Core GRADE 1: overview of the Core GRADE approach

This first article in a seven part series presents an overview of the essential elements of the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach that has proved extremely useful in systematic reviews, health technology assessment reports, and clinical practice guidelines. GRADE guidance has appeared in many articles dealing with both core issues and more specialised and complex guidance, and it has evolved over time. This series of articles presents GRADE essentials, Core GRADE, focusing on the core judgments necessary to summarise the comparative evidence about alternative care options and to make recommendations that apply to the care of individual patients. This article presents detailed guidance on formulating questions using the PICO (population, intervention, comparison, outcome) structure, and refining the question considering possible differences in relative and absolute effects across patient groups. The article then provides an overview of the remainder of the Core GRADE approach, including decisions about the certainty of the evidence and considerations in moving from evidence to guidance and recommendations

Core GRADE 2: choosing the target of certainty rating and assessing imprecision

This second article in a seven part series presents the Core GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to deciding on the target of the certainty rating, and decisions about rating down certainty of evidence due to imprecision. Core GRADE users assess if the true underlying treatment effect is important or not in relation to the minimal important difference (MID) or, alternatively, if a true underlying treatment effect exists. The location of the point estimate of effect in relation to the chosen threshold determines the target. For instance, using the MID thresholds, a point estimate greater than the MID suggests an important effect and less than the MID, an unimportant or little to no effect. Users then rate down for imprecision if the 95% confidence interval crosses the MID for benefit or harm

Towards a Sustainable Construction Industry: A Fuzzy Synthetic Evaluation of Critical Barriers to Entry and the Retention of Women in the South African Construction Industry

Over the past few decades, numerous efforts have been made to increase the proportion of women in the construction industry, coupled with various calls for legislation and rules to prohibit gender discrimination. Despite these efforts, minimal progress has been noticed in the construction industry. While recruitment remains crucial, the current culture in construction reveals a knowledge gap in recruitment and retention in employment—a concept known as a ‘leaky pipeline’. Lack of awareness of career options and the challenges of working in a male-dominated, occasionally discriminatory workplace are some of the significant barriers to attracting and keeping women in the construction industry. Much of the research in South Africa shows that most construction companies employed few women but only in lower secretarial and administrative positions. Therefore, this study investigated the barriers facing women’s entry and retention in construction-related employment in South Africa using fuzzy synthetic evaluation (FSE) to understand and prioritise the barriers. Data were collected through the administration of online and paper-based questionnaires. The results of the analysis show that the barriers in the order of criticality include support and empowerment issues (SEs), educational/academic-related barriers (ABs), barriers from professional conditions and work attributes (BPs), social perception and gender stereotype barriers (SPs), professional perceptions and gender bias (PP), and individual confidence/interest/awareness/circumstance-related barriers (IBs), respectively. Based on the findings of the study, several recommendations, including on-the-job tutoring and flexible work arrangements, amongst others, were provided

Comparing p62 and LC3 as Autophagy Biomarkers: Insights into Cellular Homeostasis

Autophagy is a fundamental cellular process that maintains homeostasis by the degradation of damaged organelles and proteins. It plays crucial roles in cellular remodelling, development, and disease progression. These roles apply to the study of neurodegenerative diseases which is heavily linked to the toxicity produced by unwarranted accumulation of cellular material. A key player in autophagy is LC3, which translocate to autophagosomal membranes during the process. Detecting fluorescently labelled LC3-II through immunofluorescence provides a valuable method for assessing autophagy levels in samples. In a similar premise p62, also known as sequestosome-1 (SQSTM-1), is an adaptor between LC3 and ubiquitinated substrates, facilitating their incorporation into autophagosomes for degradation. Consequently, p62 levels can reflect autophagic activity and this study explores the viability of the protein as an autophagy biomarker. Using a variety of autophagy inhibitors, autophagic flux could be assessed and a comparison could be made between the response to the inhibition between LC3 and p62. The absence of statistically significant results in any of the test markers, whether it is the inhibitors in immunofluorescence, or the western blotting results does not support the original hypothesis. Consequently, this study concludes that p62 is unsuitable as an autophagy biomarker. Even though p62 has been extensively studied as a biomarker, it remains controversial. Further investigations are required to clarify its role and address any technical challenges whilst for now, LC3 remains the gold standard biomarker. However, understanding p62’s nuances and alternative functions could potentially enhance our understanding of autophagy dynamics

