxazolidone)s. The functional polymer is produced at a high rate and functionalization degree, without requiring the isolation of any intermediates. This work demonstrates the enormous potential of flow technology for the facile and fast continuous production of functional polymers by SGP.

Phosphorus (P) is a finite resource and necessary nutrient for agriculture. Urine contains a higher concentration of P than domestic wastewater, which can be recovered by source separation and treatment (hereafter urine diversion). Commercial and institutional (CI) buildings are a logical location for urine diversion since restrooms account for a substantial fraction of water use and wastewater generation. This study estimated the potential for P recovery from human urine and water savings from reduced flushing in CI buildings, and proposed an approach to identify building types and community layouts that are amenable to implementing urine diversion. The results showed that urine diversion is most advantageous in CI buildings with either high daily occupancy counts or times, such as hospitals, schools, office buildings, and airports. Per occupant P recovery benchmarks were estimated to be between 0.04-0.68 g/cap·d. Per building P recovery rates were estimated to be between 0.002-5.1 kg/d, and per building water savings were estimated to be between 3 and 23 % by volume. Recovered P in the form of phosphate fertilizer and potable water savings could accrue profits and cost reductions that could offset the capital costs of new urine diversion systems within 5 y of operation. Finally, urine diversion systems can be implemented at different levels of decentralization based on community layout and organizational structure, which will require socioeconomic and policy acceptance for wider adoption., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Treavor Boyer is an editor at Water Research X., (© 2024 The Authors. Published by Elsevier Ltd.)

Autism can be considered both a personal and social identity. Identifying the factors contributing to positive Autistic identity development is crucial given the potential implications for mental health and wellbeing. In this systematic review, we aimed to synthesize quantitative literature on Autistic identity to identify the (individual and environmental) factors associated with Autistic identity, and to ascertain the relationship between Autistic identity and mental health and wellbeing. A total of 3,617 studies were screened and 20 met our inclusion criteria. Results indicated that people developed a more positive Autistic identity when receiving external autism acceptance and external support. The association between individual factors and Autistic identity were largely nonsignificant or inconclusive, highlighting the need for broad support that meets the needs of a range of Autistic people, rather than specific subgroups. Importantly, positive Autistic identity was associated with improved mental health and wellbeing. Peer support and/or self-directed support resources may be valuable mechanisms for supporting Autistic people to cultivate a positive Autistic identity. The evaluation of such support, including the long-term impacts on identity development, will be a critical avenue for future research., (© 2024 The Authors. Autism Research published by International Society for Autism Research and Wiley Periodicals LLC.)

Lay Abstract: In some situations, autistic people feel pressure to change their social behaviour by camouflaging. In other situations, autistic people feel they don't need to change their social behaviour. Instead, they feel they can socialise in ways that feel authentic or true to themselves. Past research has tended to focus on autistic people's experiences of camouflaging rather than their experiences of authenticity. In this study, we asked autistic people what it is like for them when they can socialise in ways that feel authentic or true to themselves. Autistic people described authentic-feeling socialising as more free, spontaneous and open than camouflaging. In supportive environments, this kind of socialising had more positive and less negative consequences than camouflaging. Autistic people felt that having self-awareness and acceptance of their own social needs and being around autistic and nonautistic people who were accepting and understanding helped them to socialise in authentic-feeling ways. Autistic people also spoke about communication behaviours they felt nonautistic people should use to help overcome misunderstandings and create autism-friendly social environments. These findings suggest it is helpful for autistic people to have access to supportive and accepting social environments in which they feel able to socialise in ways that feel authentic to them. In creating such social environments, it is important to focus on nonautistic people's knowledge and attitude towards autistic people and also their ability to use helpful communication behaviours., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship and/or publication of this article.

