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ObjectivesTo synthesise evidence on user experience of medical abortion at homeTo develop a realist programme theory to explain what interventions improve user experience for whom and in what context.To use this programme theory to develop recommendations for service providers and those having medical abortions at homeBackgroundChanges in the therapeutic, technological and regulatory landscape are increasing access to medical abortion at home. This intervention is safe, effective and acceptable to most. Clinical pathways and user experience are nevertheless variable and a minority would not choose this method again. We synthesised evidence to inform service development and responsiveness for different people and contexts.MethodsWe used a realist approach to literature review that starts from an initial programme theory and generates causal explanations in the form of context-mechanism-outcome configurations to test and develop that theory. We searched the literature 01/01/2000 - 09/12/2022 using broad search terms and then selected papers for their relevance to theory development in contexts relevant to service development in the UJ. Data were analysed using a realist approach to analysis to develop causal explanations.ResultsOur searches identified 12,517 potentially relevant abstracts with 835 selected for the full text assessment and 49 papers included in the final review. Our synthesis suggests that having a choice of abortion location remains essential as some people are unable to have a medical abortion at home. Choice of place of abortion (home or clinical setting) was influenced by service factors (number, timing and wait for appointments), personal responsibilities (caring/work commitments), geography (travel time/distance), relationships (need for secrecy) and wish to be aware of/involved in the process. We found that the option for self-referral through a telemedicine consultation, realistic information on range of experiences, opportunities to personalise the process, improved pain relief and choice of when and how to discuss contraception could improve experience.DiscussionAcknowledging the work done by patients when moving an intervention from clinic to home is important. This includes preparing a space, managing privacy, managing work/caring obligations, deciding when/how to take medications, understanding what is normal, assessing experience and deciding when and how to ask for help. Strategies that reduce surprise or anxiety and enable preparation and a sense of control support the transition of this complex intervention outside healthcare environments.Strenghts and limitations–Strengths: systematic and transparent approach to the realist review, which was conducted in accordance with the RAMSES standards (27); Authorship team represents a variety of clinical and academic backgrounds–Limitations: analysis on publicly accessible literature, located through recognised research databases and Google; there were gaps in the evidence that we found and we have highlighted these in our conclusions.

Background: \ud The need to engage boys in gender-transformative relationships and sexuality education (RSE) to reduce adolescent pregnancy is endorsed by WHO. We aimed to test an intervention which used a gender-transformative approach to engage adolescents in RSE to prevent unprotected sex.\ud \ud Methods: \ud This cluster-randomised trial with process and economic evaluations tested a school-based intervention entitled If I Were Jack versus standard RSE (control) for students (aged 14–15 years) in UK schools. Schools were randomly allocated (1:1) and masked to allocation at baseline. The primary outcome was self-reported avoidance of unprotected sex (sexual abstinence or use of reliable contraception at last sex) after 12–14-months. We analysed the data using intention-to-treat mixed effects regression models.\ud \ud Findings: \ud Of 803 schools assessed for eligibility, 263 schools were invited by letter, of which 66 schools agreed to be randomly assigned, of which 62 schools completed follow-up. The trial was done between Feb 1, 2018, and March 6, 2020. 8216 students participated at baseline in 2018; 6561 (79·85%) provided 12–14 months follow-up. There was no significant difference in the primary outcome of avoidance of unprotected sex: 2648 (86·62) of 3057 in the intervention group avoided unprotected sex versus 2768 (86·41%) of 3203 in the control group (adjusted odds ratio [aOR] 0·85 [95% CI 0·58–1·26], p=0·42). Exploratory post-hoc analysis of the two components of the primary outcome showed that significantly more intervention students used reliable contraception at last sex compared with control students and there was no significant difference between the groups for sexual abstinence. No adverse events were reported.\ud \ud Interpretation: \ud The intervention had a null effect on the primary outcome of preventing unprotected sex (increasing sexual abstinence or use of reliable contraception) in the whole student population. However, the results showed significant increases in use of reliable contraceptives for sexually active students. Engaging all young people early through RSE is important so that as they become sexually active, rates of unprotected sex are reduced.\ud \ud Funding: \ud National Institute for Health Research.

Objective The objective of this review is to identify and understand how a family support role has been delivered in rapid response teams in hospital settings. Introduction A family support role in a hospital rapid response team is a designated position that is responsible for supporting the family members of people being medically attended to during a hospital rapid response. Support may include the provision of guidance to the family regarding a hospital procedure, support whilst witnessing the rapid response, or assisting the family to process their emotional response. This review will assist in identifying the ways in which the family support role is delivered in rapid response teams within a hospital environment. Inclusion criteria Family support must be delivered by a person who has a designated family support role within a rapid response team in a hospital setting. Studies will not be limited to geographical location, gender, or culture. Studies are not limited to year of publication or methodological design. Methods Databases will include MEDLINE (Ovid), Embase (Ovid), CINAHL, and Cochrane. Gray literature will be searched with predetermined search criteria. Two independent authors will be used to screen articles and perform data extraction on a predetermined data extraction form. A narrative Summary of Findings is planned, alongside a presentation of the data in diagrammatic or tabular form.

