Social psychological research has shown how far-right leaders mobilize people by claiming that majority populations are threatened or silenced. This paper builds on this work to examine a related process in naturalistic interactions: how riotous actions are explained and justified through appeals to 'British values' in online forums. Using discursive psychology, we analyse talk surrounding the riots that followed the stabbing of three young girls in Southport, England-the UK race riots of August 2024. We show that invoking British or English values serves two key functions: it renders rioters' actions self-explanatory and offers a competing account of rioters as the more authentic representation of Britishness and the British people than the government. This reframing of 'British values' offers up a challenge to those attributing riots to 'far right' motivations and instead portrays the riots as effortful and even ideal expressions of British citizenship. Thus, British values operate not merely as symbols but as rhetorical tools that can sanitize the 'far-right' label linking the riots, immigration, state policy and national identity.
This paper details the design and development of a discipline-specific English for Academic Purposes (EAP) syllabus for undergraduate students majoring in architecture and design related disciplines in an art school in China. Guided by the comprehensive needs analysis model established by Dudley-Evans and St. John [Developments in English for specific purposes: a multi-disciplinary approach. Cambridge University Press (1998)] and Swales [Genre analysis: English in academic and research settings. Cambridge University Press (1990)] genre theory, this study employed a university-wide questionnaire to gather data from 650 participants, including students and faculty. The needs analysis identified a critical disparity between students' target academic aspirations-such as engaging in international collaboration, pursuing studies abroad, and understanding foreign lectures-and their present situational capabilities, particularly in listening comprehension and command of disciplinary vocabulary. In response to these findings, the proposed "Architectural Art English" syllabus is constructed around a genre-based, content and language integrated learning (CLIL) as well as task-based language teaching (TBLT) approach. It systematically incorporates seven key academic and professional genres relevant to the field: textbooks and monographs, research papers, case studies, and lecture scripts as input genres; and design statements, presentation scripts, and research abstracts as output genres. Each instructional unit is organized around a central architectural theme, utilizing authentic cases and genre analysis of move structures to make disciplinary discourse conventions explicit. The pedagogical framework emphasizes task-based learning, featuring authentic activities such as case analysis, design project presentations, and paper abstract writing to bridge the gap between language skills and disciplinary knowledge. This syllabus aims to addresses the complex interaction of learners' target needs, subjective wants, and current proficiencies, facilitating their active participation in the global academic community of architecture and design.
During early vocabulary growth, infants use single words to express complete ideas. Requests ("milk") and protests ("no!") are fundamental ways that infants communicate their needs. However, understanding what an infant wants from a single word can be challenging. Caregivers likely rely on infants' gestures and actions to interpret single-word utterances. How common are requests and protests during everyday activities? To what extent do infants accompany their requests and protests with gestures (e.g., points to request) and/or actions (e.g., flailing arms to protest)? Are caregivers more likely to respond to such "multimodal" requests and protests than to infants' words alone (i.e., unimodal speech)? We observed 31 toddlers (12-24 months) with their mothers during everyday interactions at home. In aggregate, infants expressed 2580 single-word utterances, with nearly half being requests (35%) or protests (8%). Most requests and protests (84%) were multimodal, occurring in the context of actions (mostly) or gestures. Unexpectedly, although infants' gestures/actions often "aligned" with their words in meaning or intent (e.g., saying "no" while pushing a toy away), infants also displayed "misaligned" gestures/actions (e.g., saying "no" to one toy while reaching for another). In particular, infants' aligned' multimodal requests and protests were more likely to elicit a response from mothers than were their words alone. Findings underscore the embodied and embedded nature of early communication in the natural home setting: Infants express their intentions by coupling words with gestures/actions, and certain types of multimodal communications are more effective than others in fulfilling their goals.
Severe combined immunodeficiency is an inherited condition arising from mutations in at least 19 known genes. Severe combined immunodeficiency can be identified through screening, family history or clinical presentation. Severe combined immunodeficiency is usually asymptomatic at birth and presents, in infancy, as recurrent and frequently severe infections. Without treatment, severe combined immunodeficiency is usually fatal in the first year of life. To summarise the available evidence relevant to newborn screening for severe combined immunodeficiency in the UK NHS newborn blood spot screening programme. Three research questions, concerning the accuracy of screening tests, the efficacy of early treatment and the acceptability of screening, were developed to address this objective. Eleven bibliographic databases were searched for relevant studies from 2011 to April 2024. Separate inclusion criteria were specified for each research question. Study selection, data extraction and assessment of methodological quality followed standard systematic review methods. A narrative synthesis of results is presented, structured by research question. No meta-analyses were conducted. Most positive predictive values, calculated from reports of newborn blood spot screening programme experience, were between 3.6% and 26%. Screening algorithms incorporating repeat sampling in preterm babies appeared to reduce false positives due to prematurity. However, the large number of other conditions that can give rise to a positive screening result mean that the positive predictive value for severe combined immunodeficiency remains consistently poor. Two small studies reported that early diagnosis of severe combined immunodeficiency, via newborn blood spot screening or family history and following the introduction of newborn blood spot screening, respectively, was associated with non-statistically significant improvements in post-transplant survival. A third study analysed data on n = 902 United States patients with severe combined immunodeficiency collected over a 28-year period and reported the results of multivariable Cox regression analyses, adjusted for demographic disease-related and transplant-related variables found to be significant on univariate analysis, showing that diagnosis of severe combined immunodeficiency via newborn blood spot screening significantly improved survival compared to diagnosis via clinical presentation. Qualitative data from the publications included in this evidence summary were generally indicative of parental support for newborn blood spot screening for severe combined immunodeficiency, but was mainly derived from parents of healthy newborns. The systematic review component of this evidence summary was limited by a restriction to full publications in the English language. The current published evidence base alone is not adequate to fully support implementation of newborn blood spot screening for severe combined