Patient and public involvement (PPI) increasingly features in the shaping, design, and conduct of mental health research. This review identifies and synthesizes evidence of barriers and facilitators of PPI in mental health research within university settings. The search strategy followed PRISMA guidance and involved keyword searches in eight peer reviewed databases, grey literature, hand searching two journals, requests to national mental health organizations, and backwards and forwards citation searching. We included primary mental health studies on patient and public involvement, with data on facilitators and barriers. Data were extracted capturing author, date and country of publication, study aim, participant and research team composition, data collection and analysis methods, and levels of PPI. Quality appraisal was conducted using the CASP Checklist for Qualitative Research, with an additional item on intersectionality. We conducted an inductive thematic analysis, before holding a peer-debriefing session with a lived experience working group. The final dataset included 51 articles that were either of a qualitative design or contained analyzed qualitative data. Barriers and facilitators were grouped around the following themes: the structure of the research environment, organizational culture, and individual needs. Good practice exists, but the wider research environment and power imbalances within universities constrain PPI. For PPI in mental health research to reach its full potential, the redistribution of power, building capacity for all, the provision of safe working environments, and widening inclusion in the research process are necessary. This review involved researchers with lived experience of mental ill health.

Background: Ventilator-associated pneumonia (VAP) primarily occurs due to the aspiration of secretions containing microorganisms from the oropharynx or stomach into the lungs. Preventing aspiration is a critical strategy for reducing VAP incidence. This study analyzed the impact of aspiration prevention measures—head-of-bed elevation (HOBE) and enhanced oral care—on VAP rates in adult intensive care units (ICUs). Method: This interventional study was conducted in the adult ICU of a 2,734-bed tertiary care hospital. A total of 8 ICUs (medical, surgical, cardiology, cardiovascular, neurology and neurosurgery) with 112 beds observed an increase in VAP incidence from January to April 2023, prompting enhanced measures in May 2023. The first intervention involved revising and reinforcing indications for head-of-bed elevation (HOBE) while strengthening monitoring and on-site feedback. During clinical procedures such as positional changes requiring a supine position, oropharyngeal suctioning was performed before lowering the head of the bed, and staff were trained to ensure prompt restoration of the HOBE to the appropriate position afterward. The second intervention improved oral care by replacing chlorhexidine and gauze with tooth brushing. A protocol was developed requiring 2 minutes of brushing teeth, artificial airways, tongue, and palate using a silicone toothbrush moistened with saline or sterile water, excluding patients with contraindications such as bleeding risks. Monitoring revealed missed areas during brushing, necessitating additional simulation training using dental models and colored toothpaste to confirm plaque removal. The pre-intervention period was conducted over 9 months (August 2022 to April 2023), while the intervention period lasted 17 months (July 2023 to November 2024). VAP incidence rates were compared before and after the intervention. Additionally, the incidence of VAP associated with pathogens such as Klebsiella pneumoniae, Acinetobacter baumannii, or Pseudomonas aeruginosa, often isolated from dental plaques of ICU patients, were analyzed. Results: The incidence rate of VAP per 1,000 ventilator days among adult ICU patients decreased from 3.9 (66/16,849) before the intervention to 2.4 (78/32,185) after the intervention (IRR, 0.62, 95% CI, 0.45-0.86; P = 0.007). Similarly, the incidence rate of VAP associated with pathogens K. pneumoniae, A. baumannii, or P. aeruginosa were 1.6 (27/16,849) before the intervention, and 1.0 (31/32,185) after the intervention (IRR, 0.60, 95% CI, 0.36-1.01; P = 0.07). Conclusion: As a result of implementing enhanced head-of-bed elevation and oral care protocols for ventilated patients in the adult ICU, the incidence of VAP significantly decreased. Further multicenter studies are needed to validate our findings.

