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Acceptability of, and preference for, human papillomavirus self-sampling for physically Disabled women: A cross-sectional survey
No full textBackgroundPhysically Disabled women face multiple barriers to cervical screening, contributing to lower uptake and increased health inequalities. Human papillomavirus self-sampling has been shown to increase screening participation in under-screened populations, but little is known about its acceptability for Disabled women.MethodsA cross-sectional online survey was conducted with 1493 UK-based participants who identified as having a physical disability, impairment, condition, or difference that makes cervical screening difficult or impossible. Participants completed questions on the acceptability of human papillomavirus self-sampling, attitudes and beliefs relating to self-sampling, and future screening preferences. Descriptive statistics and multinomial logistic regression were used to analyse responses.ResultsMost participants reported that they would be able to carry out self-sampling themselves (63.3%) and would be willing for a healthcare professional to use a self-sampling kit on their behalf (59.1%). Many (70.5%) had concerns about not performing the test correctly. Around half (53.0%) would prefer self-sampling at home if offered a screening choice. Women who had never attended screening, or who had delayed/missed appointments, were significantly more likely to prefer self-sampling (odds ratios 13.11 and 5.25, respectively) than women who had always attended. Approximately a fifth of participants (18.7%) would prefer a non-speculum clinician-taken test.ConclusionHuman papillomavirus self-sampling was acceptable to many physically Disabled women and preferred over conventional screening, particularly among those who had delayed/missed screening or never attended. Implementation should include tailored accessible instructions to support human papillomavirus self-sampling, disability-informed clinical support, and consideration of non-speculum clinician-taken samples to ensure equitable access and reduce inequalities in cervical screening
Narrative systematic review for autism spectrum disorders screening tools in school settings.
No full textEarly screening for autism spectrum disorder (ASD) can enhance educational and health outcomes for affected children. This narrative systematic review explores school-based screening tools used around the world to identify children with ASD and explore the differences across socio-demographic groups. Systematic review of electronic databases (EMBASE, MEDLINE, PsycINFO, Cochrane and Scopus) in October 2024 of papers published between 2011 and 2024. Mainstream school-based settings globally. Children aged 4-16 years old attending mainstream school. School-based screening tools for ASD, including all types of informant and format of tools reported in eligible studies. Primary outcomes included prevalence of screen positives, sensitivity and specificity of the screening tools. Secondary outcomes included participants' sex, socioeconomic status and ethnicity, and the relation of this to the primary outcomes. Of 7765 eligible articles, 14 studies were included in this review. We identified eight different school-based ASD screening tools. Study populations ranged from 103 to 16 556 children, with sensitivity and specificity varying by screening tool used, age group, setting and ASD prevalence. The percentage of children screening positive for ASD ranged from 0.7% to 8.5%. Studies were conducted in Europe (n=6), Western Pacific (n=4), the Americas (n=3) and Eastern Mediterranean (n=1) regions. No studies explicitly explored accuracy or validity outcomes based on ethnicity or socioeconomic status. Half of the 14 studies (n=7) reported the sensitivity and specificity of the screening tools; sensitivity ranged from 58% to 94% and specificity from 61% to 100%. There was insufficient evidence to recommend any single ASD screening tool. ASD screening tools vary widely across the globe, with limited standardisation. Evidence is lacking on how ethnicity and socioeconomic status affect their effectiveness in schools. Given the dearth of scientific evidence in this field, collaboration among educators, researchers and policymakers is needed to establish the evidence base for universal screening, identify optimal tools, coordinate their use and ensure their validation for specific populations. [Abstract copyright: © Author(s) (or their employer(s)) 2026. Re-use permitted under CC BY. Published by BMJ Group.
