City St George's, University of London

BACKGROUND: Public policies aim to promote well-being, and ultimately the quality of later life. Positive perspectives of ageing are underpinned by a range of appraoches to successful ageing. This study aimed to investigate whether baseline biological, psychological and social aproaches to successful ageing predicted future QoL. METHODS: Postal follow-up in 2007/8 of a national random sample of 999 people aged 65 and over in 1999/2000. Of 496 valid addresses of survivors at follow-up, the follow-up response rate was 58% (287). Measures of the different concepts of successful ageing were constructed using baseline indicators. They were assessed for their ability to independently predict quality of life at follow-up. RESULTS: Few respondents achieved all good scores within each of the approaches to successful ageing. Each approach was associated with follow-up QoL when their scores were analysed continuously. The biomedical (health) approach failed to achieve significance when the traditional dichotomous cut-off point for successfully aged (full health), or not (less than full health), was used. In multiple regression analyses of the relative predictive ability of each approach, only the psychological approach (perceived self-efficacy and optimism) retained significance. CONCLUSION: Only the psychological approach to successful ageing independently predicted QoL at follow-up. Successful ageing is not only about the maintenance of health, but about maximising one's psychological resources, namely self-efficacy and resilience. Increasing use of preventive care, better medical management of morbidity, and changing lifestyles in older people may have beneficial effects on health and longevity, but may not improve their QoL. Adding years to life and life to years may require two distinct and different approaches, one physical and the other psychological. Follow-up health status, number of supporters and social activities, and self-rated active ageing also significantly predicted QoL at follow-up. The longitudinal sample bias towards healthy survivors is likely to underestimate these results.

The K(+) channel expression pattern of microglia strongly depends on the cells' microenvironment and has been recognized as a sensitive marker of the cells' functional state. While numerous studies have been performed on microglia in vitro, our knowledge about microglial K(+) channels and their regulation in vivo is limited. Here, we have investigated K(+) currents of microglia in striatum, neocortex and entorhinal cortex of young adult and aged mice. Although almost all microglial cells exhibited inward rectifier K(+) currents upon membrane hyperpolarization, their mean current density was significantly enhanced in aged mice compared with that determined in young adult mice. Some microglial cells additionally exhibited outward rectifier K(+) currents in response to depolarizing voltage pulses. In aged mice, microglial outward rectifier K(+) current density was significantly larger than in young adult mice due to the increased number of aged microglial cells expressing these channels. Aged dystrophic microglia exhibited outward rectifier K(+) currents more frequently than aged ramified microglia. The majority of microglial cells expressed functional BK-type, but not IK- or SK-type, Ca(2+) -activated K(+) channels, while no differences were found in their expression levels between microglia of young adult and aged mice. Neither microglial K(+) channel pattern nor K(+) channel expression levels differed markedly between the three brain regions investigated. It is concluded that age-related changes in microglial phenotype are accompanied by changes in the expression of microglial voltage-activated, but not Ca(2+) -activated, K(+) channels.

Introduction: Antimicrobial resistance (AMR) presents a major global health threat, driven in part by the inappropriate use of antibiotics including in low- and middle-income countries (LMICs). Improving the quality of antibiotic use is a key rationale for the development of the WHO's AWaRe (Access, Watch and Reserve) system. There is a need to review the uptake of the AWaRe system since its launch to guide future practice. Methods: A literature search was conducted between 2017, the launch of AWaRe, and 2024. Inclusion criteria were studies that reported on antibiotic use in LMICs using the AWaRe system. Results: Eighty-five studies were included in the review, of which 56.4% focused on antibiotic use trends, with 28.2% reporting on prescribing patterns; 51.7% of the studies included inpatients. Only 14.1% of studies reported meeting the 2024 United Nations General Assembly (UNGA) AMR recommended target of at least 70% of human antibiotic use being Access antibiotics, with a concerning trend of overuse of Watch antibiotics (68.2% of studies). Dispensing practices revealed significant dispensing of antibiotics without prescriptions especially in Pakistan and Bangladesh. Watch antibiotics were more available but also more expensive than Access antibiotics. Conclusions: Encouragingly, many LMICs are now reporting antibiotic use via the AWaRe system, including in antimicrobial stewardship programmes (ASPs). Wide variation exists in the proportion of AWaRe antibiotics used across LMICs, with overuse of Watch antibiotics. There is an urgent need for targeted AWaRe-based ASPs in LMICs to meet recent UNGA recommendations. Improving the use, availability and affordability of Access antibiotics is essential to combat AMR.

