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Anorexia nervosa has a high mortality rate and is often treated in the inpatient setting, where close monitoring and medical support are available. Consistent with objective biomedical benchmarks, conventional inpatient treatment is often focussed on weight gain. Consumers report that clinicians provide care focussed on weight and physical restoration without adequate consideration of their full spectrum of needs. The aim of this study was to explore consumers' perspectives of the biomedical focus on weight gain in the inpatient care of anorexia nervosa. This study employed a qualitative approach, involving semistructured interviews, and participants were recruited from relevant social media communities. This study was ethically approved by a university ethics committee and the COREQ checklist ensured ethical reporting. Ten women participated in interviews. Participants reported that the biomedical imperative of weight gain is focussed on at the exclusion of other relevant determinants of well‐being, and the narrow focus on weight gain does not suitably prepare consumers for discharge. The conflict between clinicians' biomedical focus and consumers' broader unmet needs leads to harmful interpersonal dynamics and feelings of invalidation. The inpatient care of anorexia nervosa needs to develop beyond biomedically driven objectives and incorporate the merits of an approach that substantively integrates person‐centred care, therapeutic relationships and trauma‐informed principles. [ABSTRACT FROM AUTHOR]

Medically compromised people with anorexia nervosa are cared for in inpatient settings where clinicians closely monitor health and safety. Clinicians are in a position of power, with the capacity to impose mandated weight gain to achieve medical stabilisation. Consumers are in a vulnerable position, compelled to temporarily relinquish autonomy and to accept coercive practices that often diminish the quality of the therapeutic relationship. Clinicians' position of power in mental healthcare has a dual potential for both healing and harm, and limited attention has been given to consumers' views of clinicians' power. The aim of this qualitative descriptive study was to investigate the consumer perspective of clinicians' power in the inpatient care of anorexia nervosa, establishing insight into the beneficence and maleficence of the power asymmetry. Ten women with anorexia nervosa in the community participated in semi‐structured interviews online. The COREQ checklist was used to ensure accuracy and completeness of reporting. Thematic analysis revealed that abuses of power were common in the course of inpatient AN care, however life‐saving measures were regarded as defensible. The perception of clinicians' power was determined by the strength of interpersonal relationships and clinicians' clinical competence. To mitigate the potential for harmful experiences, clinicians' use of power must be exercised with close consideration for consumer perspectives, with the integration of person‐centred care and trauma‐informed care principles. [ABSTRACT FROM AUTHOR]

Background: Advances in biomedical HIV prevention will soon offer young women a choice of HIV prevention methods, including various pre-exposure prophylaxis (PrEP) modalities such as daily oral pills, dapivirine vaginal ring, and long-acting injectable agents. By understanding preferences for contraceptive methods, we may draw analogies for the HIV prevention needs of young women. The UChoose Study was an open-label randomised cross-over study designed to evaluate the acceptability and preference for several contraceptive options as a proxy for HIV prevention methods that use similar types of administration. The study enrolled healthy HIV uninfected young women aged 15 to 19 years. At enrolment, participants were randomly assigned to a contraceptive method for a period of 16 weeks in the form of monthly Nuvaring® (vaginal ring), daily combined oral contraceptive (daily pills), or bi-monthly injectable contraceptive (injectable). After 16 weeks, participants crossed over to another contraceptive method, and those who had received the injectable and the daily pills received the vaginal ring for another 16 weeks, whereas those who had received the vaginal ring were able to choose between the injectable and daily pills, to ensure that all participants tried the vaginal ring—the least familiar option to the study population. Results: Thirty-three participants were purposively recruited to participate in seven focus group discussions (FGD) and completed a pre-survey for their assigned group. Our sample comprised 14 participants randomised to use of the vaginal ring and daily pills and 19 participants randomised to use of the vaginal ring and injectable. For most participants, their preferences for a prevention method were based primarily on their desire to avoid negative aspects of one method rather than their positive user experience with another method. Most participants expressed initial hesitancy for trying new contraception method products; however, a lack of familiarity was moderated by a strong interest in diverse user-controlled prevention methods. Participants valued methods that had infrequent dosing and simplified use requirements. The injection and vaginal ring were preferred over daily pills as a potential HIV prevention method. Conclusion: Expanding the availability of diverse products could provide adolescents with multiple choices in HIV prevention for the uninitiated. Trial registration: ClinicalTrials.gov (NCT02404038). Registered March 31, 2015—Registered. [ABSTRACT FROM AUTHOR]

Young women remain disproportionately affected by the HIV epidemic in South Africa. Clinical trials have shown that the dapivirine vaginal ring (DVR) is safe and effective at reducing HIV infection in women. In March 2022, the South African Health Products Regulatory Authority approved the use of the DVR in women aged 18 years and older who are unable or unwilling to use oral pre-exposure prophylaxis, as an additional choice for preventing HIV in women at substantial risk. Modelling studies have suggested that the DVR could have a substantial impact if prioritized for women at substantial risk of HIV or women aged 22-29 years. The licensing of the DVR in South Africa is a milestone event that brings the first long-acting and woman-controlled HIV prevention method another step closer to reaching the people who need it. As South Africa prepares its introduction, it is critical to examine the unmet need for HIV prevention and to review the clinical trial data that led to the DVR's approval. [ABSTRACT FROM AUTHOR]

Introduction: There is limited understanding of how social dynamics impact pre-exposure prophylaxis (PrEP) adherence among adolescent girls and young women (AGYW) in generalized HIV-epidemic settings. We examined experiences of oral PrEP use disclosure to various social groups with the goal of identifying supportive relationships that can be leveraged to promote adherence. Methods: We used qualitative methods to explore experiences disclosing PrEP use and the perceived impact of disclosure on adherence among 22 South African AGYW (16–25 years) taking daily oral PrEP. Serial in-depth-interviews (IDIs) were conducted 1-, 3-, and 12-months post-PrEP initiation. Respondents also self-reported their disclosures separately for various social groups and adherence was assessed using intracellular tenofovir-diphosphate levels. Results: Qualitative respondents had a median age of 20.5 years and reported disclosing their PrEP use to friends (n = 36 total disclosures), partners, siblings, other family members (n = 24 disclosures each), and parents (n = 19 disclosures). IDI data revealed that parents and partners provided the most support to respondents and a lack of support from these groups was most often perceived as negatively affecting PrEP use. AGYW described difficulties explaining PrEP to their mothers, who believed PrEP was HIV treatment or would lead to HIV infection. Disclosure to household members was notably meaningful for AGYW (both positively and negatively). Respondents reported leveraging supportive relationships for pill reminders. For respondents who perceived a household member would be unsupportive, however, non-disclosure was less feasible and PrEP use was often stigmatized. To avoid stigma, several respondents hid or discontinued PrEP. Conclusions: While supportive relationships may facilitate PrEP use, disclosure can also lead to stigma. Counselors should support AGYW in disclosing to key people in their social networks and provide AGYW with materials that lend credibility to explanations of PrEP. Community education is necessary to alleviate PrEP-related stigma and facilitate disclosure. [ABSTRACT FROM AUTHOR]

