Children, young people and the League of Nations in interwar Britain

This article asks how the League of Nations, and its supporters in Britain, sought to mobilize young people c.1918–39. How did children and young people associated with the League of Nations Union engage with the League of Nations? What meanings were ascribed to this engagement? Drawing on sources from the League of Nations and local junior branches, we explore spaces for internationalist engagement from the local community to overseas travel. We conclude that children and young people emerged as a distinct group of actors in international affairs and were part of the League’s wider mission to create an informed international public opinion

Embedding an illustrator in the process of co-producing resources to enhance communication and shared decision-making for patients prescribed high-risk medication

ObjectivesTo examine how embedding an illustrator in the process of co-producing resources to support shared decision-making (SDM) can enhance communication between patients and healthcare professionals (HCPs).MethodsThree case studies were identified involving high-risk medications where the utility of effective visual communication resources is key to SDM due to the risk of information being misinterpreted leading to potential serious adverse effects. An iterative approach was adopted to the phases of co-production, where the Illustrator acted as a conduit between patients and specialist knowledge of the clinical team. The expertise of the Illustrator was harnessed to balance the use of visual and written information, working with the HCPs in co-creating the messaging.ResultsCase Study 1 relates to the urgent administration of hydrocortisone injection for adrenal crisis in adults and children. Case Study 2 relates to self-management of the need to adjust oral corticosteroid dosing during periods of adrenal insufficiency to prevent adrenal crisis. Case Study 3 focused on women with reproductive potential prescribed or considering sodium valproate for the management of epilepsy. The benefits of involving an Illustrator were evident across all case studies, invoking supportive, empowering and empathic visual communication throughout, leading to removal of some text by the clinical team.ConclusionsHarnessing the expertise of Illustrators as part of a multi-disciplinary team with patients was seen as an enabler for authentic co-production to support an empathic approach to SDM in these three case studies. Further evaluation is needed to assess the impact of the use of visual communication resources of this nature in healthcare, and the impact on patient behaviours and clinical outcomes

Number of Publications on New Clinical Prediction Models: A Bibliometric Review

Concerns have been expressed about the abundance of new clinical prediction models (CPMs) proposed in the literature. However, the extent of this proliferation in prediction research remains unclear. This study aimed to estimate the total and annual number of CPM development-related publications available across all medical fields. Using a validated search strategy, we conducted a systematic search of literature for prediction model studies published in Pubmed and Embase between 1995 and the end of 2020. By taking random samples for each year, we identified eligible studies that developed a multivariable model (ie, diagnostic or prognostic) for individual-level prediction of a health outcome across all medical fields. Exclusion criteria included development of models with a single predictor, studies not involving humans, methodological studies, conference abstracts, articles with unavailable full text, and those not available in English. We estimated the total and annual number of published regression-based multivariable CPM development articles, based on the total number of publications, proportion of included articles, and the search sensitivity. Furthermore, we used an adjusted Poisson regression to extrapolate our results to the period 1950-2024. Additionally, we estimated the number of articles that developed CPMs using techniques other than regression (eg, machine learning). From a random sample of 10,660 articles published between 1995 and 2020, 109 regression-based CPM development articles were included. We estimated that 82,772 (95% CI 65,313-100,231) CPM development articles using regression were published, with an acceleration in model development from 2010 onward. With the addition of articles that developed non-regression-based CPMs, the number increased to 147,714 (95% CI 125,201-170,226). After extrapolation to the years 1950-2024, the number of articles increased to 156,673 and 248,431 for regression-based models and total CPMs, respectively. Based on a representative sample of publications from the literature, we estimated that nearly 250,000 articles reporting the development of CPMs across all medical fields were published until 2024. CPM development-related publications continue to increase in number. To prevent research waste and close the gap between research and clinical practice, focus should shift away from developing new CPMs to facilitating model validation and impact assessment of the plethora of existing CPMs. Limitations of this study include restriction of search to articles available in English and development of the validated search strategy prior to the popularity of artificial intelligence and machine learning models

Maternal physiological parameters and routine laboratory tests to screen for maternal sepsis: an observational cohort study

Maternal sepsis can lead to poor outcomes for the mother and neonate, and early diagnosis and treatment of infection is important to prevent sepsis. Current guidance to recognise maternal sepsis includes assessment of physiological markers, however normal physiological changes of pregnancy can hinder the diagnosis of sepsis. This study investigated the utility of routine clinical variables, including laboratory tests, in screening for maternal sepsis. Patients considered at risk of obstetric sepsis were recruited into a single centre cohort study. Microbiological, histological and clinical data categorised patients into three diagnostic groups: 'infection confirmed', 'infection unknown' and 'infection unlikely'. Differences in physiological and routine laboratory variables were investigated. Between November 2020 and December 2022, 154 pregnant patients were recruited. Comparison between 'infection confirmed' (n=58) and 'infection unlikely' (n=17) showed statistical differences in temperature (P <0.001), neutrophil count (P =0.003) and leukocyte count (P =0.004) at the time of recruitment. Temperature was the best discriminator with an area under the receiver operating characteristic curve (AUC-ROC) of 0.82 (95% CI 0.70 to 0.94, P <0.0001) with an optimal threshold of ≥37.5°C. This observational cohort study demonstrated that maternal temperature ≥37.5°C (rather than the threshold of 38°C found in most screening tools) may be important in screening patients at risk of developing maternal sepsis. When temperature ≥37.5°C persists, medical care should be expedited and maternal infection considered

Exploring the impact of travel vlog attributes on silver tourists’ behavioural intentions: the role of cognitive and emotional resonance

