Challenges in child and adolescent mental health services (CAMHS), including complex and fragmented services, are well documented, particularly to young people with severe mental health problems and complex needs. Research on young people's experiences of CAMHS is scarce. Especially studies on young people who have dropped out of CAMHS and/or transitioned to alternative services are lacking. This article addresses the following research question: Which discourses can be identified when young people with severe mental health problems and complex needs enrolled in Youth Flexible Assertive Community Treatment (Youth Flexible ACT) articulate their past treatment in CAMHS, and contrast it with their current treatment? We conducted a qualitative study using semi-structured interviews with 12 participants aged 15 to 19, recruited via convenience sampling from three Youth Flexible ACT teams in Norway. The interview data were analysed using a Fairclough-inspired critical discourse analysis (CDA), where discourse is understood as a particular way of understanding and talking about the world, and language is seen as a social practice rather than an individual activity. We identified three dominant discourses when the young people talked about conventional services/CAMHS in Norway: a biomedical, a paternalistic and a neoliberal. The findings suggest that treatment in CAMHS is shaped by a market-oriented understanding of mental health (neoliberal discourse), a medical model that reduces complex problems to medical terms (biomedical discourse), and a lack of user participation (paternalistic discourse). The findings indicate a gap between what young people see as helpful, the aims outlined in guidelines and the young participants' descriptions of CAMHS. The lack of user involvement and the unequal power balance need to be actively addressed with concrete practices that support more equal participation. The findings highlight the need for more differentiated treatment pathways for this group of young people, enabling timely, tailored support and reducing the risk of ineffective initial interventions. Our findings indicate that the framework in CAMHS is poorly suited to the needs of this group. In contrast, differently organised services, such as Youth Flexible ACT, may offer an alternative by providing a coherent framework for holistic, integrated and person-centred care.
Insights into transition metal homeostasis of Cupriavidus metallidurans have relied heavily on the construction and characterization of deletion mutants. To reveal the genetic consequences of these deletions, the genomes of C. metallidurans strain CH34 wild type and 34 of its mutants were analyzed. The genome of C. metallidurans wild type remained stable when the strain was strictly kept under the appropriate conditions. Omission of selection pressure or construction of mutants, however, resulted in three different kinds of mutations. Large deletions affected genomic islands or regions in the vicinity of transposon-associated genes. Some of these large deletions could be assigned to groups of overlapping deletions associated with groups of mutants, for instance, those with deletions in metal-efflux systems. Second, single-nucleotide polymorphisms (SNPs), such as point mutations, small insertions, or deletions, with a high variant frequency, were candidates for suppressor mutations, for example, in the corA1 or yidC genes. The third and novel kind of mutations comprised hypervariable regions, groups of SNPs with low variant frequencies in a small region of up to 70 base pairs that were located upstream or within genes. In the well-studied example involving the central zinc uptake regulator Zur, the hypervariable regions in the zur gene enabled the production of a GTP cyclohydrolase, restoring folate biosynthesis in double mutants. These data demonstrate that mutations de-stabilize the genome of C. metallidurans, accumulating changes that result in adaptation to the absence of the respective deleted gene, in some cases via hypervariable regions.IMPORTANCETo determine how bacteria thrive, they are often isolated from their natural environment and maintained in a laboratory. Mutations are introduced, and these derivatives are characterized phenotypically. Understanding how bacteria and their derivatives adapt to the effects of site-directed mutations, curing of plasmids, or just the laboratory environment is important. We show here that changes in the genomes of Cupriavidus metallidurans mutants occurred in all instances except when the wild type was maintained under selection conditions. The secondary mutations identified may be neutral, but some may affect the outcome of subsequent experiments performed to analyze the phenotypes. Our findings indicate that all generated mutations should undergo complete genomic sequencing. The information gained may deepen our understanding of bacterial life processes.
