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Introduction: For academic promotion, clinical faculty are expected to excel in clinical care, teaching, and scholarship. Ensuring adequate protected time and resources to engage in scholarly work in the face of competing clinical responsibilities is critical. The authors examined academic leaders' perspectives across affiliate hospitals of a large medical school regarding the definition of clinical full-time effort and academic time, best practices to enable academic success, and barriers to faculty advancement., Methods: Open-ended, semistructured, individual interviews were conducted with a purposive sample of clinical department and division heads. Interview data were examined to illuminate the range and commonalities in practices and to identify successful approaches., Results: Interviews were conducted with 17 academic leaders across 6 affiliate hospitals. There was considerable variability in clinical full-time effort definition. "Academic time," more accurately characterized as "nonclinical time," was typically 1 day a week for nonshift specialties and mostly used for administrative work or completing clinical documentation. Certain departments were more explicit in designating and protecting time for academic pursuits; some had invested resources in intensive programs for academic advancement with built-in expectations for accountability. The impact of documentation burden was considerable in certain departments., Discussion and Conclusion: Marked variability exists in time allocations for clinical and academic work, as well as in resources for academic success. This supports the potential value of establishing standards for defining and protecting academic time, motivating clinical faculty to engage in academic work, and building accountability expectations. Sharing best practices and setting standards may enhance academic advancement. Strategies to reduce documentation burden may enhance wellness., Competing Interests: Conflicts of InterestDr Misra has consulted for Abbvie and served on the Scientific Advisory Board of Ipsen in the last 2 years. She also receives royalties from UpToDate. Dr Becker has funding support from Merck and Company, Inc.

The advent of generative artificial intelligence and large language models has ushered in transformative applications within medicine. Specifically in ophthalmology, large language models offer unique opportunities to revolutionise digital eye care, address clinical workflow inefficiencies, and enhance patient experiences across diverse global eye care landscapes. Yet alongside these prospects lie tangible and ethical challenges, encompassing data privacy, security, and the intricacies of embedding large language models into clinical routines. This Viewpoint highlights the promising applications of large language models in ophthalmology, while weighing up the practical and ethical barriers towards their real-world implementation. This Viewpoint seeks to stimulate broader discourse on the potential of large language models in ophthalmology and to galvanise both clinicians and researchers into tackling the prevailing challenges and optimising the benefits of large language models while curtailing the associated risks., Competing Interests: Declaration of interests PvW declares financial interests as a cofounder of Enlighten Imaging, an early-stage medical technology start-up company devoted to hyperspectral retinal imaging and image analysis, including the development of artificial intelligence systems; research grant support from Roche and Bayer; and honoraria from Roche, Bayer, Novartis, and Mylan. RT declares consulting fees from Novartis, AbbVie, Allergan, Bayer, Alcon, Roche Genentech, Thea, Apellis, Iveric Bio, and Oculis; honoraria from Optic 2000; support for attending meetings from Novartis, AbbVie, Allergan, and Bayer; participation on advisory boards for Novartis, AbbVie, Allergan, Bayer, Apellis, Iveric Bio, Oculis, and Roche Genentech; a leadership role as the President Elect of Euretina; stock in Oculis; and equipment and materials from Zeiss. SS declares grants from Bayer and Boehringer Ingleheim; consulting fees from Roche, AbbVie, Apellis, Bayer, Biogen, Boehringer Ingelheim, Novartis, Janssen Pharmaceuticals, Optos, Ocular Therapeutix, and OcuTerra; support for attending meetings and travel from Bayer and Roche; participation on data safety monitoring boards or advisory boards for Novo Nordisk and Bayer; leadership in RCOphth, Macular Society, and Editor of EYE; stock in Eyebiotech; and equipment and materials from Boehringer Ingleheim. AYL reports grants to their affiliated institutions from Santen, Novartis, Carl Zeiss Meditec, Microsoft, NVIDIA, the National Institutes of Health (NIH; grant numbers NIH/NEI K23EY029246 and NIH OT2OD032644), Research to Prevent Blindness, and the Latham Vision Innovation Award. AYL reports consulting fees from USDA, Genentech, Verana Health, Johnson & Johnson, Gyroscope, Janssen Research and Development, and Regeneron; payment for lectures from Topcon; and payment from Alcon Research for various educational events and activities. ARR declares a grant from the Health and Medical Research Fund (grant number 19201991). CSL reports grants to their institution from the NIH (grant numbers NIH/NIA R01AG060942, NIH/NIA U19AG066567, and NIH OT2OD032644), Research to Prevent Blindness, and the Latham Vision Innovation Award; and consulting fees from Boehringer Ingelheim. TYW declares consulting fees from Aldropika Therapeutics, Bayer, Boehringer Ingelheim, Genentech, Iveric Bio, Novartis, Plano, Oxurion, Roche, Sanofi, and Shanghai Henlius; funding from the National Key R&D Program, China (grant number 2022YFC2502800); and being an inventor, patent holder, and cofounder of the start-up companies EyRiS and Visre. All other authors declare no competing interests., (Copyright © 2023 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license. Published by Elsevier Ltd.. All rights reserved.)

Introduction: The Objective Structured Clinical Examination (OSCE) has been widely used in health professions education since the 1970s. The global disruption caused by the COVID-19 pandemic restricted in-person assessments and medical educators globally sought alternative means to assess and certify students and trainees to meet the acute demand for health-care workers. One such solution was through virtual OSCE (vOSCE), which modified traditional in-person OSCE using videoconference platforms. This meta-ethnography sought to synthesise qualitative literature on candidates' and assessors' experiences of vOSCE to evaluate whether it may have a role in future assessment practices., Methods: In June 2022, we systematically searched PsycINFO, Medline and ERIC for peer-reviewed qualitative and mixed-methods articles that described candidates' and assessors' experiences of virtual OSCE in health professions education. Of 1069 articles identified, 17 were synthesised using meta-ethnography., Results: The final synthesis represented 1190 candidates and assessors from faculties of medicine, dentistry, nursing, pharmacy and osteopathy. We developed our findings into four key concepts. 'Strengthening confidence in a virtual environment' highlighted attempts to overcome and mitigate concerns associated with transitioning from in-person to virtual assessment. 'Understanding the scope of use as an assessment' reflected on the suitability of vOSCE in assessing various skills. 'Refining operational processes' emphasised the technical challenges of implementing vOSCE and impacts on accessibility and resources. 'Envisioning its future role' considered the applicability of vOSCE in the climate of rapid development in telehealth., Conclusion: This meta-ethnography highlighted that although vOSCE was primarily considered a temporary and crisis response, candidates and assessors recognised positive, as well as negative, consequences of the transition towards them. Moving forward, medical education policymakers should carefully consider the extent to which elements of vOSCE could be incorporated into assessment systems, particularly in light of the rise of telehealth in clinical practice., (© 2023 The Authors. Medical Education published by Association for the Study of Medical Education and John Wiley & Sons Ltd.)

