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Background Wheat is one of the most widely grown crop in temperate climates for food and animal feed. In order to meet the demands of the predicted population increase in an ever-changing climate, wheat production needs to dramatically increase. Spike and grain traits are critical determinants of final yield and grain uniformity a commercially desired trait, but their analysis is laborious and often requires destructive harvest. One of the current challenges is to develop an accurate, non-destructive method for spike and grain trait analysis capable of handling large populations. Results In this study we describe the development of a robust method for the accurate extraction and measurement of spike and grain morphometric parameters from images acquired by X-ray micro-computed tomography (μCT). The image analysis pipeline developed automatically identifies plant material of interest in μCT images, performs image analysis, and extracts morphometric data. As a proof of principle, this integrated methodology was used to analyse the spikes from a population of wheat plants subjected to high temperatures under two different water regimes. Temperature has a negative effect on spike height and grain number with the middle of the spike being the most affected region. The data also confirmed that increased grain volume was correlated with the decrease in grain number under mild stress. Conclusions Being able to quickly measure plant phenotypes in a non-destructive manner is crucial to advance our understanding of gene function and the effects of the environment. We report on the development of an image analysis pipeline capable of accurately and reliably extracting spike and grain traits from crops without the loss of positional information. This methodology was applied to the analysis of wheat spikes can be readily applied to other economically important crop species.

The aim of this study was to identify, using cluster analysis, novel sleep phenotypes in a population based cohort of infants, and to explore the associations between infant sleep profiles and their mothers’ health and well-being. 11,134 mothers of 9-month old infants were interviewed as part of the Growing Up in Ireland National Longitudinal study and reported on their health and infant’s sleep patterns. 16 infant sleep variables were recorded together with measures of parental stress, depression, health and well-being. Multiple iterations of a two-step hierarchical cluster analysis were carried out to identify the optimum number of clusters and the subset of parental-reported sleep variables required to identify distinct sleep profiles. Four distinct sleep profiles were identified based on the following variables; (1) infant sleep duration at night, (2) parental sleep duration, (3) does baby wake during night (yes, no)? (4) Usual sleep location for most of the night and, (5) parental reporting of problem infant sleep patterns. This identified two less favorable profiles with both infants and mothers sleeping less and where mothers are more likely to report their infants’ sleep patterns as problematic. Mothers of infants belonging to these sleep profiles were more likely to have higher levels of stress, depressive symptoms, and poorer self-reported health than other sleep profiles. Breastfeeding was associated with both groups and rates were highest in a group of infants that were more likely to co-sleep with their parents and have diverse ethnic backgrounds. This study demonstrates, for the first time, two infant sleep profiles with distinct phenotypical frameworks that are significantly associated with maternal stress, depression, and poorer self-report of health.

Summary Multicellular organisms exchange information and resources between cells to co-ordinate growth and responses. In plants, plasmodesmata establish cytoplasmic continuity between cells to allow for communication and resource exchange across the cell wall. Some plant pathogens use plasmodesmata as a pathway for both molecular and physical invasion. However, the benefits of molecular invasion (cell-to-cell movement of pathogen effectors) are poorly understood. To begin to investigate this and identify which effectors are cell-to-cell mobile, we performed a live imaging-based screen and identified 15 cell-to-cell mobile effectors of the fungal pathogen Colletotrichum higginsianum. Of these, 6 are “hypermobile”, showing cell-to-cell mobility greater than expected for a protein of its size. We further identified 3 effectors that can indirectly modify plasmodesmal aperture. Transcriptional profiling of plants expressing hypermobile effectors implicate them in a variety of processes including senescence, glucosinolate production, cell wall integrity, growth and iron metabolism. However, not all effectors had an independent effect on virulence. This suggests a wide range of benefits to infection gained by the mobility of C. higginsianum effectors that likely interact in a complex way during infection. Competing Interest Statement The authors have declared no competing interest.

To examine current practices in late-phase trials published in major medical journals and examine trialists’ views about core outcome set (COS) use. A sequential multi-methods study was conducted. We examined late-phase trials published between October 2019 and March 2020 in JAMA, NEJM, The Lancet, BMJ, and Annals of Internal Medicine. The COMET database was searched for COS potentially relevant to trials not reporting using a COS; overlap of trial and COS outcomes was examined. An online survey examined awareness of, and decisions to search for and use a COS. Ninety-five trials were examined; 93 (98%) did not report using a COS. Relevant COS were identified for 31 trials (33%). Core outcomes were measured in 9 (23%) studies; all trials measured at least one core outcome. Thirty-one trialists (33%) completed our survey. The most common barrier to COS use was trialist's own outcome preferences and choice (68%). The most common perceived facilitator was awareness and knowledge about COS (90%). COS use in this cohort of trials was low, even when relevant COS were available. Increased use of COS in clinical trials can improve evaluation of intervention effects and evidence synthesis and reduce research waste.