Electroencephalogram (EEG) reflect changes in the electrophysiological activity of the brain and can be used in the diagnosis of Alzheimer's disease (AD). Each EEG channel provides real-time information about the brain, while different EEG channels contain different information about the brain. Using all EEG channel data for AD diagnosis contains redundancy data, leading to increased computation and reduced data analysis accuracy. In this paper, a diagnostic method for AD based on Particle Swarm Optimization (PSO) EEG channel selection and Gated Recurrent Unit (GRU) is proposed. Using EEG energy as the fitness function and PSO to select EEG channels, the redundant information in EEG data is reduced and the accuracy of EEG data analysis is improved. GRU is a special kind of recurrent neural network (RNN) structure. It uses EEG data extracted by the principal component analysis (PCA) feature based on singular value decomposition (SVD) as input to the model. And it has a good advantage in analyzing the time series of EEG. The results show that the classification accuracy of the method in this paper reaches 0.9487, which is higher than the performance of other proposed methods. Compared to the results of using all EEG channel data analysis, the classification accuracy of this method was improved by 0.0757. It shows that the method proposed in this paper can improve the classification accuracy of EEG in AD classification tasks and can be applied to related classification tasks.
GATA transcription factors play important roles in plant development as well as light and hormone responses. Carrot is a kind of valuable root vegetable. The above-ground part of the carrot is affected by light during growth, which in turn affects the growth status of taproots. The functions of GATA factors have been characterized in several plant species. Little is known about the GATA factors in carrot biological process. In this study, 30 GATA family members were first identified in the carrot genome and classified into four subfamilies, named A-GATA, B-GATA, C-GATA, and D-GATA. C-GATA and D-GATA have specific functional motifs suggesting evolutionary conservation among plants. Predicted cis-elements of GATA factors revealed their potential hormone-responsive and light-responsive functions. Among them, B-GATA has been studied extensively and is represented by the GNC and GNL genes. There were three GNC/GNL homologs in carrot: DcGATA18, DcGATA20, and DcGATA22. Functional analysis revealed that the GNC homolog gene DcGATA20 was mainly expressed in carrot leaves, followed by petioles, and was barely detectable in taproots. Overexpression of DcGATA20 exhibited promotion of chlorophyll accumulation and increased the expression levels of DcGUN4 and DcCHLI1, along with a significant increase in expression of the transcription factor, DcGLK1, which is important for chlorophyll synthesis. In addition, the expression of the chlorophyll degradation gene DcSGR1 (STAY GREEN 1) was decreased. These results indicated that GNC genes exhibit functional conservation in carrot and may be helpful for understanding other GATA members' functions.
Gob-side entry retaining is a coal no-pillar mining technology, which can recover coal pillar resources and reduce the quantity, and cost of roadway excavation. However, due to the breaking slewing and sinking movement of the roof of the overlying rock layer, the surrounding rock of the retained roadway will produce large deformation. In order to effectively reduce the stress transfer from the overlying rock layer, the method of cutting off the immediate roof and main roof can be used. This paper is to introduce the combination support composed of single pillar, π-beam, articulated roof beam and iron shoe, a kind of mechanization and high practicality of the cutting roof support, and to make it clear that the synergistic bearing mechanism of the cutting roof for gob-side entry retaining is formed automatically. In the first stage, anchor cable reinforcement is carried out on the roof and coal wall of the roadway in the area of over-supporting the working face. In the second stage, cut roof support is carried out after the working face is extracted. In the third stage, the roadway is repaired in the stabilized area for gob-side entry retaining channel adopts along the roadway joint cut roof support, cut off the immediate roof and main roof in the side of the mining gob area. While the gangue filling the mining gob area to form a wedge-shaped gangue roadside. In this paper, through theoretical calculations, numerical simulation and on-site measurement methods to determine the gangue for gob-side entry retaining gangue rib and cut roof support of the synergistic bearing characteristics. This paper proposes a combination support composed of single pillar, π-type beam, articulated roof beam and iron shoe, and analyzes the roof support structure of the combination support for gob-side entry retaining, the mechanism of cutting off the roof, and the synergistic bearing characteristics of gangue rib support. Comprehensive numerical simulation analysis and engineering practice results show that: roadway side of gob-side entry retaining is composed of combined support and gangue rib, they jointly bear the roof pressure, the formation of synergistic bearing structure. The range of plastic zone of surrounding rock for gob-side entry retaining decreases with the reduction of cutting angle. In the field operation, the damage rate of the combination support is low, and the deformation of the surrounding rock for gob-side entry retaining is small, so the effect of surrounding rock control is remarkable.