Introduction: HIV incidence remains high among African adolescent girls and young women (AGYW), who would benefit from pre‐exposure prophylaxis (PrEP). Strategies to increase PrEP adherence and persistence need to be evaluated in African AGY, including incentives conditional on high adherence. Methods: The 3Ps for Prevention Study was a 12‐month prospective cohort of 200 women ages 16 to 25 initiating PrEP in South Africa from 2017 to 2018. Participants received retrospective feedback about drug levels at Months 1, 2 and 3; half was randomized to receive a 200 Rand shopping voucher ($13 US) at Months 2, 3 and 4, conditioned on high intracellular tenofovir diphosphate (TFV‐DP) levels in dried blood spots (≥500 fmol/punch at Month 1, ≥700 fmol/punch at Months 2 and 3). The primary analysis was intention‐to‐treat, comparing the proportion with high PrEP adherence (≥700 fmol/punch) at Month 3 by randomized group, based on 100% efficacy among men who have sex with men. Results: Median age of the 200 women was 19 years (interquartile range [IQR] 17, 21); 86% had a primary sexual partner. At Month 3, the mean TFV‐DP level was 822 fmol/punch (SD 522) in the incentive group and 689 fmol/punch (SD 546) in the control group (p = 0.11). Forty‐five (56%) of 85 women in the incentive group and 35 (41%) of 85 women in the control group had TFV‐DP levels ≥700 fmol/punch (RR 1.35; 95% CI 0.98, 1.86; p = 0.067), which declined to 8% and 5% in the incentive and control groups at Month 12 (no significant difference by arm). 44% refilled PrEP without gaps, 14% had a gap of ≥3 weeks in coverage subsequently restarted PrEP and 54% accepted at the final dispensing visit at Month 9. No new HIV infections were observed after PrEP initiation. Conclusions: Among South African AGYW initiating PrEP, drug levels indicated high PrEP adherence in almost half of women at Month 3, with a non‐statistically significant higher proportion with high adherence among those in the incentive group. Over half persisted with the 12‐month PrEP programme although high adherence declined after Month 3. Strategies to support PrEP adherence and persistence and longer‐acting PrEP formulations are needed. [ABSTRACT FROM AUTHOR]

Introduction: Young women in Southern Africa have extremely high HIV incidence rates necessitating the availability of female‐controlled prevention methods. Understanding adolescent preference for seeking contraception would improve our understanding of acceptability, feasibility and adherence to similar modes of delivery for HIV prevention. Methods: UChoose was an open‐label randomized crossover study over 32 weeks which aimed to evaluate the acceptability and preference for contraceptive options in healthy, HIV‐uninfected, female adolescents aged 15 to 19 years, as a proxy for similar HIV prevention methods. Participants were assigned to a contraceptive method for a period of 16 weeks in the form of a bi‐monthly injectable contraceptive, monthly vaginal Nuvaring® or daily combined oral contraceptive (COC) and then asked to state their preference. At 16 weeks, participants crossed over to another contraceptive method, to ensure that all participants tried the Nuvaring® (least familiar modality) and additionally, either the injection or COC. Primary outcomes were contraceptive acceptability and preference. At the end of the 32 weeks they were also asked to imagine their preference for an HIV prevention modality. Secondary endpoints included changes in sexual behaviour, contraceptive adherence and preference for biomedical and behavioural HIV prevention methods. Results: Of the 180 participants screened, 130 were enrolled and randomized to the Nuvaring® (n = 45), injection (n = 45) or COC (n = 40). Significantly more Nuvaring® users (24/116; 20.7%) requested to change to another contraceptive option compared to injection (1/73; 1.4% p = 0.0002) and COC users (4/49; 8% p = 0.074). Of those that remained on the Nuvaring®, adherence was significantly higher than to COC (p < 0.0001). Significantly more injection users (77/80; 96.3%) thought this delivery mode was convenient to use compared to Nuvaring® (74/89; 83.1%; p = 0.0409) or COC (38/50; 76.0%; p = 0.0034). Overall, the preferred contraceptive choice was injection, followed by the ring and lastly the pill. Conclusions: Adherence to daily COC was difficult for adolescents in this cohort and the least favoured potential HIV prevention option. While some preferred vaginal ring use, these data suggest that long‐acting injectables would be the preferred prevention method for adolescent girls and young women. This study highlights the need for additional options for HIV prevention in youth. [ABSTRACT FROM AUTHOR]

Objective: This study examined the types of goals set, the degree to which goals were achieved, and the factors influencing goal attainment for participants in a Recovery College, a recovery-based mental health education program that uses peer learning advisors to facilitate individual student learning plans. Method: Students of the Recovery College set baseline goals that were rated in terms of importance and difficulty in line with the Goal Attainment Scale (GAS) framework and reviewed at follow-up points. Goals were reviewed to determine areas of priority and an analysis of goal attainment was conducted using multinomial logit regression analysis. Results: Sixty-four students recorded their goals. The most common goal areas identified related to education, socialization, physical health, mental health, and employment. Seventy percent of goals were fully or partially achieved with goals rated as having a lower difficulty more likely to be achieved. Conclusion and Implications for Practice: Recovery College is a program model that can effectively support personal goal achievement, a recommended indicator of personal recovery and program success. The GAS proved to be a useful instrument for measuring goal setting and attainment in students' recovery journeys and peer learning advisors were effective in facilitating this process. The setting and achievement of physical health goals is of clinical significance. This study builds on limited published evidence demonstrating the important role that Recovery Colleges play in supporting participants to identify and achieve their personal goals. Further, it highlights the contribution that peer workers can make to this process, in keeping with the coproduction philosophy of the Recovery College model. [ABSTRACT FROM AUTHOR]

