This systematic review consists of two parts. Part I seeks to synthesise evidence from primary or secondary research studies examining the implementation and effectiveness of case management tools and approaches currently being used to counter radicalisation to violence. Part II is an ‘overview of reviews’ that seeks to identify relevant and transferable lessons from systematic reviews and meta‐analyses of case management tools and approaches used in the broader field of violence prevention that could be applied to counter‐radicalisation practice. It aims to go further than standard Campbell systematic reviews of intervention effectiveness by incorporating two distinct parts. Part I aligns with a standard Campbell systematic review procedure by examining case management tools and approaches that are used to counter the specific problem of radicalisation to violence. Part II goes further by examining case management tools and approaches that are used to counter other forms of interpersonal and collective violence, and discussing how evidence drawn from this research might inform interventions seeking to counter radicalisation to violence. By examining research that would fall outside the scope of a review solely focused on the problem of radicalisation to violence, Part II aims to capture insights relevant to policy, practice and research that would otherwise be absent.1.11.1.1violence, defined as the process by which ‘a person or group takes on extreme ideas and begins to think they should use violence to support or advance their ideas or beliefs’ , as well as engagement in violent extremist and terrorist activity Neumann, . This reRadicalisation is a contested concept, with some authors challenging the empirical evidence on which dominant models of radicalisation are based  and other forms of targeted violence (Part II), there are links between them. This section therefore discusses both types of intervention in turn, as well as the synergies between them.1.2.1Despite the term's ubiquity today, there remains a lack of consensus over how to define ‘radicalisation’, or how to model the radicalisation process Silva, . This habeliefs, behavioural models frame radicalisation as the process by which individuals become involved in violent behaviour. Interventions underpinned by the former model of radicalisation typically have a broader focus than those that are more explicitly focused on preventing violent behaviour given that a broad range of beliefs—including beliefs that are not explicitly violent—have been defined as ‘extremist’ by some governments  tackle risk factors believed to contribute to cognitive and/or behavioural radicalisation; and/or b) strengthen protective factors believed to mitigate against both forms of radicalisation  and ‘CVE’ (countering violent extremism) are often used to describe the increasingly diverse range of interventions that are designed to counter radicalisation to violence. The P/CVE field is complex, with a range of governmental and non‐governmental actors now delivering a variety of interventions. These are often categorised using the public health model of primary, secondary and tertiary prevention  against other people ; for developing and delivering work plans tailored to these needs (planning and implementation); for measuring and monitoring a client's progress ; and for assessing whether the work plan has effectively met the client's needs or delivered specific client‐level outcome measures (transition). Research would suggest that case management interventions in this field are commonly designed to work in this way  can be differentiated.Radicalisation is commonly understood as a process that is driven by the presence of risk factors and/or the absence of protective factors, with different models of radicalisation placing different weight on the relative importance of risk versus protective factors ; social (or meso‐level) and structural (or macro‐level) drivers  which place greater emphasis on building those strengths believed to contribute to desistance Dean, .Strengths‐based approaches seek to promote the strengths of offenders so they can satisfy their needs without resorting to violence Marsden, . DesistaThe ultimate aim of case management interventions is the prevention of future violent extremist behaviour. However, individual components of these interventions may seek to deliver more specific outcomes that are believed to contribute to the over‐arching goal of countering radicalisation to violence. These outcomes may be informed by risk‐oriented approaches, and in turn be used to measure the effectiveness of an intervention at tackling different radical outcomes such as those set out in systematic reviews conducted by Wolfowicz et al.  and LöseHowever, outcomes may also be strengths‐based. These are more oriented towards the development of key strengths and skills that are believed to contribute to disengagement from violent extremism, such as the development of pro‐social supports, education and training, and employment  this review will attempt to make the implicit assumptions that underpin counter‐radicalisation interventions more explicit, and to examine the validity of different assumptions more systematically