Purpose: It has been suggested that follow-up visits for pediatric patients after full-mouth dental rehabilitation (FMDR) under general anesthesia (GA) are important to evaluate healing and restorative treatment, review oral hygiene instruction, provide nutritional counseling and address guardians' concerns. The purpose of this study was to evaluate pediatric dentists' current utilization of follow-up visits after GA and to evaluate pediatric dentists' and guardians' perceptions of their purpose and value. Methods: Three separate surveys were administered: (1) pediatric dentist survey, (2) guardian pre-appointment survey and (3) guardian post-appointment survey. The guardian surveys examined their perceptions of a follow-up visit before and after FMDR under GA. The pediatric dentist survey examined current utilization and perception of follow-up appointments. Results: Most clinicians (72 percent) reported scheduling a follow-up visit. Providers generally agreed that the post-operative appointments were important (69 percent). Of the guardians who attended the follow-up visit, 96.3 percent agreed that the post- operative visit was useful. Conclusion: Both pediatric dentists and guardians of patients undergoing FMDR under GA agreed that a follow-up visit after GA was valuable despite low complication rates.

Background: Fitspiration is a social media phenomenon purported to inspire viewers to lead healthier lifestyles but can result in negative psychological outcomes such as body dissatisfaction. This study aimed to develop a tool to audit Instagram fitspiration accounts and screen for content that could have potentially negative psychological effects., Methods: This study developed and implemented an audit tool to (1) identify credible fitspiration accounts (i.e., accounts that do not portray potentially harmful or unhealthy content) and (2) describe the content of identified accounts. The most recent 15 posts of 100 leading Instagram fitspiration accounts were audited. Accounts were deemed non-credible and were excluded if they contained fewer than four fitness-related posts or portrayed nudity or inappropriate clothing, sexualisation or objectification, extreme body types, "thinspiration", or negative messages., Results: Many accounts contained fewer than four fitness-related posts (n = 41), sexualisation or objectification (n = 26), nudity or inappropriate clothing (n = 22), and/or extreme body types (n = 15). Three accounts failed on all four criteria, while 13, 10 and 33 failed on three, two, or one criterion, respectively. Therefore, only 41% of accounts were considered credible. Inter-rater reliability (percentage agreement and Brennan and Prediger's coefficient κ q ) was high (Stage 1: 92% agreement [95% CI 87, 97], κ q 0.84 [95% CI 0.73, 0.95]; Stage 2: 93% agreement [95% CI 83, 100], κ q 0.85 [95% CI 0.67, 1.00]). Account holders of credible fitspiration accounts were predominantly female (59%), aged 25-34 (54%), Caucasian (62%), and from the United States (79%). Half held a qualification related to physical activity or physical health (e.g., personal trainer, physiotherapy; 54%). Most included accounts included an exercise video (93%) and example workout (76%)., Conclusion: While many popular Instagram fitspiration accounts offered credible content such as example workouts, many accounts contained sexualisation, objectification or promotion of unhealthy or unrealistic body shapes. The audit tool could be used by Instagram users to ensure the accounts they follow do not portray potentially harmful or unhealthy content. Future research could use the audit tool to identify credible fitspiration accounts and examine whether exposure to these accounts positively influences physical activity., (© 2023. The Author(s).)

BackgroundAdequate identification and testing of people at risk for HIV is fundamental for the HIV care continuum. A key strategy to improve timely testing is HIV indicator condition (IC) guided testing.AimTo evaluate the uptake of HIV testing recommendations in HIV IC-specific guidelines in European countries.MethodsBetween 2019 and 2021, European HIV experts reviewed guideline databases to identify all national guidelines of 62 HIV ICs. The proportion of HIV IC guidelines recommending HIV testing was reported, stratified by subgroup (HIV IC, country, eastern/western Europe, achievement of 90-90-90 goals and medical specialty).ResultsOf 30 invited European countries, 15 participated. A total of 791 HIV IC guidelines were identified: median 47 (IQR: 38-68) per country. Association with HIV was reported in 69% (545/791) of the guidelines, and 46% (366/791) recommended HIV testing, while 42% (101/242) of the AIDS-defining conditions recommended HIV testing. HIV testing recommendations were observed more frequently in guidelines in eastern (53%) than western (42%) European countries and in countries yet to achieve the 90-90-90 goals (52%) compared to those that had (38%). The medical specialties internal medicine, neurology/neurosurgery, ophthalmology, pulmonology and gynaecology/obstetrics had an HIV testing recommendation uptake below the 46% average. None of the 62 HIV ICs, countries or medical specialties had 100% accurate testing recommendation coverage in all their available HIV IC guidelines.ConclusionFewer than half the HIV IC guidelines recommended HIV testing. This signals an insufficient adoption of this recommendation in non-HIV specialty guidelines across Europe.

Context: Competency-based assessment of learners may benefit from a more holistic, inclusive, approach for determining readiness for unsupervised practice. However, despite movements towards greater patient partnership in health care generally, inclusion of patients in postgraduate medical learners' assessment is largely absent., Methods: We conducted a scoping review to map the nature, extent and range of literature examining the inclusion (or exclusion) of patients within the assessment of postgraduate medical learners. Guided by Arskey and O'Malley's framework and informed by Levac et al. and Thomas et al., we searched two databases (MEDLINE® and Embase®) from inception until February 2021 using subheadings related to assessment, patients and postgraduate learners. Data analysis examined characteristics regarding the nature and factor influencing patient involvement in assessment., Results: We identified 41 papers spanning four decades. Some literature suggests patients are willing to be engaged in assessment, however choose not to engage when, for example, language barriers may exist. When stratified by specialty or clinical setting, the influence of factors such as gender, race, ethnicity or medical condition seems to remain consistent. Patients may participate in assessment as a stand-alone group or part of a multi-source feedback process. Patients generally provided high ratings but commented on the observed professional behaviours and communication skills in comparison with physicians who focused on medical expertise., Conclusion: Factors that influence patient involvement in assessment are multifactorial including patients' willingness themselves, language and reading-comprehension challenges and available resources for training programmes to facilitate the integration of patient assessments. These barriers however are not insurmountable. While understudied, research examining patient involvement in assessment is increasing; however, our review suggests that the extent which the unique insights will be taken up in postgraduate medical education may be dependent on assessment systems readiness and, in particular, physician readiness to partner with patients in this way., (© 2022 Association for the Study of Medical Education and John Wiley & Sons Ltd.)

Importance: The research agenda in pediatric hospital medicine has seldom considered the perspectives of young people, parents and caregivers, and health care professionals. Their perspectives may be useful in identifying questions on topics for research., Objective: To prioritize unanswered research questions in pediatric hospital medicine from the perspectives of young people, parents/caregivers, and health care professionals., Design, Setting, and Participants: Between August 4, 2020, and August 19, 2021, two online surveys and a virtual workshop were conducted, using modified Delphi technique and nominal group technique. Young people, parents/caregivers, and health care professionals with experiences in pediatric hospital medicine in Canada were included., Interventions: The established James Lind Alliance Priority Setting Partnership method was used. In phase 1, a survey collected unanswered questions regarding pediatric hospital medicine via 3 open-ended questions. Survey responses were used to develop summary questions that went through an evidence-checking process. Unanswered questions were brought to a phase 2 interim prioritization survey. The top 10 unanswered research questions in pediatric hospital medicine were established at the final priority setting workshop., Main Outcomes and Measures: Survey responses, top 10 research questions., Results: The phase 1 survey was completed by 188 participants (148 of 167 [89%] females; 17 of 167 [10%] males; mean [SD] age, 39.5 [12.4] years) and generated 495 unanswered research questions and comments, of which 58 were deemed out of scope. The remaining 437 responses were grouped into themes (eg, communication, shared decision-making, health service delivery, and health service management) and then refined to 75 unanswered research questions. Of these 75, only 4 questions had sufficient evidence. To make the number of questions in phase 2 manageable, 21 questions submitted by only 1 respondent were eliminated. Fifty unanswered research questions were included in the phase 2 survey, which was completed by 201 participants (165 of 186 [89%] females; 19 of 186 [10%] males; mean [SD] age, 40.0 [11.0] years). A short list of 16 questions-the top 10 questions from patient partners (youths, parents/caregivers) and clinicians-was presented at the final priority setting workshop and the top 10 questions were prioritized. The top 10 questions focused on the care of special inpatient populations (eg, children with medical complexity), communication, shared decision-making, support strategies in the hospital, mental health supports, shortening length of stay, and supporting Indigenous patients, parents/caregivers, and families., Conclusions and Relevance: This patient-oriented pediatric hospital medicine priority setting partnership identified the most important unanswered research questions focused on the care of children in the hospital. These questions provide a possible roadmap for research on areas deemed important to young people, parents/caregivers, and clinicians.