A conceptual model for healthcare-seeking research and interventions in cutaneous leishmaniasis
No full textBackgroundHealthcare-seeking is not merely a biomedical response to illness but a socially and culturally embedded practice reflecting the dynamic interplay of multiple factors. Traditional health behavioural models often overlook the nuanced socio-cultural, environmental, and systemic dimensions associated with neglected tropical diseases. We developed a conceptual model for healthcare-seeking grounded in the lived experiences of rural Sri Lankan communities with cutaneous leishmaniasis (CL).MethodsWe employed a systematic, participatory, and iterative approach to develop the conceptual model, beginning with stakeholder identification. The problem context was explored using empirical data collected through multimethod studies and expert consultations, which informed the model’s objectives and scope. Data were analysed and synthesised to conceptualise key components and influencing factors of healthcare-seeking in CL. The model was iteratively refined through expert review, with sustained stakeholder engagement ensuring contextual relevance and applicability.ResultsOur conceptual model outlines the healthcare-seeking process for CL, integrating two complementary dimensions. On the horizontal axis of the model, we describe the pathway dimension, consisting of four key landmarks: (1) symptom recognition, (2) perceived health threats, (3) decisions on taking actions, and (4) help seeking from the biomedical sector. The vertical axis shows the determinant dimension, which emphasises both proximal and distal factors that shape healthcare-seeking and is grouped into four aspects: (1) individual factors, (2) disease characteristics, (3) social context, and (4) structural determinants. Some Individual factors (i.e. disease awareness, perceived severity) affected the entire pathway, whereas others (i.e. perceived treatability, psychosocial impact, and costs) influenced decisions on when, where and how to seek healthcare. Disease-related characteristics, including clinical manifestations, prevalence, transmission, and progression, played a critical role, while factors within the social context, such as family and neighbourhood cohesion, health beliefs, and myths about CL, further shaped healthcare decisions. Broader structural determinants, including health and non-health policies, health literacy, media influence, medical pluralism, and healthcare system factors, indirectly but significantly affected the entire process.ConclusionsThis conceptual model presents the dynamic interplay of cognitive, social, cultural, and structural factors shaping healthcare-seeking in CL. By mapping how individuals navigate illness pathways within broader societal and systemic contexts, this model provides a holistic understanding, informing the design of interventions to improve healthcare-seeking in CL at different levels
Fracture detection using a low-dose computed tomography paediatric bone fracture phantom: A multi-reader study of radiographers
No full textIntroductionLow-dose computed tomography (CT) has been proposed as an alternative approach to investigate suspected physical abuse (SPA). This is an important consideration for children under 1 year of age due to the inconvenience of initial and follow-up imaging in addition to CT of the head. Results from a pilot study using a bone fracture paediatric phantom suggested that fracture detection was inconsistent using low-dose CT. The aim of this study was to evaluate whether those findings were consistent for a larger cohort of observers.MethodsNine CT datasets were reviewed by 18 radiographers who marked the fractures using specialist image viewing software. Fractures detected were compared to the known fractures in the commercial paediatric bone fracture phantom. Sensitivity, specificity, positive and negative predictive values (PPV, NPV), with bootstrapped 95 % confidence interval (CI), were calculated.ResultsNone of the observers detected all seven fractures, with a maximum of five identified by four observers. Bootstrapping predicted that the most commonly detected fractures were of the skull with a sensitivity of 88 %, specificity of 67 %, 95 % CI for PPV ranging from 96 to 99 % and NPV of 15–44 % and the tibia and fibula with a sensitivity of 70 %, specificity of 83 %, 95 % CI for PPV ranging from 93 to 99 % and NPV of 16–45 %.ConclusionRadiographers had overall sensitivity of 60 % for fracture detection on this phantom, unaffected by radiation dose, but with large variability between observers. Therefore, more research is required to identify the factors that may have influenced this, such as experience, fracture or phantom-based effect.Implications for practiceThere is currently no evidence to support a change in current clinical practice which is the radiographic skeletal survey series to investigate SPA in children
Geochemical evidence for fluid provenance and hydrothermal alteration processes in sub-salt units of the Northern Red Sea