than has been done previously. This review does not examine the individual components of each intervention's theory of change . Instead, it attempts to synthesise evidence relating to each over‐arching case management approach that is used in this space. This analysis is aligned with Hodgkinson et al.'s  widely‐cand which were delivered in a GLM‐consistent way . By synthesising evidence drawn from interventions sharing a common approach, this review was able to examine the assumptions underpinning the GLM; and the effectiveness of GLM‐informed interventions. Their review therefore provides a template for identifying different approaches by reviewing the underlying assumptions of an intervention, for assessing an approach's effectiveness in terms of impact on client‐level outcomes, and for evaluating whether an intervention is implemented in a way that is consistent with these underlying assumptions.The importance of this type of analysis is illustrated by a recent systematic review of the Good Lives Model (GLM) conducted by Mallion et al. , which, 1.4.2The limitations of the evidence base underpinning counter‐radicalisation interventions are well‐established  examining whether the use of case management in this context is supported by evidence; (b) providing a robust assessment of the potential efficacy of case management in this context, and ‘what works, for whom, how and in what circumstances’ Gielen, ; and (c)2violence reduction is not the only possible indicator of tools’ impact. If risk assessment tools do, indeed, reduce violence and offending, this relationship may be indirect, and contingent upon professionals’ risk management practices. examining the effectiveness of case management tools and approaches in delivering primary and secondary outcomes relevant to countering violence; and (2) examining the processes by which these tools and approaches are implemented in practice. This twin focus is informed by guidance for conducting evaluations of terrorism risk reduction programmes developed by Williams and Kleinman . This ap(1)effectiveness of the different case management tools and approaches that are currently being used to counter radicalisation to violence.Evidence relating to the (2)implementation of these tools and approaches.Evidence relating to the (3)transferability to counter‐radicalisation work.Identify relevant insights from wider research on interventions seeking to counter other forms of violence and assess their The primary objectives of this review are therefore to synthesise:Parts I and II of the review are guided by specific research questions.Part I: Evaluating Case Management Counter‐Radicalisation InterventionsPart II: Learning from related fieldsWhilst there are synergies between the objectives of Part I and Part II of the review, there are important methodological differences. It is therefore necessary to outline the methodologies for each part separately. To this end, Section 33.1problem  and the type of intervention  that will be analysed across both questions. However, as each question focuses on a different types of data , they will require separate inclusion criteria relating to the comparator conditions  and outcome measures that are relevant. This section will therefore first discuss the specific outcome measures and research designs that will be included in the analysis relating to each question, before discussing criteria that will be applied across Part I of the review as a whole.The inclusion criteria for research relating to questions 1 and 2 are comparable in terms of the specific 3.1.1–Primary outcomes will include measures of disengagement, desistance or deradicalisation captured using, for example, risk assessment tools; arrest or prosecutions data; case notes; and qualitative or quantitative data relating to recidivism.–Secondary outcomes will include data on the impacts that specific tools or approaches have on client participation/engagement with interventions : Assesses risk using measures relating to three domains: engagement with a group, cause or ideology; intent to cause harm; and capability to cause harm : Assesses risk against beliefs, attitudes, and ideology; history, action and capacity; commitment and motivation; protective/risk mitigating indicators; and criminal history, personal history, and mental disorder : Assesses risk across proximal warning behaviours; and distal characteristics  with primary and secondary client‐level outcome measures relating to countering radicalisation to violence. To be included in Part I of the review, studies must report on the below primary and/or secondary outcomes:Evidence for the effectiveness of an intervention in delivering such outcomes may be captured in different ways. For example, client‐level impact may be assessed using tools that capture whether specific risk factors have been successfully eliminated and/or specific protective factors have been successfully developed. However, other interventions may use tools to assess a client's ‘distance travelled’ towards positive outcomes ;–Matched control group designs;–Unmatched control group designs where the control group has face validity;–Unmatched control group designs allowing for difference‐in‐difference