There is a long tradition of literature review articles in management. Despite attempts to establish consensus around what constitutes a high-quality literature review, there remains significant dissensus. To explore conflicting views empirically, we draw on a mixture of topic modeling and abductive qualitative analysis to conduct an extensive meta-level review of literature reviews. We find 10 different kinds of literature reviews in practice, each of which has a different purpose. This makes management different from other disciplines that have been subject to more standardization. Further, we note that our findings largely do not overlap with existing classifications of literature reviews. The key distinction we propose is identifying a review article’s purpose, as determined by differences in reflexivity and substantive focus. We use these two dimensions to develop a directional space that will help authors fit their articles to the status of the field they are reviewing, instead of blindly following a single idealized model or procedure. Looking into the future, we argue that as advances in artificial intelligence will likely make some review purposes redundant, scholars should develop new reviewing practices. Technologically infused and collective ways of reviewing the literature could help make researchers’ engagement more reflexive, dynamic, and impactful.

Estimation of the disease burden attributable to environmental factors is a powerful tool for prioritizing environmental and pollution management and public health actions around the world. The World Health Organization (WHO) began estimating the environmental disease burden in 2000, which has formed the basis for the modern estimation approach conducted in the Global Burden of Disease, Injuries, and Risk Factor (GBD) study. In 2021, environmental and occupational risk factors in the GBD were responsible for 18.9% (12.8 million) of global deaths and 14.4% of all disability-adjusted life years (DALYs), led by ambient PM 2.5 air pollution (4.2% DALYs, 4.7 million deaths) and household air pollution from the use of solid fuels for cooking (3.9% DALYs, 3.1 million deaths). Climate change exacerbates many environmental hazards, leading to increased disease burdens from heat, air pollution, vector-borne diseases, storms, and flooding. Other environmental risk factors not included in the GBD, such as poor indoor air quality, various chemical exposures, and environmental noise pollution, also significantly contribute to disease burden in many countries, though more efforts are needed to generate and integrate data resources for inclusion in global estimations.

Importance: Whether α2-adrenergic receptor agonist-based sedation, compared with propofol-based sedation, reduces time to extubation in patients receiving mechanical ventilation in the intensive care unit (ICU) is uncertain. Objective: To evaluate whether dexmedetomidine- or clonidine-based sedation reduces duration of mechanical ventilation compared with propofol-based sedation (usual care). Design, Setting, and Participants: Pragmatic, open-label randomized clinical trial conducted at 41 ICUs in the UK including adults who were within 48 hours of starting mechanical ventilation, were receiving propofol plus an opioid for sedation and analgesia, and were expected to require mechanical ventilation for 48 hours or longer. The median time from intubation to randomization was 21.0 (IQR, 13.2-31.3) hours. Recruitment occurred from December 2018 to October 2023; the last follow-up occurred on December 10, 2023. Interventions: The bedside algorithms used targeted a Richmond Agitation-Sedation Scale score of -2 to 1 (unless clinicians requested deeper sedation). The algorithms supported uptitration in the dexmedetomidine- and clonidine-based sedation intervention groups and supported downtitration for propofol-based sedation followed by sedation primarily with the allocated sedation (dexmedetomidine or clonidine). If required, supplemental use of propofol was permitted. Main Outcomes and Measures: The primary outcome was time from randomization to successful extubation. The secondary outcomes included mortality, sedation quality, rates of delirium, and cardiovascular adverse events. Results: Among the 1404 patients in the analysis population (mean age, 59.2 [SD, 14.9] years; 901 [64%] were male; and the mean APACHE II score was 20.3 [SD, 8.2]), the subdistribution hazard ratio (HR) for time to successful extubation was 1.09 (95% CI, 0.96-1.25; P = .20) for dexmedetomidine (n = 457) vs propofol (n = 471) and was 1.05 (95% CI, 0.95-1.17; P = .34) for clonidine (n = 476) vs propofol (n = 471). The median time from randomization to successful extubation was 136 (95% CI, 117-150) hours for dexmedetomidine, 146 (95% CI, 124-168) hours for clonidine, and 162 (95% CI, 136-170) hours for propofol. In the predefined subgroup analyses, there were no interactions with age, sepsis status, median Sequential Organ Failure Assessment score, or median delirium risk score. Among the secondary outcomes, agitation occurred at a higher rate with dexmedetomidine vs propofol (risk ratio [RR], 1.54 [95% CI, 1.21-1.97]) and with clonidine vs propofol (RR, 1.55 [95% CI, 1.22-1.97]). Compared with propofol, the rates of severe bradycardia (heart rate <50/min) were higher with dexmedetomidine (RR, 1.62 [95% CI, 1.36-1.93]) and clonidine (RR, 1.58 [95% CI, 1.33-1.88]). Compared with propofol, mortality was similar over 180 days for dexmedetomidine (HR, 0.98 [95% CI, 0.77-1.24]) and clonidine (HR, 1.04 [95% CI, 0.82-1.31]). Conclusions and Relevance: In critically ill patients, neither dexmedetomidine nor clonidine was superior to propofol in reducing time to successful extubation. Trial Registration: ClinicalTrials.gov Identifier: NCT03653832.