Background: The Republic of Korea ranks second among OECD countries for tuberculosis (TB) incidence. National TB control guidelines mandate latent TB infection (LTBI) screening and treatment for healthcare workers (HCWs), especially those in high-risk departments. At our 2,700-bed tertiary hospital in Seoul, annual LTBI screening and treatment have been actively implemented since 2017, targeting HCWs at elevated risk of TB exposure. This study evaluates LTBI conversion rates among high-risk HCWs and characteristics of HCWs with conversion (converters) over the past five years. Methods: Following national guidelines, HCWs were classified into three high-risk groups: those likely to have routine contact with pulmonary TB patients (Group A), those caring for immunocompromised patients (Group B), and those at risk of respiratory infections despite no routine TB contact (Group C). Annual screening included interferon-gamma release assay (IGRA) and chest radiography. HCWs with positive IGRA results (≥0.35 IU/m) were strongly encouraged to undergo latent tuberculosis treatment. We analyzed data from HCWs working in high-risk tuberculosis units who had worked for more than five years from 2020 to 2024. HCWs with prior IGRA positivity were excluded. Results: Among, 1467 HCWs, 15.9% (233/1,467) had been diagnosed with LTBI before 2020, while the cumulative LTBI conversion rate between 2020 and 2024 was 5.3% (65/1,234). The annual LTBI conversion rates ranged between 0.7% and 1.5%. The median age of converters was 42 years, significantly older than non-converters (median 38 years; P = 0.02). Male converters comprised 24.6% (16/65) compared to 14.6% (171/1,169) in the non-converter group (P = 0.03). Longer tenure was observed among converters (median 16 years) than non-converters (median 12 years; P = 0.01). Although medical technicians and emergency room staff exhibited higher conversion rates, these differences were not statistically significant. Among LTBI cases, 78.8% completed treatment, with 9.1% demonstrating reversion. The annual incidence of active tuberculosis among HCWs at our hospital significantly declined to an average of 0.2 cases per year between 2020 and 2024, compared to 4.4 cases per year between 2015 and 2019 Conclusions: Annual LTBI screenings revealed conversion rates of approximately 1%, primarily affecting older, long-tenured, and male HCWs. Active LTBI treatment effectively reduced the risk of active TB among hospital staff.

Background: Universal decolonization using chlorhexidine gluconate (CHG) foaming soap in a hospital system has been shown to reduce healthcare-associated infections (HAIs) and colonization by multidrug-resistant organisms. Limited data exist on optimal strategies to improve compliance, and the impact of improved compliance on HAI rates. This study evaluates the effect of increasing CHG compliance on MRSA HAI rates. Methods: In 2022, our acute care VA hospital started universal CHG bathing treatment, by requiring a daily CHG bath for all patients in intensive care units and medical/surgical floors, unless contraindicated. Despite this, compliance was below goal. We performed root cause analyses to identify factors contributing to poor compliance, and then initiated a bundled intervention, including nursing staff education on the benefits of CHG bathing to reduce HAIs, how to reframe discussions with patients about refusals, removal of one alternative soap product from the inventory, and moving the CHG bathing product in clean supply rooms to be in proximity with other patient hygiene products for easier access. We evaluated the utilization of CHG bathing products through inventory data on utilization of 4 fluid ounce bottles of 4.0% weight/volume CHG solution, documentation of at least one CHG bath in the electronic medical record (EMR) per unique hospitalization, and HAI rates per National Healthcare Safety Network (NHSN) definitions for methicillin resistant Staphylococcus aureus (MRSA), before (08/2023-02/2024) and after (03/2024-12/2024) implementation of the bundle. Results: Identified barriers to CHG adherence included use of less effective alternative soap agents, perceptions of patient skin irritation from CHG, difficulty integrating CHG into existing workflows, and lack of understanding of the benefits of CHG bathing. After bundled interventions, inventory usage CHG bottles increased from 170 to 270 bottles per 1,000 bed days of care (BDOC) (p Conclusion: An intervention of staff education, removal of an alternative soap product, and improving access to CHG bathing products in supply rooms, resulted in improved CHG bathing adherence, and was associated with a reduction in MRSA HAIs in an acute care VA hospital. Interestingly, the decrease in MRSA HAIs was achieved despite an absence of complete adherence. Further data on additional strategies to improve compliance and strategies to improve healthcare worker documentation should be explored.