Understanding inter-subject variability in drug pharmacokinetics and pharmacodynamics is important to ensure that all patients attain suitable drug exposure to achieve efficacy and avoid toxicity. Inter-subject variability in the pharmacokinetics of therapeutic monoclonal antibodies (mAbs) is generally moderate to high; however, the factors responsible for the high inter-subject variability have not been comprehensively reviewed. In this review, the extent of inter-subject variability for mAb pharmacokinetics is presented and potential factors contributing to this variability are explored and summarised. Disease status, age, sex, ethnicity, body size, genetic polymorphisms, concomitant medication, co-morbidities, immune status and multiple other patient-specific details have been considered. The inter-subject variability for mAb pharmacokinetics most likely depends on the complex interplay of multiple factors. However, studies aimed at investigating the reasons for the inter-subject variability are sparse. Population pharmacokinetic models and physiologically based pharmacokinetic models are useful tools to identify important covariates, aiding in the understanding of factors contributing to inter-subject variability. Further understanding of inter-subject variability in pharmacokinetics should aid in development of dosing regimens that are more appropriate. [ABSTRACT FROM AUTHOR]

Immersion in well-designed outdoor environments can foster the habits of mind that enable critical and authentic scientific questions to take root in students’ minds. Here we share two design cases in which careful, collaborative, and intentional design of outdoor learning environments for informal inquiry provide people of all ages with embodied opportunities to learn about the natural world, developing the capacity for understanding ecology and the ability to empathize, problem-solve, and reflect. Embodied learning, as facilitated by and in well-designed outdoor learning environments, leads students to develop new ways of seeing, new scientific questions, new ways to connect with ideas, with others, and new ways of thinking about the natural world. Using examples from our collaborative practises as experiential learning designers, we illustrate how creating the habits of mind critical to creating scientists, science-interested, and science-aware individuals benefits from providing students spaces to engage in embodied learning in nature. We show how public landscapes designed in creative partnerships between educators, scientists, designers, and the public have potential to amplify science learning for all. [ABSTRACT FROM AUTHOR]

Effective communication requires reliable signals and competent receptors. Theoretical and empirical accounts of animal signaling focus overwhelmingly on the capacity of the signaler to convey the message. Nevertheless, the intended receiver's ability to detect a signal depends on the condition of its receptor organs, as documented for humans. The impact of receptor organ condition on signal reception and its consequences for functional behavior are poorly understood. Social insects use antennae to detect chemical odors that distinguish between nestmates and enemies, reacting aggressively to the latter. We investigated the impact of antennal condition, determined by the density of sensilla, on the behavior of the weaver ant Oecophylla smaragdina. Worker aggression depended upon the condition of their antennae: workers with fewer sensilla on their antennae reacted less aggressively to nonnestmate enemies. These novel data highlight the largely unappreciated significance of receptor organ condition for animal communication and may have implications for coevolutionary processes in animal communication. [ABSTRACT FROM AUTHOR]

Background: The South Australian Department of Health has administered the Active Australia Survey triennially since 1998 to assess physical activity levels in the South Australian adult population. Survey findings may reflect the impact of health messages on the population and provide evidence to inform public health policy. This study analyzed the data from the South Australian Active Australia Surveys from 1998 to 2010 to quantify trends in the physical activity patterns of the total population and groups within the population over this period. Methods: The study used a retrospective analysis of the SA Health Active Australia Surveys of 1998, 2001, 2004, 2007, and 2010. Data were age-adjusted to the Australian 2001 Population Census. Proportions reporting sufficient physical activity for health benefits (≥ 150 min/week) were calculated by year of survey, and according to the following variables: gender, age group, area, educational level, income bracket, and body mass index (BMI). Population proportions statistics were used to determine the significance of the changes in levels of physical activity between 1998 and 2010. Results: The main finding was a significant increase in the overall proportion of the population reporting sufficient physical activity. However, the changes were not uniform across categories. Differences in proportions reporting sufficient physical activity appear to have narrowed within the categories of gender and BMI but have widened within the categories of educational level and income bracket. Changes were relatively consistent across age and geographic location. Conclusions: The results suggest that government programs to increase engagement in regular physical activity have been effective in some groups within the total population. They provide strong evidence to support the need for better ways of increasing physical activity levels and thus improving health outcomes for disadvantaged groups in the South Australian population. [ABSTRACT FROM AUTHOR]

B DISCUSSION: b Macrophage Activation Syndrome (MAS), classified as secondary hemophagocytic lymphohistiocytosis (HLH), is a potentially fatal complication of several rheumatic diseases characterized by excessive systemic inflammation as a result of activation and proliferation of macrophages and T lymphocytes, and is most commonly associated with SJIA. The presentation of MAS is recognized to have significant overlap with sepsis, as this patient's presentation with fevers, leukocytosis and hypotension were initially attributed. 5. Castillo L, Carcillo J. Secondary hemophagocytic lymphohistiocytosis and severe sepsis/ systemic inflammatory response syndrome/multiorgan dysfunction syndrome/macrophage activation syndrome share common intermediate phenotypes on a spectrum of inflammation. [Extracted from the article]

Trauma‐informed care is an approach to the delivery of mental health care based on an awareness of the high prevalence of trauma in the lives of people accessing mental health services, the effects of trauma experiences and the potential for trauma or re‐traumatization to occur in the context of care. Across Australia, inquiries and reports have increasingly indicated an urgent need for mental health services to become trauma‐informed. However, how Australian mental health services should deliver trauma‐informed care is not well documented. Efforts towards trauma‐informed care in any setting require engagement with those who receive care. This qualitative study used an experience‐based co‐design methodology to explore the perspectives of consumers of mental health services in Australia and their family members, in relation to the question 'what would a trauma‐informed mental health service look like?' Focus groups were held with consumers (n = 10) and carers (n = 10). Thematic analysis of transcripts identified that consumers and carers consider that trauma‐informed care requires increased awareness of trauma amongst mental health staff, opportunities to collaborate in care, active efforts by services to build trust and create safety, the provision of a diversity of models and consistency and continuation of care. The findings provide important new information about the experiences of Australian service users and have implications for the implementation of trauma‐informed care across settings. [ABSTRACT FROM AUTHOR]