BACKGROUND AND AIMS: The feasibility and impact of high intensity exercise programmes in patients with hypertrophic cardiomyopathy (HCM) are unknown. This study was conducted to determine the feasibility of a high intensity exercise programme and explore safety and efficacy outcomes in patients with HCM. METHODS: Participants were randomized to a 12-week supervised exercise programme (n = 40) in addition to usual care, or usual care alone (n = 40). All participants underwent assessment at baseline and 12 weeks. The exercise group was re-evaluated 6 months post-programme. Feasibility was assessed by (i) recruitment, adherence, and retention rates; (ii) staffing ratios; (iii) logistics; and (iv) acceptability of the intervention. The primary exploratory safety outcome was a composite of arrhythmia-related events. Exploratory secondary outcomes included changes in (i) cardiorespiratory fitness; (ii) cardiovascular risk factors; and (iii) quality of life, anxiety, and depression scores. RESULTS: Overall, 67 (84%) participants completed the study (n = 34 and n = 33 in the exercise and usual care groups, respectively). Reasons for non-adherence included travel, work, and family commitments. Resource provision complied with national cardiac rehabilitation standards. There was no difference between groups for the exploratory safety outcome (P = .99). At 12 weeks, the exercise group had a greater increase in peak oxygen consumption (VO2) [+4.1 mL/kg/min, 95% confidence interval (CI) 1.1, 7.1] and VO2 at anaerobic threshold (+2.3 mL/kg/min, 95% CI 0.4, 4.1), lower systolic blood pressure (-7.3 mmHg, 95% CI -11.7, -2.8) and body mass index (-0.8 kg/m2, 95% CI -1.1, -0.4), and greater improvement in hospital anxiety (-3, 95% CI -4.3, -1.7) and depression (-1.7, 95% CI -2.9, -0.5) scores, compared to the usual care group. Most exercise gains dissipated at 6 months. CONCLUSIONS: A high intensity exercise programme is feasible in patients with HCM, with apparent cardiovascular and psychological benefits, and no increase in arrhythmias. A large-scale study is required to substantiate findings and assess long-term safety of high intensity exercise in HCM.

INTRODUCTION: Antimicrobial resistance (AMR) poses a significant threat, particularly in low- and middle-income countries (LMICs), exacerbated by inappropriate antibiotic use, access to quality antibiotics and weak antimicrobial stewardship (AMS). There is a need to review current evidence on antibiotic use, access, and AMR, in primary care across key countries. AREAS COVERED: This narrative review analyzes publications from 2018 to 2024 regarding access, availability, and use of appropriate antibiotics. EXPERT OPINION: There were very few studies focussing on a lack of access to antibiotics in primary care. However, there was considerable evidence of high rates of inappropriate antibiotic use, including Watch antibiotics, typically for minor infections, across studied countries exacerbated by patient demand. The high costs of antibiotics in a number of LMICs impact on their use, resulting in short courses and sharing of antibiotics. This can contribute to AMR alongside the use of substandard and falsified antibiotics. Overall, limited implementation of national action plans, insufficient resources, and knowledge gaps affects sustainable development goals to provide routine access to safe, effective, and appropriate antibiotics. CONCLUSIONS: There is a clear need to focus health policy on the optimal use of essential AWaRe antibiotics in primary care settings to reduce AMR in LMICs.