Antimicrobial resistance is an urgent public health threat, and despite significant consumption of antimicrobials in pregnancy, there remain opportunities for improvement of their use in the obstetric population. Improvement in antimicrobial utilization can be streamlined by assessing baseline characteristics, utilization of diagnostic testing, awareness of peripartum protocols, and recognition of penicillin allergies. In a single healthcare system including 8 obstetric hospitals, an administrative review identified 199 different regimens used among 8,528 patients based on American College of Obstetrician and Gynecologists (ACOG) guidelines. Other notable factors include 65.6% of patients having no cultures obtained despite being started on empiric antibiotics, duplicative coverage when multiple clinical scenarios overlap, and a high incidence of reported penicillin allergies with obstetric providers lacking comfort to reconcile and de-label allergies. By reviewing these individual aspects, this can highlight opportunities for improvement of antimicrobial use and stewardship in obstetric populations.

VR sketching tools have matured to a practical level, enabling use across various 3D design disciplines. Studies into VR sketching in design report beneficial affordances but are based on brief testing of tools in simulated tasks. Consequently, there is a knowledge deficit in understanding how to effectively integrate VR sketching into design projects. We address this gap with a case study on the sustained use of VR sketching in 10 automotive concept design projects over 10 months. In analysing designers’ logbooks, which captured design development, and post-study reflections, we show how the affordances of VR sketching outlined in literature manifest in practice. Specifically, we show how and when designers can exploit the precedence of 3D geometry embodied in VR sketches to advance the design process in terms of several dimensions of design fidelity. We highlight where process advantages are realised through (1) increased spatial fidelity, reducing the time required to iterate 2D sketches, (2) operational fidelity supporting dynamic testing of concept functionality via animation and (3) environmental fidelity supporting contextualising components and storytelling. As such, our findings highlight how and when practitioners can realise the comparative benefits of VR sketching alongside traditional sketching and 3d modelling during the concept design process.

Prenatal maternal mental health and social determinants of health may influence pregnancy, child hospitalisation, and child neurodevelopmental outcomes in critical congential heart disease (CHD). We examined 189 mother–child dyads of children born with CHD who underwent neonatal cardiac surgery and completed neurodevelopmental assessment between the ages 13 and 29 months. We used latent profile analysis to identify distinct maternal groups based on prenatal maternal mental health screening scores and individual- and neighbourhood-level social determinants of health factors. We examined the association between maternal groups with their child’s gestational age, birth weight, hospital length of stay (HLOS), and neurodevelopment. Latent profile analysis identified two distinct groups: high-risk (n = 46) and low-risk (n = 143). Mothers in the high-risk group had higher mental health screening scores, lower age, higher social vulnerability, lower education, and were more likely to have Medicaid insurance and represent a minority group than mothers in the low-risk group. The high-risk group had children with lower gestational age and weight at birth, longer HLOS, and lower cognitive, language, and motor scales than children in the low-risk group (p < 0.05). Sensitivity analysis in mother–infant dyads without foetal extracardiac conditions found that significant relationships persisted in the high-risk group, with lower gestational age and lower language scale scores than the low-risk group (p < 0.05). Children of mothers with adverse prenatal maternal mental health and social determinants of health risks had significantly worse pregnancy and child outcomes. Interventions are critically needed to address maternal mental health and social determinants of health risks beginning in the prenatal period.

The use of extended reality (XR) for education of healthcare personnel (HCP) is increasing. XR equipment is reusable and often shared between HCP in clinical areas; however, it may not include manufacturer’s instructions for use (MIFU) in healthcare settings. Considerations for the selection of equipment and development of cleaning and disinfection protocols are described.