Purpose: Efforts have been made to standardize laboratory variant interpretation, but clinicians are ultimately tasked with clinical correlation and application of genetic test results in patient care. This study aimed to explore processes clinicians utilize when reviewing and returning genetic test results, and how they impact patient care., Methods: Medical geneticists, genetic counselors, and nongenetics clinicians from two Midwestern states completed surveys (n = 98) and in-depth interviews (n = 29) on practices of reviewing and returning genetic test results. Retrospective chart review (n = 130) examined discordant interpretations and the impact on care., Results: Participants reported variable behaviors in both reviewing and returning results based on factors such as confidence, view of role, practice setting, and relationship with the lab. Providers did not report requesting changes to variant classifications from laboratories, but indicated relaying conflicting classifications to patients in some cases. Chart reviews revealed medically impactful differences in interpretation between laboratories and clinicians in 18 (13.8%) records., Conclusion: Clinician practices for reviewing and integrating genetic test results into patient care vary within and between specialties and impact patient care. Strategies to better incorporate both laboratory and clinician expertise into interpretation of genetic results could result in improved care across providers and settings., (© 2021. The Author(s), under exclusive licence to the American College of Medical Genetics and Genomics.)

Background: There is growing recognition that wellness interventions should occur in context and acknowledge complex contributors to wellbeing, including individual needs, institutional and cultural barriers to wellbeing, as well as systems issues which propagate distress. The authors conducted a multiple-methods study exploring contributors to wellbeing for junior residents in diverse medical environments who participated in a brief resilience and stress-reduction curriculum, the Stress Management and Resiliency Training Program for Residents (SMART-R)., Methods: Using a waitlist-controlled design, the curriculum was implemented for post-graduate year (PGY)-1 or PGY-2 residents in seven residency programs across three sites. Every three months, residents completed surveys, including the Perceived Stress Scale-10, General Self-Efficacy Questionnaire, a mindfulness scale (CAMSR), and a depression screen (PHQ-2). Residents also answered free-text reflection questions about psychological wellbeing and health behaviors., Results: The SMART-R intervention was not significantly associated with decreased perceived stress. Linear regression modeling showed that depression was positively correlated with reported stress levels, while male sex and self-efficacy were negatively correlated with stress. Qualitative analysis elucidated differences in these groups: Residents with lower self-efficacy, those with a positive depression screen, and/or female residents were more likely to describe experiencing lack of control over work. Residents with higher self-efficacy described more positive health behaviors. Residents with a positive depression screen were more self-critical, and more likely to describe negative personal life events., Conclusions: This curriculum did not significantly modify junior residents' stress. Certain subpopulations experienced greater stress than others (female residents, those with lower self-efficacy, and those with a positive depression screen). Qualitative findings from this study highlight universal stressful experiences early in residency, as well as important differences in experience of the learning environment among subgroups. Tailored wellness interventions that aim to support diverse resident sub-groups may be higher yield than a "one size fits all" approach., Trial Registration: NCT02621801 , Registration date: December 4, 2015 - Retrospectively registered., (© 2021. The Author(s).)

Liquid marbles are versatile structures demonstrating a pseudo-Leidenfrost wetting regime formed by encapsulating microscale volumes of liquid in a particle shell. The liquid core is completely separated from the exterior through air pockets. The external phase consists of hydrophobic particles, in most cases, or hydrophilic ones distributed as aggregates. Their interesting features arise from the double solid-fluid character. Thus, these interesting formations, also known as “dry waters”, have gained attention in surface science. This review paper summarizes a series of proposed formulations, fabrication techniques and properties, in correlation with already discovered and emerging applications. A short general review of the surface properties of powders (contact angle, superficial tension) is proposed, followed by a presentation of liquid marbles’ properties (superficial characteristics, elasticity, self-propulsion etc.). Finally, applications of liquid marbles are discussed, mainly as helpful and yet to be exploited structures in the pharmaceutical and medical field. Innovative pharmaceutical forms (Pickering emulsions) are also means of use taken into account as applications which need further investigation.

This manuscript describes the development and implementation of community engagement as a mission at UCLA's David Geffen School of Medicine (DGSOM) and UCLA Health System, and summarizes survey results documenting existing community-engaged projects and interest between 2010 to 2013.

Background: The assessment of clinical competence and the impact of training in ambulatory settings are two issues of importance in the evaluation of medical student performance., Purpose: This study compares the clinical skills performance of students placed in three types of community preceptors' offices (pediatrics, medicine, family medicine) on yearly clinical skills assessments with standardized patients. Our goal was to see if the site specialty impacted on clinical performance., Methods: The students in the study were completing a 3-year continuity preceptorship at a site representing one of the disciplines. Their performance on the four clinical skills assessments was compared., Results: There was no significant difference in history taking, physical exam, communication, or clinical reasoning in any year (ANOVA p< or = .05) There was a small but significant difference in performance on a measure of interpersonal and interviewing skills during Years 1 and 2., Conclusion: The site specialty of an early clinical experience does not have a significant impact on performance of most of the skills measured by the assessments.

Background: Information transfer is critical in the primary care to specialist referral process and has been examined extensively in the US and other countries, yet there has been little attention to the patient's perspective of the information transfer process. This cross-sectional study examined the quality of the information received by patients with a chronic condition from the referring and specialist physician in the specialist referral process and the relationship of the quality of information received to trust in the physicians., Methods: Structured telephone interviews were conducted with a random sample of 250 patients who had experienced a referral to a specialist for the first visit for a chronic condition within the prior six months. The sample was selected from the patients who visited specialist physicians at any of the 500 hospitals from the National Research Corporation client base., Results: Most patients (85%) received a good explanation about the reason for the specialist visit from the referring physician yet 26% felt unprepared about what to expect. Trust in the referring physician was highly associated with the preparatory information patients received. Specialists gave good explanations about diagnosis and treatment, but 26% of patients got no information about follow-up. Trust in the specialist correlated highly with good explanations of diagnosis, treatment, and self-management., Conclusion: Preparatory information from referring physicians influences the quality of the referral process, the subsequent coordination of care, and trust in the physician. Changes in the health care system can improve the information transfer process and improve coordination of care for patients.