RATIONALE: The increasing prevalence of myopia is a growing global public health problem, in terms of rates of uncorrected refractive error and significantly, an increased risk of visual impairment due to myopia-related ocular morbidity. Interventions to slow its progression are needed in childhood, when myopia progression is most rapid. This is a review update, conducted as part of a living systematic review. OBJECTIVES: To assess the comparative efficacy and safety of interventions for slowing myopia progression in children using network meta-analysis (NMA). To generate a relative ranking of interventions according to their efficacy. To produce a brief economic commentary, summarising economic evaluations. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, and three trial registers. The latest search date was 19 February 2024. ELIGIBILITY CRITERIA: We included randomised controlled trials (RCTs) of optical, pharmacological, light therapy and behavioural interventions for slowing myopia progression in children, up to 18 years old. OUTCOMES: Critical outcomes were progression of myopia (mean difference (MD) in the change in spherical equivalent refraction (SER, dioptres (D)), and axial length (AL, mm) in the intervention and control groups at one year or longer), and difference in the change in SER and AL following cessation of treatment (rebound). RISK OF BIAS: We assessed the risk of bias (RoB) for SER and AL using the Cochrane RoB 2 tool. SYNTHESIS METHODS: We followed standard Cochrane methods. We rated the certainty of evidence using the GRADE approach for change in SER and AL at one and two years. We used the surface under the cumulative ranking curve (SUCRA) to rank the interventions for all available outcomes. INCLUDED STUDIES: We included 104 studies (40 new for this update) that randomised 17,509 children, aged 4 years to 18 years. Most studies were conducted in China or other Asian countries (66.3%), and North America (14.4%). Eighty-four studies (80.8%) compared myopia control interventions against inactive controls. Study durations ranged from 12 months to 48 months. SYNTHESIS OF RESULTS: Since most of the networks in the NMA were poorly connected, our estimates are based on direct (pairwise) comparisons, unless stated otherwise. The median change in SER for controls was -0.65 D (55 studies, 4888 participants; one-year follow-up). These interventions may reduce SER progression compared to controls: repeated low intensity red light (RLRL: MD 0.80 D, 95% confidence interval (CI) 0.71 to 0.89; SUCRA = 93.8%; very low-certainty evidence); high-dose atropine (HDA (≥ 0.5%): MD 0.90 D, 95% CI 0.62 to 1.18; SUCRA = 93.3%; moderate-certainty evidence); medium-dose atropine (MDA (0.1% to < 0.5%): MD 0.55 D, 95% CI 0.17 to 0.93; NMA estimate SUCRA = 75.5%; low-certainty evidence); low dose atropine (LDA (< 0.1%): MD 0.25 D, 95% CI 0.16 to 0.35; SUCRA = 53.2%; very low-certainty evidence); peripheral plus spectacle lenses (PPSL: MD 0.45 D, 95% CI 0.16 to 0.74; SUCRA = 50.2%; very low-certainty evidence); multifocal soft contact lenses (MFSCL: MD 0.27 D, 95% CI 0.18 to 0.35; SUCRA = 49.9%; very low-certainty evidence); and multifocal spectacle lenses (MFSL: MD 0.14 D, 95% CI 0.08 to 0.21; SUCRA = 30.8%; low-certainty evidence). The median change in AL for controls was 0.33 mm (58 studies, 9085 participants; one-year follow-up). These interventions may reduce axial elongation compared to controls: RLRL (MD -0.33 mm, 95% CI -0.37 to -0.29; SUCRA = 98.6%; very low-certainty evidence); HDA (MD -0.33 mm, 95% CI -0.35 to -0.30; SUCRA = 88.4%; moderate-certainty evidence); MDA (MD -0.24 mm, 95% CI -0.34 to -0.15; NMA estimate SUCRA = 75.8%; low-certainty evidence); LDA (MD -0.10 mm, 95% CI -0.13 to -0.07; SUCRA = 36.1%; very low-certainty evidence); orthokeratology (ortho-K: MD -0.18 mm, 95% CI -0.21 to -0.14; SUCRA = 79%; moderate-certainty evidence); PPSL (MD -0.13 mm, 95% CI -0.21 to -0.05; SUCRA = 52.6%; very low-certainty evidence); MFSCL (MD -0.11 mm, 95% CI -0.13 to -0.09; SUCRA = 45.6%; low-certainty evidence); and MFSL (MD -0.06 mm, 95% CI -0.09 to -0.04; SUCRA = 26.3%; low-certainty evidence). Ortho-K plus LDA probably reduces axial elongation more than ortho-K monotherapy (MD -0.12 mm, 95% CI -0.15 to -0.09; SUCRA = 81.8%; moderate-certainty evidence). At two-year follow-up, change in SER was reported in 34 studies (3556 participants). The median change in SER for controls was -1.01 D. The ranking of interventions to reduce SER progression was close to that observed at one year; there were insufficient data to draw conclusions on cumulative effects. The highest-ranking interventions were: HAD (SUCRA = 97%); MDA (NMA estimate SUCRA = 69.8%); and PPSL (SUCRA = 69.1%). At two-year follow-up, change in AL was reported in 33 studies (3334 participants). The median change in AL for controls was 0.56 mm. The ranking of interventions to reduce axial elongation was similar to that observed at one year; there were insufficient data to draw conclusions on cumulative effects. The highest-ranking interventions were: ortho-K plus LDA (SUCRA = 94.2%); HAD (SUCRA = 96.8%); and MDA (NMA estimate SUCRA = 88.4%). There was limited evidence on whether cessation of myopia control therapy increases progression beyond the expected rate of progression with age. Adverse events and treatment adherence were not consistently reported. Two studies reported quality of life, showing little to no difference between intervention and control groups. We were unable to draw firm conclusions regarding the relative costs or efficiency of different myopia control strategies in children. AUTHORS' CONCLUSIONS: Most studies compared pharmacological and optical treatments to slow the progression of myopia with an inactive comparator. These interventions may slow refractive change and reduce axial elongation, although results were often heterogeneous. Less evidence is available for two years and beyond; uncertainty remains about the sustained effect of these interventions. Longer term and better quality studies comparing myopia control interventions alone or in combination are needed, with improved methods for monitoring and reporting adverse effects. FUNDING: Cochrane Eyes and Vision US Project is supported by grant UG1EY020522, National Eye Institute, National Institutes of Health. REGISTRATION: The previous version of this living systematic review is available at doi: 10.1002/14651858.CD014758.pub2.