Trauma Informed Care is an approach to the delivery of mental health care that requires sensitivity to the prevalence and effects of trauma in the lives of people accessing services. While TIC is increasingly emphasized in mental health policy and frameworks in Australia, people working in mental health settings have reportedly struggled to translate the values and principles into their everyday practice. This qualitative study used an experience‐based co‐design methodology to explore the potential for implementation of Trauma Informed Care into mental health services in Australia. The experiences of consumers, carers, clinicians, and managers were gathered. This paper presents the perspectives of clinicians (n = 64) and senior managers (n = 9) from across three Local Health Districts in New South Wales in Australia. All data were analysed thematically to address the research question: What is needed for Trauma Informed Mental Health Services in Australia? To be trauma‐informed, managers required: leadership at all levels, access to resource, relevant and accessible training, support for staff, resolution of wider systems issues, and clarification of the concept and actions of TIC. Clinicians identified that to be trauma‐informed they required services to: be aware of staff well‐being, support different ways of working, address workplace cultures and provide increased resources. The findings have implications for any service, team or individual seeking to implement TIC within mental health settings. [ABSTRACT FROM AUTHOR]

Background: In low-middle income countries (LMICs), such as South Africa, there is an urgent need to strengthen reproductive health care (RHC) services, and improve testing for sexually transmitted infections (STIs). Self-testing, self-sampling and e- Health platforms are potential affordable, accessible tools to achieve this and require further exploration. We have recently reviewed programmatic, ethical and economic considerations for implementations of self-testing/self-sampling point-of-care tests for STIs, including HIV, in the context of LMICs. Despite demonstrable efficacy, many available tests are not currently available in LMICs, including South Africa, and the regulatory framework to oversee these need to be developed. Here, we aimed to evaluate online self-testing and self-sampling service providers available in South Africa, as a mapping exercise to support development of national regulatory guidelines. Methods: South African e-Health providers of STI tests (including both self-sampling and self-testing) were identified by searching Google (Nov 2022 to Jan 2023). Information on tests and associated services were collected from various websites, with further information obtained from providers via an online survey. This information was compared with South African Health Products Regulatory Authority (SAHPRA) and Health Professions Council of South Africa (HPCSA) standards for existing diagnostics and STI management. Results: Thirty-four individual tests were identified, of which 30 were self-tests and four were selfsampling tests, available from nine unique service providers (Table 1). These included tests for HIV (8/34), syphilis (6/34), herpes simplex virus (HSV) (5/34), Chlamydia trachomatis (4/34), Neisseria gonorrhoeae (4/34), Hepatitis B (2/34), Hepatitis C (3/34) and 2 multiplexed tests that included Trichomonas vaginalis, C. trachomatis and N. gonorrhoeae. Most were either antigen-based (12/34) or antibody-based rapid tests (13/34), and required blood (14/34). Only 5/34 required urogenital sampling, while 11/34 did not state the sample type required. Of the 34 tests, 56% were manufactured in South Africa, with the mean cost per service being 20 United States Dollars (range: 1- 62 USD). Conclusion: e-Health and self-testing for STIs are available in South Africa and offer an important approach to improving care. This exercise will aid national policymakers in drafting guidelines for management and regulation of STI self-tests and e- Health providers in South Africa. [ABSTRACT FROM AUTHOR]

Internationally, lead agencies and consumer movements emphasise the need for high-level research participation in mental health. However, evidence suggests that people with lived experience tend to be recruited as subjects rather than as active agents in research, or are consulted in tokenistic ways. Although participatory research has the potential to rectify epistemic disparities, few studies have grappled with how to move from exclusion and tokenism to high-level research participation. This paper describes a qualitative co-evaluation of a co-produced model of research partnership, Raising the Bar, which involved deliberate establishment and facilitation of six participatory research teams, comprising 28 lived experience and 'conventional' mental health researchers. Findings indicate that the theoretical elements of the model set the bar high from the outset, supporting research teams to address inconsistencies in knowledge about participation. It also provided researchers with the competencies and resources to undertake participatory research in egalitarian team structures, and to negotiate new forms of non-traditional research outputs - thereby challenging whom research might be for and how it might be made accessible. Finally, the model shifted collective meanings about research, lending credibility to participatory practices, which came to be seen as essential for meeting the needs of affected communities. Nonetheless, systemic barriers to participatory research remain, and need to be recognised and acted upon to promote a culture that supports high-level research participation. [ABSTRACT FROM AUTHOR]

Background: Students from a range of health disciplines need to learn from people with lived experience of mental distress and recovery to develop recovery capabilities for mental health practice. Aims: The aims of this study are to describe the co‐design of a teaching resource, to explore the experience of people with lived experience during the resource development, and to evaluate the outcome of the resource on student recovery capabilities. Method: Using a sequential mixed method, a project group consisting of six people with lived experience and 10 academics from five health disciplines was convened to co‐develop teaching resources. People with lived experience met independently without researchers on several occasions to decide on the key topics and met with the research team monthly. The teaching resource was used in mental health subjects for two health professional programmes, and the Capabilities for Recovery‐Oriented Practice Questionnaire (CROP‐Q) was used before and after to measure any change in student recovery capabilities. Scores were compared using the Wilcoxon signed rank test. The people with lived experience were also interviewed about their experience of being involved in constructing the teaching resources. Interviews were audiotaped, transcribed, and analysed thematically. Results: The finished resource consisted of 28 short videos and suggested teaching plans. Occupational therapy and nursing student scores on the CROP‐Q prior to using the educational resource (n = 33) were 68 (median) and post scores (n = 28) were 74 (median), indicating a statistically significant improvement in recovery capability (P = 0.04). Lived experience interview themes were (i) the importance of lived experience in education; (ii) personal benefits of participating; (iii) co‐design experience; and (iv) creating the resource. Conclusion: Co‐design of teaching resources with people with lived experience was pivotal to the success and quality of the final product, and people with lived experience described personal benefits of participating in resource development. More evidence to demonstrate the use of the CROP‐Q in teaching and practice is needed. [ABSTRACT FROM AUTHOR]

The interaction between cervicovaginal virome, bacteriome and genital inflammation has not been extensively investigated. We assessed the vaginal DNA virome from 33 South African adolescents (15–19 years old) using shotgun DNA sequencing of purified virions. We present analyses of eukaryote-infecting DNA viruses, with a focus on human papillomavirus (HPV) genomes and relate these to the vaginal bacterial microbiota (assessed by 16S rRNA gene sequencing) and cytokines (assessed by Luminex). The DNA virome included single-stranded (Anelloviridae, Genomoviridae) and double-stranded DNA viruses (Adenoviridae, Alloherpesviridae, Herpesviridae, Marseilleviridae, Mimiviridae, Polyomaviridae, Poxviridae). We identified 110 unique, complete HPV genomes within two genera (Alphapapillomavirus and Gammapapillomavirus) representing 40 HPV types and 12 species. Of the 40 HPV types identified, 35 showed positive co-infection patterns with at least one other type, mainly HPV-16. HPV-35, a high-risk genotype currently not targeted by available vaccines, was the most prevalent HPV type identified in this cohort. Bacterial taxa commonly associated with bacterial vaginosis also correlated with the presence of HPV. Bacterial vaginosis, rather than HPV, was associated with increased genital inflammation. This study lays the foundation for future work characterizing the vaginal virome and its role in women's health. [ABSTRACT FROM AUTHOR]