Telemedicine as a technology has been available for nearly 50 years, but its diffusion has been slower than many had anticipated. Even efforts to reimburse providers for interactive video (IAV) telemedicine services have had a limited effect on rates of participation. The resulting low volume of services provided (and consequent paucity of research subjects) makes the phenomenon difficult to study. This paper, part of a larger study that also explores telemedicine utilization from the perspectives of referring primary care physicians and telemedicine system administrators, reports the results of a survey of specialist and subspecialist physicians who are users and nonusers of telemedicine. The survey examined self-assessed knowledge and beliefs about telemedicine among users and nonusers, examining also the demographic characteristics of both groups. Statistically significant differences were found in attitudes toward telemedicine between users and nonusers, but in many respects the views of the two groups were rather similar. Physicians who used telemedicine were aware of the limitations of the technology, but also recognized its potential as a means of providing consultation. Demographic differences did not explain the differences in the knowledge and beliefs of user and nonuser consultant physicians, although some of the differences may be explained by other aspects of the professional environment.

This article presents results of the second stage of a research project which explored the palliative care needs of 69 residents with a noncancer diagnosis in South Australia. Extensive data were collected prospectively from case notes, and resident and staff interviews over a 10-week period. Residents were suffering multiple conditions and were highly dependent for activities of daily living. Most residents' care was consistent with a palliative approach, with only three residents in the study referred to a specialist palliative care service. However, for some residents, pain and symptom management were not always adequate, and referral to a specialist palliative care service would have been appropriate. This research indicates that, with additional education, it could be possible to extend the principles and philosophy of palliative care by adopting a palliative care approach within aged care facilities.

Background: The use of the private sector for health care is increasing, but it is unclear whether this will reduce demand on the NHS. The aim of this study was to examine the relationship between private and NHS outpatient referral rates accounting for their association with deprivation., Methods: This is a prospective survey of general practitioner referrals to private and NHS consultant-led services between 1 January and 31 December 2001 from 10 general practices in the Trent Focus Collaborative Research Network, United Kingdom. Patient referrals were aggregated to give private and NHS referral rates for each electoral ward in each practice., Results: Of 17,137 referrals, 90.4 percent (15,495) were to the NHS and 9.6 percent (1642) to the private sector. Private referral rates were lower in patients from the most deprived fifth of wards compared with the least deprived fifth (rate ratio 0.25, 95 percent CI 0.15 to 0.41, p < 0.001), whereas NHS referral rates were slightly higher in patients in the most deprived fifth of wards (rate ratio 1.18, 95 percent CI 0.98 to 1.42, p = 0.08) both after age standardisation and adjustment for practice. The NHS referral rate was significantly higher (rate ratio 1.40, 95 percent CI 1.15 to 1.71, p = 0.001) in wards with private referral rates in the top fifth compared with the bottom fifth after adjustment for deprivation and practice., Conclusions: Increased private health care activity does not reduce the demand for NHS care: NHS and private referral rates were positively associated with each other after adjusting for age, deprivation and practice.

Independent and innovative GPs are often attracted to a specialism. Specialist GPs provide a bridge between primary and secondary care. A formal framework for specialist training is now in place.

Abstract The global outbreak of clade 2.3.4.4b H5N1 highly pathogenic influenza A virus (HP H5N1) has had an unprecedented impact on wild birds including raptors, but long-term population impacts have not been addressed. To determine if raptors survive infections with HP H5N1, raptors from the upper Midwest United States were serologically tested for antibodies to influenza A virus (IAV), H5 and N1. Raptors were sampled at The Raptor Center’s (University of Minnesota) wildlife rehabilitation hospital and at Hawk Ridge Bird Observatory. Samples were tested for IAV antibodies using a commercially available blocking ELISA, with positive samples tested for antibodies to H5 and N1. Antibodies to IAV were detected in 86 out of 316 individuals representing 7 species. Antibodies to H5 and N1 were detected in 60 individuals representing 6 species. Bald eagles had the highest seroprevalence with 67/97 (69.1%) seropositive for IAV and 52 of these 67 (77.6%) testing positive for antibodies to both H5 and N1. Prevalence of antibodies to IAV observed in this study was higher than reported from raptors sampled in this same region in 2012. The high prevalence of antibodies to H5 and N1 indicates a higher survival rate post-HP H5N1 infection in raptors than previously believed.

Abstract Background Sleep, physical activity, and nutrition (SPAN) are critical behaviours for health, although they have traditionally been studied separately. We examined the combined associations of SPAN and the minimum between-individual variations associated with meaningfully lower all-cause mortality risk. Methods This prospective cohort analysis included 59,078 participants from the UK Biobank (median age: 64.0 years; 45.4% male) who wore trackers for 7 days and self-reported dietary data. Wearable-measured sleep (hours/day) and moderate to vigorous physical activity (MVPA; mins/day) were calculated using a machine learning based schema. A 10-item diet quality score (DQS) assessed the intake of vegetables, fruits, fish, dairy, whole grains, vegetable oils, refined grains, processed and unprocessed meats, and sugary beverages (0–100 for all components with higher values indicating higher quality). Cox proportional hazards models were used to estimate hazard ratios (HR) for all-cause mortality risk across 27 separate joint tertile combinations of SPAN behaviours with the lowest tertile for all three as the referent group. For more granular clinical interpretations, we examined combined incremental dose–response changes of the SPAN behaviours using the 5th percentile of each behaviour as the referent point. Results Over the 8.1-year median follow-up time, 2,458 mortality events occurred. Compared to the referent group of combined SPAN exposure (lowest tertiles for all three), the optimal SPAN combination involving moderate sleep duration (7.2–8.0 h/day), high MVPA (42–103 min/day), and a DQS between 57.5 and 72.5 was associated with an HR of 0.36 (95% CI: 0.26–0.50). Relative to the 5th percentile of sleep (5.5 h/day), physical activity (7.3 min/day), and nutrition (36.9 DQS), a theoretical minimum combined increase of 15 min/day of sleep, 1.6 min/day MVPA, and 5 DQS points (corresponding to e.g., extra 1/2 serving of vegetables per day or 1 less serving of processed meat per week) was associated with 10% lower all-cause mortality risk (0.90; 0.88–0.93). Combined increases of 75 min/day of sleep, 12.5 min/day MVPA, and 25 DQS points were associated with 50% lower all-cause mortality risk (0.50; 0.44–0.58). Conclusions This study highlights the potential health value of subtle combined SPAN modification in relation to mortality risk and expands opportunities for more holistic recommendations.