BACKGROUND: Community resilience and health emergency communication are both crucial in promoting a community's ability to endure crises and recover from emergency events. Yet, a notable gap in theory and evidence exists in the relationship between them. We aim to explore the relationship between community resilience and health emergency communication and to identify strategies and interventions to strengthen their usefulness to each other. Based on the results, a secondary aim was to develop a model of community-centred resilience and health emergency communication. METHODS: A systematic review of literature published between January 1990 and February 2024 was undertaken following Joanna Briggs Institute guidelines. Electronic databases (Web of Science, Social Science Citation Index, PubMed/MEDLINE) were searched using key terms. Eligibility criteria were developed from the literature and the knowledge of the multidisciplinary team. Inductive thematic analysis generated key themes. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were applied to present the findings. RESULTS: The searches identified 300 articles, of which 86 met the inclusion criteria. Two main themes were identified from the literature: (i) the relationship between emergency communication and community resilience, including subthemes: building trust and collaboration within communities, identifying resources and their distribution, tailoring communication strategies, considering inclusion and equity, and community engagement and feedback and (ii) strategies and interventions, including subthemes: facilitating community structures as channels for communication, respecting personal and private boundaries in health communication, targeting outreach for effective crisis communication, building resilience through training and communication initiatives, and demonstrating commitment to equity and inclusion. CONCLUSIONS: There is a small, yet valuable, body of evidence to demonstrate the value of bolstering community-centred resilience for emergency preparedness, response and recovery. The model of community-centred resilience and health emergency communication developed can inform policy, research and practice. Further research is required to develop and test community-centred approaches to enhance inclusive risk communication and equitable recovery.