We synthesised views and experiences of three teams (student mentees, alumni mentors, and staff) in our pilot mentorship scheme within a distance learning MSc, evaluated the scheme, and developed a conceptual model of “triadic partnerships.” Thematic analysis of our qualitative data revealed a strong consensus across all teams. The triadic partnerships were reported to help reduce the feeling of “distance” in distance learning. Through developing triadic partnerships, our mentorship scheme provided added value beyond that offered previously by staff alone: credible and relatable authenticity within supportive mentoring by alumni. Since the scheme’s launch, student engagement has increased, with high levels of reported satisfaction and positive feedback and greater confidence among all teams. Our research connects the framework developed by Healey et al. (2014, 2016) to the literature on mentoring, offering a conceptual model on triadic partnerships. We encourage readers to consider the different relationships within multidimensional student partnerships in their own contexts.

Although water-borne viruses have important implications for the health of humans and other animals, little is known about the impact of human land-use on viral diversity and evolution in water systems such as rivers. We used metagenomic next-generation sequencing to compare the diversity and abundance of viruses at sampling sites along a single river in New Zealand that differed in human land use impact, ranging from pristine to urban. From this we identified 504 putative virus species, of which 97% were novel. Many of the novel viruses were highly divergent, and likely included a new subfamily within the Parvoviridae. We identified at least 63 virus species that may infect vertebrates – most likely fish and water birds – from the Astroviridae, Birnaviridae, Parvoviridae and Picornaviridae. No putative human viruses were detected. Importantly, we observed differences in the composition of viral communities at sites impacted by human land-use (farming and urban) compared to native forest sites (pristine). At the viral species level, the urban sites had higher diversity (327 virus species) than the farming (n=150) and pristine sites (n=119), and more viruses were shared between the urban and farming sites (n=76) than between the pristine and farming or urban sites (n=24). The two farming sites had a lower viral abundance across all host types, while the pristine sites had a higher abundance of viruses associated with animals, plants and fungi. We also identified viruses linked to agriculture and human impact at the river sampling sites in farming and urban areas that were not present at the native forest sites. Overall, our study shows that human land-use can impact viral communities in rivers, such that further work is needed to reduce the impact of intensive farming and urbanization on water systems.

ObjectiveTo inform UK service development to support medical abortion at home, appropriate for person and context.DesignRealist reviewSetting/participantsPeer-reviewed literature from 1 January 2000 to 9 December 2021, describing interventions or models of home abortion care. Participants included people seeking or having had an abortion.InterventionsInterventions and new models of abortion care relevant to the UK.Outcome measuresCausal explanations, in the form of context-mechanism-outcome configurations, to test and develop our realist programme theory.ResultsWe identified 12 401 abstracts, selecting 944 for full text assessment. Our final review included 50 papers. Medical abortion at home is safe, effective and acceptable to most, but clinical pathways and user experience are variable and a minority would not choose this method again. Having a choice of abortion location remains essential, as some people are unable to have a medical abortion at home. Choice of place of abortion (home or clinical setting) was influenced by service factors (appointment number, timing and wait-times), personal responsibilities (caring/work commitments), geography (travel time/distance), relationships (need for secrecy) and desire for awareness/involvement in the process. We found experiences could be improved by offering: an option for self-referral through a telemedicine consultation, realistic information on a range of experiences, opportunities to personalise the process, improved pain relief, and choice of when and how to discuss contraception.ConclusionsAcknowledging the work done by patients when moving medical abortion care from clinic to home is important. Patients may benefit from support to: prepare a space, manage privacy and work/caring obligations, decide when/how to take medications, understand what is normal, assess experience and decide when and how to ask for help. The transition of this complex intervention when delivered outside healthcare environments could be supported by strategies that reduce surprise or anxiety, enabling preparation and a sense of control.