Markerless inside-out surgical instrument tracking using a tool-mounted camera offers a promising solution to the limited clinical adoption of the existing navigation systems, which primarily rely on outside-in optical tracking and are constrained by line-of-sight issues. However, its performance in the surgical environment, with its unique challenges, remains largely unexplored. This work benchmarks state-of-the-art inside-out methods, namely, visual Simultaneous Localization and Mapping (vSLAM) methods. To this end, we collected a first-of-its-kind dataset in spine endoscopy, providing ground-truth tool poses. We recorded endoscopic spine surgeries performed on a high-fidelity training model in a real operating room environment, containing synchronized stereo images from tool-mounted cameras, sub-millimetric ground truth pose data from a commercial optical tracking system, and the endoscopic feed. Using this dataset, the instrument tracking accuracy of a selected number of vSLAM algorithms was compared. The best performing approach achieved a root mean squared absolute trajectory error of 2.0 mm and 1.47 degrees, reaching accuracies of around 1 mm and 1 degree on selected sequences. However, it shows degraded performance in the presence of challenges such as occlusions and scene-object dynamics. Markerless inside-out tracking using vSLAM demonstrated high accuracy, indicating potential feasibility for navigated endoscopic spine applications. Our evaluation revealed that current algorithms remain insufficiently robust for routine clinical use. The presented study and dataset establish a foundation for future research toward reliable, real-time inside-out navigation in minimally invasive surgery.
First impressions matter: The young mind is impressionable. Work experience, as a teenager, with a physician or surgeon, can be brilliant, formative, and inspiring, or it can be otherwise. These two 55-word stories are reflections on such work experience, with a kind general surgeon, almost 40 years ago. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Stiripentol (STP) is a kind of effective antiepileptic medicine, but its hepatotoxicity has been documented. However, the cause of its hepatotoxicity remains unclear. In this study, we attempted to explain its hepatotoxicity from the perspective of protein adduction derived from STP. We proposed that STP could produce an electrophilic carbonium ion, which formed hepatic GSH conjugation and protein adduction, and the carbonium ion was produced through two pathways, spontaneous dehydration and sulfation catalyzed by sulfotransferases (SULTs). STP-derived glutathione (GSH) conjugate was found in chemical reaction systems involving STP and GSH, which indicates that STP can undergo spontaneous dehydration to produce a carbonium ion. Increased GSH conjugate was observed in mouse liver cytosol incubation supplemented with GSH in the presence of the sulfation cofactor 3'-phosphoadenosyl-5'-phosphosulfate, which indicates that sulfation metabolism by SULTs can accelerate the production of carbonium ions. GSH conjugation and protein adduction were found in the livers of STP-treated mice and mouse primary hepatocytes, and 2,6-dichloro-4-nitrophenol, an inhibitor of SULTs, displayed an inhibitory effect on them. Serum alanine aminotransferase and aspartate aminotransferase activities in STP-treated mice and cytotoxicity in mouse primary hepatocytes displayed dose- and concentration-dependent trends, respectively, as did protein adduction. L-Buthionine-sulfoximine co-treatment potentiated the protein adduction and the susceptibility of hepatocytes to the cytotoxicity of STP. These findings suggest that protein adduction is responsible for STP-induced hepatotoxicity, and GSH serves a detoxification function against protein adduction.
Classically social prescription interventions focus on loneliness in adulthood, however another transitional stage of the lifespan associated with loneliness is new parenthood. A first-of-its-kind, socially prescribed, creative play programme is being trialed for families with 0-2-year-olds in a deprived ward in the North of England. Yet little is known about the perspectives of key stakeholders on this type of social prescription. This study examined the experience, attitudes and perspectives stakeholders hold around social prescription for families with infants. Individual in depth interview study. This study recruited 12 different stakeholders with practice or policy roles relating to family health and wellbeing, from general practitioners to members of parliament, with different power dynamics and roles to take part in a seven-question semi-structured interview. The interview addressed relationships between stakeholders, how they feel families might value or stigmatize socially prescribed creative play interventions and their thoughts and experiences with social prescription. The interview transcripts were analysed using an inductive descriptive thematic analysis. Three main themes were identified 1) Normalizing a New Offer: Getting it Right the First Time, 2) Barriers to Socially Prescribed Family Intervention and 3) Social Prescription for Complicated Families with Varying Needs. Findings suggest social prescription for families with infants would be welcome, and may relieve strain on our health systems. However, questions remain around how best to deliver such interventions, demonstrating the importance of evaluation to provide evidence to inform wider commissioning and promote sustainability and scaling.