INTRODUCTION: Global migration has increased in recent decades owing to war, conflict, persecution and natural disasters, but also secondary to increased opportunities related to work or study. Migrants' risk of tuberculosis (TB) differs depending on migration, socioeconomic status, mode of travel and TB risk in transit, TB incidence and healthcare provision in country of origin. Despite advances in TB care for migrants and new treatment strategies, decisions for managing migrants at risk of TB often rely on expert opinions, rather than clinical evidence. METHODS: A systematic literature search was conducted, studies were mapped to different recommendation groups and included studies were synthesised by meta-analysis where appropriate. Current evidence on the diagnosis of active TB in migrants entering the European Union/European Economic Area and UK, including clinical presentation and diagnostic delay, treatment outcomes of drug-susceptible TB, prevalence, and treatment outcomes of multidrug-resistant/rifampicin-resistant TB and TB/HIV co-infection, was summarised. A consensus process was used based on the evidence. RESULTS: We documented that migrants had higher vulnerability for TB, including an increased risk of extrapulmonary TB, multidrug-resistant/rifampicin-resistant TB, TB/HIV co-infection and worse TB treatment outcomes compared to host populations. Consensus recommendations include screening migrants for TB/latent TB infection according to country data, a minimal package for TB care in drug-susceptible and multidrug-resistant/rifampicin-resistant TB, implementation of migrant-sensitive strategies and free healthcare and preventive treatment for migrants with HIV co-infection. CONCLUSION: Dedicated care for TB prevention and treatment in migrant populations within the European Union/European Economic Area and UK is essential.

Existing studies of political polarization are often limited to a single country and one form of polarization, hindering a comprehensive understanding of the phenomenon. Here we investigate patterns of polarization online across nine countries (Canada, France, Germany, Italy, Poland, Spain, Turkey, UK, USA), focusing on the structure of political interaction networks, the use of toxic language targeting out-groups, and how these factors relate to user engagement. First, we show that political interaction networks are structurally polarized on Twitter (currently X). Second, we reveal that out-group interactions, defined by the network, are more toxic than in-group interactions, indicative of affective polarization. Third, we show that out-group interactions receive lower engagement than in-group interactions. Finally, we identify a common ally-enemy structure in political interactions, show that political mentions are more toxic than apolitical mentions, and highlight that interactions between politically engaged accounts are limited and rarely reciprocated. These results hold across countries and represent a step towards a stronger cross-country understanding of polarization. Identifying patterns of polarization is important for understanding its root cause. Here, using Twitter data from 9 countries, the authors show that out-group mentions use more toxic language than than in-group mentions, and political mentions are more toxic than apolitical mentions.

INTRODUCTION: Digital mental health interventions (DMHIs) overcome traditional barriers enabling wider access to mental health support and allowing individuals to manage their treatment. How individuals engage with DMHIs impacts the intervention effect. This review determined whether the impact of user engagement was assessed in the intervention effect in Randomised Controlled Trials (RCTs) evaluating DMHIs targeting common mental disorders (CMDs). METHODS: This systematic review was registered on Prospero (CRD42021249503). RCTs published between 01/01/2016 and 17/09/2021 were included if evaluated DMHIs were delivered by app or website; targeted patients with a CMD without non-CMD comorbidities (e.g., diabetes); and were self-guided. Databases searched: Medline; PsycInfo; Embase; and CENTRAL. All data was double extracted. A meta-analysis compared intervention effect estimates when accounting for engagement and when engagement was ignored. RESULTS: We identified 184 articles randomising 43,529 participants. Interventions were delivered predominantly via websites (145, 78.8%) and 140 (76.1%) articles reported engagement data. All primary analyses adopted treatment policy strategies, ignoring engagement levels. Only 19 (10.3%) articles provided additional intervention effect estimates accounting for user engagement: 2 (10.5%) conducted a complier-average-causal effect (CACE) analysis (principal stratum strategy) and 17 (89.5%) used a less-preferred per-protocol (PP) population excluding individuals failing to meet engagement criteria (estimand strategies unclear). Meta-analysis for PP estimates, when accounting for user engagement, changed the standardised effect to -0.18 95% CI (-0.32, -0.04) from - 0.14 95% CI (-0.24, -0.03) and sample sizes reduced by 33% decreasing precision, whereas meta-analysis for CACE estimates were - 0.19 95% CI (-0.42, 0.03) from - 0.16 95% CI (-0.38, 0.06) with no sample size decrease and less impact on precision. DISCUSSION: Many articles report user engagement metrics but few assessed the impact on the intervention effect missing opportunities to answer important patient centred questions for how well DMHIs work for engaged users. Defining engagement in this area is complex, more research is needed to obtain ways to categorise this into groups. However, the majority that considered engagement in analysis used approaches most likely to induce bias.