The number of health care mobile applications (MAs) has increased drastically in recent years, but research on efficacy and approaches to provide MA intervention is lacking. The PTSD Coach was designed to help individuals with posttraumatic stress disorder (PTSD) symptoms to understand and manage symptoms. Use of MA tends to drop off quickly; this pilot study tested the use of the PTSD Coach with brief telephone support by paraprofessionals. A total of 29 participants with elevated PTSD symptoms recruited from Veterans Affairs primary care clinics completed baseline and 4-month follow-up surveys including the PTSD Checklist, Patient Health Questionnaire for depressive symptoms, and Quality of Life Enjoyment and Satisfaction Questionnaire. Participants received PTSD Coach MA intervention plus paraprofessional brief telephone support reported the phone support was helpful and greater than 70% of participants maintained use of the MA throughout the 3-month intervention period. Results indicated that participants showed significant improvement on PTSD reexperiencing symptoms, depressive symptoms, and quality of life after intervention. The PTSD Coach MA plus brief telephone support is a promising approach for primary care patients managing psychiatric symptoms. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Introduction Teenage pregnancy remains a worldwide health concern which is an outcome of, and contributor to, health inequalities. The need for gender-aware interventions with a focus on males in addressing teenage pregnancy has been highlighted as a global health need by WHO and identified in systematic reviews of (relationship and sexuality education (RSE)). This study aims to test the effectiveness of an interactive film-based RSE intervention, which draws explicit attention to the role of males in preventing an unintended pregnancy by reducing unprotected heterosexual teenage sex among males and females under age 16 years. Methods and analysis A phase III cluster randomised trial with embedded process and economic evaluations. If I Were Jack encompasses a culturally sensitive interactive film, classroom materials, a teacher-trainer session and parent animations and will be delivered to replace some of the usual RSE for the target age group in schools in the intervention group. Schools in the control group will not receive the intervention and will continue with usual RSE. Participants will not be blinded to allocation. Schools are the unit of randomisation stratified per country and socioeconomic status. We aim to recruit 66 UK schools (24 in Northern Ireland; 14 in each of England, Scotland and Wales), including approximately 7900 pupils. A questionnaire will be administered at baseline and at 12–14 months postintervention. The primary outcome is reported unprotected sex, a surrogate measure associated with unintended teenage pregnancy. Secondary outcomes include knowledge, attitudes, skills and intentions relating to avoiding teenage pregnancy in addition to frequency of engagement in sexual intercourse, contraception use and diagnosis of sexually transmitted infections. Ethics and dissemination Ethical approval was obtained from Queen’s University Belfast. Results will be published in peer-reviewed journals and disseminated to stakeholders. Funding is from the National Institute for Health Research. Trial registration number ISRCTN99459996

Introduction Teenage pregnancy remains a worldwide health concern which is an outcome of, and contributor to, health inequalities. The need for gender-sensitive interventions with a focus on males in addressing teenage pregnancy has been highlighted as a global health need by the World Health Organisation and identified in systematic reviews of relationship and sexuality education (RSE). This study aims to test the effectiveness of an interactive film-based RSE intervention which draws explicit attention to the role of males in preventing an unintended pregnancy by reducing unprotected heterosexual teenage sex among males and females under age 16 years. Methods and analysis A Phase III effectiveness cluster randomised trial with embedded process and economic evaluations. If I Were Jack encompasses a culturally sensitive interactive film, classroom materials, a teacher-trainer session and parent animations, and will supplement usual RSE for the target age group in schools in the intervention group. Schools in the control group will not receive the intervention and will continue with usual RSE. Participants will not be blinded to allocation. Schools are the unit of randomisation stratified per country and socio-economic status. We aim to recruit 66 UK schools (24 in Northern Ireland; 14 in each of England, Scotland and Wales) and approximately 7900 pupils. A questionnaire will be administered at baseline and at 12-14 months post-intervention. The primary outcome is reported unprotected sex, a surrogate measure associated with unintended teenage pregnancy. Secondary outcomes include knowledge, attitudes, skills and intentions relating to avoiding teenage pregnancy in addition to frequency of engagement in sexual intercourse, contraception use, and diagnosis of sexually transmitted infections. Ethics and dissemination Ethical approval was obtained from Queen’s University Belfast. Results will be published in peer-reviewed journals and disseminated to stakeholders. Funding is from the National Institute for Health Research.Trial registration ISRCTN: 99459996; Pre-resultsSTRENGTHS AND LIMITATIONS OF THIS STUDY • The study is evaluating the first RSE intervention to be developed and trialled which explicitly promotes a gender-sensitive approach to addressing teenage pregnancy by focussing on male perspectives. • The intervention is culturally sensitive to different parts of the UK, non-directive in terms of pregnancy resolution options and sufficiently flexible to allow use within schools which vary in their personal development/RSE policy, including in faith-based schools.• It is the first RSE Intervention to be developed and trialled across all four nations of the UK, allowing for exploration of what works best where.• Due to the nature of the intervention and setting – within schools – participating teachers, pupils and parents cannot be blinded to allocation.• A biological measure of adolescent conception rates was not possible and hence we rely on a surrogate measure of incidence of unprotected sex.