Investigating the component structure of the Health of the Nation Outcomes Scales for people with Learning Disabilities (HoNOS-LD)

Background: Outcome measurement is increasingly recognised as a vital element of high-quality service provision, but practice remains variable in the field of intellectual disabilities. The Health of the National Outcome Scales for people with Learning Disabilities (HoNOS-LD) is a widely used Clinician Reported Outcome Measure in the UK and beyond. Over its 20-year lifespan, its psychometric properties have been frequently investigated. Multiple dimensionality reduction analyses have been published, each proposing a different latent structure. Aim: To analyse a set of HoNOS-LD ratings to test its internal consistency, to identify the optimal number of latent variables, and to propose the items that group together in each domain. Methods: A Principal Component Analysis of 169 HoNOS-LD ratings was performed to produce an initial model. The component loadings for each HoNOS-LD item were then examined, allowing the model to be adjusted to ensure the optimal balance of statistical robustness and clinical face-validity. Results: HoNOS-LD’s internal consistency (18 items) was ‘acceptable’ (Cronbach’s alpha = 0.797). On excluding three items that had no bivariate correlations with the other 15 items internal consistency rose to ‘good’ (Cronbach’s alpha = 0.828). The final, four-component solution, using the 15 items possessed good internal reliability. Conclusion: HONOS-LD statistical properties compared favourably to the other published latent structures and adheres to the tool’s rating guidance. The four-component solution offers an acceptable balance of statistical robustness and clinical face validity. It provides advantages over other models in terms of internal consistency and/or viability for use at a national level in the UK

Levetiracetam in epilepsy and autism spectrum disorder: analysis of safety, tolerability, and efficacy

Purpose: One in five people with autism spectrum disorder have epilepsy and take Anti-Seizure Medications (ASM). However, the impact of ASM on people with autism is under researched. This study evaluates the efficacy and tolerability of Levetiracetam (LEV) for autistic people and epilepsy. Method: Data was derived from the English Epilepsy Research Database Register which compares ASM responses in those with neurodevelopmental disorders to those without. Age range was 18–50 years as there were no autistic research participants with autism prescribed LEV over 50. Twelve-month ASM data, including withdrawal rate, seizure frequency and adverse effects were compared. Fisher\u27s exact test was used to assess univariate associations between outcomes and autism with significance accepted as p \u3c 0.05. Logistic regression was used to assess autism group differences after adjustment for potential confounders (age, gender, presence of baseline physical and mental health conditions). Results: Of 175 (aged 18–50) research participants across 18 NHS Trusts, prescribed LEV between 2000 and 2020, 40 were autistic. There was no significant association between withdrawal rate (P = 0.626), or grouped side effects (physical P = 0.165, mental health P = 0.791). Autism was significantly associated with aggression with LEV in univariable analysis but this association was no longer significant after accounting for multiple testing A significant non-linear relationship between efficacy and the autism group (P \u3c 0.001) was found. Conclusions: This study supports the use of LEV for people with autism and epilepsy as there is no difference in response noted to those without autism. However, they may have less prominent changes in efficacy

A five-year retrospective analysis (2017-2022) of reported incidents from a primary care-based education provider