immunodeficiency. With respect to UK National Screening Committee population screening criteria, criterion 4 was partially met and there was insufficient evidence to adequately assess whether criterion 6 was met. The findings of this evidence summary should be considered alongside findings from the recent in-service evaluation of newborn screening for severe combined immunodeficiency conducted in the NHS in England and the results of cost-effectiveness modelling. Further work is needed to inform policy on how the identification of non-severe combined immunodeficiency T-cell lymphopenia conditions by screening should be treated. Stakeholder dialogue and patient and public involvement activities may be helpful. In particular, the views of parents who have lived experience of a non-severe combined immunodeficiency (incidental) finding from newborn blood spot screening for severe combined immunodeficiency should be sought. This study is registered as PROSPERO CRD42024544200. This award was funded by the National Institute for Health and Care Research (NIHR) Evidence Synthesis programme (NIHR award ref: NIHR168307) and is published in full in Health Technology Assessment; Vol. 30, No. 45. See the NIHR Funding and Awards website for further award information. The UK National Screening Committee wants to know if screening all newborn babies for severe combined immunodeficiency would help babies and their families. Severe combined immunodeficiency is a rare, inherited condition that results in low numbers of white blood cells and prevents the body from fighting infection properly. There are usually no symptoms of severe combined immunodeficiency when an affected baby is born; however, a diagnosis of severe combined immunodeficiency is considered an emergency because the condition usually results in death in the first year, unless the child receives treatment. There is a test that can be used to screen for severe combined immunodeficiency; however, it is important to note that this test also identifies a large number of other conditions that affect the immune system. The UK National Screening Committee does not currently recommend screening newborn babies for severe combined immunodeficiency. This evidence summary was commissioned by the UK National Screening Committee as part of its regular, scheduled reviews of existing recommendations. There is evidence that babies with severe combined immunodeficiency who are diagnosed early, through screening, do better after treatment than those who are not diagnosed until they develop symptoms. However, most babies who have a screening test suggesting severe combined immunodeficiency do not actually have severe combined immunodeficiency. There is some evidence that parents support newborn screening for severe combined immunodeficiency; however, most of this evidence comes from parents of healthy newborns. There is a lack of information about the views of parents whose babies had a screening test suggesting severe combined immunodeficiency but did not have severe combined immunodeficiency. The evidence is not currently good enough to fully support implementation of newborn blood spot screening for severe combined immunodeficiency. The findings from the recent in-service evaluation of newborn screening for severe combined immunodeficiency conducted in the NHS in England should be considered with the findings from this evidence summary.
Autistic children often show reduced theory of mind (ToM). However, existing ToM measures neither sufficiently distinguish ToM ability from performance nor interpret both scores effectively, limiting their interpretability and clinical utility. To resolve these limitations, we characterized the measurement-based functioning levels and correspondence between ToM ability and performance among preschool to school-aged children. Data from 288 autistic and 168 neurotypical children were analyzed using a multidimensional Rasch model. The functioning levels and correspondence were established using expected responses across statistically distinguishable ToM levels. The results revealed three levels of ToM ability-Early (failure on all items), Basic (success on desire-based emotion), and Advanced (success on all items)-and five levels of ToM performance: Pre-ToM (understanding needs and wants), Emerging (simple emotion recognition), Transition (first-order false belief), Premature (contextual understanding), and Mature (pragmatic understanding). Importantly, while ToM performance tended to improve with ToM ability, only 20% of the items were comparable with neurotypical children. In conclusion, our findings highlight a critical gap in autistic children and provide the first empirically derived functioning framework linking ToM ability and performance. Beyond theoretical contribution, this study offers a practical pathway toward valid assessments and tailored interventions that target children's specific social-cognitive needs. Autistic children often face challenges in everyday social situations, which are partially related to reduced theory of mind (ToM). Most existing ToM measures either focus on performance in structured tasks (ToM ability) or real‐life behaviors (ToM performance). However, they rarely explain how these two aspects are related or which scores can be attributed to basic or advanced levels. In this study, we analyzed data from autistic and neurotypical children within the preschooler to school‐aged period to define three levels of ToM ability, five levels of ToM performance, and how these levels correspond. We found that many autistic children can pass ToM tasks, but only a small proportion of everyday ToM behaviors can reach levels similar to those of their neurotypical peers. This framework can help clinicians and researchers to collectively interpret ToM ability and performance scores and to optimize individual goals based on their strengths and weaknesses.
Bisphenols are emerging organic contaminants often released into the environment, especially in aquatic systems. Specifically, Bisphenol A (BPA) is generally used in synthetic polymers and thermal paper production, and has been found in different environments and organisms, affecting ecosystems and human life. However, bisphenol contamination in karst systems remains poorly studied, although karst groundwaters are widely exploited for drinking use. This study presents a preliminary screening of BPA, bisphenol AP (BPAP) and C (BPC) in a karst system, from surface watercourses to cave groundwaters, using the novel AptaStick system for bisphenol family. Results confirmed BPA pollution in the karst system, with highest values inside a cave. BPAP and BPC were not detected in water samples. Potential pollution sources are likely linked to diffuse anthropogenic inputs within the catchment area, combined with event-driven transport dynamics. As a potential source of BPA contamination, microplastic (MP) pollution was concurrently investigated during high-flow conditions, finding from 0 to 7.7. MPs/L. These data expand previous assessments conducted under low-flow conditions in the same karst system. Natural and regenerated microfibres (MFs) were analyzed too, finding from 0 to 136 items/L. This work wants to be a first evaluation of both bisphenol and MP pollution in karst systems, stressing the importance of monitoring pollutants in these highly vulnerable environments. Moreover, it provides a first evaluations of how pollutant distribution may vary within the different hydrological compartments of a karst system, not only between surface and groundwater environments, but also among flowing, percolation, and stagnant waters within the subterranean network. This approach contributes to a better understanding of the spatial heterogeneity and transport dynamics of emerging contaminants in karst environments, supporting the development of appropriate conservation measures for habitats and species protection, and suitable drinking water resources management.
