Negotiating Care: The Biographical Narratives of Young Adults Who Questioned Their Gender When Younger.

Current discussions about gender identity are increasingly politicised, particularly in the UK. An individual's body becomes a site of competing interests that attempt to regulate the physical, social and moral boundaries between biological sex and a socially realised gender. Care becomes defined within this context.

Helicopter emergency medical services demonstrate reduced time to emergency anaesthesia in an undifferentiated trauma population: a retrospective observational analysis across three major trauma networks.

Background: Early rapid sequence induction of anaesthesia (RSI) and tracheal intubation for patients with airway or ventilatory compromise following major trauma is recommended, with guidance suggesting a 45-min timeframe. Whilst on-scene RSI is recommended, the potential time benefit offered by Helicopter Emergency Medical Services (HEMS) has not been studied. We compared the time from 999/112 emergency call to delivery of RSI between patients intubated either in the Emergency Department or pre-hospital by HEMS.

Self-monitoring of blood pressure following a stroke or transient ischaemic attack (TASMIN5S): a randomised controlled trial.

Background: Blood pressure (BP) control following stroke is important but currently sub-optimal. This trial aimed to determine whether self-monitoring of hypertension with telemonitoring and a treatment escalation protocol, results in lower BP than usual care in people with previous stroke or transient ischaemic attack (TIA).

Methods: Unblinded randomised controlled trial, comparing a BP telemonitoring-based intervention with control (usual care) for hypertension management in 12 primary care practices in England.

The necessity of validity diagnostics when drawing causal inferences from observational data: lessons from a multi-database evaluation of the risk of non-infectious uveitis among patients exposed to Remicade.

Background: Autoimmune disorders have primary manifestations such as joint pain and bowel inflammation but can also have secondary manifestations such as non-infectious uveitis (NIU). A regulatory health authority raised concerns after receiving spontaneous reports for NIU following exposure to Remicade, a biologic therapy with multiple indications for which alternative therapies are available. In assessment of this clinical question, we applied validity diagnostics to support observational data causal inferences.

Comparison of the effectiveness of a serious game and pre-recorded lecture in diagnosis and treatment planning of oral lesions for dental students.

This research evaluated the effectiveness of an online simulation-based serious game as a learning tool in diagnosis and treatment planning for oral lesions (SimOL) in comparison to a pre-recorded lecture-based approach and to determine its appropriate integration into the undergraduate dental curriculum. A crossover randomized control trial was conducted with a cohort of 77 dental undergraduates. They were randomly assigned into two groups.

Deep reinforcement learning and fuzzy logic controller codesign for energy management of hydrogen fuel cell powered electric vehicles.

Hydrogen-based electric vehicles such as Fuel Cell Electric Vehicles (FCHEVs) play an important role in producing zero carbon emissions and in reducing the pressure from the fuel economy crisis, simultaneously. This paper aims to address the energy management design for various performance metrics, such as power tracking and system accuracy, fuel cell lifetime, battery lifetime, and reduction of transient and peak current on Polymer Electrolyte Membrane Fuel Cell (PEMFC) and Li-ion batteries. The proposed algorithm includes a combination of reinforcement learning algorithms in low-level control loops and high-level supervisory control based on fuzzy logic load sharing, which is implemented in the system under consideration.

A randomised controlled pilot trial protocol for patient led cognitive gamified training during haemodialysis.

Disruptions in cognitive function have been reported in individuals undergoing haemodialysis and those with chronic kidney disease. This pilot study protocol primarily assesses the feasibility and acceptability of using mobile cognitive gaming apps for patient-led cognitive training during haemodialysis sessions. The protocol consists of three phases: (1) reviewing and evaluating available cognitive gaming apps, (2) conducting focus groups/interviews with people with kidney disease to determine app preferences, and (3) undertaking a quasi-experimental randomised controlled trial to compare cognitive outcomes between a patient-led app intervention group and a standard care control group over four months.

Structural and functional determination of peptide versus small molecule ligand binding at the apelin receptor.

We describe a structural and functional study of the G protein-coupled apelin receptor, which binds two endogenous peptide ligands, apelin and Elabela/Toddler (ELA), to regulate cardiovascular development and function. Characterisation of naturally occurring apelin receptor variants from the UK Genomics England 100,000 Genomes Project, and AlphaFold2 modelling, identifies T89 as important in the ELA binding site, and R168 as forming extensive interactions with the C-termini of both peptides. Base editing to introduce an R/H168 variant into human stem cell-derived cardiomyocytes demonstrates that this residue is critical for receptor binding and function.