analysis; and–Time‐series designs.Only quantitative studies using experimental  or ‘stronger’ quasi‐experimental research designs ; and those factors that influence whether tools and approaches are implemented as‐intended/expected (Q2b).Where relevant, experimental and those stronger quasi‐experimental designs outlined above will be included in the analysis of Question 2. However, as this question is focused on assessing the process of implementation, and not on evaluating impact, quantitative studies with weaker quasi‐experimental or non‐experimental designs will also be included in this analysis.Only evidence relating to implementation from quantitative studies with ‘stronger’ research designs  designs will be included in the meta‐analysis for question 2. Quantitative studies with weaker studies will only be included in the qualitative analysis as outlined in the data analysis section later in the protocol.Qualitative and mixed‐methods research will be included in our analysis for question 2, with qualitative and quantitative data analysed separately. Qualitative data is crucial for understanding how practitioners are using tools such as the ERG 22+ to monitor client progress and outcomes . However, qualitative data will be examined separately to quantitative data  and will not be included in any meta‐analysis .3.1.4Both peer‐reviewed and non‐peer‐reviewed/grey literature studies will be included.3.1.5case management interventions, and their associated tools and approaches, seeking to counter radicalisation to violence. This will include ‘standalone’ case management interventions, as well as programmes in which case management is one of many components being used to tackle radicalisation to violence.Part I of the review will examine studies that report on 1.They must focus on individual clients (and not communities or collectives) and meet the definition of a case management intervention outlined above .2.They should be designed to counter radicalisation to violence. Interventions must seek to prevent at‐risk individuals from engaging in violent extremism and/or promote the disengagement of those who are already engaged in violent extremism . Where possible, this review will also examine evidence relating to how ‘at risk’ individuals are assessed as being eligible for an intervention, as well as the specific measures used to assess an individual's progress and outcomes. This review excludes primary interventions as they are focused on delivering client‐level outcomes whose relationship to violence is often less explicit  with the aim of countering radicalisation to violence. Interventions must meet two inclusion criteria:–Examine the implementation or impact of violent extremism risk assessment tools. Studies examining a) how practitioners use tools to assess clients, develop intervention plans or monitor and evaluate client progress and outcomes  analysed separately.3.1.7secondary interventions working with those at risk of engagement in violent extremism, and tertiary interventions working to prevent further engagement in violent extremism and/or promote desistance and disengagement amongst those already involved in violent extremism. There are no exclusion criteria on the context/setting in which an intervention is delivered, and a variety of populations will be included in the review. This will range from interventions working with individuals in community settings who have not yet committed an offence, and those working with individuals in post‐conviction contexts.We will include research on 3.1.8There are no demographic exclusion criteria.Empirical studies engaging with practitioners, stakeholders and clients will be included in the review, but case management interventions working with victims of violence will be excluded. The full text coding scheme used by the reviewers will identify the population of the study  in order to separate out key findings and conclusions relevant to each population. Where possible, other contextual variables  will also be coded.3.1.9There are no geographical exclusion criteria.3.1.10Research in languages other than English will be reviewed, including studies in Russian, French, Danish, Norwegian, Swedish and German.3.1.11Only studies published after January 2000 will be included on the basis that the term ‘radicalisation’ did not emerge in policy circles until the 21st Century Neumann, .3.21.Targeted keyword searches of academic databases  have developed a comprehensive list of key words that will be used to search the academic databases listed in Table ddaway's  in theirThe full key words search strategy as outlined below will first be replicated across the principal databases listed in Table Problem  and Intervention (Any Field: prevent* OR Any Field: treat* OR Any Field: interven*). Search results were sorted on relevance, and a skimming review of the abstracts and titles of the first 100 records was conducted. This exercise identified a large number of irrelevant studies that either a) did not discuss a case management tool or approach; or b) did not conduct empirical research. In response, a range of alternative search strategies were piloted across multiple academic databases  to increase the relevance of the results. A further