Recovery Colleges assist people in their personal recovery journeys by offering an approach that transforms conventional mental health care by using an educational framework. While evaluations of these colleges have demonstrated effectiveness in promoting personal recovery, scant research has been published regarding their economic evaluation. To conduct a cost-benefit analysis of the South Eastern Sydney Recovery and Wellbeing College in Australia by exploring health utilisation and direct costs. The overall costs of the Recovery College sample (reported from 2014 to 2017) were used to derive a per person, per year cost, adjusted for inflation to 2020 Australian dollars. Benefits were determined by analysing pre/post health service utilisation by service users, and subsequently calculating a net cost saving, There was a statistically significant reduction in Emergency Department and inpatient mental health utilisation following participation in the Recovery College. The net cost savings was A$269 per student per year. This study indicates that the Recovery College can play an important role in decreasing mental health service and ED utilisation. This reflects reduced reliance on traditional mental health services, thus suggesting that students develop improved self-agency and ability to manage their own mental health. [ABSTRACT FROM AUTHOR]

The Southern African HIV Clinicians Society has released updated recommendations for post-exposure prophylaxis (PEP) in their 2023 guideline. PEP is a preventive intervention that involves administering antiretroviral therapy to an HIV-negative person who has been exposed to the virus. The guideline provides a stepwise approach to providing PEP, including prevention of exposure, initial assessment following exposure, and appropriate counseling and support. It also discusses the risk of transmission in different settings and emphasizes the importance of adherence to the full 28-day course of treatment. The document also addresses considerations for other health conditions related to exposure and provides recommendations for follow-up counseling and referral for individuals experiencing anxiety and trauma. [Extracted from the article]

Internationally, lead agencies and consumer movements emphasise the need for high-level research participation in mental health. However, evidence suggests that people with lived experience tend to be recruited as subjects rather than as active agents in research, or are consulted in tokenistic ways. Although participatory research has the potential to rectify epistemic disparities, few studies have grappled with how to move from exclusion and tokenism to high-level research participation. This paper describes a qualitative co-evaluation of a co-produced model of research partnership, Raising the Bar, which involved deliberate establishment and facilitation of six participatory research teams, comprising 28 lived experience and 'conventional' mental health researchers. Findings indicate that the theoretical elements of the model set the bar high from the outset, supporting research teams to address inconsistencies in knowledge about participation. It also provided researchers with the competencies and resources to undertake participatory research in egalitarian team structures, and to negotiate new forms of non-traditional research outputs - thereby challenging whom research might be for and how it might be made accessible. Finally, the model shifted collective meanings about research, lending credibility to participatory practices, which came to be seen as essential for meeting the needs of affected communities. Nonetheless, systemic barriers to participatory research remain, and need to be recognised and acted upon to promote a culture that supports high-level research participation. [ABSTRACT FROM AUTHOR]

The past two decades have seen diversification of drug development pipelines and approvals from traditional small molecule therapies to alternative modalities including monoclonal antibodies, engineered proteins, antibody drug conjugates (ADCs), oligonucleotides and gene therapies. At the same time, physiologically based pharmacokinetic (PBPK) models for small molecules have seen increased industry and regulatory acceptance. This review focusses on the current status of the application of PBPK models to these newer modalities and give a perspective on the successes, challenges and future directions of this field. There is greatest experience in the development of PBPK models for therapeutic proteins, and PBPK models for ADCs benefit from prior experience for both therapeutic proteins and small molecules. For other modalities, the application of PBPK models is in its infancy. Challenges are discussed and a common theme is lack of availability of physiological and experimental data to characterise systems and drug parameters to enable a priori prediction of pharmacokinetics. Furthermore, sufficient clinical data are required to build confidence in developed models. The PBPK modelling approach provides a quantitative framework for integrating knowledge and data from multiple sources and can be built on as more data becomes available. [ABSTRACT FROM AUTHOR]

Background: Symptoms of sexually transmitted infections (STIs) and urinary tract infections (UTIs) overlap. Patient history and physical examination may not be sufficient for the differentiation of UTIs from STIs. Yet, accuracy and rapidity in diagnosis and treatment are a global concern given the high overuse and misuse of antibiotics for STIs and UTIs, which contribute to the growth of antimicrobial resistance (AMR). The UK Antimicrobial Resistance National Action Plan (NAP) seeks to encourage more self-care to reduce antibiotic prescribing for common infections such as UTIs. This may discourage patients from seeking professional help, thereby increasing the likelihood of misdiagnosis. As part of a wider evaluation of the NAP, we looked at women's experiences of their UTIs, their self-care activities and, in particular, the overlap in symptoms between STIs and UTIs, and the implications of this overlap, with a view to providing insights to improve care. Methods: We conducted a thematic analysis of data collected through four focus groups and twenty follow-up semi-structured interviews with lowincome and ethnic minority women in England with recent experience of UTIs. We compared the women's experiences and understandings of UTIs with the way that UTIs are framed in the UK healthcare system, particularly in the AMR NAP. Results: The overlap of STI and UTI symptoms affected how women experienced their UTIs and sought professional healthcare. Women often expressed worries typically related to STIs, such as concern about having their sexual practices judged during medical consultations and fear of partner unfaithfulness or partner violence. Consulting healthcare professionals was crucial in alleviating those fears, making medical advice valued by women irrespective of whether or not they received treatment. Conclusion: There is a need for re-framing of UTIs in UK health policy and clinical guidance, which takes into greater account the potential complexities resulting from the proximity of UTIs to STIs. This should take place through collaboration between women and primary care and genitourinary medicine professionals. Health professionals and policymakers should consider the overlap between STIs and UTIs when advising women on when and how to seek professional advice and care. [ABSTRACT FROM AUTHOR]