Background Patient safety incident reporting and analysis are often confined to secondary care, despite 95% of dentistry occurring in primary care. Peninsula Dental Social Enterprise (PDSE) delivers primary care dentistry in education-based settings and uses a report-review-action process to underpin its patient safety framework. Aim This article analyses trends in clinical incident data, reflecting on learning to improve overall patient safety. Methods A retrospective observational study was employed to analyse incidents over a five-year period (2017-2022) using anonymised data from the PDSE reporting system. Results Over the five-year reporting period, there were an average of 13.1 total incidents per 1,000 appointments. Sub-analysis of reported incidents revealed 1.5 clinical incidents and 0.9 ‘near miss\u27 incidents. A soft-tissue injury rate of 0.6, a contamination injury rate of 0.9, and 0.3 written complaints were reported per 1,000 appointments. Conclusion Patient safety is a key component of quality dental care, especially when delivering clinical dental education. PDSE fosters an environment of transparency, enabling the provider to monitor incidents and learn from them. This results in systems improvements sitting at the heart of the clinical service. With a lack of data published from similar settings, comparison to the sector is limited. Further sharing of data is encouraged to enable standardisation and quality benchmarking

Microneedle electrodes: materials, fabrication methods, and electrophysiological signal monitoring‑narrative review

Flexible, microneedle-based electrodes offer an innovative solution for high-quality physiological signal monitoring, reducing the need for complex algorithms and hardware, thus streamlining health assessments, and enabling earlier disease detection. These electrodes are particularly promising for improving patient outcomes by providing more accurate, reliable, and long-term electrophysiological data, but their clinical adoption is hindered by the limited availability of large-scale population testing. This review examines the key advantages of flexible microneedle electrodes, including their ability to conform to the skin, enhance skin-electrode contact, reduce discomfort, and deliver superior signal fidelity. The mechanical and electri-cal properties of these electrodes are thoroughly explored, focusing on critical aspects like fracture force, skin penetration efficiency, and impedance measurements. Their applications in capturing electrophysiological signals such as ECG, EMG, and EEG are also highlighted, demonstrating their potential in clinical scenarios. Finally, the review outlines future research directions, emphasizing the importance of further studies to enhance the clinical and consumer use of flexible microneedle electrodes in medical diagnostics

Celebrating Children and Young People’s Nursing Conference, 2025 ‘Our Present, Our Future: Keynote presentation: The Fit4CYP project

Northumbria University is delighted to be hosting this national conference in partnership with the Great North Childrens Hospital (Newcastle Hospitals NHS Foundation Trust), Northumbria Healthcare NHS Foundation Trust (Childrens Nursing Services) and South Tyneside and Sunderland NHS Foundation Trust (Childrens Nursing Services).Conference aim:This conference will provide one of the largest national and international forums for children and young people’s (CYPs) nurses to collaborate and network on a range of contemporary topics relevant to their practice. A broad range of activities is planned with the aim to connect, inspire, and educate, encouraging thought provoking exchanges. Delegates will be offered the opportunity to share ideas and experiences for the present and future of the profession, meeting the needs of children, young people, and their families

Mathematics in the Early Years Curriculum

Curriculum is a point of struggle within early years education, whereby the pedagogic traditions of being play-based and child-centred, do not overtly sit comfortably with notions of subjects and courses of study that are typically associated with curricula. Mathematics is an illustrative example of this tension within early years education curricula, whereby mathematics lends itself to established structured models of curricula, such as Bernstein\u27s Collection Code, but this structure runs counter to the perceived freedom of play. Combine free play with the emphasis on the outdoors in early years education, and an additional point of struggle emerges as to how to combine the traditions of play, free-flow outdoor education and formal subjects such as mathematics. Therefore, this research answers the question to what extent do outdoor activities provide a quality mathematics curriculum? Drawing on a mixed-methods, case study approach of four different early years education settings in England (preschool, nursery school, day nursery and reception class), empirical data are used to compare the approaches and practices of mathematics education in outdoor environments. The findings identify the role of adults, the kinds of activities and resources used and in what context influence the pacing and sequencing of mathematics curriculum. The study demonstrates how educators move between curriculum types in support of both structure and child autonomy