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This study proposes a novel concept for the automated and computerised segmentation of ultrasound images of bone based on motion information. Force is applied on the heel region using the ultrasound probe and then removed while recording the video of the bone using ultrasound. The interface between the bone and surrounding tissues is the region that moves with maximum speed. This concept is utilised to determine a map of movement, where speed is the criterion used for the bone segmentation from the surrounding tissues. To achieve that, the image is subdivided into regions of uniform sizes, followed by tracking individual regions in the successive frames of the video using an optical flow algorithm. The average movement speed is calculated for the regions. Then, the regions with the higher speed are identified as bone surfaces. It is given as the initial contour for the Chan-Vese algorithm to achieve smoother bone surfaces. Then, the final output from the Chan-Vese is post-processed using a boundary tracing algorithm to get the last automated bone segmented output. The segmented outcomes are compared against the manually segmented images from the experts to determine the accuracy. Bhattacharyya distances are used to calculate the accuracy of the algorithmic and manual output. The quantitative results from Bhattacharyya distances indicated an excellent overlap between algorithmic and manual works (average ± STDEV Bhattacharyya distance: 0.06285 ± 0.002051). The bone-segmented output from the optical flow algorithm is compared with the model output and the texture-based segmentation method's output. The work from the motion estimation methods has better segmentation accuracy than the model and texture segmentation methods. The results of this study suggest that this method is the first attempt to segment the heel bone from the ultrasound image using motion information., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Ethical approval: All methods were carried out in accordance with relevant guidelines and regulations. Ethical approval was secured from Staffordshire University Ethics committee, Stoke-on-Trent, England. All participants provided written informed consent before any data was collected., (© 2025. The Author(s).)

This study aimed to identify some of the reasons held by participants for either disclosing or concealing a sexual fantasy. Participants were asked to describe either how their partner responded to a disclosure or (for those reporting on an undisclosed sexual fantasy) how they anticipated that their partner was likely to respond. A mixed-methods approach was employed. Two hundred and eighty-seven participants were surveyed about their reasons for disclosing/concealing fantasies and either their actual or anticipated disclosure experiences. The majority of participants (69.3%) indicated having disclosed a sexual fantasy at some point in their relationship. Five categories of reasons for disclosing/not disclosing a sexual fantasy were generated through descriptive content analysis. These categories were sexual gratification , relationship-motivated , partner traits or characteristics , communication patterns , and specific fantasy content . Participant descriptions of their partner's response to the disclosure of their sexual fantasy were frequently coded as positive. For those describing how they believed their partner would be likely to respond to the disclosure of reported sexual fantasy, these anticipated responses were often coded as negative. The findings of the current study deepen our understanding of sexual fantasy disclosure and highlight some of the reasons held for either disclosing or concealing sexual fantasies. More widely, these findings may have implications for sex education, furthering our understanding of sexual dysfunction and sex/relationship therapy.

Aim: The paper explores the barriers and enablers for international nurses who are assimilating to new healthcare systems in the United Kingdom and implications for the global healthcare context., Background: The worldwide shortage of nurses has led to high levels of global mobility. It is therefore essential to acknowledge the international nature of healthcare and the diversity of experience within the nursing workforce. The paper reflects on the authors' experiences of designing and delivering acculturation and communication skills training for Internationally Educated Nurses (IENs) who work in the National Health Service in the United Kingdom., Discussion: The paper highlights the challenges of assimilating to a new healthcare environment, the importance of support and the value of 'two-way learning'. The author discusses the hidden processes of social and personal adjustment, which are not widely reported., Conclusion: Successful cultural integration should be multifaceted and include opportunities for two-way learning. Nurses require ongoing and directed support to deliver high-quality care in diverse and changing health systems., Implications for Nursing Policy: As healthcare in the UK is and continues to become increasingly international, the benefits and challenges this presents need to be acknowledged by both government and healthcare management in the form of policy recommendations, guidelines and regulatory frameworks which go beyond testing clinical and linguistic skills on arrival and aims to promote well-being, retention, and reduced stress at work., (© 2024 International Council of Nurses.)