Incorporating wavelength information into a monochrome image is of great interest for imaging spectroscopy. Here, we show that by exploiting the properties of multiple scattering materials, we can encode spectral information in a CMOS image, where the spectral resolution obtained is only limited by the scattering strength of the material. As a proof-of-concept, we demonstrate this technique using a thin multiple scattering layer of gallium phosphide nanowires and a microlens array. We achieve a spectral resolution of approximately 4 nm and a reconstructed image containing 64 pixels. We demonstrate that a computational technique which is commonly used in compressive sensing can be used to reconstruct both sparse and dense spectra, when undersampling and oversampling a signal, respectively. This method provides an ultra-compact solution to obtaining both spatial and spectral information in one measurement, for potential use in portable spectroscopy.

Imaging spectroscopy is of great importance for applications such as environmental sensing and astronomy observations. These devices rely on the acquisition and storage of vast amounts of spectral and spatial information. As experimental techniques are becoming more sophisticated, there is an increasing amount of data to collect and process. Here, we show that spectral information can be undersampled and fully reconstructed at nm resolution, with the aid of a multiple scattering material. We measure spectrally- and spatially-dependent speckle patterns, over a broad wavelength range, which are calibrated and stored in a spectral intensity transmission matrix. A compressive sensing technique is used to limit data collection at the acquisition stage during both the calibration and the reconstruction process. This enables fast reconstruction with minimal data storage needed, and offers a solution for light-weight, compact hyperspectral imaging systems.

This collection of audience responses aims to give a sense of what Kira O’Reilly’s work has left behind in the memories of the people who have watched, touched, and participated in her work, over the last 20+ years.

Encoding of spectral information onto monochrome imaging cameras is of interest for wavelength multiplexing and hyperspectral imaging applications. Here, the complex spatio-spectral response of a disordered material is used to demonstrate retrieval of a number of discrete wavelengths over a wide spectral range. Strong, diffuse light scattering in a semiconductor nanowire mat is used to achieve a highly compact spectrometer of micrometer thickness, transforming different wavelengths into distinct speckle patterns with nanometer sensitivity. Spatial multiplexing is achieved through the use of a microlens array, allowing simultaneous imaging of many speckles, ultimately limited by the size of the diffuse spot area. The performance of different information retrieval algorithms is compared. A compressive sensing algorithm exhibits efficient reconstruction capability in noisy environments and with only a few measurements.

We demonstrate the use of deep learning for fast spectral deconstruction of speckle patterns. The artificial neural network can be effectively trained using numerically constructed multispectral datasets taken from a measured spectral transmission matrix. Optimized neural networks trained on these datasets achieve reliable reconstruction of both discrete and continuous spectra from a monochromatic camera image. Deep learning is compared to analytical inversion methods as well as to a compressive sensing algorithm and shows favourable characteristics both in the oversampling and in the sparse undersampling (compressive) regimes. The deep learning approach offers significant advantages in robustness to drift or noise and in reconstruction speed. In a proof-of-principle demonstrator we achieve real time recovery of hyperspectral information using a multi-core, multi-mode fiber array as a random scattering medium., Comment: 12 pages, 6 figures + Appendix of 5 pages and 5 figures

As the first comprehensive study of Buddhism and law in Asia, this interdisciplinary volume challenges the concept of Buddhism as an apolitical religion without implications for law. Buddhism and Law draws on the expertise of the foremost scholars in Buddhist studies and in law to trace the legal aspects of the religion from the time of the Buddha to the present. In some cases, Buddhism provided the crucial architecture for legal ideologies and secular law codes, while in other cases it had to contend with a pre-existing legal system, to which it added a new layer of complexity. The wide-ranging studies in this book reveal a diversity of relationships between Buddhist monastic codes and secular legal systems in terms of substantive rules, factoring, and ritual practices. This volume will be an essential resource for all students and teachers in Buddhist studies, law and religion, and comparative law.

Purpose In communication disorders research, clinical groups are frequently described based on patterns of performance, but researchers often study only a few participants described by many quantitative and qualitative variables. These data are difficult to handle with standard inferential tools (e.g., analysis of variance or factor analysis) whose assumptions are unfit for these data. This article presents multiblock discriminant correspondence analysis (MUDICA), which is a recent method that can handle datasets not suited for standard inferential techniques. Method MUDICA is illustrated with clinical data examining conversational trouble-source repair and topic maintenance in dementia of the Alzheimer’s type (DAT). Seventeen DAT participant/spouse dyads (6 controls, 5 participants with early DAT, 6 participants with moderate DAT) produced spontaneous conversations analyzed for co-occurrence of trouble-source repair and topic maintenance variables. Results MUDICA found that trouble-source repair sequences and topic transitions are associated and that patterns of performance in the DAT groups differed significantly from those in the control group. Conclusion MUDICA is ideally suited to analyze language and discourse data in communication disorders because it (a) can identify and predict clinical group membership based on patterns of performance, (b) can accommodate few participants and many variables, (c) can be used with categorical data, and (d) adds the rigor of inferential statistics.