INTRODUCTION: Implementing artificial intelligence (AI) in healthcare, particularly in primary care settings, raises crucial questions about practical challenges and opportunities. This study aimed to explore the perspectives of general practitioners (GPs) on the impact of AI in primary care. METHODS: A convenience sampling method was employed, involving a hybrid workshop with 12 GPs and 4 GP registrars. Verbal consent was obtained, and the workshop was audio recorded. Thematic analysis was conducted on the recorded data and contemporaneous notes to identify key themes. RESULTS: The workshop took place in 2023 and included 16 GPs aged 30 to 72 of diverse backgrounds and expertise. Most (93%) were female, and five (31%) self-identified as ethnic minorities. Thematic analysis identified two key themes related to AI in primary care: the potential benefits (such as help with diagnosis and risk assessment) and the associated concerns and challenges. Sub-themes included anxieties about diagnostic accuracy, AI errors, industry influence, and overcoming integration resistance. GPs also worried about increased workload, particularly extra, unnecessary patient tests, the lack of evidence base for AI programmes or accountability of AI systems and appropriateness of AI algorithms for different population groups. Participants emphasised the importance of transparency, trust-building, and research rigour to evaluate the effectiveness and safety of AI systems in healthcare. CONCLUSION: The findings suggest that GPs recognise the potential of AI in primary care but raise important concerns regarding evidence base, accountability, bias and workload. The participants emphasised the need for rigorous evaluation of AI technologies. Further research and collaboration between healthcare professionals, policymakers, and technology organisations are essential to navigating these challenges and harnessing the full potential of AI.

Abstract The land has been a source of capital accumulation since colonization through extractive activities like mining and industrial agriculture. Indigenous peoples have profoundly different relationships with the land, which are more relational than extractive. However, their knowledge has been subjugated by and systematically excluded from Western conservation policies, which are based on colonial modes of control. We begin to address this issue by elaborating on a community‐based participatory project, namely a Conservation Impact Bond (CIB), developed in Canada with Deshkan Ziibiing. This CIB was unique since it combined Indigenous and Western knowledges and aimed at restoring ecosystems by building relationships of kinship between peoples and the land. Based on our findings, we propose a Two‐Eyed Seeing relationship‐building process model – a multi‐stakeholder initiative (MSI) incorporating Indigenous and Western knowledges. We discuss the implications of our findings for mobilizing capital to serve collective rather than private interests while promoting Indigenous resurgence and land regeneration. We suggest shifting from extractive to regenerative capital is necessary to address the climate and biodiversity loss crises. This transformation could be achieved by embracing a relational ontology through Two‐Eyed Seeing.

ABSTRACT Reliable sensor node localization is essential for internet of underwater things (IoUT) applications because it allows management, communication, and sensing in large, uncharted oceanic environments. This research focuses on developing a learning‐enabled node localization model for IoUT using autonomous underwater vehicles (AUVs). To estimate the locations of AUVs, active and passive sensor nodes, a double deep Q‐learning (dDQL) based localization algorithm is introduced. AUVs serve as mobile anchor nodes, and the algorithm uses an online value iteration process to optimize node locations. Active sensor nodes initiate the localization process by transmitting messages, whereas passive sensor nodes determine their location without sending signals. Furthermore, the proposed algorithm for exaggerated crayfish optimization (ExCo) utilizes the selection of optimal actions. The proposed dDQL with ExCo acquired RMSE, localization error, time, delay, throughput, and energy consumption of 1.44E‐07 m, 7.19E‐08 m, 16153.16 s, 13.08 s, 0.98 bps, and 0.35 J, respectively.