Purpose: An increased prevalence of peripheral polyneuropathy (PN) in Parkinson's disease (PD) associated with greater functional impairment has previously been reported. A possible cause has been suggested as levodopa therapy. The aim of this real-world study was to assess the prevalence and the characteristics of PN in PD and to investigate the putative association between PN and oral levodopa., Methods: A cohort of 692 consecutive patients with idiopathic PD had routine clinical, laboratory, and lower limb clinical neurophysiology assessment when attending the certified tertiary Parkinson center, Schön Klinik Neustadt, Neustadt in Holstein, Germany, between 2016 and 2019. Patients were sent by general neurologists for the medication adjustment, physiotherapy, ergotherapy, and logopaedic treatment. A retrospective cross-sectional review of the data was performed., Findings: The mean age of the cohort was 72.6 (8.44) years (range, 44-90 years) and 60% were male. The age of the first PD manifestation was 65.22 (10.09) years (range, 31-88 years). Of 692 patients with PD, 507 (73.27%) had clinical signs of neuropathy and PN was first diagnosed 6.3 (5.7) years after the PD onset. Of these 507 patients, 446 (87.96%) underwent the electrophysiological investigations with PN confirmed in 396 patients (88.79% out of 446 electrophysiologically investigated patients with PD). Peripheral polyneuropathy was ruled out in 50 patients (11.21% of 446 electrophysiologically investigated patients with PD). The half of patients had moderate and severe sensory axonal PN (201 patients or 53.03% of all 396 with confirmed PN). The mean motor examination part of the Movement Disorders Society's Unified PD Rating Scale score in patients with PN was significantly higher (off, 30.48 [11.60] points; on, 19.92 [10.27] points), than in patients without PN (off, 27.17 [14.57] points; on, 17.14 [11.98] points), with P < 0.01 in the both off and on states. The mean levodopa daily dosage was similar in patients with PN and without PN (565 mg vs 556 mg, P = nonsignificant). No difference between other dopaminergic medication in PN and non-PN group was found., Implications: PN is highly prevalent in patients with PD. There was no association between oral levodopa or other dopaminergic medication and PN. More awareness of PN in PD clinics and further understanding of the pathophysiology, which leads to the development of an axonal polyneuropathy in PD, are required., Competing Interests: Declaration of competing interest None., (Copyright © 2024 Elsevier Inc. All rights reserved.)

Aims: To determine estimated costs to treat two hypothetical diabetes related foot ulcers of differing severity in different World Health Organization regions., Methods: Descriptions of two standardised diabetes related foot ulcers of differing severity were sent to foot teams. Each centre was sent a picture and description of the ulcers, and a series of potential interventions. Respondents were asked to estimate how much each intervention would cost in their centre, and how many times each would be required before the ulcer would heal. These estimated costs were converted to US dollars., Results: Responses were received from 51 centres. Estimated costs for treating each wound were highest in the North America and Caribbean region. The average estimated cost of treating the milder wound was $2,942, (range $79-$17,758). Relative costs compared to those of North America and the Caribbean ranged from 0.36 to 0.75. The average time needed to cover the estimated costs of treating the wound was 8.6 (0.3-62.3) months' salary. The average estimated cost of treating the more severe wound was $17,403, ($546-$67,178). Relative costs ranged from 0.06 to 0.69. The average time needed to cover the estimated costs of treating the wound was 22.7 (0.2-98.3) months' salary., Conclusions: The estimated costs of treating ulcers vary widely across the world., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2025 The Author(s). Published by Elsevier B.V. All rights reserved.)

Objectives: Haemodialysis extends life for people with end-stage kidney disease (ESKD) worldwide, but it imposes significant psychosocial burdens and there is little evidence about successful adjustment. This study aimed to improve understanding of successful psychosocial adjustment to in-centre haemodialysis (ICHD; dialysis in a hospital or satellite unit)., Methods: Individual semi-structured interviews were conducted with a purposive sample of 18 people with ESKD who had all received in-centre haemodialysis in the UK for at least 90 days in the last two years. An inductive thematic analysis was employed to identify themes from the verbatim interview transcripts., Results: There were four themes: 1) reaching a state of acceptance , which described the importance of accepting the necessity of dialysis; 2) taking an active role in treatment , which described how being actively involved in treatment gave participants greater feelings of autonomy and control; 3) utilising social support networks , which described the benefits of instrumental and emotional support; and 4) building emotional resilience , which described the importance of optimism and positivity., Conclusions: The themes demonstrated elements of successful adjustment that could be targeted by interventions to promote psychological flexibility and positive adjustment among people receiving in-centre haemodialysis worldwide.