This study aimed to assess the user experiences of radiography students and healthcare radiation professionals regarding an X-ray scatter application that uses augmented reality (AR) to present X-ray scatter maps on mobile devices. A descriptive qualitative and quantitative study design was employed in two phases. Participants used the application either during the development phase (phase-1, n = 4) or as part of radiation protection training related to their studies or professional practice (phase-2, n = 100). Subsequently, participants took part in a thematic interview (phase-1) or completed an anonymous questionnaire (phase-2). The largest participant groups in the second phase were radiography students (n = 45), radiographers (n = 44), and physicians (n = 9). Data were analysed using descriptive and inferential statistics. Based on the first phase of the study, modifications were made to the application's user interface. In the second phase, the majority of responses to Likert-scale questions addressing the application's technical performance, visual appearance, and educational value were favourable. Overall, 91% and 87% of respondents either agreed or somewhat agreed with the statements "The app helped me conceptualise the behaviour of X-ray scatter" and "The app is a valuable addition to traditional radiation protection training", respectively. Similarly, 53% and 57% of respondents either agreed or somewhat agreed with the statements "The app worked as I wanted it to" and "The app was easy to use", respectively. Most respondents considered the application a valuable addition to traditional radiation protection training. With further development, its usability could be improved and a better focus on radiation protection training across different radiology specialties could be achieved. These findings support the use of AR-based applications as supplementary tools in radiation protection training for healthcare students and professionals.
The incidence of inflammatory bowel disease (IBD) is rising across Southeast Asia, yet real-world data on clinical phenotypes, treatment strategies, and outcomes in tuberculosis (TB)-endemic, resource-constrained settings remain scarce. To characterize disease phenotypes, treatment utilization, and 1-year outcomes in a Vietnamese inception cohort of newly diagnosed IBD patients in a tuberculosis-endemic, resource-constrained setting. Single-center, hybrid retrospective-prospective inception cohort study. Consecutive adults diagnosed with Crohn's disease (CD) or ulcerative colitis (UC) at a tertiary referral center in Ho Chi Minh City, Vietnam, between June 2019 and June 2024. A Baseline Cohort (N = 126) was analyzed for phenotypic characterization. Patients completing ⩾12 months of follow-up comprised the Outcome Cohort (N = 66) for assessment of treatment patterns and clinical, biochemical, and endoscopic outcomes. Treatment followed an accelerated step-up strategy with originator anti-tumor necrosis factor (TNF) agents (infliximab/adalimumab) after mandatory TB screening. Among 126 patients (80 CD, 46 UC), CD was characterized by substantial diagnostic delay (median 12 months), with 57.6% presenting stricturing or penetrating behavior and 25.0% having undergone intestinal resection before IBD confirmation. Extensive colitis (E3) predominated among UC patients (63.0%), and 78.3% had moderate-to-severe disease. Anti-TNF utilization increased from 13.6% within the first 2 months after diagnosis to 45.5% at 1 year. In the Outcome Cohort (N = 66), steroid-free clinical remission was achieved in 63.6%, and mucosal healing was documented in 62.3% of endoscopically evaluated patients. Serious infections occurred in 9.1%, with TB reactivation in 4.5%. IBD in Vietnam presents with diagnostic delays, complicated phenotypes, and high surgical rates at initial presentation. Despite these challenges, an accelerated step-up strategy with early anti-TNF escalation was associated with favorable 1-year steroid-free remission and mucosal healing rates. These findings suggest that treat-to-target care with early biologic escalation may be feasible in selected patients in TB-endemic, resource-constrained settings, provided that structured TB monitoring is implemented. Successful one-year treatment of severe, newly diagnosed inflammatory bowel disease in Vietnam using early, strong medications despite high tuberculosis risks Inflammatory bowel disease (IBD) is becoming more common in Southeast Asia, including Vietnam. However, diagnosing it is difficult because its symptoms are very similar to intestinal tuberculosis (TB), a common infection in the region. Because of this confusion, patients often suffer for a long time—sometimes up to a year—before finding out they have IBD. By the time they are properly diagnosed, their disease is often severe, and some even require surgery before receiving the correct diagnosis. In this study, we looked at 126 adults newly diagnosed with IBD at a major hospital in Vietnam. We wanted to see if treating them quickly with strong, advanced medications (known as biologics) would be safe and effective. We found that this treatment approach was associated with encouraging one-year outcomes. After one year of treatment, about 64% of the patients felt completely well without needing to take steroid medications. Furthermore, tests showed that the inside of the intestines had healed completely in 62% of the patients. However, because these strong medications can lower the body’s immune defenses, we carefully tested everyone for TB before starting treatment. Even with negative initial TB tests, 4.5% of patients still developed TB later. This highlights that ongoing monitoring for tuberculosis may be important throughout the course of biologic treatment, rather than relying solely on a single test before starting therapy.