Improving outcomes for very preterm babies in England: does place of birth matter? Findings from OPTI-PREM, a national cohort study.

Objective: Babies born between 27 and 31 weeks of gestation contribute substantially towards infant mortality and morbidity. In England, their care is delivered in maternity services colocated with highly specialised neonatal intensive care units (NICU) or less specialised local neonatal units (LNU). We investigated whether birth setting offered survival and/or morbidity advantages to inform National Health Service delivery.

Science of Learning Strategy Series: Article 6, Elaboration.

The science of learning (learning science) is an interprofessional field that concerns itself with how the brain learns and remembers important information. Learning science has compiled a set of evidence-based strategies, such as distributed practice, retrieval practice, and interleaving, which are quite relevant to continuing professional development. Spreading out study and practice separated by cognitive breaks (distributed practice), testing oneself to check mastery and memory of previously learned information (retrieval practice), and mixing the learning of separate but associated information (interleaving) represent strategies that are underutilized in continuing professional development.

Current state of APPE-readiness assessments in schools or colleges of pharmacy.

Objective: To determine components and assessments included in Advanced Pharmacy Practice Experience (APPE) readiness plans in United States Doctor of Pharmacy (PharmD) programs.

Methods: An electronic survey was emailed to the American Association of Colleges of Pharmacy Laboratory Instructors Special Interest Group. Survey items included demographic information about the program, APPE-readiness plan implementation status and components.

Efficacy of Extranasal Neurostimulation for Patients With Neuropathic Corneal Pain: A Pilot Study.

Purpose: Neuropathic corneal pain (NCP) has been recognized as a distinct disease, yet treatment options remain limited. The aim of this pilot study was to explore the effectiveness of extranasal neurostimulation (EXNS) as a potential pain relief strategy for individuals with the peripheral component of NCP.

Methods: A retrospective study was performed to identify patients who were diagnosed with refractory peripheral or mixed NCP and subsequently underwent a single session of EXNS.

Use of interactional metadiscourse and identity construction in responses to negative online reviews of Chinese and British hotels.

In the business context, effectively responding to negative reviews is critical for a hotel to maintain reputation and customer relations. To explore the linguistic devices employed in addressing guest complaints, a corpus-based study is conducted on the use of interactional metadiscourse and identity construction in responses to negative online reviews of Chinese and British Hotels. Drawing upon the statistical results of the usage of interactional metadiscourse and the analysis of discourse examples, this study delves into the frequency and similarities/differences in the employment of five subcategories of interactional metadiscourse across the respective corpora of 100 responses to negative reviews from hotels in Beijing and hotels in London.

Implementing digital respiratory technologies for people with respiratory conditions: A protocol for a scoping review.

The value of 'data-enabled', digital healthcare is evolving rapidly, as demonstrated in the COVID-19 pandemic, and its successful implementation remains complex and challenging. Harmonisation (within/between healthcare systems) of infrastructure and implementation strategies has the potential to promote safe, equitable and accessible digital healthcare, but guidance for implementation is lacking. Using respiratory technologies as an example, our scoping review process will capture and review the published research between 12th December 2013 to 12th December 2023.

Posterior Vault Distraction Osteogenesis for Craniosynostosis-Surgical Outcomes Over 12 Years.

Introduction: Posterior vault distraction osteogenesis (PVDO) allows significant increase in intracranial volume but is associated with complications including cerebrospinal fluid (CSF) leaks, infection and device failure. The authors outline their outcomes over 12 years and the impact of PVDO on pre-existing Chiari malformation type 1 (CM).

Method: Retrospective review of all PVDOs in our unit over a period of 12 years from 2011 to 2023.

Epidemiology and Molecular Characterisation of Multidrug-Resistant Isolated from Cow Milk.

Antimicrobial resistance (AMR) is a growing global concern and poses a significant threat to public health. The emergence of multidrug-resistant organisms, including , also presents a risk of transmission to humans through the food chain, including milk. This study aimed to investigate the prevalence of in raw milk in the Chattogram metropolitan area (CMA) of Bangladesh and their phenotypic and genotypic antimicrobial resistance patterns.

Providing Physical Health Checks for People with Severe Mental Illness in Primary Care in England: An Evaluation of a Locally Enhanced Service.