Study Design: Retrospective cohort study., Objective: Tackling delayed diagnosis in degenerative cervical myelopathy (DCM) is a global research priority. On average, it takes 2-5 years, leading to worse outcomes from surgery and greater disability. Many countries in the UK use interface triage units run by specialist physiotherapists that sit between primary and secondary care termed musculoskeletal services. Their role in the efficient diagnosis of DCM is unknown. The aim of this study was to map the journey of the patient in the musculoskeletal service and to establish the presenting signs and symptoms., Methods: A retrospective review of 2.5 years of clinical notes was performed in a musculoskeletal service. Process mapping was utilised to visualise the patient's journey and identify delays to diagnosis and presenting signs and symptoms., Results: Twenty-seven cases were reviewed. Patients spent an average of three months in the service. There was a wide variety of presenting symptoms. DCM was more often suspected if patients had both upper limb symptoms and gait disturbance or pathological reflexes. Delays occurred when patients had no gait disturbance or a normal or incomplete neurological assessment. Longest delays occurred when patients received electrophysiology tests for differential diagnosis of peripheral neuropathies. Delays were also seen with incorrect triaging of MRI results., Conclusions: Where DCM is the principal differential diagnosis, diagnosis was faster. Incomplete examination, misinterpretation of MRI findings or delays in other investigations contributed to delays. Improved awareness and protocols of care within musculoskeletal services represent an opportunity to accelerate diagnosis in DCM., (© 2025 John Wiley & Sons Ltd.)

The impact of therapeutic interventions on red blood cell (RBC) deformability and microscale transport is investigated, using statins as an exemplar. Human RBCs were treated in vitro with two commonly prescribed statins, atorvastatin and rosuvastatin, at clinically relevant concentrations. Changes in RBC deformability were quantified using a microfluidic-based ektacytometer and expressed in terms of the elongation index. Dilute suspensions of the statin-treated RBCs were then perfused through a microfluidic pillar array, at a constant flow rate and negligible inertia, and imaged. Particle Tracking Velocimetry (PTV) was applied to track RBCs, identify preferential paths and estimate their velocities, whereas image processing was used to estimate cell dynamics, perfusion metrics and distributions. The findings were compared against those of healthy, untreated cells. Statins enhanced RBC deformability in agreement with literature. The extent of enhancement was found to be statin-dependent. The softer statin-treated cells were found to flow in straight, less tortuous paths, spend more time inside the pillar array and exhibit lower velocities compared to healthy RBCs, attributed to their enhanced deformation and longer shape recovery time upon impact with the array posts. The in vitro microfluidic approach demonstrated here may serve as a monitoring tool to personalise and maximise the outcome of a therapeutic treatment., Competing Interests: Declaration of competing interest The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Stavroula Balabani reports financial support was provided by UK Research and Innovation. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)

Objective: Assess the effectiveness of digital health interventions (DHIs) in reducing blood pressure (BP) among individuals with high blood pressure and identify the impact of age, sex, and phone-based delivery methods on BP., Methods: A systematic review and meta-analysis was undertaken according to the PRISMA and JBI. A comprehensive search was conducted across multiple databases. Randomised controlled trials (RCTs), mixed methods, descriptive, and experimental studies enrolling adult patients (≥18 years) with high BP and containing DHIs with blood pressure management aspect were included. We used a random-effects meta-analysis weighted mean difference (MD) between the comparison groups to pool data from the included studies. The outcome included the pooled MD reflecting systolic (SBP) or diastolic (DBP) change from baseline to 6-month period. Risk of bias was assessed using standardised tools., Results: Thirty-six studies with 33,826 participants were included in the systematic review. The pooled estimate (26 RCTs) showed a significant reduction in SBP (MD = -1.45 mmHg, 95 % CI: -2.18 to -0.71) but not in DBP (MD = -0.50 mmHg, 95 % CI: -1.03 to 0.03), with evidence of some heterogeneity. Subgroup analysis indicated that smartphone app interventions were more effective in lowering SBP than short message services (SMS) or mobile phone calls. Additionally, the interventions significantly reduced the SBP compared with the control, regardless of participant sex., Conclusion: Our findings indicate that DHIs, particularly smartphone apps, can lower SBP after 6 months in individuals with hypertension or high-risk factors, although changes might not be clinically significant. Further research is needed to understand the long-term impact and optimal implementation of DHIs for BP management across diverse populations., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

This ecumenical White Paper aims to clarify the profile of Christian healthcare chaplaincy in a context of rapidly changing healthcare systems. The increasing complexity and specialization of healthcare, the shift towards outpatient care, mounting economic pressures, the demographic and epidemiological transitions towards chronic and elderly care, and global health crises are profoundly transforming and challenging Christian healthcare chaplaincy. At the same time, the societal context of healthcare chaplaincy is also changing rapidly. While church resources and influence are declining, spiritual and religious diversification is on the rise. This paper engages with this rapid change as a moment of opportunity. It addresses the role of Christian healthcare chaplains in a time of change and clarifies their theological basis, their professional competencies, and the future of their education and training., Competing Interests: Declarations. Conflict of interest: The authors have no relevant financial or non-financial interests to disclose., (© 2025. The Author(s).)