This study examines the effects of different stimuli in travel vlogs on the responses of silver tourists. A particular focus is on the effects of cognitive and emotional resonance. A total of 376 valid questionnaires were collected from Chinese nationals aged 50 years and older. The results indicate that certain attributes of travel vlogs, namely information usefulness, vlogger’s attractiveness, para-social interaction, and audio-visual stimuli, can positively influence the behavioural intentions of silver tourists. In addition, emotional resonance tends to play a more important role in the responses of silver tourists than cognitive resonance. The results suggest that travel vlogs could serve as effective tools for destination marketers aiming to gain a competitive advantage in the silver tourism sector. In addition, in the process of developing or selecting travel vlog content, it is essential for marketing professionals to incorporate informative travel messages accompanied by high-quality audio-visual elements

Co-Designing for Desistance: Developing My Journey to Support People in the Criminal Justice System

This article explores the development of My Journey, a web-based application (app) co-designed with people in the criminal justice system (CJS) to facilitate desistance. Developed in partnership with Include UK, a third-sector organisation, the app aims to promote agency, improve access to resources, and facilitate practitioner support for people in the CJS. Grounded in desistance theories, My Journey embodies principles such as agency, strengths-based approaches, and positive relationship-building, promoting person-centred and individualised support. The co-design process engaged five practitioners and 41 people with lived experience, ensuring the app reflected their needs. By integrating theoretical insights with practical application, My Journey represents an innovative attempt to translate desistance theories into a useable digital technology to support people and practitioners in the CJS. This article outlines the key themes of desistance translated into the app, details the co-design methodology, and presents the app’s features, highlighting its potential to bridge theory and practice

Gambling, suicide and mental health treatment utilisation in Wales: case–control, whole-population-based study

BackgroundGambling-related harm is a global public health concern. Suicide mortality is increased among people who experience gambling harm, and people who die by suicide often have contact with mental health treatment services in the months preceding their death.AimsTo assess via a case–control study how gambling diagnosis predicts suicidal death and mental healthcare utilisation using linked routinely collected healthcare data.MethodWe linked the Welsh Longitudinal General Practice Dataset, Annual District Death Extract, Patient Episode Database for Wales, and Outpatient Appointments Dataset Wales using the Secure Anonymised Information Linkage (SAIL) Databank. A sample of individuals with gambling diagnosis who died by suicide and an age- and sex-matched comparator group of all-cause decedents between 1993 and 2023 were extracted. Predictors of suicidal death, including mental health diagnosis and treatment contacts, were analysed using binary logistic regression models and chi-squared tests.ResultsA matched cohort of 92 individuals diagnosed with a gambling diagnosis (mean age 61.5 years, s.d. 13.1; 71% male) who died by suicide and 2990 comparators were identified. Gambling diagnosis status was a significant predictor of suicide (odds ratio 30.94; 95% CI 3.57–268.28; P = 0.002). Individuals with gambling disorder had significantly more mental health treatment contacts (P < 0.001), particularly in-patient contacts (P < 0.001). No difference in out-patient contacts was found.ConclusionsHistorical diagnosis of gambling harm is a significant predictor of suicidal death and mental health treatment utilisation. Improved screening and coding practices would facilitate greater data linkage research on gambling-related suicide and suicide prevention

The Role of Ferroptosis in Tuberous Sclerosis Complex Disease

Tuberous Sclerosis Complex disease is a rare genetic disorder that results in the uncontrolled growth of affected cells, leading to the development of benign tumours in different tissues of the body that cause neurological disorders, skin problems, and heart, kidney and lung dysfunction. The condition is characterised by mutations in the TSC subunit genes (TSC1 or TSC2) leading to continuous activation of the mammalian target of rapamycin (mTOR) pathway, a central driver of cell proliferation and metabolism. Rapidly dividing cells require increased iron metabolism to maintain a wide spectrum of cellular processes, such as DNA synthesis and cellular respiration. However, these processes must be tightly regulated as excess iron is toxic to cells, via reactive oxygen species (ROS) and Fenton reactions, triggering ferroptosis, an iron-dependent form of programmed cell death. To avoid ferroptosis, cells must upregulate pathways that detoxify ROS. Tied into this is the role glutathione peroxidase enzymes (GPXs) play in regulating ROS homeostasis. Preliminary data from collaborators shows increased expression of Gpx8 in TSC2-/- mouse embryonic fibroblasts (MEFs). Localised to the endoplasmic reticulum (ER), GPX8 is an enzyme which neutralises the build-up of hydrogen peroxide (H2O2), an important ROS involved in lipid peroxidation and the induction of ferroptosis. Furthermore, the overexpression of GPX8 has been shown to be associated with an aggressive phenotype in breast cancer due to its influence on the epithelial-mesenchymal transition required for metastasis (Khatib et al., 2020). We hypothesise that GPX8 plays a role in the evasion of ferroptosis in Tuberous Sclerosis Complex patient tumours. This project will use RNA-seq data from TSC-/- AML cells to profile genes involved in ferroptosis. We will use TSC2-/- and TSC2+/+ (wt) angiomyolipoma (AML) cells derived from Tuberous Sclerosis Complex patient kidneys as a disease model to explore the role GPX8 and ferroptosis play in Tuberous Sclerosis Complex disease. The proteins involved in the induction/evasion of ferroptosis will be explored by immunoblotting, flow cytometry and confocal microscopy. Small molecule inducers of ferroptosis or siRNA targeting of GPX8 expression will be used for viability assays and wound healing assays in TSC2-/- vs wt cells