Background: Chlamydia trachomatis is a leading cause of poor reproductive health outcomes in women and may also increase HIV risk. Infections are often asymptomatic and undiagnosed in developing countries, where syndromic management is standard-of-care. Studies from South Africa estimate a prevalence of up to 40% in adolescent girls, which has undoubtedly increased due to disruption of health services during the pandemic. Chlamydia remains a major health concern, with vaccines urgently required. Although there is some evidence for partial protection after natural infection, this is poorly defined, highlighting the need to understand chlamydia immunity in the context of its natural history. Thus, we characterised chlamydia-specific CD4+ T cell responses in highly exposed young women, to understand the impact of multiple exposures. Methods: T cell responses were measured by multiparameter flow cytometry in HIV-uninfected young women (16-22 years old) with either confirmed chlamydia infection (NAAT+) or positive IgG ELISA (n=45). PBMCs were stimulated with a single peptide pool covering C. trachomatis major outer membrane protein and intracellular IFN-γ, IL-2 and TNF-α measured in CD3+CD4+ T cells. Nonparametric statistical tests were used for all data analysis. Results: Of the 45 women included in the study, 24/45 (53%) were experiencing a primary chlamydia infection (NAAT+/IgG-); 16/45 (36%) had a persistent/recurrent infection (NAAT+/IgG+); and 5/45 (11%) were NAAT-/IgG+, considered evidence of previous/recovered infection. All recovered women had detectable chlamydia-specific CD4+ T cells producing any cytokine, compared to ~80% of women with active infection (NAAT+/IgG+ or NAAT+/IgG-). Notably, CD4+ IFN-γ+ T cells were found in all five recovered women, but in only 50% and 33% of women with persistent and primary infections, respectively. Consequently, recovered women had a significantly higher frequency of chlamydia-specific CD4+T cells producing IFN-γ than those with primary infections (p=0.007). We also found a weak positive correlation between chlamydia-specific CD4+ IFN-γ responses and the relative concentrations of chlamydia-specific IgG (r=0.31, p=0.036). Conclusion: We report an important potential association between chlamydia-specific Th1/IFN-γ responses and relative exposure in young women, which may reflect immune cell migration dynamics during active infection. These findings may have significant implications for mucosal vaccine strategies and evaluation and should be explored further. [ABSTRACT FROM AUTHOR]

Introduction: Telehealth, especially the use of real-time video and phone visits in ambulatory care, is increasingly important in the wake of the COVID-19 pandemic. The current state of internal medicine (IM) interns' telehealth training at the start of residency is unknown. Objective: To characterize the attitudes, training, and preparedness of IM interns regarding the use of telehealth video and phone visits in ambulatory care. Materials and Methods: We conducted a cross-sectional survey of IM interns at four IM residency programs in the United States in 2020. Results: One hundred fifty-six surveys were analyzed (response rate 82%). Seventy-five percent of interns rated training in the use of real-time video and phone visits for ambulatory care as important or very important. The vast majority received no training (74%) or clinical experience (90% no prior video visits, 81% no prior phone visits) during medical school. More interns believed that primary care may be effectively delivered via video visits compared with phone visits (77% vs. 35%). Most interns (69%) missed clinical time during medical school due to the COVID-19 pandemic; 41% felt that the pandemic negatively affected their ambulatory care preparation. Overall, the majority of interns (58%) felt prepared for primary care; only 12% felt prepared to deliver primary care using either video or phone visits. Conclusions: Although IM interns had favorable attitudes toward video and phone visits, few had training or clinical experience; most felt unprepared. Residency programs may need to close training gaps for current interns in conducting telehealth video and phone visits. [ABSTRACT FROM AUTHOR]

Vaccine-induced neutralizing antibodies (nAbs) are key biomarkers considered to be associated with vaccine efficacy. In United States government-sponsored phase 3 efficacy trials of COVID-19 vaccines, nAbs are measured by two different validated pseudovirus-based SARS-CoV-2 neutralization assays, with each trial using one of the two assays. Here we describe and compare the nAb titers obtained in the two assays. We observe that one assay consistently yielded higher nAb titers than the other when both assays were performed on the World Health Organization's anti-SARS-CoV-2 immunoglobulin International Standard, COVID-19 convalescent sera, and mRNA-1273 vaccinee sera. To overcome the challenge this difference in readout poses in comparing/combining data from the two assays, we evaluate three calibration approaches and show that readouts from the two assays can be calibrated to a common scale. These results may aid decision-making based on data from these assays for the evaluation and licensure of new or adapted COVID-19 vaccines. [ABSTRACT FROM AUTHOR]

Participation of people with lived experience (LE) in mental health research is vital for improving the quality and relevance of research priorities, outcomes, and knowledge translation. Inclusion of people with LE is also recognized as central for achieving health service reform including commitments to human rights, social, and epistemic justice. Although a lack of research training is cited as a barrier to LE participation, few studies have examined the value of training for, or the specific requirements of, people with LE. This study seeks to address this gap. It reports on a longitudinal, qualitative study examining shifts in experience and knowledge, and unmet needs, of people with LE over the course of a coproduced research training programme. Findings indicate that the programme enabled participants to understand the role, value, and levels of LE participation in research. Participants also stressed the importance of the 'embodied lived expertise' of LE researchers who co‐delivered the training programme. Nonetheless, participants indicated that they felt unprepared for the challenges of working in systems where LE knowledge is subordinated, and experiences of being silenced and powerless could mirror those previously experienced in mental health services and the community. Participants indicated a need for training that provided them with the epistemic resources to render such experiences intelligible. Findings also indicate that training in participatory research is required for conventional mental health researchers, to support them to navigate power asymmetries and value LE knowledge contributions. [ABSTRACT FROM AUTHOR]

Recovery‐focused educational programmes have been implemented in mental health services in an attempt to transform care from a purely biomedical orientation to a more recovery‐oriented approach. Mental health nurses have identified the need for enhancing their abilities and confidence in translating recovery knowledge into mental health nursing practice. However, recovery‐focused educational programmes have not fully address nurses' learning needs. Therefore, this review synthesized the evidence of the effectiveness of recovery‐focused educational programmes for mental health nurses. A systematic search of electronic databases and hand‐searched references was conducted. It identified 35 programmes and 55 educational materials within 39 studies. Synthesizing the literature revealed three themes and nine subthemes. The first theme, a framework for understanding and supporting consumers' recovery, had four subthemes: consumers' involvement, multidisciplinary approach, profession‐specific training, and performance indicators. The second theme, contents of educational materials, included the subthemes: knowledge development and recovery‐focused care planning. The final theme, nurses' learning experiences, included the subthemes: understanding recovery, the positive effects of recovery‐focused educational programmes, and implementation of recovery‐oriented practices. Based on these findings, a mental health nursing recovery‐focused educational programme framework is proposed. Further research should investigate the effectiveness of the framework, especially in relation to recovery‐focused care planning and consumer and carer involvement in the development, delivery, participation, and evaluation of these educational programmes. [ABSTRACT FROM AUTHOR]