Background: Globally, most people with head and neck cancers (HNCs) are diagnosed with advanced-stage disease. HNC diagnostic stage has multifactorial explanations, with the role of health system factors not yet fully investigated., Methods: HNC centres (n = 18) from the HEADSpAcE Consortium were surveyed via a bespoke health system questionnaire covering a range of factors. Centres were compared using the least square means for the presence/absence of each health system factor to their proportion of advanced-stage HNC., Results: Health system factors associated with lower proportion in advanced-stage diagnosis were formal referral triaging (14%, 95% CI-0.26, -0.03), routine monitoring of time from referral to diagnosis (16%, 95% CI-0.27, -0.05), and fully publicly funded systems (17%, 95% CI-0.29, -0.06). Several health systems factors had no routinely available data., Conclusions: Through identifying and monitoring health systems factors associated with lower proportions of advanced stage HNC, interventions could be developed, and systems redesigned, to improve early diagnosis., (© 2025 The Author(s). Head & Neck published by Wiley Periodicals LLC.)

This retrospective study, utilising prospectively collected data, investigates the use of spine ultrasound as an alternative method for assessing scoliosis, with the aim of reducing radiation exposure. We included 92 patients aged 10 to 16 years with suspected idiopathic scoliosis. Exclusion criteria were weight over 150 kg, metal implants, pre-existing conditions, secondary deformities, and cognitive impairments. Each patient underwent clinical assessment and full spine radiographs, followed by spine ultrasound using the Scolioscan® system. Unprocessed B-mode ultrasound images were analysed using automatic measurements. The correlation between Ultrasound Coronal Angle (UCA) and Radiographic Cobb Angle (RCA) was evaluated at initial and follow-up visits. Strong correlations were found between UCA and RCA, with correlation coefficients ranging from 0.786 to 0.903 (p < 0.001). The regression formula showed good predictive accuracy for curve progression on follow-up radiographs. The best results were observed in females and in primary thoracic curves (r = 0.936, p < 0.001). Although only four patients exhibited true progression (≥5° increase in Cobb angle), changes in scoliotic angles were effectively detected using ultrasound. This study confirms the feasibility of unprocessed spine ultrasound for scoliosis monitoring in clinical settings. Automatic measurements without 3D reconstruction make ultrasound a practical tool for tracking progression. The regression model shows potential for predicting curve progression, although further validation is needed. These findings suggest spine ultrasound could reduce the need for radiographs, benefiting patients by minimising radiation exposure while providing reliable monitoring of scoliosis progression and treatment outcomes.

Background: Scotland's National Oral Health Programme for Children, Childsmile, provides targeted home toothbrushing support for families of young children (0-3 years) in the home setting. The study describes the adaptation of an existing dental practice-based intervention from the Netherlands using pictorial cards (Uitblinkers) for use in the programme. The aims were to modify Uitblinkers for the setting and context in Scotland by: (1) identifying the barriers that parents/carers in need of extra support face in implementing supervised toothbrushing; (2) explore consensus about behaviour change techniques that are appropriate and valid to address these; and (3) making recommendations for the design of a co-produced home-support tool and identifying facilitators for implementation in practice., Methods: A modified Delphi study was carried out consisting of two survey rounds with a purposively recruited expert panel (n = 21) to develop consensus on home toothbrushing barriers (aim 1), behaviour change techniques (aim 2) and considerations for implementation (aim 3). Proposition statements for the Delphi were derived from literature, discussions with project advisors and from Uitblinkers, an existing behaviour change intervention for parents developed by the Academic Centre for Dentistry Amsterdam (ACTA) and delivered in dental practice. Then 12 in-depth, semi-structured interviews were conducted with Dental Health Support Workers in Scotland (delivering the home support toothbrushing intervention) to gather the views on the proposed toothbrushing barriers, behaviour change techniques and considerations for implementation (aim 1 to 3). Delphi results are presented descriptively in terms of percentage agreement and priority ratings. Interview transcripts were analysed using Template Analysis., Results: From the Delphi study, a final set of 11 overlapping child, parent and environmental/social toothbrushing barriers was agreed upon (aim 1), to be addressed through a tool based on applied Motivational Interviewing, and a combination of Operant Conditioning, Stimulus Control and Goal-Setting techniques (aim 2). Experts supported the tool as realistic for delivery in the home setting, provided staff were trained. A physical 'paper' tool was preferred to a proposed electronic version (aim 3). Themes from interviews were: (1) the barriers present an exhaustive set and are valid from staff experience with families; (2) Motivational interviewing is appropriate and fits with usual practice; (3) the included behaviour change techniques are workable; (4) the tool is generally feasible within the operation of Childsmile home visits; (5) the tool is not less applicable for children with additional support needs., Conclusions: A card-based conversational intervention to provide targeted home toothbrushing support for families of young children (0-3 years) in the home setting in Scotland, drawing from a template from the Netherlands, has been deemed worthy of further testing based on expert consensus and staff views on barriers faced, appropriate behaviour change techniques to address these and the design of a physical tool., (© 2025 The Author(s). Community Dentistry and Oral Epidemiology published by John Wiley & Sons Ltd.)