stage of piloting was conducted between the 3rd and 5th May 2022 following feedback from the Campbell Crime and Justice editorial board. Based on this piloting process, the search strategy will include three domains as outlined below:–Problem: Key words relevant to violent extremism and its synonyms ; or specific ideologies .AND–Intervention: Key words describing synonyms for interventions  and tools ; and the different stages of the case management process ;AND–Outcomes: Key words relating to primary outcomes of prevention ; and desistance To understand the scale of the literature, a preliminary search was conducted on 20/05/21 in PsycNet using key words categorised under two search domains: 3.2.2A number of key journals, grey literature databases, and research repositories will be hand‐searched, with the specific approach taken to searching each source tailored to the functionality  of its website.3.2.3The bibliographies of the studies listed in Table 3.2.4The review team and the review's advisory board has a strong knowledge of existing empirical research into interventions seeking to counter radicalisation to violence operating in a number of different continents. One member of the review team (A. C.) also has specific expertise on the use of case management tools and approaches for countering radicalisation to violence .3.3(1)Team members will translate the English key words into the specific languages assigned to them, and will identify alternative terms for any key words for which a direct translation does not exist. These language‐specific key words will be used to search for literature in academic databases containing research in that language.(2)This will include searching language‐specific databases Where relevant, language specialists will also hand search key journals published in LOE  and LOE research outputs of relevant research institutions and professional agencies known to them. Again, each team member will be responsible for identifying and recording relevant sources of this type.(4)Each specialist will be asked to identify other studies known to them. As recommended by Walpole , we willThe research team includes researchers who are fluent in those languages listed in Section 3.43.4.11.All studies identified through the search strategy above will be imported into EndNote. Duplicate records will be removed before the initial list is uploaded into Covidence.2.One reviewer (JL) will use Covidence to review all titles and exclude duplicate and obviously irrelevant studies .3.Two reviewers (JL and ML) will then use Covidence to review all remaining abstracts to exclude obviously irrelevant studies . Both reviewers will then conduct a second stage of abstract screening using a screening tool (see Appendix II). An online meeting will be arranged to resolve any conflicts. A third reviewer (SM) will make the final decision in the event that conflicts are not resolved.4.The same two trained reviewers (JL and ML) will conduct a full text screening of all remaining studies in Covidence, guided by the same screening tool. Once the full‐text screening has been completed, the two reviewers will meet (either in person or online) to review their decisions, and to resolve any conflicts. In the event that a conflict cannot be resolved, a senior reviewer (SM) will make the final decision. SM will also review the final list of included studies against the inclusion criteria above.English language studies will be screened using a five‐stage process:3.4.21.The titles of all studies in languages other than English will be reviewed by the primary LOE reviewer with the relevant language skills, and clearly irrelevant studies excluded .2.The abstracts of remaining studies will then be screened by the same primary LOE reviewer, and by a secondary LOE reviewer with relevant language skills. If necessary, an online meeting will be arranged to resolve any conflicts. SM will again make the final decision on any outstanding conflicts.3.The above process will then be repeated for full‐texts.4.Once the screening process has been completed, the primary LOE reviewer will translate the abstract and full‐texts of each remaining non‐English language study into English. The primary English‐language reviewer (JL) will then check the full‐text and abstract of each study against the inclusion criteria, and, if necessary, an online meeting held with the primary LOE reviewer to discuss any studies that do not appear to meet the inclusion criteria. SM will again make the final decision on conflicts.Non‐English language studies will be screened using a four‐stage process. The same screening and data extraction tools will be used for both English and non‐English language studies:3.5A data extraction and coding tool has been developed to guide the full‐text coding process (see Appendix III). This tool will capture key details about each individual study; descriptive information about the specific interventions, tools and/or approaches examined by each study; and relevant information relating to their effectiveness and implementation. English language studies will be double‐blind coded by the primary reviewers (JL and ML) during the full‐text screening stage. LOE studies will be double‐blind