Lay Abstract: Employment interviews are challenging for many autistic people, for example, due to difficulties with interpreting questions. Autistic people also have differences in non-verbal communication, such as emotional expression, eye-contact, and gestures, with research showing that these factors negatively affect first impressions. Some studies have shown that perceptions of autistic people are more positive when the person observing them, such as an interviewer, is already aware of their diagnosis. However, previous research has not studied how disclosing one's autism diagnosis affects perceptions of a candidate undergoing a full employment interview. Participants in this study acted as raters, who watched a video of an autistic person undergoing a mock employment interview with a researcher, and then rated their overall impressions of them on factors important to real-world hiring decisions, such as confidence, motivation, and knowledgeability. Prior to watching the interview, raters were either (1) not aware of the interviewee's diagnosis, (2) made aware of their diagnosis, or (3) made aware of their diagnosis and provided with additional information about autism, such as differences in behaviours and communication. The results show that disclosing an autism diagnosis improved ratings compared to not disclosing the diagnosis. Providing additional information about autism alongside the diagnostic label did not improve ratings further. The findings are important for employers and autistic people; employers should consider improving procedures by which autistic people can disclose their diagnosis prior to interview should they wish, and autistic people may wish to consider the potential benefits of disclosing their diagnosis., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Lay Abstract: Autistic people are more likely to have mental and physical health problems than non-autistic people. Annual health checks could reduce these problems by finding and treating them early. Annual health checks are yearly medical appointments where a primary healthcare provider (such as a doctor or nurse) can check things like a patient's weight and heart rate and ask if they have any worries about their health. In this study, we wanted to understand what might encourage primary healthcare providers to use annual health checks with their autistic patients. First, we spoke to 10 autistic people and 11 primary healthcare providers. Using the findings from these conversations, we created an online survey for primary healthcare providers in England. We used the findings from the interviews and survey to help us understand what would encourage primary healthcare providers to offer annual health checks for autistic people. Our participants said that a lack of time and staff would make it hard to provide health checks. To help, they said other members of staff (such as nurses and healthcare assistants) could do the health checks, rather than doctors. They also said parts of the process could be made automatic to save time (e.g. sending automatic reminders). Knowledge about autism was important too (e.g. knowing about the common conditions autistic people have, and how to best support autistic patients). Participants said training on these topics, produced and delivered with autistic people, could encourage them to use annual health checks with their autistic patients.

Among the various substances found in the feed source for the production of ultrapure water (UPW), urea is challenging to remove because it is a small molecular weight molecule that is not easily oxidized and does not carry a charge under neutral pH conditions. Urease enzyme, found in various organisms such as plants and bacteria, catalyze the hydrolysis of urea into carbon dioxide and ammonia. In this study, urease was immobilized on the polyamide layer of a reverse osmosis (RO) membrane to remove urea in UPW systems. The removal efficiency of urea by urease-coated RO membrane showed up to 27.9 % higher urea removal efficiency compared to the pristine membrane. This increase in urea removal can be attributed to both physical and biological effects from the urease coating on the membrane. Firstly, urease on the membrane surface can act as an additional physical barrier for urea to pass through. Secondly, urea can be hydrolyzed by the enzyme when it passes through the urease-coated RO membrane. In a two-pass RO system typical for UPW production, the removal of urea by a urease-coated membrane would be enhanced by twofold. This overall method can significantly increase the removal efficiency of urea in UPW systems, especially when considering the compounded removal by the urease coating, rejection by RO, and additional reactions by other treatment processes. Moreover, urea in UPW systems can be removed without the installment of additional processes by simply coating urease on the existing RO membranes., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

We calculated the attributable cost of several healthcare-associated infections in a community hospital network: central-line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), hospital-onset Clostridioides difficile infections (CDI-HOs) (43 hospitals); surgical site infections (SSIs) (40 hospitals). From 2016 to 2022, the total cost of CLABSIs, CAUTIs, CDI-HOs, and SSIs was $420,012,025.

Peg-shaped and missing lateral incisor teeth are common features for patients affected by hypodontia. While improvements in dental appearance may be a strong motivating factor for these patients, providing dental treatment to improve the clinical condition and achieve an acceptable and stable outcome can be complex and lengthy.For patients affected by hypodontia, discussion and consideration of various approaches to their individual treatment are best achieved in a multidisciplinary team environment. This allows debate of options and joint agreement between at least orthodontic and restorative dentistry specialist colleagues, based largely on clinical factors, towards a treatment plan that is acceptable to the patient. As most patients with this lateral incisor form of hypodontia are initially treated as teenagers and young adults, there is also an understanding that treatment outcomes will have lifelong maintenance and resource implications to consider.This paper identifies and discusses the key clinical features that influence the treatment planning process for a patient with either missing or peg lateral incisor teeth. These will often involve consideration of whether to open or close the lateral incisor spaces and whether to restore or replace a peg lateral incisor tooth. The process should be patient-centred, evidence-based, and aim to minimise the lifelong treatment burden, retaining options for future maintenance and retreatment., (© 2023. The Author(s).)