Blood flow loop (BFL) models offer controlled and customizable environments to simulate the dynamic conditions of blood circulation. Historically, these evaluations of flow diverting stents have consisted of a simple single lumen model. This study is the first of its kind to compare surface modified flow diverters deployed distal to a bifurcation in a BFL model and is supported through additional data generated from a thrombin-antithrombin (TAT) assay. Test articles were deployed distal to a bifurcation, designed to present a more challenging environment for platelet activation than the traditional Chandler loop. Test articles included the following devices: Surpass Elite® with BioStealth™ Surface, Surpass Elite without BioStealth Surface, and Pipeline™ devices with Shield Technology™. Adhered platelet count, thrombus coverage scoring, flow rate at test termination, optical and scanning electron microscopy images, and TAT concentration were collected for each device type. The bifurcated blood flow loop model enabled differentiation between device types. Compared to the Unmodified surface, the BioStealth surface had a lower adhered platelet count, lower average thrombus coverage scores, and higher flow rate at test termination across six bovine donors, and a lower TAT concentration in human blood. The BioStealth Surface had no immature thrombus accumulation when viewed under SEM compared to the other studied surfaces. In an evaluation utilizing the novel bifurcated BFL model, Surpass Elite with BioStealth Surface demonstrated significantly lower adhered platelet count when compared to the Unmodified surface and statistically equivalent adhered platelet count to Shield. The TAT assay with human blood produced similar trends. The implications of these findings should be investigated through future in vitro and in vivo studies.
Miscarriage is the most common complication in early pregnancy and is associated with adverse mental health outcomes. Expectant parents want emotional support during this devastating life event, yet few receive the support they desire. Access to support may be affected by individual, societal, and systemic factors. This study aims to map international English literature about the barriers and facilitators to accessing psychosocial support. As miscarriage can have enduring psychological impacts, it is pertinent to uncover factors impacting access to psychosocial support, as this may reduce the psychological impact of miscarriage and promote wellbeing. Any peer-reviewed English literature that explores barriers and facilitators to accessing psychosocial support in an adult population experiencing miscarriage will be considered for inclusion in the review, including perceptions from partners and health professionals. Literature that assesses other forms of pregnancy loss (e.g., ectopic pregnancy, molar pregnancy, termination of pregnancy, stillbirth, neonatal death) is out of scope. To ensure methodological rigour and transparency, the planned scoping review will be conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews (PRISMA-ScR) guidelines. A systematic search of PubMed/MEDLINE, PsycINFO, Web of Science, and CINAHL will be conducted to identify relevant literature. The final scoping review will present the results of the search, study inclusion, and data analysis. Quantitative data will be presented in tabular format, stratified by geographical location and definition of miscarriage. Qualitative data will be coded and synthesized using descriptive qualitative content analysis. Barriers and facilitators will be presented visually using a socio-ecological model framework whilst recommendations to minimize barriers and enhance facilitators will be tabulated. The planned review is the first of its kind to identify barriers and facilitators to accessing psychosocial support following miscarriage. Outcomes have the potential to advance understanding about access to psychosocial support, which could enhance miscarriage care and alter the psychological trajectory of people impacted by miscarriage.