Introduction: Oral, vaginal and other pre-exposure prophylaxis (PrEP) products for HIV prevention are in various stages of development. Low adherence poses a serious challenge to successful evaluation in trials. In a previous study, we developed tools to screen for general adherence and specifically monitor intravaginal ring adherence within the context of HIV prevention clinical trials. This study aimed to further validate the screening tool and to adapt and provide initial psychometric validation for an oral pill monitoring tool. Materials and methods: We administered a cross-sectional survey between June and October 2018 at a trial site located near Cape Town, South Africa, and another in Thika, Kenya, with 193 women who had experience using daily oral pills. We fit confirmatory factor analysis models on the screening tool items to assess our previously-hypothesized subscale structure. We conducted an exploratory factor analysis of oral PrEP monitoring items to determine the underlying subscale structure. We then assessed the construct validity of each tool by comparing subscales against each other within the current sample and against our original sample, from a study conducted in four sites in South Africa, including Cape Town. Results: The screening tool structure showed moderate evidence of construct validity. As a whole, the tool performed in a similar way to the original sample. The monitoring tool items, which were revised to assess perceptions about and experiences using daily oral PrEP, factored into five subscales that showed moderate to good reliability. Four of the five subscales had a similar structure overall to the vaginal ring monitoring tool from which they were adapted. Conclusions: Accurate measurement of HIV-prevention product adherence is of critical importance to the assessment of product efficacy and safety in clinical trials, and the support of safe and effective product use in non-trial settings. In this study, we provide further validation for these measures, demonstrating the screening tool's utility in additional populations and adapting the monitoring tool's utility for different HIV-prevention products. [ABSTRACT FROM AUTHOR]

Background. Adolescents in sub-Saharan Africa are at risk for human immunodeficiency virus (HIV) infection and unintended pregnancies. Observational studies suggest that injectable hormonal contraceptives (HCs) increase the HIV risk, although their effects on genital inflammation, particularly HIV-susceptible T-helper 17 (Th17) cells, are unknown. In a randomized crossover study, the effect of injectable norethisterone oenanthate (NET-EN), combined contraceptive vaginal rings (CCVR; NuvaRing), and combined oral contraceptive pills (COCPs) on cervical Th17 cells and cytokines were compared. Methods. Adolescents (n = 130; 15–19 years) were randomly assigned 1:1:1 to NET-EN, CCVR, or COCPs for 16 weeks, then subsequently crossed over to another HC for 16 weeks. Estrogen, follicular stimulating hormone (FSH), and luteinizing hormone (LH) levels were measured. Chemokine receptor 5 (CCR5), human leukocyte antigen (HLA) DR isotope, and cluster of differentiation 38 (CD38) expression by cervical cytobrush-derived CD4+ T cells was assessed by fluorescence-activated cell sorting. Th17 cells were defined as CCR6+ and CCR10-. Cervicovaginal Th17-related cytokines were measured by Luminex. Results. CCVR use for the first 16 weeks was associated with reduced Th17 frequencies and lower FSH and LH concentrations, as compared to NET-EN and COCPs, with FSH concentrations and Th17 frequencies correlating significantly. However, Th17- related cytokine concentrations (interleukin [IL]-21, IL-1β, tumor necrosis factor–α, interferon-γ) and CCR5, HLA-DR, CD38, and Th17 frequencies were significantly higher in CCVR than NET-EN and COCP. At crossover, CCVR users changing to COCPs or NET-EN did not resolve activation or cytokines, although switching from COCP to CCVRs increased cytokine concentrations. Conclusions. CCVR use altered endogenous hormone levels and associated cervical Th17 cell frequencies to a greater extent than use of NET-EN or COCPs, although Th17 cells were more activated and Th17-related cytokine concentrations were elevated. While CCVRs may impact the HIV risk by regulating Th17 numbers, increased activation and inflammation may balance any risk gains. [ABSTRACT FROM AUTHOR]

Paclitaxel is the backbone of standard chemotherapeutic regimens used in a number of malignancies and is frequently given with concomitant medications. Newly developed oncolytic agents, including tyrosine kinase inhibitors are often shown to be CYP3A4 and P-gp inhibitors. The aim of this study was to develop a PBPK model for intravenously administered paclitaxel in order to predict the incidence of neutropenia and to estimate the DDI potential as a victim drug. The dose-dependent effects on paclitaxel plasma protein binding, volume of distribution and drug clearance were considered for dose levels of 80 mg/m2, 135 mg/m2 and 175 mg/m2. A pharmacodynamics model that incorporate the impact of paclitaxel on the neutrophil was developed. The relative metabolic clearance via CYP3A4 and CYP2C8, the renal clearance as well as P-gp mediated biliary clearance were incorporated in the model in order to assess the neutropenia in the presence of DDI. The developed PBPK-PD model was able to recover the drop in neutrophils observed after the administration of 175mg/m2 of paclitaxel over a 3-h duration. The mean nadir observed was 1.9 × 109 neutrophils/L and was attained after 10 days of treatment, and a fraction of 47% of the population was predicted to have at some point a neutropenia including 12% with severe neutropenia. In the case of concomitant administration of ketoconazole, 39% of the population was predicted to suffer from severe neutropenia. In summary, PBPK-PD modeling allows a priori prediction of DDIs and safety events involving complex combination therapies which are often utilized in an oncology setting. Image, graphical abstract [ABSTRACT FROM AUTHOR]