Lay Abstract: Many autistic adults experience public stigma, which refers to negative attitudes and treatment from others. Because of that, some autistic adults may also apply unhelpful beliefs to themselves, which is known as internalised stigma. There is some evidence that both public stigma and internalised stigma are linked to poorer mental health in autistic adults. Clearly, it is crucial to change how society thinks and acts towards autistic people. There are several programmes that are trying to do this. But as change can be slow, support may also be needed to help autistic people cope with and challenge stigma. Using an online survey, we gathered the views of 144 autistic adults and parents/caregivers of autistic people in the United Kingdom on whether a stigma support programme for autistic adults is needed and, if so, what it should 'look' like. Most participants felt it was important for autistic adults to have support in managing stigma because of the harmful effects that stigma has on mental health and the challenges that autistic adults face in disclosing their diagnosis. However, participants were also concerned that such a programme could convey the message that autistic people, rather than society, need to change. Participants suggested that the programme should be positive and practical, helping autistic adults to understand and accept themselves, as well as learn context-specific strategies for responding to stigma and/or disclosing their diagnosis. They also stressed that the programme should be flexible and inclusive, recognising that autistic adults have very different needs and preferences.

Background & Aims: Exploring Being Autistic is an autistic-led group-based programme providing psychoeducation and peer support to newly identified/diagnosed autistic adults. In 2020, due to social distancing measures implemented following the coronavirus pandemic, Exploring Being Autistic was adapted for online delivery. Here, we aimed to replicate previous research into the in-person delivery of Exploring Being Autistic, to determine whether similar results were obtained when the programme was delivered online. Further, we aimed to identify the unique opportunities and challenges that online delivery afforded., Methods: We used a community-based participatory research (CBPR) approach, whereby the autistic developer and facilitator of Exploring Being Autistic worked collaboratively with a team of academic researchers throughout the research process. Together, we evaluated two iterations of the online Exploring Being Autistic programme, involving 16 attendees. Attendees completed questionnaires before, during and after the programme. Attendees were also invited to participate in two post-programme (group or individual) interviews: one following the completion of the programme (time one) and another 6-8 months later (time two). Attendees were included in the research if they completed at least one questionnaire or interview. Data were analysed qualitatively, using reflexive thematic analysis., Results: Experiences of participating in the programme tended to be positive. Participants appreciated the autistic-led nature of the programme, found unity in the diversity of the group, and developed a positive and practical outlook as a result of the programme. Further analyses of our data revealed mixed views regarding the online delivery of the programme. Opportunities of online delivery were noted, such as this mode of participation reducing cognitive load, enabling the programme to be accessible to more participants, and fostering meaningful social connections among participants. However, technology and practical issues were felt to cause barriers, and some human aspects of participation were felt to be 'lost in translation' (e.g., in breakout groups)., Conclusions: The online delivery of the Exploring Being Autistic programme yielded similar results to previous, in-person evaluations of the programme. While we identified positive aspects of online delivery, this mode did not entirely suit everyone's needs., Implications: From the current findings, we can make several recommendations to develop online support for autistic people. First, flexibility is key. To make support accessible and inclusive to a broad range of autistic people, the option for attendees to engage in-person, online or in hybrid formats should be considered. Second, if delivering support online, the use of breakout rooms should be carefully considered. While participants appreciated the opportunity to meet different people, some participants found the unpredictability and lack of scaffolding associated with breakout rooms challenging. To mitigate these challenges, groups could be pre-determined and shared with the attendees in advance (although consideration should be given to how the groups 'fit' together, and whether groupings should be changed at set intervals). Gentle warnings should also be given to those in breakout rooms, to alert them of the need to re-join the main group. Finally, support with technological aspects relating to engagement should be prioritised., Competing Interests: The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The two originally evaluated iterations of the Exploring Being Autistic programme (reported in Crane et al., 2021) were funded by the Lottery Awards for All and Reading Council, respectively. The two online iterations of the Exploring Being Autistic programme (reported in this paper) were funded by the Big Lottery Fund and by the participants themselves, respectively. CH developed the Exploring Being Autistic programme and shares the intellectual property of the programme with AutAngel CIC, of which she is Founder and Director., (© The Author(s) 2023.)