The sequential hydration of organic radical cations provides a model system to investigate the intriguing interaction between the radical and solvent with unconventional carbon-based ionic hydrogen bonds. In this context, a benzonitrile radical cation (BN•+) bonded to water (H2O) has been experimentally investigated by infrared (IR) spectrum with a single water molecule and mass spectra with up to seven water molecules. In this work, we performed a comprehensive potential energy surface search at the highly accurate doubly hybrid density functional theory (XYGJ-OS) and couple-cluster level to exhaustively explore the low-lying structures of BN•+-(H2O) n=1-6. For n = 1, an isomer where water binds to the ortho-C-H group is determined as the most populated configuration at room temperature due to its low energy and chirality. Calculated thermal-averaged IR spectrum reveals that this ortho-isomer plays an essential role in quantitative reproduction of the experimentally measured counterpart of BN•+-H2O. As the number of water molecules increases, a kind of distonic cation including a cycle that consists of a protonated water cluster, cyano group, and hydroxyl substituent is identified as the kinetically dominant species at ambient conditions, which requires overcoming an energy barrier as high as 30 kcal/mol to isomerize to the most stable configurations. The characteristic protonated water cluster moiety in the kinetically stable isomers results in strong ionic hydrogen bonds, which are responsible for the absence of signals of BN•+-(H2O) n≤3 in experimental mass spectra. Calculated IR spectra demonstrate that the range between 1700 and 2700 cm-1 is the diagnostic region for distinguishing kinetically and thermodynamically stable isomers. These findings establish a paradigm for the interaction between BN•+ and water, paving the way for a further understanding of the hydration of organic radical cations.
Achieving surgical expertise requires repetition and continuous practice. As clinical demands increase and opportunities for safe learning decline, enhancing surgical training methods is essential. In this study, we investigate what kind of errors beginners make during mastoidectomy and posterior tympanotomy and what factors precede those injuries. We analyzed video recordings of 30 medical students performing mastoidectomy and posterior tympanotomy on 3D-printed temporal bone models. The participants were trained using either traditional methods or VR. We assessed surgical injuries and their possible underlying causes by analyzing the end result and video recordings. The most common surgical errors were injuries to the posterior ligament of the incus, posterior ear canal wall, and incus body in 64%, 27%, and 13% of the models, respectively. Common factors included insufficient anatomical knowledge, inadequate exposure, poor spatial orientation, and inattention to nearby anatomical features during targeted work. Novice surgeons commonly make errors which differ from previously reported error-rates for experienced surgeons. These data could be useful to better understand what novices are struggling with when developing surgical training methods in the future.
Sudden cardiac death (SCD) can be caused by heritable cardiac conditions, as such, up to 50% of family members may be at risk. Coroners are responsible for communicating this risk, in addition to investigating the cause of death. The purpose of this study was to explore how family members of SCD victims experience the type, timing, and suitability of communication with coroners about the cause of death and their own risk for SCD. We conducted an explanatory sequential mixed methods study. Eligible family members of SCD victims aged 2 to 70 years, who died in 2021 from a potentially heritable cardiac condition and were investigated by the Office of the Chief Coroner of Ontario (Canada), were invited to complete a web survey or telephone interview. We used descriptive statistics to analyze the survey data and thematic analysis to analyze the interview data. Quantitative and qualitative data integration occurred at multiple levels. We sent survey invitations to 126 family members of 115 SCD victims; 50 completed the web-based survey between September 2022 and February 2024. We interviewed a subset of 17 participants. Most received initial communication by phone (n=30, 60%) or in-person (n=13, 26%). Although many (n=39; 78%) received a timeline for death investigation results, 16 (32%) did not receive results within the expected timeframe. In interviews, family members described effective communication as clear, with the coroners' demeanor being important, in particular, perceived as kind, accessible, and approachable. When communication needs went unmet, families relied on external support networks (outside of the coroner system) to fill information gaps. Suggestions for improved communication included repeating information and using multiple communication modes to enhance understanding. Findings emphasize the need for coroners to use empathetic approaches and provide timely, clear information. Addressing communication gaps may better meet the needs of grieving SCD families.
In plant science, understanding the hierarchical structure of leaf venations is crucial for insights into plant physiology, evolution, and ecology. However, data-driven segmentation methods are hampered by the lack of specialized datasets for hierarchical leaf vein analysis. To address this, we introduce the HierArchical Leaf Vein Segmentation (HALVS) dataset, the first of its kind, containing 5057 high-definition scanned leaf images from three species with 83.8 person-days of human annotations across three vein levels. We propose a novel label-efficient hierarchical segmentation framework combining Partially Supervised Semantic Segmentation (PSSS) and Denoising Diffusion Label Refinement (DDLR). PSSS classifies leaf pixels using primary and secondary vein annotations to generate high-confidence pseudo-labels for the background and tertiary veins, reducing omission errors. DDLR then refines these pseudo-labels, propagating structural priors from sparse veins to accurately recover tertiary veins. This framework significantly improves the integrity and connectivity of tertiary veins at low annotation costs. We also pioneer cross-species learning, training models on easily-annotated species and applying them to difficult ones. Despite challenges, DDLR remarkably enhances segmentation performance across all vein levels, providing an effective solution for complex hierarchical patterns and advancing agricultural research.