Non-Steroidal Anti-inflammatory Drugs (NSAIDs) are widely used for pain and inflammation relief and are available over the counter in India. Despite common adverse drug events (ADEs), formal reporting and patient awareness remain low. This cross-sectional study in a primary care facility in Haridwar, Uttarakhand, assessed 201 patients aged 18 to 75 years using NSAIDs for at least three months for chronic pain. A structured de novo questionnaire (Cronbach's α 0.85) evaluated their knowledge, attitude, practices (KAP), risk factors, and self-reported ADEs. Results showed 47% lacked NSAID knowledge, 66% held negative attitudes, and 55% did not comply with prescriptions. Around 63% were at risk of complications, and 67% experienced ADEs. Most (68%) wanted to stop NSAIDs, while 58% favored alternative therapies for pain management. The study revealed limited awareness of NSAID risks in this region, with many experiencing ADEs and at risk of complications. The findings highlight the urgent need for educational programs and revisiting current NSAID usage guidelines to prevent ADEs and promote safer alternatives in India. This study explored how people use Non-Steroidal Anti-inflammatory Drugs (NSAIDs) which are common pain killers, for long-term pain conditions, their knowledge, along with attitude towards these medicines. NSAIDs are common medicines used to reduce pain and inflammation, but many people experience side effects with their use. We surveyed 201 adults in Haridwar, India, who had been using NSAIDs for at least three months. The results showed that 66.66% of users reported side effects, such as stomach problems, heart issues, skin related or other complications. Despite this, 63.20% continued using NSAIDs even though they were at risk of serious health issues. We found that 68% of participants wanted to stop using NSAIDs due to concerns about side effects and effectiveness over time. Meanwhile, 58% preferred using alternative therapies like traditional or complementary medicines for managing chronic pain. Our study also revealed differences based on socioeconomic status: people in higher-income groups had better knowledge and practices related to NSAID use, while those in lower-income groups needed more education to use these medicines safely. This research highlights a need for better education programs about safe NSAID use, especially in lower socioeconomic communities. It also suggests that health providers like doctors and nursing staff should discuss alternative pain management options with patients. Improving awareness and understanding of NSAID risks can help reduce harmful side effects amongst patients. If certain new policies are made regarding NSAIDs prescription, it will further reduce hospital visits by patients due to complaints of side effects with these drugs, thereby saving money and providing better health care.
To determine the differences in the awareness of hearing loss and interest in hearing aid support measures in general community residents who did or did not attend hearing-related lectures. This study aimed to clarify whether self-reported hearing loss matched or deviated from audiometry results. The participants were 136 community residents (men: 44, women: 92) aged ≥60 years who participated in public lectures for citizens or attended senior citizens' public meetings that were held between April 2023-2025. The lectures and meetings were categorized based on whether their theme was hearing loss (hearing-related group, 80 participants) or other than hearing loss (non-hearing-related group, 56 participants). Surveys on hearing as well as pure-tone audiometry (1000 and 4000 Hz) for interested participants were performed. Statistical analysis was performed using the chi-square test and Mann-Whitney U test, with the level of significance set at p < 0.05. Self-awareness of hearing loss was determined in 77.5% and 37.5% of participants in the hearing-related and non-hearing-related groups, respectively, indicating a significantly higher result in the hearing-related group (p < 0.01). Usage rates for hearing assistive devices, such as hearing aids, in the hearing-related and non-hearing-related groups were 41.3% and 10.7%, respectively. Audiometry revealed that thresholds were elevated across all tested frequencies for the hearing-related group, but mainly increased at 4000 Hz for the non-hearing-related group. In the non-hearing-related group, 31.4% of the subjects without hearing-loss awareness had an objective hearing-loss (better hearing-ear average of ≥40 dB). Regardless of hearing-loss awareness, approximately half of the participants wanted to use hearing aids; awareness of cochlear implants was found in approximately 30% participants. A discrepancy was observed between self-reported hearing status and audiometric results among community-dwelling older adults. Some individuals lacked awareness of elevated hearing thresholds. Although interest in hearing aid use was relatively high, opportunities for objective evaluation and appropriate recommendation appeared limited. Community-based strategies to improve early identification and access to hearing rehabilitation may support healthy aging in older populations.
Promoting access to effective depression treatment represents a crucial opportunity to mitigate increased suicide risk. We examined treatment trajectories for 8- to 29-year-old autistic enrollees of Medicaid, the U.S. safety net insurance program, with a new claim for major depressive disorder (MDD; N = 44,074). Using group-based trajectory modeling, we identified groups with similar probabilities of receiving psychotherapy or antidepressants in the 5 months following their new MDD claim - a period of acute treatment need. We also examined odds of trajectory group membership by demographic factors and co-occurring intellectual disability (ID) using multinomial logistic regression. Trajectory modeling suggested existence of four treatment trajectories: no/limited treatment (39%), gradual treatment decline (21%), late treatment initiation (14%), and continuous treatment (25%). Adjusted odds of continuous treatment, relative to no/limited treatment, were lower for Black enrollees (odds ratio [OR]: 0.63, 95% confidence interval [CI]: [0.59, 0.68]), Hispanic enrollees (OR: 0.58, 95% CI: [0.54, 0.62]), and those with co-occurring ID (OR: 0.84, 95% CI: [0.79, 0.89]), and highest for 8- to 12-year-olds (OR: 1.80, 95% CI: [1.60, 2.03]) and females (OR: 1.15, 95% CI: [1.09, 1.21]). Many Medicaid-enrolled autistic people do not receive depression treatment. Improving treatment in autistic enrollees requires varied and multi-faceted approaches that must consider demographic and clinical factors.Lay AbstractWe wanted to know if autistic people on Medicaid get therapy or antidepressants after being diagnosed with depression. We also looked at whether people who are also diagnosed with intellectual disability, are female, are children, or are Black or Hispanic are more or less likely to get this care. Earlier studies show that just over half of the people on Medicaid get any treatment after being diagnosed with depression. But no one has looked closely at autistic people on Medicaid. Getting treatment can help reduce depression symptoms and may lower the risk of suicide. In our study, we looked at autistic people on Medicaid who were newly diagnosed with depression. We tracked whether they got therapy or antidepressants over the next 5 months. We grouped people based on how much treatment they got. The largest group (39%) got no treatment. The second group (21%) started treatment but did not continue for all 5 months. The third group (14%) started treatment around the third month and kept going for 2 months. The last group (25%) got treatment for all 5 months. Autistic people who were Black, Hispanic, or had intellectual disability were least likely to get enough treatment. Autistic children and females were most likely to get enough treatment. In short, many autistic people are not getting the care they need for depression. Some may not get enough treatment to feel better. This can make depression last longer and raise the risk of suicide. We need to improve access to care, especially for those who are least likely to get it.