Aims: The associations of glucagon-like peptide-1 receptor agonists (GLP-1RAs) and outcomes among patients with obesity according to the presence of cardiovascular risk factors (metabolically healthy obesity (MHO) or metabolically unhealthy obesity (MUHO)) remain unclear. We examined the associations of GLP-1RAs with mortality and adverse cardiovascular events in patients with MHO and MUHO., Methods: The TriNetX network was utilized to select a cohort of patients with MHO or MUHO, and use or non-use of GLP-1RAs with propensity score matching (1:1). Cardiovascular events were identified during follow-up., Results: A total of 2 983 151 patients with obesity (512 434 with MHO and 2 470 717 with MUHO) were included in the study. Among these, 416 713 (13.9%) were GLP-1RA users. After propensity score matching, GLP-1RA use in MUHO was associated with a significantly lower risk of mortality (HR 0.580 [95% CI, 0.566-0.595]), ischemic stroke (HR 0.921 [0.890-0.953]), AF (HR 0.913 [0.888-0.938]) and hospitalization for HF (HR 0.925 [0.900-0.949]) during follow-up compared with non-use of GLP-1RA. Patients with MHO had a markedly lower risk of clinical events than those with MUHO. A trend towards a lower risk of cardiovascular events associated with GLP-1RA was seen among patients with MHO. There was no statistical interaction in the risk of cardiovascular outcomes with GLP-1RA use for MHO and MUHO patients., Conclusions: The use of GLP-1RAs was associated with lower rates of cardiovascular events than no use in patients with MUHO. Similar but non-statistically significant trends were seen in patients with MHO., (© 2025 John Wiley & Sons Ltd.)

Objective: Research is required to better understand the experience and effectiveness of dyadic developmental psychotherapy (DDP), a promising intervention developed to meet the complex needs of developmental trauma-experienced children in substitute care. DDP is a systemic intervention, within which the child's carer plays a significant role. Given their significant role and the lack of existing research, this study aimed to explore how foster carers experience DDP., Design: A qualitative design using semi-structured interviews with 10 foster carers was implemented., Method: Interviews conducted via Microsoft Teams and telephone were recorded, transcribed and analysed using interpretative phenomenological analysis., Results: Four group experiential themes and 11 subthemes were formed; 'from disbelief to clarity', 'scaffolded and safe', 'attuned and connected' and "It's worth it". From initial confusion and disappointment, came clarity of self-understanding and a more attuned, connected attachment relationship. DDP was experienced as both fulfilling and demanding., Conclusions: Though the need to explore DDP's effectiveness remains, this study suggests foster carers experience DDP as a demanding yet worthwhile intervention. Implications for practice, especially an increased need for relational safety and carer support are explored, as well as avenues for future research., (© 2025 The British Psychological Society.)