Background Recent research, which explored the use of Quality Improvement (QI) methods in the Covid-19 pandemic response, found that Quality Improvement principles were utilised during the crisis management period, albeit without direct intention. Following on from this work, the aim of this paper extends that study by investigating the sustainability and resilience of not only the changes implemented by healthcare staff during Covid-19 in Ireland, but the resilience of the wellbeing of healthcare staff themselves through the various waves of Covid-19. Methods To explore healthcare staffs experience of Quality Improvement and the sustainability and resilience of both Quality Improvement initiatives and healthcare staff, a qualitative design was implemented. Semi-structured interviews took place online over Zoom with 11 healthcare staff members from the Irish healthcare service in the Spring of 2022. An analysis of the narratives was conducted using thematic analysis supported by NVivo12. Results Four key themes were evident from the data: (i) From fear to exhaustion; (ii) maintaining person-centred approaches to care; (iii) Covid-19 as a medium for change, and; (iv) staff resilience and appetite for Quality Improvement. Discussion The results of this work identified three key learnings; (i) integrating learning into policies and practice: (ii) the role of collective leadership and devolving/sharing power; and (iii) key drivers/factors that promote sustainability of QI interventions. Despite the challenges in recruitment of research participants experienced during the pandemic, a narrative approach supported the collation of rich and nuanced insights into the experiences of healthcare staff during this time. Conclusion A growing body of literature currently exists on how healthcare staff felt during the Covid-19 pandemic. However, as the waves of Covid-19 have declined, it is vital to examine how the feelings of burnout and disillusionment will affect engagement with Quality Improvement in the future. It is also worth noting and examining the feeling of purpose and pride participants expressed from working through the Covid-19 pandemic. This study has helped to address this gap.

Background There has been a rise in the participation, professionalism, and profile of female sports in recent years. Sprinting ability is an important quality for successful athletic performance in many female team sports. However, much of the research to date on improving sprint performance in team sports is derived from studies with male participants. Given the biological differences between the sexes, this may be problematic for practitioners when programming to enhance sprint performance in female team-sport athletes. Therefore, the aims of this systematic review were to investigate (1) the overall effect of lower body strength training on sprint performance, and (2) the effect of specific strength training modalities (i.e., reactive-; maximal-; combined-; special-strength) on sprint performance in female team-sport athletes. Methods An electronic database search was performed using PubMed, MEDLINE, SPORTDiscus, CINAHL, The Cochrane Library, and SCOPUS to identify relevant articles. A random-effects meta-analysis was performed to establish standardised mean difference with 95% confidence intervals and the magnitude and direction of the effect. Results Fifteen studies were included in the final analysis. The 15 studies represent a total sample size of 362 participants (intervention n  = 190; control n  = 172) comprising 17 intervention groups and 15 control groups. The overall effects revealed small improvements in sprint performance in favour of the experimental group over 0–10 m and moderate improvements over sprint distances of 0–20 m and 0–40 m. The magnitude of improvement in sprint performance was influenced by the strength modality (i.e., reactive-, maximal-, combined-, and special-strength) utilised in the intervention. Reactive- and combined-strength training methods had a greater effect than maximal- or special-strength modalities on sprint performance. Conclusion This systematic review and meta-analysis demonstrated that, when compared with a control group (i.e., technical and tactical training), the different strength training modalities exhibited small to moderate improvements in sprint performance in female team-sport athletes. The results of a moderator analysis demonstrated that youth athletes (< 18 years) yielded a greater improvement in sprint performance compared with adults (≥ 18 years). This analysis also supports the use of a longer programme duration (> 8 weeks) with a higher total number of training sessions (> 12 sessions) to improve overall sprint performance. These results will serve to guide practitioners when programming to enhance sprint performance in female team-sport athletes.