Reliable continuous non-invasive blood pressure monitoring technology should support clinicians to maintain blood pressure within appropriate limits peri-operatively. Previous studies have shown conflicting results regarding measurement accuracy. This systematic review and six meta-analyses evaluated the accuracy and precision of non-invasive continuous arterial blood pressure measurement technologies (volume clamp technology, applanation tonometry and photoplethysmography) compared with invasive arterial measurement in adults. We analysed pooled bias (mean difference between non-invasive and invasive measurement), standard deviation and limits of agreement. In each meta-analysis, mean arterial pressure (MAP), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were analysed separately. Acceptability was defined according to Association for the Advancement of Medical Instrumentation® (AAMI) criteria. Sixty-five studies were included: two meta-analyses for volume clamp technology (ClearSight™, CNAP™); three meta-analyses for applanation tonometry (T-Line™, Vasotrac™ and N-CAT™); and one meta-analysis for photoplethysmography technology. For volume clamp technologies, none met AAMI criteria for bias and SD in relation to MAP, SBP and DBP. T-Line, Vasotrac and N-CAT met the AAMI criteria for bias for MAP (2.53 mmHg, 0.36 mmHg, -0.37 mmHg), SBP (-0.07 mmHg, 1.20 mmHg, -3.68 mmHg) and DBP (3.09 mmHg, 1.09 mmHg, 0.84 mmHg), respectively. In terms of standard deviation, only N-CAT (MAP 6.97 mmHg, SBP 7.14, mmHg, DBP 6.55 mmHg) met AAMI criteria for all blood pressure parameters. Photoplethysmography technology met AAMI criteria for bias (MAP -0.09 mmHg, SBP 0.49 mmHg, DBP -0.26 mmHg) and standard deviation (MAP 6.86 mmHg, DBP 6.38 mmHg). Overall, the AAMI criteria for bias and SD were not fulfilled for most of the devices tested and wide limits of agreement are of concern. One applanation tonometry device (N-CAT) shows promise. Clinicians should be aware of the lack of interchangeability with invasive blood pressure management. Researchers looked at 65 studies that tested different non‐invasive machines used to measure blood pressure continuously. They compared these machines with the standard invasive method (putting a tube into an artery), which is usually more accurate. The technologies studied included volume clamp devices, applanation tonometry devices and photoplethysmography devices. The researchers checked how close the non‐invasive readings were to the invasive readings. Doctors need accurate blood pressure readings during and after surgery so they can keep patients safe. New non‐invasive machines are easier and safer to use, but it is important to know whether they are accurate enough to replace invasive monitoring. The researchers wanted to find out which devices worked best. Most of the non‐invasive devices were not accurate enough to fully match the standard invasive method. Some devices gave readings that were too different from the invasive readings, which could make treatment decisions harder. One device called N‐CAT performed better than most others and showed promising results. Overall, the study found that doctors should be careful when using these non‐invasive devices because they may not always give the same results as invasive blood pressure monitoring.
Climate change is threatening crop yield of a broad range of agricultural species, impacting global food security and trade. Crop wild relatives may contain climate adaptations that can be quickly introduced into cultivars, especially in perennial tree crops that use rootstock. Identifying climate resilient genotypes that can potentially be used as alternative rootstock is imperative to mitigate the impacts of climate change. Here, we used whole genome sequence data of 59 wild Juglans hindsii (Northern California black walnut) and 39 wild J. californica (Southern California black walnut) adult trees to: (i) determine predicted adaptedness to future climate based on landscape genomic models, (ii) explore their adaptedness if used as rootstock in existing walnut orchards and (iii) identify potential future planting sites within existing croplands. Wild J. hindsii has the highest predicted adaptedness to the future climate of Northern and Central California walnut orchards, while wild J. californica has the highest predicted adaptedness to Southern and Central California walnut orchards. Juglans californica has high adaptedness to the future climate of more existing cropland than J. hindsii does. If walnut farmers wanted to test new rootstock sources for their existing orchards or convert their farmland into walnut orchards, this study informs the exploration of such ideas. We illustrate how landscape genomic tools can be utilized in agricultural contexts as first steps in identifying climate adapted genotypes.
Wanting to implement a sustainable learner coaching program in academic medicine and prior exposure to coaching initiatives raised questions, including planning, implementation and assessment, and resource allocation. This scoping review examines coaching across medical learners, reported program elements, success factors, and barriers. Following the PRISMA-ScR guidelines, which were informed by Levac et al. on Arksey and O'Malley's framework and Braun and Clarke's thematic analysis, PubMed, Scopus, and ERIC were searched through May 2024. Articles were screened, the data were extracted and coded. The mixed methods analysis included descriptive statistics and thematic analysis. Themes/domains were developed and refined through consensus. Of 801 articles screened, 141 were included in the analysis. Coaching publications in academic medicine have increased, peaking in 2023 (n = 20). Most articles focused on competency-based coaching (n = 91), followed by learner wellness (n = 26). Coaching was more frequently studied in GME (n = 92), with overlaps in UME (n = 64) and faculty (n = 43). Six domains emerged: overview/general, coaching program related, coaching process related, coaching outcomes, coaching success factors, and coaching barriers. The articles reflected a broad conceptualization of coaching in academic medicine. Coaching programs varied in structure but commonly aimed to support competency, wellness, interpersonal skills, and self-directed learning. Reporting on coach recruitment, training, and compensation was inconsistent. Coaching processes incorporated reflection, goal setting, and observation. The coaching outcomes encompassed skills development and personal and professional growth. Success factors included institutional support and coach training; barriers involved time constraints, role ambiguity, and coachee readiness. Coaching is increasingly used in academic medicine to address diverse and evolving learner needs across settings, within the United States and internationally. This review reveals the conceptual breadth and structural variability of coaching programs and the flexibility of coaching as a practice for individualizing learner success. The findings offer insights and serve as a resource for institutions seeking to develop, implement, or refine coaching initiatives.