Abstract Structural stigma towards gender minority (GM; people whose current gender does not align with sex assigned at birth) people is an important contributor to minority stress (i.e., stress experienced due to one’s marginalized GM identity), although existing variables are unclear in their inclusion of social norms, or societal stigma, as a key component of the construct. We examined potential variables representing structural stigma, including variables that are inclusive of societal stigma, to identify those that most strongly relate to minority stress outcomes. We tested variables identified in the literature as measures of structural stigma inclusive of societal stigma (LGBT + Business Climate Index, state voting behaviors, and Google Trends search data), the most commonly used structural stigma variable (State Policy Environment Tally), and proxy variables (region, population density) for comparison. The relationships between structural stigma and minority stress model outcomes were tested in a sample of GM participants from The Population Research in Identity and Disparities for Equality (PRIDE) Study (N = 2,094) 2019 Annual Questionnaire using a structural equation model (SEM). Lower structural stigma (i.e., higher LGBT Business Climate Index) was associated with lower experienced stigma (β= -0.260, p

Abstract Background Sotrovimab is a neutralising monoclonal antibody (nMAB) currently available to treat extremely clinically vulnerable COVID-19 patients in England. Trials have shown it to have mild to moderate side effects, however, evidence regarding its safety in real-world settings remains insufficient. Methods Descriptive and multivariable logistic regression analyses were conducted to evaluate uptake, and a self-controlled case series analysis performed to measure the risk of hospital admission (hospitalisation) associated with 49 pre-specified suspected adverse outcomes in the period 2–28 days post-Sotrovimab treatment among eligible patients treated between December 11, 2021 and May 24, 2022. Results Here we show that among treated and untreated eligible individuals, the mean ages (54.6 years, SD: 16.1 vs 54.1, SD: 18.3) and sex distribution (women: 60.9% vs 58.1%; men: 38.9% vs 41.1%) are similar. There are marked variations in uptake between ethnic groups, which is higher amongst individuals categorised ethnically as Indian (15.0%; 95%CI 13.8, 16.3), Other Asian (13.7%; 95%CI 11.9, 15.8), white (13.4%; 95%CI 13.3, 13.6), and Bangladeshi (11.4%; 95%CI 8.8, 14.6); and lower amongst Black Caribbean individuals (6.4%; 95%CI 5.4, 7.5) and Black Africans (4.7%; 95%CI 4.1, 5.4). We find no increased risk of any of the suspected adverse outcomes in the period 2–28 days post-treatment. Conclusions We find no safety signals of concern for possible adverse outcomes in the period 2-28 days post treatment with Sotrovimab. However, there is evidence of unequal uptake of Sotrovimab treatment across ethnic groups.

Few sources have reported empirical social contact data from resource-poor settings. To address this shortfall, we recruited 1,363 participants from rural and urban areas of Mozambique during the COVID-19 pandemic, determining age, sex, and relation to the contact for each person. Participants reported a mean of 8.3 (95% CI 8.0–8.6) contacts per person. The mean contact rates were higher in the rural site compared with the urban site (9.8 vs 6.8; p

Abstract Background The introduction of poly(ADP-ribose) polymerase (PARP) inhibitors represented a paradigm shift in the treatment of ovarian cancer. Genomic data from patients with high-grade ovarian cancer in six phase II/III trials involving the PARP inhibitor olaparib were analyzed to better understand patterns and potential causes of genomic instability. Patients and methods Homologous recombination deficiency (HRD) was assessed in 2147 tumor samples from SOLO1, PAOLA-1, Study 19, SOLO2, OPINION, and LIGHT using next-generation sequencing technology. Genomic instability scores (GIS) were assessed in BRCA1 and/or BRCA2 (BRCA)-mutated (BRCAm), non-BRCA homologous recombination repair-mutated (non-BRCA HRRm), and non-HRRm tumors. Results BRCAm was identified in 1021/2147 (47.6%) tumors. BRCAm tumors had significantly higher GIS than non-BRCAm tumors (P

Abstract Introduction Quality midwifery education is central to improving midwifery service delivery and maternal and newborn health outcomes. In many settings, midwifery educators insufficiently prepared for their teaching role and deficient curriculum compared to international standards affect the quality of healthcare provided by the midwifery graduates. This study assessed the effectiveness of an EmONC enhanced midwifery curriculum delivered by trained and mentored midwifery educators on the quality of education and student performance in Kenya. Methods A cluster randomised controlled trial in 20 midwifery colleges (12 intervention, 8 control colleges). Educators in both arms received training in teaching/EmONC skills to deliver the updated national midwifery curriculum. The intervention arm received additional 3-monthly post-training mentoring for 12 months. Educators’ knowledge and confidence in EmONC/teaching skills was assessed before and after training and at 3, 6, 9 and 12 months. Teaching skills observations at baseline and endline in both study arms were also assessed. Knowledge, self-rated confidence and three OSCE in EmONC practical skills among final year midwifery students were assessed. Linear mixed effects models were used to evaluate the effect of intervention on educators and students. Results Seventy four educators and 146 students participated. Training significantly improved educators’ mean knowledge (61.3%-73.3%) and confidence to teach EmONC (3.1–4.2 out of 5). Observed teaching skills mean scores of educators in the intervention arm were significantly higher compared to those of controls at endline (89.4%-vs-72.2%, mean difference 17.2 [95%CI, 3.2–29.8]). Mean scores for students in the intervention arm were significantly higher than those in controls for knowledge (59.6%-vs-51.3%, mean difference 8.3 [95%CI, 1.6–15.0]) and the three skills assessed (means; mean difference (95%CI): shoulder dystocia (64.5%-vs-42.7%; 21.8 (10.8–33.9); newborn resuscitation (43.9% vs 26.1%; 17.8 (2.0–33.9); and maternal shock resuscitation (56.5%-vs-39.2%; 17.3 (8.0–26.0) and combined average skills scores (55.0%-vs-36.0; 19.0 (8.7–29.5). Conclusion Training and supportive mentoring improved the quality of educators’ teaching pedagogy and EmONC skills and enhanced students’ learning. Overall performance in EmONC knowledge and skills was significantly higher for students who were taught by trained and mentored educators compared to those who received training alone. Thus, a local mentoring system is effective to enhance learning and effectiveness of an EmONC-updated midwifery curriculum.

BackgroundGlobally, women consume less alcohol than men, but alcohol consumption among women has declined less in recent years than among men. Drinking rates and alcohol-related harms vary substantially across population groups of women, and sexual minority women (eg, lesbian, bisexual, and queer) are at notably high risk. An emerging body of literature suggests that in addition to minority stress (eg, stigma, discrimination), drinking norms and drinking cultures likely influence sexual minority women’s drinking. Almost no research has explored these factors as possible targets of interventions. Sober curiosity is a rapidly growing wellness movement that may be particularly salient for sexual minority women. It encourages individuals to be “curious” about the reasons they choose to drink and alcohol’s effects on their life and health. ObjectiveThe aims of this research are to (1) explore the perspectives of the drinking social worlds of sexual minority women, their awareness of the sober curious movement, perceptions of their own and their peers’ drinking and desire to drink less, and perceived barriers and facilitations to changing their drinking behaviors and (2) identify key elements of an alcohol reduction intervention tailored for sexual minority women. MethodsWe conducted a comprehensive review of the literature on alcohol interventions with sexual minority women. The handful of studies we found paid scant attention to drinking cultures, normative beliefs, or other key elements of sober curiosity. To address the study aims, we are conducting 2 descriptive studies with adult (>18 years) sexual minority women using mixed methods. One includes focus group interviews (n=24-36) and a national survey (n=100-120) with sexual minority women in Scotland. The other includes in-depth interviews (n=18-20) with sexual minority women in the United States. Data from the 2 countries and 3 sources will be analyzed using qualitative and quantitative methods to identify patterns and relationships across data to validate or corroborate findings. ResultsEach of the studies received ethics approval in August 2023 and is currently open for recruitment. We anticipate completing data collection in spring 2025. The results of qualitative analyses will be summarized as themes, and results of survey data analyses will be summarized in tables. Findings will be presented to 2 panels of international experts who will assist in identifying critical elements of an alcohol reduction intervention tailored to the unique needs of sexual minority women. ConclusionsWith the assistance of the expert panels, we will use Acceptability, Practicability, Effectiveness, Affordability, Side-Effects, and Equity criteria to inform the development of a tailored intervention building on tenants of sober curiosity to assist sexual minority women in reducing harmful drinking. International Registered Report Identifier (IRRID)DERR1-10.2196/63282