WHAT IS KNOWN ON THE SUBJECT?: Psychological formulation brings together a service user story and expertise, with psychological knowledge, research, and practitioners clinical experience to make sense of a service users' presentation (thinking about their difficulties but also strengths). Evidence into the effectiveness of formulation is largely anecdotal, qualitative, or small scale. Although this is very valuable research, there is not a lot of research which quantitatively evidences the role of formulation for service users or services. Quantitative evidence that does exist is also conflicting. Considering how widely psychological formulation is used, and the governing guidelines that recognize this as a core competency for psychological practitioners, it is important to continue to add to the evidence base. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Psychological formulation can increase staff empathy and hope. This could help service users to feel more understood and hopeful. Formulation; however, did not impact feelings of personal distress in staff. This research may suggest a need for the two distinct processes (i.e. team formulation and reflective practice) to support all components of empathy within inpatient services. Psychological formulation could support the provision of psychologically informed care within inpatient services, of which promotes effective care delivery., Abstract: OBJECTIVES: National Health Service (NHS) values, such as empathy and therapeutic optimism, are integral when supporting service users with complex mental health presentations. There is some evidence to suggest that psychological formulation can increase empathy and optimism in healthcare professionals. This study, therefore, aimed to investigate whether a psychological formulation of a hypothetical service user with a complex presentation, typically labelled with a diagnosis of borderline personality disorder (BPD), increased empathy and therapeutic optimism in professionals working in mental health inpatient services., Method: Sixty-six mental health professionals working in NHS inpatient services took part in a pre- and post-vignette study. Participants were asked to read a case vignette about a hypothetical service user, with a diagnostic label of BPD, and complete questionnaires capturing levels of empathy and therapeutic optimism. Participants were then randomized into two conditions and either asked to read the same information again (control condition) or read a psychological formulation based on the same hypothetical service user (intervention condition). The findings were analysed using a series of ANCOVAs/ANCOHETs., Results: Two constructs of empathy (i.e. perspective taking and empathic concern), and therapeutic optimism significantly increased following exposure to the psychological formulation when compared to the control group condition., Conclusion: This study warrants further replication. These initial findings; however, indicate that psychological formulation can significantly increase the ability to perspective take, display empathic concern, and hold therapeutic optimism towards service users with a presentation associated with a diagnosis of BPD., (© 2024 John Wiley & Sons Ltd.)

Resting energy expenditure (REE) and metabolic fuel utilization (carbohydrate or fat) proxied by respiratory quotient (RQ) from indirect calorimetry enables more precise measurement of energy needs and fat oxidation capacity. The study compared the effectiveness of providing energy expenditure information during diet and exercise weight intervention versus standard of care (SOC) on weight loss outcomes. Fifty-two participants with obesity were recruited from a specialist weight loss service, randomized 1:1 to intervention (INT) or SOC only. Participants in INT received four-weekly dietetic counselling, using biofeedback from energy expenditure data to recommend caloric restriction and physical activity goals, in addition to SOC. The primary outcome was the mean difference in weight loss between both groups after 24 weeks. Secondary outcomes include participant acceptability and tolerability using indirect calorimetry. Participants in the INT group demonstrated additional weight loss (-2.3 kg [95% CI: -3.1, -1.5]; p <.001), reduced waist circumference (-3.9 cm [95% CI: -5.48, -2.26]; p <.001), and decreased body fat percentage (-1.5% [95% CI:-2.31, -0.72], p <.001), compared to SOC, after adjusting for baseline body mass index, age, and sex. Forty-two percent (10/24) of participants in INT group achieved the minimum clinically significant threshold of 5% weight loss from baseline, compared to 8% (2/26) in the SOC group (p = .007). Participant acceptability and tolerability of indirect calorimetry were high, with mean scores of 4.5 ± 0.6 and 4.2 ± 0.7 (5-point Likert scale). The study establishes the safety and practical integration of biofeedback using indirect calorimetry promoting improved self-regulation and enhancing weight loss., (© 2024 The Author(s). Clinical Obesity published by John Wiley & Sons Ltd on behalf of World Obesity Federation.)