To characterize a patient group with refractory orofacial pain (OFP) at a tertiary pain clinic with emphasis on subtype distribution, comorbidities, sex differences and psychological factors. This retrospective study reviewed 98 consecutive patients assessed at the National Unit of Orofacial Pain, Haukeland University Hospital, Bergen, Norway (2017-2021). All patients were investigated by an interdisciplinary team that used a structured clinical interview and assessments and patients completed a series of standardized questionnaires that formed the basis for the final diagnosis and treatment plan. The International Classification of Orofacial Pain (ICOP-2020) was launched later and therefore retrospectively used forming the basis for this study. Five primary subtypes were analyzed: primary myofascial orofacial pain (pMOP), post-traumatic trigeminal neuropathic pain (PTTNP), persistent idiopathic facial pain (PIFP), trigeminal neuralgia (TN) and burning mouth syndrome (BMS). Secondary MOP (sMOP) was recorded when myalgia co-occurred with another primary diagnosis. Descriptive statistics, χ 2-tests and one-way ANOVA was performed. The most frequent diagnosis was pMOP (60.2%), followed by PTTNP (20.4%), PIFP (14.3%), TN (4.1%), and BMS (3.1%). Twenty-five patients had more than one diagnosisa(aPercentages do not sum to 100%. A total of 25 patients with overlapping diagnoses, including 23 patients with secondary MOP and 2 patients with dual primary diagnoses.). Significantly more women (82.6%) had OFP (p<0.05). Patients with pMOP experienced longest mean pain duration (9.9 years) and reported comorbidities such as body pain, headaches and arthritis more frequently than non-MOP groups (p < 0.05). sMOP was present in 75% of PTTNP cases (p = 0.0038). Psychometric and functional measures varied across subtypes: patients with pMOP exhibited the highest scores on HADS (15.3), MFIQ (14.4), and RS (7.0). Refractory OFP is dominated by pMOP and female patients. The strong association between PTTNP and sMOP suggests early combined management of neuropathic- and muscle pain which may limit chronification. Together, our findings support a personalized, interdisciplinary approach to OFP that can improve diagnostic precision and optimize long-term patient outcomes. We conducted this study to better understand people living with long-lasting pain in the face or mouth who had not improved after earlier treatment. We wanted to identify the types of pain they experienced, what other health problems they reported, and how the pain affected daily life. The study included 98 adults examined at Norway’s National Unit for Orofacial Pain. Most participants had experienced pain for many years. Each person was assessed by a multidisciplinary team that provided a diagnosis and treatment plan. Diagnoses were based on the International Classification of Orofacial Pain (ICOP). The most common diagnosis was primary myofascial orofacial pain, meaning pain originating from the jaw muscles. Around 60% of participants had this condition. About 20% had neuropathic pain caused by nerve injury, while fewer had other types of facial pain. Many individuals with nerve injury also had jaw muscle pain, suggesting that nerve damage may contribute to the later development of muscle pain. Participants with jaw muscle pain frequently reported headaches, widespread body pain, and arthritis. Symptoms of anxiety and depression were also common, highlighting how persistent pain can affect both physical and mental health. These findings suggest that people with long-lasting orofacial pain need early, coordinated, and multidisciplinary care. Treatment should address not only nerve and muscle pain, but also associated health conditions and psychological well-being, with a focus on the whole person rather than isolated symptoms.
Obesity is a common, complex, and often persistent chronic disease associated with serious health and social consequences. In the United States, recent data indicates that almost 20% of children and adolescents have obesity. Management of pediatric obesity involves multidisciplinary teams, including pediatricians, pediatric specialists, dietitians, behavioral health specialists, and exercise professionals, who deliver intensive health behavior and lifestyle treatment. Prior survey data from Pediatric Endocrine Society (PES) members indicate variability in practice patterns. There is an urgent need to assess current practices across groups and use these data to establish a standard of care across institutions. This is a cross-sectional survey of 38 providers who treat pediatric obesity. We report descriptive statistics (mean/median/IQR) only. Of 168 potential respondents, 38 completed the survey. 61% of the clinics are run within the Pediatric Endocrine division. All clinics offer pharmacotherapy, while only some offer bariatric surgery treatment. There is a wide divergence in the structure, staffing, visit frequency, intake process, and operational workflow between programs. All programs are staffed with a physician or APP, 97% with dieticians, 60% with psychologists or behavioral health therapists, and 39% with bariatric surgeons. Ideal and actual follow up times were mismatched, with programs wanting to see patients for follow up more often than they were able to. The survey provides a detailed snapshot of current practices within pediatric weight management programs, highlighting the strengths and the substantial variability that characterize the field. While many clinics share core elements, there remains a divergence in others. These differences reflect the diverse environments in which programs operate and underscore the benefit of standardized models for delivering pediatric obesity care. This survey is an important foundation, but broader national efforts are essential to guide standardization, inform policy, and support the development of high-quality, accessible pediatric obesity care.