Point of care ultrasound (POCUS) has increasingly been used by midwives worldwide. In 2018, the scope of midwifery care in Ontario was expanded to include POCUS to allow practitioners to provide more comprehensive care. In response to the scope expansion, a new continuing POCUS education course was created in collaboration with faculty and clinicians from obstetrics, midwifery, and medical radiation sciences. The continuing education sonography course focused on fostering the knowledge, skills and judgment Ontario midwives required to safely perform these new POCUS skills. The course included online modules, a two-day hands-on bootcamp workshop, and a clinical practicum under the supervision of a sonographer to confirm competency across the three trimesters of pregnancy. This paper outlines the process for POCUS curriculum development and implementation in pregnancy care following course completion. The first cohort of 17 learners completed the course in 2019. The new curriculum was well received by learners for learning and applying bedside sonography in clinical care. The indications to use POCUS most frequently reported by learners after course completion included assessment of pregnancy viability and fetal presentation. Challenges identified by participants with the course included learning new content such as physics and struggling to complete the clinical practicum due to the coronavirus pandemic. The success of this course is indicated by the completion of the objective structured clinical exams for all learners and meeting the competencies for beginning their practicum. The POCUS continuing education course plays an important role in providing the knowledge, skills and ability to perform point of care pregnancy scans among midwives.

Introduction Despite the current opioid crisis resulting in tens of thousands of deaths every year, buprenorphine, a medication that can reduce opioid-related mortality, withdrawal, drug use and craving, is still underprescribed in the emergency department (ED) for treatment of opioid use disorder (OUD). The EMergency department-initiated BuprenorphinE for opioid use Disorder (EMBED) trial introduced a clinical decision support (CDS) tool that improved the proportion of ED physicians prescribing buprenorphine but did not affect patient-level rates of buprenorphine initiation. The present trial aims to build on these findings by optimising CDS use through iterative improvements, refined interventions and clinician feedback to enhance OUD treatment initiation in EDs.Methods and analysis The Adaptive Decision support for Addiction Treatment (ADAPT) trial employs the Multiphase Optimization Strategy (MOST) framework to refine a multicomponent CDS tool designed to facilitate buprenorphine initiation for OUD in ED settings. Using a pragmatic, learning health system approach in three phases, the trial applies plan–do–study–act cycles for continuous CDS refinement. The CDS will be updated in the preparation phase to reflect new evidence. The optimisation phase will include a 2×2×2 factorial trial, testing the impact of various intervention components, followed by rapid, serial randomised usability testing to reduce user errors and enhance CDS workflow efficiency. In the evaluation phase, the optimised CDS package will be tested in a randomised trial to assess its effectiveness in increasing ED initiation of buprenorphine compared with the original EMBED CDS.Ethics and dissemination The protocol has received approval from our institution’s institutional review board (protocol #2000038624) with a waiver of informed consent for collecting non-identifiable information only. Given the minimal risk involved in implementing established best practices, an independent study monitor will oversee the study instead of a Data Safety Monitoring Board. Findings will be submitted to ClinicalTrials.gov, published in open-access, peer-reviewed journals, presented at national conferences and shared with clinicians at participating sites through email notification.Trial registration number NCT06799117.

BackgroundCold-water immersion (CWI) has gained popularity as a health and wellbeing intervention among the general population.ObjectiveThis systematic review and meta-analysis aimed to evaluate the psychological, cognitive, and physiological effects of CWI in healthy adults.MethodsElectronic databases were searched for randomized trials involving healthy adults aged ≥ 18 years undergoing acute or long-term CWI exposure via cold shower, ice bath, or plunge with water temperature ≤15°C for at least 30 seconds. Outcomes of interest were sleep, stress, fatigue, energy, skin health, immunity, inflammation, mental wellbeing, depression, anxiety, mood, concentration, and alertness or focus. Meta-analyses were conducted using RevMan software (version 5.4), applying random effects models to calculate standardized mean differences (SMD) between pre- and post-CWI exposure outcomes. Risk of bias was assessed using the PEDro scale.ResultsEleven studies were included, comprising 3177 total participants and a mean PEDro score of 6.4 (n = 7 moderate quality, n = 4 high quality). CWI interventions were performed in baths (n = 10) or showers (n = 1) at temperatures ranging from 7°C to 15°C and durations ranging from 30 seconds to 2 hours. The meta-analysis revealed significant increases in inflammation immediately (SMD: 1.03, [95% CI: 0.37, 1.68], p 0.05), 1 hour (SMD: -0.29 [95% CI: -0.66, 0.08], p > 0.05), 24 hours (SMD: -0.06 [95% CI: -0.50, 0.38], p > 0.05), or 48 hours (SMD: 0.09 [95% CI: -0.28, 0.46], p > 0.05) post-exposure. While meta-analysis showed no significant effects on immune function immediately (SMD: -0.16 [95% CI: -0.82, 0.51], p > 0.05) or 1 hour (SMD: -0.18 [95% CI: -1.09, 0.74], p > 0.05) post-CWI, narrative synthesis suggested longer-term benefits, including a 29% reduction in sickness absence among participants who took cold showers. Improvements were also observed in sleep quality and quality of life, but not mood.ConclusionsThis systematic review suggests that CWI delivers time-dependent effects on inflammation, stress, immunity, sleep quality, and quality of life, offering potential practical applications for health practitioners considering CWI for stress management and wellbeing support. However, the current evidence base is constrained by few RCTs, small sample sizes, and a lack of diversity in study populations. Future high-quality RCTs are needed to examine the long-term effects of CWI, its impact on diverse health outcomes, and optimal CWI protocols. PROSPERO (ID: CRD42024500591).

BackgroundStrokes are becoming more common, and with improving survival rates, the prevalence of stroke survivors has increased. Almost half of chronic stroke survivors are cognitively impaired, and healthcare services are struggling to manage these patients, leaving some feeling "abandoned". Several systematic reviews have investigated the effect of physical exercise and cognition-orientated interventions on post-stroke cognitive impairment, and have produced conflicting findings, making it difficult for clinicians and guideline producers to make evidence-based decisions. This overview of reviews aims to provide a comprehensive overview of systematic reviews investigating the effect of physical exercise and cognition-orientated interventions on post-stroke cognitive function, assess methodological quality and certainty of evidence, and identify sources of discordance between these reviews.MethodsEight databases-Embase, Medline, CINAHL, Psycinfo, SPORTDiscus, The Cochrane Database of Systematic reviews, Epistemonikos, and Scopus-plus grey literature sources will be searched. The eligibility criteria include systematic reviews of trials that included an adult stroke population and investigated physical exercise and/or cognition-orientated interventions. Only reviews that assessed at least one of the DSM-5 neurocognitive domains will be included. Screening, data extraction, and quality appraisal will be conducted by two independent reviewers. Methodological quality, certainty of evidence, and primary study overlap will be assessed using the AMSTAR-2, GRADE, and GROOVE tools, respectively. Interventions will be grouped into exercise, cognition-orientated, and combined interventions, and findings will be synthesised narratively. Heterogeneity assessment will be conducted to identify factors causing discordance between reviews.DiscussionThe findings of this overview will allow decision makers to make evidence-based decisions, stratified by methodological quality and certainty of evidence. Heterogeneity assessment may identify factors causing discordance between systematic reviews, which could inform the design of future studies.Trial registrationRegistration: PROSPERO CRD42024534179.