Human urine is a readily available nutrient source that can complement commercial fertilizer production, which relies on finite mineral resources and global supply chains. This study evaluated the effectiveness of a simplified solar distillation process for urine to recover phosphorus (P) and nitrogen for agricultural use and water for non-potable purposes. Synthetic fresh, synthetic hydrolyzed, real fresh, and real hydrolyzed urine were exposed to direct sunlight for 6 h in a simple distillation apparatus, which produced distillation bottoms and distillate. Metal phosphate precipitation in the distillation bottoms was evaluated to recover P. The non-potable water was recovered as distillate. Hydrolyzed urine recovered more metal phosphate solid in the distillation bottoms and had a higher conductivity in the distillate than fresh urine. Hydrolyzed urine also achieved greater distillate volume recovery than fresh urine. Hydrolyzed urine had a greater presence of UV-absorbing organics in the distillate than fresh urine and therefore produced a lower-quality product water. There was no significant correlation between the daily high air temperature and the volume of distillate recovered. This study provides a comprehensive data set on simplified solar distillation of human urine considering the fate of nutrients and water for different types of urine.

In this prospective, observational, method comparison clinical study, the Xpert Xpress MVP test (MVP) was evaluated using both clinician-collected (CVS) and self-collected vaginal swabs (SVS) collected in a clinical setting. The study was conducted at 12 sites, including point-of-care (POC) settings, from geographically diverse locations in the United States. Participants were biologically female patients ≥ 14 years old with signs and/or symptoms of vaginitis/vaginosis. MVP test results for BV were compared to the BD MAX Vaginal Panel (BDVP). Results for Candida group and Candida glabrata and Candida krusei targets (species not differentiated) were assessed relative to yeast culture followed by mass spectrometry for species identification. Trichomonas vaginalis (TV) results were compared relative to a composite method that included results from the BDVP and InPouch TV culture. The investigational test demonstrated high positive percent agreement ranging from 93.6 to 99.0%, and negative percent agreement ranging from 92.1% to 99.8% for both CVS and SVS specimens, indicating it may be a valuable tool for the diagnosis of vaginitis/vaginosis in laboratory and POC settings.

Initial assessments of coronavirus disease 2019 (COVID-19) preparedness revealed resource shortages and variations in infection prevention policies across US hospitals. Our follow-up survey revealed improvement in resource availability, increase in testing capacity, and uniformity in infection prevention policies. Most importantly, the survey highlighted an increase in staffing shortages and use of travel nursing.

Purpose of Review: The COVID-19 pandemic and its associated restrictions have had a significant impact on people's everyday lives, including the lives of Autistic adults. We aimed to (a) synthesise all papers currently published on the impact of the COVID-19 pandemic on autistic adults and (b) identify lessons for the care and support of Autistic adults in pandemic and post-pandemic times., Recent Findings: Fifty-five papers met the inclusion criteria. Most studies focused on the pandemic's impact on the wellbeing of Autistic adults. Several studies focused on the use of (telehealth) services or the risk of COVID-19 infection/hospitalisation., Summary: Autistic adults were significantly impacted by the pandemic, both directly as indicated by higher COVID-19 infection and hospitalisation rates, but also indirectly due to severe service disruptions and social restrictions. Even though there were large differences observed both between as well as within individuals in terms of the negative/positive effects of the COVID-19 pandemic, most studies reported a negative effect on Autistic adults' mental health. We draw several lessons from this review for the future care and support of Autistic adults, all of which must be underpinned by participatory research methods, that is, where Autistic community members are actively involved in setting research questions, testing the acceptability of the methods and interpreting and disseminating the results., Supplementary Information: The online version contains supplementary material available at 10.1007/s40474-023-00268-6., Competing Interests: Conflict of InterestThe authors declare no competing interests., (© The Author(s) 2023.)