Abstract Background Bleomycin ElectroScleroTherapy (BEST) is a new approach in the treatment of vascular malformations. After bleomycin is administered to the malformation, electric pulses are applied to the target area to enhance the effectiveness of bleomycin. The mode of action is comparable to the effect of electrochemotherapy on tumour vasculature. For the wider and safer use of BEST in the clinical treatment of low-flow vascular malformations, this Current Operating Procedure (COP) is being prepared. It is a proposal for the clinical standardisation of BEST using the Cliniporator ® as the electrical pulse generator with its associated electrodes. The electrical parameters considered in this protocol are those validated by the European Standard Operating Procedures for Electrochemotherapy (ESOPE) with the Cliniporator ® . Conclusions General requirements are proposed, and, depending on the type of lesion, local skills and the availability of radiological equipment, two technical approaches of BEST are described based on ultrasound guided intervention or combined ultrasound and fluoroscopic guided intervention.

Abstract Strategic autonomy has become a guiding principle for several states as the international order moves toward multipolarity. Turkey has also attempted to carve out a more autonomous space from its traditional Western allies by building new ties in the non-Western world, ranging from the Russia–China axis to the Middle East and beyond. This paper explores the idea and practice of strategic autonomy in Turkish foreign policy. We argue that strategic autonomy is not pre-determined or mechanically driven by ‘hedging’ behavior. We conceptualize strategic autonomy with reference to its three fundamental dimensions: structural orientation, political motive, and economic infrastructure. In this context, we highlight two soft spots in Turkish foreign policy since 2011. First, geopolitical imperatives and domestic policy priorities often contradict each other, which prevents the country from effectively implementing autonomy-seeking policies. Second, strategic autonomy is mainly associated with ‘high politics’ without paying proper attention to its geoeconomic dimension in the form of solid political economy fundamentals and economic security.

Risk studies have rapidly expanded in the last few decades. Yet this growth is characterized by fragmentation in the literature despite it being a central concept for a vast array of organizations, where their success or failure to manage risk is considered central to thriving, surviving or collapsing. We take this opportunity provided by the Perspectives format to engage with a selection of six diverse papers published in Organization Studies over four decades. Drawing from these papers, we trace the evolution of risk research in relation to its epistemic bases in either metrics or values and the strategic focus on risk as either harm or opportunity. Inspired by the tensions between each of these bases, our review of the selected articles illustrates the dynamic entanglement of these ostensibly distinct and polarized strategic and epistemic bases of risk studies. We then develop a conceptual framework to map the field of risk research and propose avenues for future research. Our framework enables us to propose a stronger focus on risk taking for opportunity, warn against becoming overly focused on the metrics for controlling harm especially in the face of enticing visualizations of harmful risk, and strongly assert values as an important epistemic basis for risk studies. As these values may be hidden or visible, we emphasize the importance of understanding whose values are foregrounded in proposing a research agenda for reclaiming societal benefit. This latter focus is a neglected area of risk studies yet is vitally important in addressing the big societal issues of our time.

Evidence of effective aphasia rehabilitation is emerging, yet intervention and delivery varies widely. This European Stroke Organisation guideline adhered to the guideline development standard procedures and Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. The resulting multi-disciplinary, evidence-based recommendations support the delivery of high-quality stroke-related aphasia rehabilitation. The working group identified 10 clinically relevant aphasia rehabilitation questions and rated outcomes' relevance and importance. Following systematic searching, independent reviewers screened title-abstracts and full-texts for randomised controlled trials of speech-language therapy (SLT) for stroke-related aphasia. Results were profiled using PRISMA. Risk-of-bias was evaluated using the Cochrane Risk-of-Bias 1 tool. We prioritised final-value data. Where possible we conducted meta-analyses (RevMan) using random effects and mean, standardised mean differences (functional communication, quality of life, aphasia severity, auditory comprehension and spoken language outcomes) or odds ratios (adverse events). Using GRADE, we judged quality of the evidence (high-to-very low) and ESO recommendation strength (very strong-to-very weak). Where evidence was insufficient to support recommendations, expert opinions were described. Based on low-quality evidence we recommend the provision of higher total SLT dose (⩾20 h) and suggest higher SLT intensity and frequency to improve outcomes in aphasia rehabilitation. Similarly, we suggest the provision of individually-tailored SLT and digital and group therapy delivery models. Very low-level evidence for transcranial direct current stimulation (tDCS) with SLT informed the expert consensus that such interventions should only be provided in the context of high-quality trials. Evidence-based clinical-research priorities to inform SLT aphasia rehabilitation intervention choice and delivery are highlighted.