BackgroundAccurate assessment of cardiovascular disease (CVD) risk is crucial for effective prevention and resource allocation. However, few CVD risk estimation tools consider social determinants of health (SDoH), despite their known impact on CVD risk. We aimed to estimate 10-year CVD risk in the Eastern Caribbean Health Outcomes Research Network Cohort Study (ECS) across multiple risk estimation instruments and assess the association between SDoH and CVD risk.MethodsFive widely used CVD risk estimation tools (Framingham and WHO laboratory, both laboratory and non-laboratory-based, and ASCVD) were applied using data from ECS participants aged 40-74 without a history of CVD. SDoH variables included educational attainment, occupational status, household food security, and perceived social status. Multivariable logistic regression models were used to compare differences in the association between selected SDoH and high CVD risk according to the five instruments.FindingsAmong 1,777 adult participants, estimated 10-year CVD risk varied substantially across tools. Framingham non-lab and ASCVD demonstrated strong agreement in categorizing participants as high risk. Framingham non-lab categorized the greatest percentage as high risk, followed by Framingham lab, ASCVD, WHO lab, and WHO non-lab. Fifteen times more people were classified as high risk by Framingham non-lab compared with WHO non-lab (31% vs 2%). Mean estimated 10-year risk in the sample was over 2.5 times higher using Framingham non-lab vs WHO non-lab (17.3% vs 6.6%). We found associations between food insecurity, those with the lowest level compared to the highest level of education, and non-professional occupation and increased estimated CVD risk.InterpretationOur findings highlight significant discrepancies in CVD risk estimation across tools and underscore the potential impact of incorporating SDoH into risk assessment. Further research is needed to validate and refine existing risk tools, particularly in ethnically diverse populations and resource-constrained settings, and to develop race- and ethnicity-free risk estimation models that consider SDoH.

Purpose: Sulfate is vital for many physiological processes, including the structural and functional maintenance of macromolecules and formation of sulfur-containing compounds essential for cartilage and bone development. SLC13A1 is a sodium-sulfate cotransporter primarily expressed in the kidney, where it mediates sulfate reabsorption and maintenance of circulating sulfate levels. In this study, we characterized the clinical, biochemical, and functional impact of biallelic SLC13A1 nonsense and/or missense variants in individuals presenting with a skeletal phenotype. Methods: Probands were identified by exome or genome sequencing and GeneMatcher. Sulfate levels were quantified using ion chromatography. SLC13A1 missense variants p.(Arg237Cys), p.(Gly448Asp), p.(Leu516Pro), and p.(Tyr582His) were characterized using bioinformatics, molecular modeling, and [35S]-sulfate uptake assays in Madin-Darby canine kidney cells. Results: All probands presented with concern for short stature and were found to have scoliosis and/or skeletal dysplasia. A reduction in plasma sulfate level and/or increase in urinary sulfate excretion was detected in 2 of 2 probands evaluated. Functional studies were consistent with SLC13A1 variants resulting in the complete loss of sulfate transport activity. Conclusion: Biallelic loss-of-function variants in SLC13A1 are a novel cause of skeletal phenotypes in humans with a measurable biomarker. Sulfate measurements should be considered in the clinical interpretation of variants identified in SLC13A1.

BackgroundGlobally, over one-third of pulmonary tuberculosis (TB) disease diagnoses are made based on clinical criteria after a negative bacteriological test result. There is limited information on the factors that determine clinicians' decisions to initiate TB treatment when initial bacteriological test results are negative.Methods and findingsWe performed a systematic review and individual patient data meta-analysis using studies conducted between January 2010 and December 2022 (PROSPERO: CRD42022287613). We included trials or cohort studies that enrolled individuals evaluated for TB in routine settings. In these studies, participants were evaluated based on clinical examination and routinely used diagnostics and were followed for ≥1 week after the initial test result. We used hierarchical Bayesian logistic regression to identify factors associated with treatment initiation following a negative result on an initial bacteriological test (e.g., sputum smear microscopy (SSM), Xpert MTB/RIF). Multiple factors were positively associated with treatment initiation: male sex [adjusted odds ratio (aOR) 1.61 (1.31, 1.95)], history of prior TB [aOR 1.36 (1.06, 1.73)], reported cough [aOR 4.62 (3.42, 6.27)], reported night sweats [aOR 1.50 (1.21, 1.90)], and having HIV infection but not on ART [aOR 1.68 (1.23, 2.32)]. Treatment initiation was substantially less likely for individuals testing negative with Xpert [aOR 0.77 (0.62, 0.96)] compared to smear microscopy and declined in more recent years. We were not able assess why clinicians made treatment decisions, as these data were not available.ConclusionsMultiple factors influenced decisions to initiate TB treatment despite negative test results. Clinicians were substantially less likely to treat in the absence of a positive test result when using more sensitive, PCR-based diagnostics.

Abstract The rumen microbiome is the focus of a growing body of research, mostly based on investigation of rumen fluid samples collected once from each animal. Exploring the temporal stability of rumen microbiome profiles is imperative, as it enables evaluating the reliability of findings obtained through single-timepoint sampling. We explored the temporal stability of rumen microbiomes considering taxonomic and functional aspects across the 7-month growing-finishing phase spanning 6 timepoints. We identified a temporally stable core microbiome, encompassing 515 microbial genera (e.g., Methanobacterium) and 417 microbial KEGG genes (e.g., K00856—adenosine kinase). The temporally stable core microbiome profiles collected from all timepoints were strongly associated with production traits with substantial economic and environmental impact (e.g., average daily gain, daily feed intake, and methane emissions); 515 microbial genera explained 45–83%, and 417 microbial genes explained 44–83% of their phenotypic variation. Microbiome profiles influenced by the bovine genome explained 54–87% of the genetic variation of bovine traits. Overall, our results provide evidence that the temporally stable core microbiome identified can accurately predict host performance traits at phenotypic and genetic level based on a single timepoint sample taken as early as 7 months prior to slaughter.

Abstract Neonatal dilated cardiomyopathy (DCM) is a poorly understood muscular disease of the heart. Several homozygous biallelic variants in LMOD2, the gene encoding the actin-binding protein Leiomodin 2, have been identified to result in severe DCM. Collectively, LMOD2-related cardiomyopathies present with cardiac dilation and decreased heart contractility, often resulting in neonatal death. Thus, it is evident that Lmod2 is essential to normal human cardiac muscle function. This study aimed to understand the underlying pathophysiology and signaling pathways related to the first reported LMOD2 variant (c.1193 G > A, p.Trp398*). Using patient-specific human induced pluripotent stem cell-derived cardiomyocytes (hiPSC-CMs) and a mouse model harboring the homologous mutation to the patient, we discovered dysregulated actin-thin filament lengths, altered contractility and calcium handling properties, as well as alterations in the serum response factor (SRF)-dependent signaling pathway. These findings reveal that LMOD2 may be regulating SRF activity in an actin-dependent manner and provide a potential new strategy for the development of biologically active molecules to target LMOD2-related cardiomyopathies.