Lay Abstract: Nearly three out of four autistic people experience mental health problems such as stress, anxiety or depression. The research already done does not guide us on how best to prevent or treat mental health problems for autistic people. Our aim was to look at the benefits and harms of different interventions on mental health outcomes in autistic people. We searched all the published randomised controlled trials (RCTs) about interventions for mental health conditions in autistic people until 17 October 2020. We also searched for RCTs that were not published in peer-reviewed journals. These were obtained from registers of clinical trials online. We then combined the information from all these trials using advanced statistical methods to analyse how good the interventions are. Seventy-one studies (3630 participants) provided information for this research. The studies reported how participants were responding to the intervention for only a short period of time. The trials did not report which interventions worked for people with intellectual disability. In people without intellectual disability, some forms of cognitive behavioural therapy and mindfulness therapy may be helpful. However, further research is necessary. Many trials used medications to target core features of autism rather than targeting mental health conditions, but these medications did not help autistic people. Until we have more evidence, treatment of mental health conditions in autistic people should follow the evidence available for non-autistic people. We plan to widely disseminate the findings to healthcare professionals through medical journals and conferences and contact other groups representing autistic people.

Lay Abstract: Recently, researchers have been interested in how autistic people experience loneliness. Yet, most of this research has focused on loneliness in autistic children and young people. We present the results of a systematic review on loneliness in autistic adults. A systematic review is a rigorous way of searching for all existing research on a topic and summarizing the findings about specific questions. We searched for all research published on this topic until 9 April 2021. We found 34 articles that investigated loneliness in autistic adults. This research showed that (1) there is fairly little research that has involved directly asking autistic adults about their first-hand experiences of loneliness (e.g. what loneliness feels like for them); (2) few research studies have used loneliness questionnaires specifically developed for autistic adults (this was attempted in just one research study); (3) collective loneliness (i.e. loneliness associated with how much an autistic person feels they 'fit in' to society) seems important to autistic adults but has not been investigated as commonly as other aspects of loneliness (e.g. loneliness associated with romantic relationships or friendships); (4) things that might increase loneliness in autistic adults include anxiety and depression, and a lack of autism understanding and acceptance, for example; and (5) things that might reduce loneliness in autistic adults include having relationships and self-acceptance, for example. In our article, we discuss the kinds of future research on loneliness in autistic adults that might be useful.