A hidden consequence of the cumulative impact of poverty, ‘hygiene poverty’ compels people to make stark choices when allocating household budgets. To increase understanding of this understudied phenomenon, we explored the prevalence of factors leading to, and impacts of, hygiene poverty in Ireland. An online survey was completed by 258 respondents during September 2023 covering a broad range of topics relating to the affordability of hygiene products. The results were analysed to identify key themes of statistical relevance in the data. Our study found 65.1 per cent of respondents had personally experienced difficulty affording essential hygiene items. Whilst lower incomes and the presence of children in the household featured, inability to afford hygiene items was also felt by those in insecure housing, people with disabilities and those from ethnic minorities. Lack of access to basic essentials prevented people from engaging fully in social, work and educational activities with negative impacts on physical and mental health across all income brackets. Drawing on existing literature alongside reporting original research, the substantive argument in this article suggests that ‘hygiene poverty’ is most usefully thought of as an aspect of deprivation, and that hygiene-related needs often sit at the bottom of a range of deprivation types.

Genetic diversity and phytochemical content are critical factors for enhancing the utility of wild plant species for breeding and conservation. In this study, we investigated wild ramie (Boehmeria nivea (L.) Gaudich. var. tenacissima (Roxb.) Miq.) populations from six coastal and island regions of South Korea. Genetic diversity was assessed in 150 samples using genotyping-by-sequencing, which revealed high genetic differentiation (Fst = 0.438) among the populations. Notably, the observed heterozygosity ranged from 0.297 to 0.422, whereas the allele richness ranged from 1.256 to 1.323. These findings suggest significant genetic variability within and among the populations. Phytochemical analyses were conducted to measure total phenolic and flavonoid contents (TPC and TFC, respectively) over 2 years. The TPC varied significantly across regions and years, with averages ranging from 2.2 to 30.3 mgGAE/g in 2021 and 3.2 to 19.6 mgGAE/g in 2022. Similarly, the TFC values exhibited regional and annual differences with significant environmental influences. Although TPC showed strong genotype-by-environment interactions, TFC was predominantly affected by environmental factors. This study highlights the potential of wild ramie as a reservoir of genetic and biochemical traits for the development of improved cultivars with high antioxidant properties. By linking genetic diversity to phytochemical variation, this study highlights the importance of conserving wild genetic resources and optimizing their use in breeding programmes. These findings provide a foundation for further exploration of the genetic and environmental factors that influence economically valuable traits in wild plants.

Background: Access to neurosurgical care is vital for conditions such as traumatic brain injuries and brain tumours. However, significant disparities in healthcare access persist in Canada, disproportionately affecting rural, Indigenous, and socioeconomically disadvantaged populations. This qualitative scoping review examines barriers and facilitators to neurosurgical access, addressing gaps in the literature concerning equity-deserving groups. Methods: A systematic literature search (2000–2024) was conducted within MEDLINE, EMBASE, Cochrane Library, PsycINFO, and Scopus, along with gray literature from governmental and non-governmental organizations. From 1400 identified records, eight qualitative or mixed-methods studies met the inclusion criteria. Thematic analysis was conducted to explore socioeconomic, geographic, racial, gender-based, and cultural barriers. Results: Four major themes emerged: delays in access, alternative healthcare options, policy barriers, and communication and coordination issues. Barriers such as transportation gaps, socioeconomic inequities, and systemic discrimination were particularly pronounced for rural and Indigenous populations. Facilitators like telehealth and improved inter-hospital coordination show potential but are limited by infrastructure constraints and cultural misalignments. Conclusions: Addressing barriers to neurosurgical care requires systemic reforms, including equitable resource allocation, expanded digital infrastructure, and culturally competent care. The lack of intersectional research on overlapping barriers underscores the need for future studies to prioritize tailored interventions to ensure timely, equitable neurosurgical care across Canada.