Abstract Background Patient and public involvement (PPI) in research is widely acknowledged as essential to achieving successful and impactful research. Despite this acknowledgement, there are limited reports on how to approach and apply meaningful PPI throughout the research cycle and how to address challenges for researchers such as doctoral students, particularly when undertaking research on sensitive topics. This paper provides insights and examples for researchers new to PPI, on the impact of active PPI and recommendations for building and developing a PPI group in a paediatric focused doctoral research study with bereaved parents and carers. Methods PPI was informed by the research cycle. The GRIPP2 short-form checklist was used to report PPI. The research was funded by the National Institute for Health and Care Research. Results PPI enhanced the research through input into the study design, recruitment, co-design of the study website and branding; and ethics amendments to increase participation in response to the COVID-19 pandemic. The literature review was extended to incorporate a PPI consultation phase and members contributed to data analysis. A flexible approach enabled involvement to develop iteratively throughout the research study, resulting in changes being made to enhance the study design and outcomes. Conclusion This paper contributes to the limited knowledge base on embedding PPI into a doctoral research study and within the paediatric setting specifically working in partnership with bereaved parents and carers. Employing an adaptive approach to meet individual PPI needs, building a trusting and respectful partnership, creating shared ownership and investment in the research, are essential components to successful PPI.

Abstract Public engagement with research (PEwR) has become increasingly integral to research practices. This paper explores the process and outcomes of a collaborative effort to address the ethical implications of PEwR activities and develop tools to navigate them within the context of a University Medical School. The activities this paper reflects on aimed to establish boundaries between research data collection and PEwR activities, support colleagues in identifying the ethical considerations relevant to their planned activities, and build confidence and capacity among staff to conduct PEwR projects. The development process involved the creation of a taxonomy outlining key terms used in PEwR work, a self-assessment tool to evaluate the need for formal ethical review, and a code of conduct for ethical PEwR. These tools were refined through iterative discussions and feedback from stakeholders, resulting in practical guidance for researchers navigating the ethical complexities of PEwR. Additionally, reflective prompts were developed to guide researchers in planning and conducting engagement activities, addressing a crucial aspect often overlooked in formal ethical review processes. The paper reflects on the broader regulatory landscape and the limitations of existing approval and governance processes, and prompts critical reflection on the compatibility of formal approval processes with the ethos of PEwR. Overall, the paper offers insights and practical guidance for researchers and institutions grappling with ethical considerations in PEwR, contributing to the ongoing conversation surrounding responsible research practices.

Abstract Introduction To achieve quality midwifery education, understanding the experiences of midwifery educators and students in implementing a competency-based pre-service curriculum is critical. This study explored the experiences of and barriers to implementing a pre-service curriculum updated with emergency obstetric and newborn care (EmONC) skills by midwifery educators, students and mentors in Kenya. Methods This was a nested qualitative study within the cluster randomised controlled trial investigating the effectiveness of an EmONC enhanced midwifery curriculum delivered by trained and mentored midwifery educators on the quality of education and student performance in 20 colleges in Kenya. Following the pre-service midwifery curriculum EmONC update, capacity strengthening of educators through training (in both study arms) and additional mentoring of intervention-arm educators was undertaken. Focus group discussions were used to explore the experiences of and barriers to implementing the EmONC-enhanced curriculum by 20 educators and eight mentors. Debrief/feedback sessions with 6–9 students from each of the 20 colleges were conducted and field notes were taken. Data were analysed thematically using Braun and Clarke’s six step criteria. Results Themes identified related to experiences were: (i) relevancy of updated EmONC-enhanced curriculum to improve practice, (ii) training and mentoring valued as continuous professional development opportunities for midwifery educators, (iii) effective teaching and learning strategies acquired – peer teaching (teacher-teacher and student-student), simulation/scenario teaching and effective feedback techniques for effective learning and, (iv) effective collaborations between school/academic institution and hospital/clinical staff promoted effective training/learning. Barriers identified were (i) midwifery faculty shortage and heavy workload vs. high student population, (ii) infrastructure gaps in simulation teaching – inadequate space for simulation and lack of equipment inventory audits for replenishment (iii) inadequate clinical support for students due to inadequate clinical sites for experience, ineffective supervision and mentoring support, lack/shortage of clinical mentors and untrained hospital/clinical staff in EmONC and (iv) limited resources to support effective learning. Conclusion Findings reveal an overwhelmed midwifery faculty and an urgent demand for students support in clinical settings to acquire EmONC competencies for enhanced practice. For quality midwifery education, adequate resources and regulatory/policy directives are needed in midwifery faculty staffing and development. A continuous professional development specific for educators is needed for effective student teaching and learning of a competency-based pre-service curriculum.

The incidence of spotted fever group (SFG) rickettsioses in the United States has tripled since 2010. Rocky Mountain spotted fever, the most severe SFG rickettsiosis, is caused by Rickettsia rickettsii. The lack of species-specific confirmatory testing obfuscates the relative contribution of R. rickettsii and other SFG Rickettsia to this increase. We report a newly recognized rickettsial pathogen, Rickettsia sp. CA6269, as the cause of severe Rocky Mountain spotted fever–like illness in 2 case-patients residing in northern California. Multilocus sequence typing supported the recognition of this pathogen as a novel Rickettsia genotype most closely related to R. rickettsii. Cross-reactivity observed for an established molecular diagnostic test indicated that Rickettsia sp. CA6269 might be misidentified as R. rickettsii. We developed a Rickettsia sp. CA6269–specific real-time PCR to help resolve this diagnostic challenge and better characterize the spectrum of clinical disease and ecologic epidemiology of this pathogen.

Abstract Acoustic communication is widespread in beetles, is often sexually dimorphic, and plays a significant role in behaviours such as premating recognition, courtship, and copulation. However, the factors that determine the presence or absence of acoustic signalling in a given species remain unclear. We examined acoustic communication in bark beetles (Scolytinae) and pinhole borers (Platypodinae), which are two speciose groups with widespread sound production capabilities. We show that body size along with the sequence of host colonisation predict the presence of acoustic communication, and report, for the first time in the animal kingdom, a size limit—1.9 mm—below which acoustic signalling ceases to be present.

Abstract Obesity increases the risk of chronic kidney disease. We have previously demonstrated the benefits of preconception maternal weight loss on fertility and pregnancy outcomes in a mouse model of maternal obesity. Here, we elucidate if preconception weight loss, either by diet modification or the glucose-like peptide 1 agonist liraglutide, used in the treatment of diabetes and obesity, improves maternal kidney outcomes in late gestation. C57BL/6 female mice were fed either a high-fat-diet (HFD) or a chow (control) diet for 8 weeks. To induce pre-pregnancy weight loss, HFD-fed dams were switched to chow diet (HFD-C) or administered liraglutide (0.3 mg/kg subcutaneous) whilst continuing on HFD (HFD-L). Liraglutide was discontinued one week prior to mating. HFD-V mice continued on HFD, with saline injections. A group of HFD-fed dams were ‘diet switched’ to chow after conception (post-conception, HFD-PC). Maternal body weight and glucose tolerance were measured: (1) preconception and (2) during late gestation followed by blood, urine and kidney collection. Serum creatinine, urinary creatinine and albumin, kidney tissue gene expression and protein were measured. In the preconception period, HFD-L and HFD-C mothers have lower urine albumin:creatinine ratios (UACR) and fatty acid synthase (FAS) protein expression (P