Background Patients with major depressive disorder (MDD) who attempt or complete suicide have elevated inflammation compared to nonsuicidal patients with MDD. However, greater severity of depression and the medical lethality of suicide attempts could account for such elevated inflammation in suicide attempters and suicide completers. Methods To clarify, we measured inflammatory markers in patients with MDD with and without high levels of suicidal ideation and in nondepressed controls (N = 124). Levels of suicidal ideation, depression severity, and recent suicide attempts were assessed by structured clinical interviews. A composite score including the inflammatory markers tumor necrosis factor‐α (TNF‐α), interleukin‐6 (IL‐6), interleukin‐10 (IL‐10), and C‐reactive protein (CRP) was used as an inflammatory index. Analysis of covariance models were used to assess group differences with adjustments for age and gender. Results Patients with MDD and high suicidal ideation had significantly higher inflammatory index scores than both controls, F(1,53) = 18.08, partial η2 = .25, P < .001, and patients with MDD and lower suicidal ideation F(1,44) = 7.59, partial η2 = .15, P = .009. In contrast, patients with lower suicidal ideation were not significantly different from controls on the inflammatory index, F(1,63) = .52, partial η2 = .01, P = .47. Follow‐up analyses indicated that differences between patients with MDD and high versus lower suicidal ideation were independent of depression severity and recent suicide attempts. Conclusions Suicidal ideation may be uniquely associated with inflammation in depressed patients.

ObjectiveFontan-associated liver disease (FALD) results from haemodynamic changes following the Fontan procedure for congenital heart disease and is associated with poorer outcomes. The prevalence of Fontan is rising due to improved survival; however, little is known about predictors of advanced liver fibrosis in adult patients. This study aimed to determine the accuracy of non-invasive fibrosis assessment tools (NIT) in predicting histologically confirmed advanced liver fibrosis in an adult Fontan cohort attending Mater Misericordiae University Hospital.MethodsPatient demographics, congenital cardiac variables and fibrosis biomarkers were recorded including liver stiffness measurement (LSM) via transient elastography, Fibrosis-4 (FIB-4) and Aspartate aminotransferase-to-Platelet Ratio Index (APRI) scores. Biopsies, taken between 2017 and 2024, were staged using the congestive hepatic fibrosis score. Analysis was performed using SPSS.Results71 patients (58% male) were included. The median age was 25 years. 62% had histological advanced fibrosis. There were no significant bleeding events post biopsy. Overall, advanced fibrosis was associated with a closed Fontan fenestration (p=0.022) and higher LSM, although with a weak correlation (p=0.04, r=0.25, area under the curve (AUC) 0.65), but not with APRI or FIB-4. There was no difference in rates of advanced fibrosis between sex (p=0.84). In females, higher APRI was associated with advanced fibrosis (p=0.045, r=0.41, AUC 0.73).ConclusionsThe majority of Fontan patients have advanced liver fibrosis in their third decade. A patent Fontan fenestration appears to reduce the risk of advanced fibrosis. Despite an association with higher LSM, there was no cut-off which could negate the need for biopsy in a significant population. Our data suggest that the discriminatory ability of NIT may vary according to sex. Liver biopsy is safe and remains the only method of reliably diagnosing advanced fibrosis in FALD.

IntroductionPoor recovery of the upper limb following a stroke has been recognised as a significant problem in the UK. Although there is good evidence that early, intense rehabilitation can lead to upper limb recovery, often this is not maintained, with less than 50% of people regaining the ability to use their upper limb for independent function at 6 months. Upper limb recovery potential is reported for many years poststroke, yet current long-term provision is insufficient.Methods and analysis60 participants will be recruited into this feasibility study, with 30 allocated to a Post Rehabilitation Enablement Programme (PREP) alone and 30 allocated to a combined programme, PREP Plus, consisting of PREP and the Graded Repetitive Arm Supplementary Programme (GRASP). We will aim to complete four iterative waves. Within each wave, the intervention design will be refined, based on participant feedback. Within each wave, there will be one cluster unit (one intervention group ;PREP Plus) and one control group ;PREP alone)). A total of five PREP sites within Northern Ireland Health and Social Care Trusts will be used for this study. PREP Plus will have a home exercise component along with exercises logs and a behaviour contract. Qualitative and quantitative measures will evaluate the acceptability and feasibility to determine how feasible it is to embed the intervention into practice, as well as to determine the feasibility of a larger, mixed-methods, randomised controlled trial to assess intervention efficacy. Clinical endpoints will also be explored.Ethics and disseminationThis study has been approved by the Health and Social Care Research Ethics Committee A, IRAS project ID (278620). Participants will provide informed consent prior to participating in the study. Information outlining the purpose of the study, what data will be collected and how the data will be managed will be provided. Results will be published in peer-reviewed journals and any published data will be available on the university data repository. The project management group will advise on different avenues for dissemination to ensure it reaches appropriate audiences.Trial registration numberNCT05090163.