No full textFor the first time in the Red Sea region, sub-salt aquifers from the northern part of the deep proximal rift basin were assessed on the provenance of formation water, flow dynamics, and hydrothermal alteration processes. Five preserved bottomhole water samples were recovered from Upper Cretaceous and Lower Miocene sedimentary units from three offshore exploratory wells, analyzed on their hydrochemical (major elements, trace elements) and multi-isotopic composition (δ2H, δ11B, δ13C, 14C, δ18O, δ37Cl, δ81Br, 87Sr/86Sr), and compared with different brine manifestations in the Middle East. NaCl type, brackish water (Red Sea Low Salinity Water, RS-LS) infiltrated nearby the Red Sea coastal area. Toward the interior part of the Red Sea basin, seawater evaporation in a sabkha-type surface environment preceded the infiltration of Na-Ca-Cl type, hypersaline Red Sea Formation Brine (RS-FB) with a mineralization of up to 348,000 mg/l, likely triggered by a global sea-level drop during Last Glacial Maximum. 14C concentrations from 3.73 ± 0.06 to 10.1 ± 0.14 pMC (percent Modern Carbon) for RS-FB and 2.12 ± 0.04 to 13.3 ± 0.1 pMC for RS-LS reveal a residence time of 17,998 ± 60 - 32,735 ± 150 yr BP (years Before Present) for the Red Sea basin aquifer systems. The infiltration of surface water occurred through vertical flow pathways along normal fault planes of hanging-walls. Overlapping carbon-14 ages for aquifers from the Red Sea Basin and the Upper Mega Aquifer System on the Arabian Platform suggest a common recharge event during Late Pleistocene period on the Arabian Peninsula under humid paleo-climatic conditions. Distinct 87Sr/86Sr ratios between RS-FB (0.707307 - 0.707350) and Mid-Miocene evaporites (0.70890 - 0.70898) exclude secondary dissolution of halite as feasible brine-forming mechanism for the studied sub-salt units. Intermediate 87Sr/86Sr signatures of RS-FB fluids (87Sr/86Sr = 0.707307 – 0.707350) between present seawater (0.7092) and Rea Sea volcanic basement (0.70269 - 0.70315), plus the presence of partially albitized feldspar and kaolinite in basement basalts, suggest a deep-circulating, active hydrothermal convective system with a calculated strontium contribution of 29% from 87Sr/86Sr -depleted basalts. A positive 18O shift (δ18O up to +6.4‰) reflects the occurrence of secondary hydrothermal water rock interaction processes. δ37Cl ratios between -0.23‰ ± 0.11 and 0.18‰ ± 0.09 indicate dynamic groundwater flow, contrasting to generally 37Cl-depleted static sedimentary pore fluids. δ11B values from 17.2 to 28.2‰ point to clay desorption as mechanism to accumulate kaolinite and illite in the Miocene and Cretaceous aquifer strata
Addition of early vocational advice to usual primary care on sickness absence in employed adults: exploratory findings from the discontinued WAVE Randomised Controlled Trial
No full textBackground and objectives To describe exploratory findings and lessons learned from the discontinued WAVE trial, which sought to determine the effectiveness and costs of adding an early vocational advice intervention to usual primary care on number of days of sickness absence over 6 months. Methods Pragmatic, multicentre, two-parallel arm, superiority, randomised controlled trial with health economic analysis in 10 general practices in England, with nested qualitative interviews. Population: Adults with fit notes for any health condition, absent from work ≥ 2 weeks and ≤ 6 months were invited to participate. Intervention and comparator: Participants were randomised (1 : 1) to usual primary care with/without vocational advice delivered by trained Vocational Support Workers. The planned sample size was 720, the first 4 months of recruitment served as an internal pilot phase and the primary outcome was self-reported days of work absence over 6 months. Results One hundred and thirty participants were recruited from 7955 invitations (May 2022–May 2023) before trial closure (64 usual care, 66 usual care plus vocational advice). Exploratory analysis of 125 participants (with outcome data) indicated small additional benefits of the vocational advice intervention over usual care [mean days absence = 37.86 (standard deviation = 48.76) vs. usual care = 42.66 (standard deviation = 57.67), incidence rate ratio = 0.913, 80% confidence interval (0.653 to 1.276)]. The vocational advice intervention was delivered remotely [mean = 4.8 contacts (range 1–12)]. Partial health economic evaluation found lower work productivity losses at 6 months after vocational advice intervention (£5513.84, standard deviation = £7101.43) compared to usual care (£6146.21, standard deviation = £8431.88). Conclusions, limitations and future work Exploratory analysis indicated a signal of effect, with differences in the number of days absent from work, costs and secondary outcomes. Key lessons learned included the need for closer working with primary care teams and more flexible recruitment methods. A future fully powered randomised controlled trial of vocational advice intervention added to usual primary care is needed to determine the effectiveness and cost-effectiveness. Funding This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme as award number 17/94/49
Some semidirect products of skew braces arising in Hopf-Galois theory
No full textWe classify skew braces that are the semidirect product of an ideal and a left ideal. As a consequence, given a Galois extension of fields L/K whose Galois group is the semidirect product of a normal subgroup A and a subgroup B, we classify the Hopf-Galois structures on L/K that realize L A via a normal Hopf subalgebra and L B via a Hopf subalgebra. We show that the Hopf algebra giving such a Hopf-Galois structure is the smash product of these Hopf subalgebras, and use this description to study generalized normal basis generators and questions of integral module structure in extensions of local fields
Immature platelet fraction as a prognostic marker in patients with pulmonary embolism.