Understanding how women navigate induced abortion care pathways is critical to ensuring person-centred, quality reproductive health services. Evidence indicates that persistent abortion stigma, the lack of choices of abortion methods and respectful care during abortion remain a global challenge to reproductive healthcare. Yet there is minimal evidence regarding abortion care pathways. This study explored induced abortion care pathways in Addis Ababa healthcare facilities. We used a descriptive qualitative approach, adopting purposive sampling techniques to recruit women who sought induced abortion care from seven facilities. The data were collected from May to July 2024. In-depth semi-structured interviews with sixteen women were digitally recorded and transcribed into the local language before being translated into English. Data were coded, organised, and analysed using inductive thematic analysis. Five main themes and their corresponding subthemes were developed through data analysis. Themes were: (i) social and emotional support, (ii) moral and social meanings shaping abortion care, (iii) accessibility and service delivery, (iv) perceived competency of abortion providers, and (v) physical and emotional effects of abortion. Many women attended the clinic alone, without their families, and received no support. Women often sought care at clinics away from their community due to concerns related to fear of stigma and social pressure. This study found long waiting times to receive abortion care, a lack of medicine and ultrasound at some facilities and limited availability of second-trimester abortions. Women reported that many providers were welcoming and competent, while others reported poor communication, the use of medical jargon, and stigmatising behaviours. Participant reported pressure to accept methods they did not want during contraceptive counselling and fear of breaches in privacy and confidentiality. Participants also described physical symptoms such as bleeding and pain, and felt ashamed and upset after the abortion, which could be associated with negative experiences. Inadequate social support, abortion stigma, and barriers to accessing abortion services, such as long waiting times and insufficient resources, were identified as significant gaps. These findings emphasised the need to strengthen person-centred abortion care and address systemic and socio-cultural barriers that undermine the quality of care. Abortion care should be easy to access, fair for everyone, and respectful of women’s needs. Kind communication and emotional support during abortion enhance the quality of care. This study explored abortion care experiences in healthcare facilities in Addis Ababa.We spoke with women who came for abortion care. We conducted face-to-face interviews employing open-ended questions. We analysed the data by thoroughly reading and checking the information to identify common patterns in women’s experiences.Women had varied experiences of support. Some received strong support from family or friends, which made them feel less worried and more confident. Some went through the abortion procedure alone as they feared pressure or shame. Many women felt abortion was a “sin” or morally wrong, while others felt confident that they had made the best decision for their lives. Women reported waiting times and service availability as challenges to accessing quality care. In addition, negative experiences such as feeling judged and ignored, as well as poor communication from providers, are reported. Women explained physical symptoms such as bleeding, fatigue and emotional outcomes including anxiety, guilt and self-blame after abortion. At the same time, some felt relieved after the abortion and satisfied with the care received.This study found that women faced challenges such as stigma and judgment, long waiting times, and limited availability of abortion services in some places. Improving the quality of abortion care can help women feel supported, reduce emotional distress, and protect their health and dignity.
Humans interpret the visual world by integrating objects with their surrounding context. When this coherence is disrupted, perception may reorganise in search of new meaning. Here, we test whether such reorganisation may be guided by causal reasoning, namely, the ability to infer how one element might act upon another. Tools provide an ideal test case because their design explicitly separates a functional part (what they do) from a manipulable part (how they are used). While the manipulable part enables grasping, the functional part determines the effect the tool produces and the kind of physical interaction it affords with other objects. For instance, the handle of a hammer provides a stable grasp, whereas the striking head transmits impact force, inviting a causal link with another object, such as a nail. Fifty-six participants (34 females; mean age = 23.02 years, SD = 3.31) looked at naturalistic scenes in which tools appeared in incongruent contexts (e.g., a hammer in a cinema), while their eye movements were recorded. Participants rapidly directed their gaze to the functional part of the tool before expanding to the broader scene. Fixations then shifted systematically from the functional component toward contextual regions that could plausibly interact with the tool. By contrast, evidence that the manipulable part guided exploration in this way was weaker, and once gaze left the tool, it was less likely to return to it. These findings suggest that visual exploration is shaped by meaning and may reflect an implicit drive to impose causal structure on perception.