Background: The safety of vaginal breech birth is associated with the skill and experience of professionals in attendance, but minimal training opportunities exist. OptiBreech collaborative care is an evidence-based care bundle, based on previous research. This care pathway is designed to improve access to care and the safety of vaginal breech births, when they occur, through dedicated breech clinics and intrapartum support. This improved process also enhances professional training. Care coordination is accomplished in most cases by a key breech specialist midwife on the team. The goal of this qualitative inventory was to describe the roles and tasks undertaken by specialist midwives in the OptiBreech care implementation feasibility study., Methods: Semistructured interviews were conducted with OptiBreech team members (17 midwives and 4 obstetricians; N = 21), via video conferencing software. Template analysis was used to code, analyze, and interpret data relating to the roles of the midwives delivering breech services. Tasks identified through initial coding were organized into 5 key themes in a template, following reflective discussion at weekly staff meetings and stakeholder events. This template was then applied to all interviews to structure the analysis., Results: Breech specialist midwives functioned as change agents. In each setting, they fulfilled similar roles to support their teams, whether this role was formally recognized or not. We report an inventory of tasks performed by breech specialist midwives, organized into 5 themes: care coordination and planning, service development, clinical care delivery, education and training, and research., Discussion: Breech specialist midwives perform a consistent set of roles and responsibilities to co-ordinate care throughout the OptiBreech pathway. The inventory has been formally incorporated into the OptiBreech collaborative care logic model. This detailed description can be used by employers and professional organizations who wish to formalize similar roles to meet consistent standards and improve care., (© 2025 The Author(s). Journal of Midwifery & Women's Health published by Wiley Periodicals LLC on behalf of American College of Nurse Midwives (ACNM).)

Risky alcohol consumption behaviours remain commonplace, representing a major threat to health and safety, and are especially evidenced by young university students. Consequently, new interventions targeting this high-risk group are required. The current study investigated young male university students' experiences of a personalised, appearance-based, facial morphing, safer drinking intervention. Twenty-five male student participants were recruited, aged 18-34 years. Inductive thematic analysis of data gathered whilst participants were immersed in the intervention, and thereby exposed to alcohol-aged images of their own faces, produced four primary themes: alcohol as a threat to appearance and health, motivations to protect appearance, motivational aspects of the intervention, and proposed improvements and applications. The results of the current study suggested that participants expressed intentions towards healthier consumption/maintenance of already non-risky intake, supporting the potential of the facial-morphing appearance-based approach to address risky alcohol consumption, even in high-risk groups., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: Within paramedic education immersive simulation is widely used to teach technical skills, but its application to non-technical aspects of practice, such as research skills, is limited. This study aimed to explore immersive simulation as a tool to teach specific research skills to paramedic students in higher education to investigate its novel capacity beyond the more traditionally considered technical elements of practice., Methods: A didactic pre-briefing was delivered to undergraduate paramedic students before they undertook an immersive simulation in which they were expected to assess, extricate, and treat a stroke patient, whilst also assessing whether he was suitable to be enrolled onto a clinical trial, provide information on this, and take consent. A large-scale immersive environment furnished with surround audio-visual display equipment was utilized; the environment also contained an ambulance, a hatchback car, and two actors. After the simulation and debriefing, students completed an online questionnaire comprising open-ended questions and the following scales: Simulation Design Scale (fidelity subscale only), Simulation Effectiveness Tool - Modified, and Satisfaction with Simulation Experience. Data were analyzed using descriptive statistics and a manifest qualitative content analysis., Results: Data were collected from twenty-eight undergraduate paramedic students. Most students believed simulation fidelity was important (89.3%) and most agreed that the simulation was realistic (82.1%). Pre - briefing (100%) and debriefing (85.7%) opportunities were considered important for increasing student's confidence and learning, and, overall, students enjoyed the simulation (89.3%). Three themes emerged during the qualitative analysis: the significance of an immersive "real" environment, enjoyment as important for engagement and learning, and improved confidence via opportunities for autonomous practice., Conclusions: Immersive simulation is a valuable pedagogical tool for the delivery of research skills teaching. These findings align with previous research which has investigated immersive simulation for teaching clinical skills, but more broadly, also highlight the compounding positive impact of immersive technology when deployed alongside actors and high-fidelity equipment.