No full textImmature platelet fraction (IPF), a population of young platelets with distinct histological and functional characteristics, is associated with adverse outcomes in several cardiovascular diseases. However, data on the role of IPF in acute pulmonary embolism (PE) is limited. The objective of this study was to evaluate the prognostic significance of IPF levels in patients with acute PE. All patients admitted to a tertiary care center's intensive cardiovascular care unit (ICCU) with confirmed diagnosis of acute PE from July 2019 to July 2024 were included. IPF measurement was carried out using an autoanalyzer (Sysmex XN-2000). The correlation between IPF level and outcome of all-cause mortality was assessed. A total of 166 patients were included. Mean age of 65.0 years (±17.3), of whom 92 (55.4%) were male. The overall one-year mortality rate was 9.0% (15 patients), while the 30-day mortality rate was 4.8% (8 patients). Multivariate logistic regression analysis demonstrated that elevated IPF levels were independently associated with increased 30-day mortality (OR 1.36; 95% CI 1.06-1.80, = .017) and one-year mortality (OR 1.23; 95% CI 1.02-1.5, = .03). Elevated IPF levels are independently associated with increased 30-day and one-year mortality in patients with acute PE. These findings highlight the potential of IPF as a prognostic marker for short-term outcomes in this patient population
The development of a risk threshold to aid risk stratified approach to monitoring for haematological, hepatic and/or renal adverse drug reactions during established cs DMARD treatment for systemic autoimmune rheumatic diseases: a RAND/UCLA Appropriateness Method consensus study
No full textObjective To explore how appropriate different intervals between monitoring blood tests are considered in relation to the risk of clinically significant adverse drug reactions in adults prescribed csDMARDs for ≥1 year for systemic autoimmune rheumatic diseases (SARD). Method A RAND/UCLA Appropriateness Method consensus study was undertaken. Members of the BSR csDMARD guideline working group who manage adults with SARD participated. Experts rated the extent to which intervals between blood tests were appropriate using Likert-type scales with responses from 1 (totally inappropriate) to 9 (totally appropriate) for 9 scenarios with 5-year predicted risk of discontinuing treatment due to abnormal monitoring blood tests from 5% to 25%. Median score and the number that voted 1–3 (inappropriate), 4–6 (unsure), and 7–9 (appropriate) were calculated for every interval in each scenario. Scenarios for which agreement could not be reached in the first round were recirculated, enclosing individual round one response and the panel median score. Consensus that an interval was appropriate for a scenario was reached where the median panel score was ≥7 and up to 6 experts rated <7. The results were discussed with PPI members and experts. Results Twenty-one of the 27 invitees participated. They comprised 11 consultants/GPs, five specialist nurses, three pharmacists, and two rheumatology specialty trainees. Consensus was reached for all scenarios. Six- and three-monthly blood tests were agreed as appropriate when the predicted risk was ≤10% and >10% over 5-years respectively. Conclusion A threshold to aid risk-stratified monitoring during established csDMARD treatment was agreed for adults with SARD
Mitigating the environmental and ecological impacts of evolving city-scale streetlighting installations
No full textArtificial light at night (ALAN), from streetlights and other sources, is ubiquitous across modern towns and cities and has wide-ranging impacts upon the natural environment. The extent, spectra and timing of light influence the physiology, behaviour and fitness of individuals of many species, shape the structure of ecological communities and the functioning of ecosystems. To date, however, it has been challenging to characterize this lighting at sufficiently fine spatial resolutions across city-wide extents. Here, we apply a Monte Carlo radiative transfer model to simulate in three dimensions the light environment resulting from emission from streetlights using the city of Exeter, UK, as an exemplar. We show that this technique can model the evolving lighting landscape of modern cities at scales, and through observables, suitable for both ecological studies and lighting professionals. We estimate measures of melatonin suppression, induced photosynthesis and phytochrome photostationary state from our models, probing how the transition towards light-emitting diode street lighting impacts physiological processes in plants and animals throughout the city. Our simulations illustrate that although the area lit by ALAN is decreasing overall at metre scales, which is lit is becoming more hostile towards many organisms