Many countries have implemented laws and policies to help healthcare providers address patient harm. However, there is limited research on their effectiveness, especially in the context of England#39;s National Health Service (NHS). This scoping review asks: How does law and policy support NHS healthcare providers in England respond to harm?. A scoping review methodology was applied to map and summarise the literature to date. MEDLINE, CINAHL, and Westlaw were searched to identify potentially relevant literature that had been published between 2000 and 2025. Literature was included if it addressed care delivery in England#39;s NHS and healthcare providers' responses to patient harm. Two reviewers independently screened the literature identified from the search against the eligibility criteria. A grey literature search of the citations within the included records was then conducted to identify relevant law and policy that supports providers of NHS healthcare in England to respond to patient harm. A total of 121 records were reviewed: 63 peer-reviewed and 58 pieces of grey literature. Data were charted using a standardised data extraction form. Themes were developed through a combination of thematic and content analysis, then presented as a narrative synthesis. The first of its kind, this scoping review identified English laws and policies that support NHS healthcare providers in England to respond to patient harm. It revealed the incongruent yet interdependent relationship that exists between England's legal systems, healthcare policies and the promoted NHS values. The scoping review highlighted how organisational culture can overshadow law and policy and be the defining factor in how providers of NHS healthcare in England respond to patient harm. The impact of law and policy in curating organisational culture and response to patient harm is an area requiring further research. Ethics approval was not required for this review.
In this work, we prepared multi-structured active emulsion gels based on W/W emulsion gel systems via associative phase separation using chitosan/carboxymethyl cellulose. The effects of different kinds of primary emulsions on the properties of W/W emulsion gel systems were investigated, and the physical properties of different multi-structured active emulsion gels were further studied. FTIR analysis showed that the formation of all emulsion gels was driven by electrostatic interaction and hydrogen bond. The CLSM and SEM results demonstrated that the O/W/W-W/W active emulsion gels (type II) were formed by filling the dispersed phase of the W/W emulsion system (type I) with the primary emulsion stabilized by chitosan, while the type III and IV active emulsion gels (O/W-W/W) were formed by filling the continuous phase of the W/W emulsion system (type I) with the primary emulsion stabilized by carboxymethyl cellulose and chitosan-carboxymethyl cellulose, respectively. Moreover, type II active emulsion gels presented the best mechanical, rheological properties, and TEO-release property, as well as the highest stability. Furthermore, all the active emulsion gels were used as active emulsion gel fresh-keeping pad, where the type II active emulsion gels showed excellent fresh-keeping effect for the fresh pork storage. Overall, these findings provide theoretical basis for the structure design of emulsion gel systems and storage food preservation.
Bound states in the continuum (BICs) are special optical modes embedded into the spectrum of free space waves but decoupled from the radiation continuum, being widely used to develop high quality (Q) factor photonic devices with different optical functionalities. Breaking the geometrical symmetry of optical systems is the most commonly used approach to access high-Q resonances termed symmetry-protected quasi-BICs. Nevertheless, the sharp decrease of the Q factor in the parameter space of asymmetries restricts the efficiency of resonators as functional devices. Here, using stacked dielectric metasurfaces, we enhance the robustness of symmetry-protected quasi-BICs against the symmetry breaking. In such designs, the coupling between a bright quasi-BIC and a dark BIC leads to dramatic enhancement of the Q factor in a wide range of asymmetry parameters, with values 4 or even 8 times as high as those obtained from conventional designs. Furthermore, engineered interlayer distance induces unidirectional quasi-BIC resonances that can continuously exist across nearly the entire parameter space, making our designs a potentially attractive platform for ultranarrow-band perfect absorption. We envision this kind of system of stacked metasurfaces as a prospective platform for suppressing out-of-plane radiation losses and radiation manipulation.