Peer support (PS) is increasingly incorporated into eating disorder services as an adjunct to clinical treatment, yet qualitative evidence exploring how it is experienced by service users remains limited. Since 2023, the Eating Disorders Unit at South London and Maudsley (SLaM) NHS Foundation Trust has piloted a 1-1 PS pathway alongside routine care. Semi-structured qualitative interviews were conducted with twelve adults diagnosed with an eating disorder who had received 1-1 PS within outpatient or day care services. Interviews explored participants' subjective experiences and the perceived meaning of PS within their wider recovery journeys. Data was analysed using reflexive thematic analysis within a constructivist-interpretivist framework. Seven interrelated themes captured how participants experienced PS: relational understanding and normalisation; informality and shared power; re-positioning the eating disorder within a wider life; safety and non-judgement; imagining recovery through lived example; practical knowledge as relationally embedded; and multi-layered relatability. Participants described PS as distinct from formal treatment, valuing its relational qualities and lived-experience grounding. A commonly reported limitation concerned the time-limited nature of PS, with many participants expressing a desire for additional sessions. This qualitative evaluation provides insight into how 1-1 PS is experienced within a specialist eating disorder service. Rather than evidencing effectiveness, the findings illuminate relational and meaning-making processes through which PS was perceived as helpful. These insights informed the development of an eating disorder-specific PS feedback tool and have implications for service development and future research. Eating disorders are serious mental health difficulties that can affect both physical health and everyday life. Although psychological treatments can be helpful, many people find recovery difficult and services are often under pressure. Peer support involves receiving support from someone who has their own lived experience of an eating disorder and recovery.Since 2023, the Eating Disorders Unit at South London and Maudsley NHS Foundation Trust has offered 1–1 peer support alongside usual eating disorder treatments. This study explored how people experienced this support. Twelve adults who had received peer support were interviewed.Participants described feeling understood, less judged, and more able to open up. Seeing a peer support worker who had experienced recovery helped participants feel hopeful and imagine a future beyond their eating disorder. Peer support also helped some people reconnect with valued parts of life, such as hobbies, relationships, and goals.Some participants described an initial apprehension around potentially triggering aspects of the PS roles, prior to starting the sessions.A common challenge was that peer support was time-limited, and many participants wanted additional PS sessions.These findings informed the development of a new feedback questionnaire which aims to capture what service users find most meaningful about peer support.
Infant regulatory problems (RP), such as sleeping disturbances, feeding difficulties and excessive crying, affect a significant number of families and can persist beyond typical developmental stages, leading to distress for both the child and parents. These challenges disrupt the co-regulatory bond between parent and infant, often resulting in mutual dysregulation, parental burnout, and strained family relationships. Sociocultural values in Western societies, combined with conflicting role expectations, can contribute to heightened parental stress. Despite growing recognition of infant mental health (IMH), families' lived experiences dealing with persistent and severe RP remain underexplored. This study addresses the existing gap by employing an Interpretative Phenomenological Approach (IPA), specifically the Multi Family Member Interview Analysis (MFMIA), to explore the nuanced and shared experiences of families in crisis. Interviews were conducted with six father-mother dyads who had received specialised tertiary IMH treatment due to persistent and severe RP in their child. Analysis revealed four phenomenological themes. First, families experienced more than stress or fatigue; RP represented an existential rupture that dismantled the predictability of everyday life (Disrupted lives). Second, traditional gender roles shaped coping strategies: fathers often sought refuge in work while mothers remained confined to relentless caregiving, creating a painful asymmetry that intensified exhaustion (A gendered struggle for balance). Third, social isolation emerged through external minimisation and internal reluctance to show vulnerability, leaving families increasingly disconnected (Alone on an island: trapped in a vicious cycle of isolation). Finally, the crisis extended beyond its acute phase, with participants describing a prolonged period characterised by significant differences between families, where persistent vulnerability intertwined with varying degrees of resilience (The past shapes the present). These results reveal a bidirectional dynamic, i.e., a spiralling mutual influence, operating between the infant and the parents, as well as within the co-parenting dyad. In this cycle, the challenges of raising a child with RP and the disruptions within the parent-child and parenting subsystems mutually reinforce each other, eroding identity, straining relationships, and fostering isolation. This study highlights the critical importance of societal recognition, accessible social support, and responsive government policies for families facing infant RP.