Background/aim: Mental health reform in Australia emphasises recovery, partnership working and prioritises consumers' needs over professionals'. Occupational therapy students must develop capabilities for working in this way. Learning from consumers' lived experience of mental illness and recovery is considered critical to developing such capabilities and aligns with occupational therapy programme accreditation for consumer involvement in designing, delivering and evaluating curricula. No definitive capability standards exist to inform curricula and little is known about Australian mental health consumers' preferred modes of involvement in health professional education. This study sought to identify consumers' priorities for curricula, and ways in which they would like to participate in entry‐level student education. Methods: An eDelphi study utilising the Policy Delphi approach was employed. Consensus by 70% of participants was set as the standard for item inclusion. The first round asked open questions about participants' priorities for recovery‐oriented curricula, their experiences with mental health workers and asked participants to identify their preferred methods of participating in education. Items generated were rated in subsequent rounds until consensus was reached in round three. Results: Twenty‐eight participants completed round one, 18 completed round two and 14 completed round three. Five core values and 171 curriculum priorities, forming 12 capability domains, reached consensus. Each capability domain comprised knowledge and understanding; skills and abilities; and behaviours and actions. Ten ways of participating in mental health curricula in entry‐level occupational therapy programmes were identified, with an emphasis on active participation in design, delivery and review of curricula. Conclusion: These findings highlight important capabilities from consumers' perspectives, suggesting key content for curricula. Active roles in designing, delivering and evaluating curricula were preferred, providing some guidance for educators seeking to involve consumers. Further research is required to refine these priorities, and to evaluate acceptability, feasibility and efficacy of varying modes of consumer involvement. [ABSTRACT FROM AUTHOR]

Background: Low adherence in recent HIV prevention clinical trials highlights the need to better understand, measure, and support product use within clinical trials. Conventional self-reported adherence instruments within HIV prevention trials, often relying on single-item questions, have proven ineffective. While objective adherence measures are desirable, none currently exist that apply to both active and placebo arms. Scales are composed of multiple items in the form of questions or statements that, when combined, measure a more complex construct that may not be directly observable. When psychometrically validated, such measures may better assess the multiple factors contributing to adherence/non-adherence. This study aimed to develop and psychometrically evaluate tools to screen and monitor trial participants’ adherence to HIV prevention products within the context of clinical trial research. Methods and findings: Based on an extensive literature review and conceptual framework, we identified and refined 86 items assessing potential predictors of adherence and 48 items assessing adherence experience. A structured survey, including adherence items and other variables, was administered to former ASPIRE and Ring Study participants and similar non-trial participants (n = 709). We conducted exploratory factor analyses (EFA) to identify a reduced set of constructs and items that could be used at screening to predict potential adherence, and at follow-up to monitor and intervene on adherence. We examined associations with other variables to assess content and construct validity. The EFA of screener items resulted in a 6-factor solution with acceptable to very good internal reliability (α: .62-.84). Similar to our conceptual framework, factors represent trial-related commitment (Distrust of Research and Commitment to Research); alignment with trial requirements (Visit Adherence and Trial Incompatibility); Belief in Trial Benefits and Partner Disclosure. The EFA on monitoring items resulted in 4 Product-specific factors that represent Vaginal Ring Doubts, Vaginal Ring Benefits, Ring Removal, and Side Effects with good to very good internal reliability (α = .71-.82). Evidence of content and construct validity was found; relationship to social desirability bias was examined. Conclusions: These scales are easy and inexpensive to administer, available in several languages, and are applicable regardless of randomization. Once validated prospectively, they could (1) screen for propensity to adhere, (2) target adherence support/counselling, and (3) complement biomarker measures in determining true efficacy of the experimental product. [ABSTRACT FROM AUTHOR]

We demonstrate that a combination of Noggin, Dickkopf-1, Insulin Growth Factor 1 and basic Fibroblast Growth Factor, promotes the differentiation of human pluripotent stem cells into retinal pigment epithelium (RPE) cells. We describe an efficient one-step approach that allows the generation of RPE cells from both human embryonic stem cells and human induced pluripotent stem cells within 40-60 days without the need for manual excision, floating aggregates or imbedded cysts. Compared to methods that rely on spontaneous differentiation, our protocol results in faster differentiation into RPE cells. This pro-retinal culture medium promotes the growth of functional RPE cells that exhibit key characteristics of the RPE including pigmentation, polygonal morphology, expression of mature RPE markers, electrophysiological membrane potential and the ability to phagocytose photoreceptor outer segments. This protocol can be adapted for feeder, feeder-free and serum-free conditions. This method thereby provides a rapid and simplified production of RPE cells for downstream applications such as disease modelling and drug screening. [ABSTRACT FROM AUTHOR]

The interaction between gut bacterial and viral microbiota is thought to be important in human health. While fluctuations in female genital tract (FGT) bacterial microbiota similarly determine sexual health, little is known about the presence, persistence, and function of vaginal bacteriophages. We conducted shotgun metagenome sequencing of cervicovaginal samples from South African adolescents collected longitudinally, who received no antibiotics. We annotated viral reads and circular bacteriophages, identified CRISPR loci and putative prophages, and assessed their diversity, persistence, and associations with bacterial microbiota composition. Siphoviridae was the most prevalent bacteriophage family, followed by Myoviridae, Podoviridae, Herelleviridae, and Inoviridae. Full-length siphoviruses targeting bacterial vaginosis (BV)-associated bacteria were identified, suggesting their presence in vivo. CRISPR loci and prophage-like elements were common, and genomic analysis suggested higher diversity among Gardnerella than Lactobacillus prophages. We found that some prophages were highly persistent within participants, and identical prophages were present in cervicovaginal secretions of multiple participants, suggesting that prophages, and thus bacterial strains, are shared between adolescents. The number of CRISPR loci and prophages were associated with vaginal microbiota stability and absence of BV. Our analysis suggests that (pro)phages are common in the FGT and vaginal bacteria and (pro)phages may interact. [ABSTRACT FROM AUTHOR]

Background: Lived experience research is conducted by people who have experience of mental health issues and is therefore better placed than more traditional research to illuminate participants' experiences. Findings that focus on identifying enablers of recovery from a lived experience perspective have the potential to assist people in their recovery process. However, this lived experience research is often difficult to find, access and interpret. We co-produced user-friendly and engaging resources to disseminate findings from six lived experience research studies. This paper seeks to answer the research questions: a) Did exposure to lived experience research increase hopefulness for participants?; and b) How else did interacting with lived experience research resources influence participants' lives? Methods: Thirty-eight participants were introduced to four resources of their choosing by peer workers over a four-week period. The helpfulness of resources was evaluated using mixed methods, including a quasi-experimental analysis of change in hope, an anonymous survey and in-depth interviews. Results: Findings indicated that the resources promoted hope, but that increases in hopefulness may not be seen immediately. Other impacts include that the resources: encouraged helpful activities; provided a positive experience; increased valued knowledge; encouraged people to reflect on their journey and think constructively about mental health issues; helped people to feel less alone; and assisted people to explain their situation to others. Conclusions: The research suggests the potential usefulness of lived experience research resources, presented in user-friendly formats, in the lives of people who experience mental health issues and implies a need to nurture this type of research. [ABSTRACT FROM AUTHOR]