Our knowledge of the psychosocial implications of skin conditions continues to broaden, as research identifies multiple psychological morbidities relating to psoriasis, eczema and acne. This includes findings of poor body image, as a result of the change in physical appearance to the skin. However, there is limited qualitative research in the UK that explores how young women with skin conditions experience unique psychosocial impacts, including body image issues. The present study explored the experiences of seven young women with psoriasis, eczema and acne. Four main themes were developed: Embarrassment over appearance related symptoms; An unrealistic female beauty standard; Change in appearance attacking personal identity; and Lack of support. The implications of these findings are discussed, including a call for a biopsychosocial approach to skin condition treatment, that prioritises the psychological and social well being of young female skin condition patients, as well as their physical health., Competing Interests: Declaration of conflicting interestsThe authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Fibromyalgia syndrome (FMS) presents a complex and challenging disorder in both the diagnosis and treatment, with emerging evidence suggesting a role of small fibre pathology (SFP) in its pathophysiology. The significance of the role of SFP in FMS remains unclear; however, recent evidence suggests degeneration and dysfunction of the peripheral nervous system, particularly small unmyelinated fibres, which may influence pathophysiology and underlying phenotype. Both skin biopsy and corneal confocal microscopy (CCM) have consistently demonstrated that ~ 50% of people with FMS have SFP. CCM, a non-invasive measure of small nerve fibres has detected small fibre loss, correlating with neuropathic pain descriptors. Additionally, quantitative sensory testing has shown abnormalities, primarily in pain pressure/mechanical pain thresholds. This narrative review provides a comprehensive understanding of the pathophysiological dimensions of FMS with a clear focus on small nerve fibres and the peripheral nervous system, offering a roadmap for future research., Competing Interests: Declarations. Conflict of interest: Anne Marshall, Mohamed Elshafei, Frank G Preston, Jamie Burgess, Nicola Goodson, Nicholas Fallon, Bernhard Frank, Sizheng Steven Zhao declare no relevant conflicts of interest. Uazman Alam has no relevant conflicts of interests pertaining to this manuscript but  declares that he has received honoraria from Viatris, Grünenthal, Eli Lilly, Procter & Gamble for educational meetings and has received investigator-led funding form Proctor & Gamble. Uazman Alam has also received sponsorship to attend educational meetings from Daiichi Sankyo and Sanofi. Ethical approval: This article is based on previously conducted studies and does not contain any new studies with human participants or animals performed by any of the authors., (© 2025. The Author(s).)

There is increasing recognition of the need to address the diverse experiences of individuals subjected to medically unnecessary, non-voluntary genital cutting in childhood. This includes children with intersex traits undergoing 'normalisation' surgeries and those with anatomically normative genitalia, such as female genital cutting or male circumcision. While most research on non-therapeutic childhood penile circumcision centres on the physical risks and benefits, far less attention has been given to the potential long-term mental health impacts, particularly from a psychotherapeutic perspective. This article adds to the existing literature by amplifying the voices of individuals who feel silenced. It presents a qualitative analysis of five interviews with men who believe their childhood circumcision negatively impacted their mental health. The analysis identifies three super-ordinate themes, highlighting the need for grief and trauma work to process unresolved psychological distress. However, the study acknowledges that these experiences may not reflect those of the broader circumcised population. Finally, the research underscores the importance of counselling professionals being adequately informed to support individuals reporting circumcision-related mental health challenges, and offers recommendations for effective therapeutic interventions aligned with existing theories of grief, trauma, and attachment.

Background: Autism spectrum disorder poses challenges in social communication and behavior, while Intellectual disabilities are characterized by deficits in cognitive, social, and adaptive skills, frequently accompanied by stereotypies and challenging behaviors. Despite the progress made in autism spectrum disorder research, there is often a lack of research focusing on individuals with co-occurring autism spectrum disorder and intellectual disability. Robot-assisted autism therapies are effective in addressing these needs. However, there is a lack of consensus on the optimal number of therapy sessions required for effective outcomes, particularly in children with comorbid autism and intellectual disability., Objectives: This study aims to investigate the optimal number of therapy sessions required for effective outcomes in robot-assisted autism therapy, specifically focusing on children with comorbid autism and intellectual disability. Gaze analysis metrics, including the average number of eye contact and average inter-eye contact delay, are utilized to assess therapy effectiveness., Methods: This study integrates gaze analysis focusing on the average number of eye contact and average inter-eye contact delay as performance metrics. A pilot investigation was conducted to explore the critical temporal window for optimal trial count in robot-assisted autism therapy for children with autism. A mathematical model was introduced and validated for eight children with autism spectrum disorder, encompassing 56 experiments conducted over 7 weeks (one trial per week). Robots presented 8 cues in 3 categories (visual, speech, motion) with 16 cues per trial., Results and Conclusions: The results, validated using single-sample Wilcoxon signed-rank tests, revealed that the unsaturated state, with a median score of 3.44, exhibited significantly lower average inter-eye contact delay (p-value = 0.014, r = 0.86) and significantly higher average number of eye contact (p-value = 0.014, r = 0.87) compared to the hypothesized medians. These findings suggest that the unsaturated state occurring in the critical temporal window has significantly higher average number of eye contact and lower average inter-eye contact delay compared to the saturated state. This study underscores the importance of tailored and targeted interventions for children with autism spectrum disorder, facilitating the development of cost-effective, time-efficient, evidence-based treatments., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.