Co-creation means engaging learners in working collaboratively to make decisions about course planning, implementation, or student assessment. Involving students in these decisions potentially enhances learning. When co-creation is part of assessment, it may reach more learners but may also pose pragmatic challenges. In this review, we focused on co-creation of assessment that may occur at any time during a health professional course. Systematic examination of learner-educator co-creation is needed to inform how educators can engage strategically in co-creation with healthcare students. The objective of this scoping review was to examine strategies for collaborative learner-educator decision-making during the design, implementation, or evaluation of student assessment in health professional education. Searches were conducted until August 1, 2024, in six databases with no date limitation (MEDLINE, Embase, Education Source Complete, CINAHL, ERIC and APA PsycInfo). Reference lists of included full-text papers and papers close to meeting inclusion criteria were manually searched, along with publications by conference abstract authors. We included all papers focused on how learners and educators share decision making regarding student assessment during a health professional course. Information about co-creation that occurs outside of a course or is not related to student assessment was excluded. Standard procedures for reviewing and summarizing data according to JBI methodology were used. Two reviewers independently screened documents and extracted data. Data about paper characteristics, where co-creation occurs, decisions that are co-created, process descriptions, and author conclusions were extracted and summarized. We screened 11,517 titles and abstracts, then 341 full-text reports for eligibility. In total, we identified 27 reports published between 1980 and 2025 that describe 25 unique courses where co-creation of assessment has been reported in the literature.Co-creation of assessment was reported in nursing, social work, medicine, health services navigation, paramedicine, pharmacy, occupational therapy and dental technology disciplines, at the undergraduate, graduate, and postgraduate levels. Most courses where co-creation occurred were mandatory. Reports spanned various years of study. Many assessment decisions were made together, predominantly assessment instructions and grading criteria. Diverse ways of co-creating with different levels of student influence over decisions were reported. The most reported strategy for co-creation was discussion during class time or in individual meetings. A wide range of benefits and ways to support co-creation were reported. Barriers, disadvantages, and future considerations were also reported. This review identifies and synthesizes existing examples of co-creation of assessment that have been integrated into health professional education. While it was mainly portrayed positively across included literature, there remains a lack of rigorous and diverse research in this area. The interventions identified in this review are diverse and highly contextual, limiting generalizability. Our findings provide a preliminary list of reported cases of co-creation of assessment and highlight contextual influences on implementation. Implementation processes need to be described in more detail to promote replication. Future research is needed to explore educator and student experiences, evaluate learning outcomes, and evaluate applicability across contexts to support evidence-informed practice. Co-creation of assessment offers a promising yet under-researched approach to creating more collaborative and authentic assessment strategies. It warrants thoughtful, context-specific application, research, and reporting in the literature. There are many ways healthcare students and teachers make decisions together during courses; more research is needed about their experiences and the effectiveness of co-creation when decisions impact student assessment. The review in brief: Reports from 8 different healthcare fields describe how students can work with their teachers during courses to make decisions about how assignments are planned, completed, and evaluated. What is this review about? Relying too much on lectures and memorization in health professional education can overwhelm students and may not prepare them for the kinds of thinking needed for safe, real-world patient care. Actively involving students in their education through co-creation (i.e., collaborative decision-making) is one strategy to customize learning to meet students’ needs. Even though there are benefits of teachers making decisions with students, there are also concerns because working together takes time and educational systems are not designed for it. There are many ways students may work with teachers during education. In this review, we focused on interactive shared decision-making where students have some choice and control over assessments. We focused on decisions about assessment because it affects all students. We did not limit the review to focus on any specific outcomes. What is the aim of this review? In this scoping review, we describe the details of 27 reports that described 25 different courses where students worked with teachers to make assessment decisions. We described where co-creation of assessment happens, what decisions are made together, how much students can influence decisions, how decisions were made, and what positive or negative consequences were noted. What are the main findings of this review? Included reports: This review includes 27 reports about co-creation of assessment in 25 different courses that were published between 1980 and 2025. About half of these papers were research studies. Papers came from 8 different countries, with most from North America. Where is co-creation of assessment happening? Co-creation of assessment happened in nursing, social work, medicine, and other allied health disciplines. It occurred in undergraduate, graduate, and postgraduate courses. Most of these courses were mandatory. What decisions are made together? Many decisions were made together, mostly when planning assignment instructions and how assignments would be graded. Other decisions that were made together happened during assignment planning, completion, and student evaluation. How much influence do students have? In most courses, students influenced specific assessment decisions such as assignment instructions or grading criteria. In other courses, students could choose what they wanted to change or worked in partnership with educators to make multiple decisions about how assessments were designed and/or graded. How do students influence decisions? Most of the time co-creation happened through discussion during class time or in individual meetings. Students also influenced decisions through email, surveys, working on documents, and more. What did authors report about the impact of co-creation? Overall, the authors thought co-creation was valuable and promoted learning. Many benefits and ways to support co-creation were described. Barriers, disadvantages, and ways to make co-creation more successful were also reported. What do the findings of this review mean? Co-creation in healthcare education needs to be done in ways that make sense for each course. The findings in this review are useful to help educators think of how they might try co-creation in their courses. This review should not be used to change policy because it does not contain enough evidence, and we do not comment on the effectiveness of each intervention included in this review. Future research is needed to understand educator and student experiences and to test the effectiveness of co-creation interventions for improving learning. How up-to-date is this review? In this review authors searched for papers up to August 1, 2024. This Campbell Systematic Review was published in May 2026.
Social media has become a core arena for contemporary sports marketing, where sports-related user-generated content increasingly shapes how fans perceive events and form engagement intentions. Among sports UGC, stadium photos shared by ordinary users are especially prevalent. However, limited research has examined how visual cues within these images influence spectators' intentions to attend or watch live sports events. Addressing this gap, the present research investigates whether human presence in sports-related user-generated photos changes spectators' intentions and through which psychological mechanism this effect occurs. Drawing on self-referencing and mental simulation theories, this research proposes that human presence in sports UGC facilitates viewers' imagination of being at the event, thereby enhancing spectating intentions. Across three experiments using authentic sports-related user-generated images, the study examined the direct effect of human presence on spectating intention, the mediating role of mental simulation, and the moderating role of stadium context. Study 1 showed that sports UGC photos containing people generated significantly stronger spectating intentions than photos without people. Study 2 demonstrated that this effect was mediated by mental simulation, indicating that human presence increased spectating intentions by enabling viewers to mentally simulate the live sports experience. Study 3 further revealed the moderating role of stadium context. The indirect effect of human presence through mental simulation was stronger in fan-oriented contexts that emphasized social interaction and shared emotions than in competition-oriented contexts that focused on athletic performance. By tracing a psychological pathway from scrolling through sports UGC to wanting to watch live sports, this research advances understanding of visual engagement and fan behavior in the evolving sports marketing landscape. The findings offer actionable insights for sports marketers, event organizers, and digital platforms seeking to leverage user-generated imagery to enhance fan engagement and drive live sports consumption.