Background: Traditional approaches for surgical site infection (SSI) surveillance have deficiencies that delay detection of SSI outbreaks and other clinically important increases in SSI rates. We investigated whether use of optimised statistical process control (SPC) methods and feedback for SSI surveillance would decrease rates of SSI in a network of US community hospitals., Methods: We conducted a stepped wedge cluster randomised trial of patients who underwent any of 13 types of common surgical procedures across 29 community hospitals in the Southeastern United States. We divided the 13 procedures into six clusters; a cluster of procedures at a single hospital was the unit of randomisation and analysis. In total, 105 clusters were randomised to 12 groups of 8-10 clusters. All participating clusters began the trial in a 12-month baseline period of control or "traditional" SSI surveillance, including prospective analysis of SSI rates and consultative support for SSI outbreaks and investigations. Thereafter, a group of clusters transitioned from control to intervention surveillance every three months until all clusters received the intervention. Electronic randomisation by the study statistician determined the sequence by which clusters crossed over from control to intervention surveillance. The intervention was the addition of weekly application of optimised SPC methods and feedback to existing traditional SSI surveillance methods. Epidemiologists were blinded to hospital identity and randomisation status while adjudicating SPC signals of increased SSI rates, but blinding was not possible during SSI investigations. The primary outcome was the overall SSI prevalence rate (PR=SSIs/100 procedures), evaluated via generalised estimating equations with a Poisson regression model. Secondary outcomes compared traditional and optimised SPC signals that identified SSI rate increases, including the number of formal SSI investigations generated and deficiencies identified in best practices for SSI prevention. This trial was registered at ClinicalTrials.gov, NCT03075813., Findings: Between Mar 1, 2016, and Feb 29, 2020, 204,233 unique patients underwent 237,704 surgical procedures. 148,365 procedures received traditional SSI surveillance and feedback alone, and 89,339 procedures additionally received the intervention of optimised SPC surveillance. The primary outcome of SSI was assessed for all procedures performed within participating clusters. SSIs occurred after 1171 procedures assigned control surveillance (prevalence rate [PR] 0.79 per 100 procedures), compared to 781 procedures that received the intervention (PR 0·87 per 100 procedures; model-based PR ratio 1.10, 95% CI 0.94-1.30, p =0.25). Traditional surveillance generated 24 formal SSI investigations that identified 120 SSIs with deficiencies in two or more perioperative best practices for SSI prevention. In comparison, optimised SPC surveillance generated 74 formal investigations that identified 458 SSIs with multiple best practice deficiencies., Interpretation: The addition of optimised SPC methods and feedback to traditional methods for SSI surveillance led to greater detection of important SSI rate increases and best practice deficiencies but did not decrease SSI rates. Additional research is needed to determine how to best utilise SPC methods and feedback to improve adherence to SSI quality measures and prevent SSIs., Funding: Agency for Healthcare Research and Quality., Competing Interests: AWB reports grant funding from the Agency for Healthcare Research and Quality, National Institute of Allergy and Infectious Diseases of the National Institutes of Health, and the Centers for Disease Control and Prevention Epicenters Program; and participation on the Advisory Board for Medincell. DJA reports grant funding from the Agency for Healthcare Research and Quality, National Institute of Allergy and Infectious Diseases of the National Institutes of Health, and the Centers for Disease Control and Prevention Epicenters Program; royalties from UpToDate; and co-ownership of Infection Control Education for Major Sports, LLC. EPD reports participation on the Advisory Board for Crely, Inc. and board membership of the Surgical Infection Society Foundation. II, JCB, KRF, YL, and NN report grant funding from the Agency for Healthcare Research and Quality., (© 2022 The Author(s).)

Lay Abstract: During the COVID-19 pandemic, high levels of depression, anxiety and stress have been reported in the general population. However, much less has been reported about the impact of COVID-19 on the mental health of autistic people. What we did: In the present study, we investigated how the mental health of autistic adults in the United Kingdom changed during the early stages of the COVID-19 pandemic. In total, 133 participants completed an online survey at two different time points. Of the 133 participants, 70 completed the survey at the first time point just before the onset of the national lockdown. This allowed us to look at changes in their mental health, from before the lockdown to 10 to 15 weeks during lockdown. All participants (133) told us about their experiences of the pandemic. What we found: While many autistic adults told us that their mental health worsened, people's experience varied. For some autistic adults, aspects of mental health (e.g. anxiety, stress) actually improved. Participants also described social changes that had occurred, at home and in the outside world. They described feelings of uncertainty during the pandemic, and discussed how the pandemic had affected some of their previous coping strategies. Participants also told us about their difficulties in accessing healthcare services and food during the early stages of the pandemic. In our article, we discuss these findings and focus on what needs to change to ensure that autistic people are better supported as the pandemic continues.

Lay Abstract: Camouflaging can be thought of as the process through which autistic people modify their natural social behaviours to adapt to, cope within or influence the largely neurotypical (non-autistic) social world. Many autistic people experience negative reactions to their natural or intuitive social behaviours when interacting with non-autistic people. Over time, in response to these negative reactions, autistic people's social behaviour often changes. We refer to autistic people's changed behaviours as 'camouflaging behaviours'. Research exploring camouflaging behaviours is still at an early stage. This study investigated camouflaging behaviours used by autistic adults in everyday social interactions using a research method that was new to the field of autism. Specifically, 17 autistic adults were filmed taking part in a common everyday social situation - a conversation with a stranger. With the help of the video of this conversation, they then showed and described their camouflaging behaviours to a researcher. These autistic people identified and described a total of 38 different camouflaging behaviours. The detailed and specific information provided by autistic adults about camouflaging behaviours generated important new insights into the ways in which autistic people adapt to, cope within and influence the neurotypical (non-autistic) social world.