: People with a severe mental illness die much earlier than the rest of the population from a preventable physical illness. Annual health checks are a way of assessing the person to then offer the appropriate interventions. Integrated Care Northampton, England used the long-term plan baseline funding allocated to them from the government department that commissions primary care services, to implement a local enhanced service.

The 2024 Nobel Prize in Physiology or Medicine: microRNA Takes Center Stage.

The Journal Editorial Board Members would like to congratulate Victor Ambros and Gary Ruvkun, who were jointly awarded the 2024 Nobel Prize in Physiology or Medicine for their groundbreaking discovery of microRNAs and the role of microRNAs in post-transcriptional gene regulation, uncovering a previously unknown layer of gene control in eukaryotes [...

A Qualitative Study of Barriers and Facilitators to the Uptake of Cardiac Rehabilitation in Octogenarians.

Despite an established evidence-base for cardiac rehabilitation (CR) improving functional outcomes and quality of life and reducing re-hospitalisation, there is limited research on CR for older cardiac patients, who require rehabilitation the most, as they are often very deconditioned due to aortic stenosis (AS). CR uptake in the UK is limited to 52% with national variability of provision and accessibility, and it is a national priority to increase uptake to 85%. Frequently, research has excluded older populations as they are deemed to be too frail or generally not suitable for inclusion.

The Impact of Cancer Status on Anxiety in Prostate Cancer Patients: A Network Analysis.

Prostate cancer (PCa) patients often also suffer from comorbid anxiety, which can impede treatment efficacy as well as be intrinsically unpleasant. Identification of the associations between particular symptoms of anxiety that are most likely to occur at different points in the PCa diagnosis-treatment journey can inform anxiety treatment choices and potentially influence their overall treatment outcomes. Although simple correlational analyses and ANOVA models of data analysis have been used to address this issue, the possibility of confounds due to the inter-relationships between other anxiety symptoms argues for the use of network analysis, which calculates each symptom-symptom connection while also taking into account the entire range of symptom relationships.

Salivary Immunoglobulin a Alterations in Health and Disease: A Bibliometric Analysis of Diagnostic Trends from 2009 to 2024.

Background/objectives: Salivary immunoglobulin A (IgA) is a mediator of local immunity and host defence. Altered IgA levels may predispose to bacterial invasion of the mucosa in the gastrointestinal tract, including the oral cavity. Our study aimed to present the diagnostic trends related to salivary IgA in health and disease based on a bibliometric analysis of published papers between 2009 and 2024.

Transferability of the Surgical Attire Guideline Adherence Decision-Making Theory Beyond New England.

The AORN surgical attire guideline promotes cleanliness in the perioperative environment to minimize patients' risks of developing surgical site infections. In 2020, the surgical attire guideline adherence decision-making model was published based on findings from a study involving New England intraoperative team members. To explore the model's transferability across the United States, we replicated the 2020 study with intraoperative personnel who did not live or work in New England.

In vitro erythropoiesis: the emerging potential of induced pluripotent stem cells (iPSCs).

Due to global blood shortages and restricted donor blood storage, the focus has switched to the in vitro synthesis of red blood cells (RBCs) from induced pluripotent stem cells (iPSCs) as a potential solution. Many processes are required to synthesize RBCs from iPSCs, including the production of iPSCs from human or animal cells, differentiation of iPSCs into hematopoietic stem cells, culturing, and maturation of the hematopoietic stem cells (HSC) to make functional erythrocytes. Previous investigations on the in vitro production of erythrocytes have shown conflicting results.

Redox-Responsive Polymeric Nanogels as Efficient mRNA Delivery Vehicles in .

Efficient delivery of sensitive nucleic acid payloads, including mRNA, in remains challenging, especially with traditional, labor-intensive transgenesis methods. We addressed these challenges using polymeric nanogels (NGs) as an advanced platform for mRNA delivery in . These polymeric delivery vehicles can be engineered to suit desired applications owing to their chemical versatility, resulting from the ability to conjugate multiple functional groups onto the same backbone.

Maternal and pregnancy factors contributing to the association between area deprivation and infant mortality in England: a retrospective cohort study.

Background: Socioeconomic inequality in infant mortality in the UK is rising. This study aims to identify contributory maternal and pregnancy factors that can explain the known association between area deprivation and infant mortality.

Methods: A cohort study was conducted using Clinical Practice Research Datalink (CPRD) primary care data between 2004 and 2019 linked to the Index of Multiple Deprivation (IMD), and infant mortality from the Office for National Statistics death data.