coded by one of the primary reviewers  and the primary LOE language specialist. An online meeting will be arranged to make a final decision on any coding conflicts and, at this stage, a third reviewer (SM) will make the final decision on any remaining conflicts.3.63.6.1Included studies will be assessed using either Version 2 of the Cochrane risk‐of‐bias tool for randomized trials (RoB 2) or the Cochrane Risk Of Bias In Non‐Randomized Studies—of Interventions (ROBINS‐I) tool  Bias arising from the randomisation process; 2) Bias due to deviations from intended interventions; 3) Bias due to missing outcome data; 4) Bias in measurement of the outcome; and 5) Bias in selection of the reported result  Bias due to confounding; (2) Bias in selection of participants into the study; At‐Intervention: (3) Bias in classification of interventions; Post‐Intervention: (4) Bias due to deviations from intended interventions; (5) Bias due to missing data; (6) Bias in measurement of outcomes; (7) Bias in selection of the reported result  meet the inclusion criteria for this review, each study will be coded separately, but only the study presenting the most complete data will be included. Documents will be assessed as reporting on the same empirical findings based on examining the extracted data for any identifiable overlap in document authors; the intervention design; the research conditions; and any references to other eligible studies identified through the searches.Studies identified for inclusion in a systematic review often report different measures for outcomes that are conceptually similar. We will transform the smallest number of effect sizes to a standardised effect size in compliance with Campbell guidelines   assess the effectiveness of each tool/approach in countering radicalisation to violence (research question 1); and (b) processes of implementation (research question 2). Evidence relating to the different research questions will be analysed and summarised separately. The analysis of both questions will consist of four stages:3.8.2Statistical analysis may not be possible given the known weaknesses in the evidence base underpinning current efforts to evaluate counter‐radicalisation interventions. However, where possible, we will conduct meta‐analyses of relevant outcome measures relating to research question 1  and 2 (implementation). As evidence relating to research question 1 will be drawn solely from experimental and stronger quasi‐experimental studies, all relevant studies will be eligible for inclusion in the meta‐analysis, provided the reported outcome data meets the criteria outlined below. However, whilst the qualitative analysis of research question 2 will include studies using weaker quasi‐experimental and non‐experimental designs, the meta‐analysis of implementation outcomes will only include data from experimental or stronger quasi‐experimental designs. An example of such a study would be an experimental or quasi‐experimental study comparing how different groups of practitioners/practitioners working in different contexts implemented a specific tool or approach. As noted above, we will only include studies building on independent findings in the meta‐analysis. Therefore, studies reporting on the same empirical findings, or conceptually similar outcomes in the same study will only be included once.We expect that this review will need to consider multiple factors (particularly different case management tools and approaches) and various outcomes in order to capture the likely variety in how outcomes related to disengagement, desistance or deradicalisation (research question 1), and processes of implementation (research question 2) are captured by different studies. Given the broad spectrum of case management tools and approaches that are likely being used to counter radicalisation to violence and the large amount of potential outcome variables relating to each of the research questions we will run meta‐analyses for all factors and outcome combinations for which at least two inputs from independent samples can be identified. In general, we follow protocols of Campbell systematic reviews on related topics as guides . In these instances, we will calculate Hedges' g (standardised mean differences) directly. However, should evaluations report binary outcomes , we will compute effect sizes as odds ratios. The odd ratios will be then transformed into Hedges’ g for the meta‐analyses  use specific case management tools; and b) do so in a way that is consistent with their intended function are effective at delivering positive intervention outcomes , where possible, this data will be synthesised using one of the alternative methods to meta‐analysis that the Cochrane collaboration deems to be acceptable  of an intervention in a specific setting or population will be similar to the observed level of effectiveness (or perceptions and experiences) observed in a systematic review’  gathered from a subset of cases supported through one intervention does not necessarily mean that specific intervention will be effective in other contexts, or deliver better outcomes in case management interventions more broadly : Primary outcomes will include measures of disengagement and desistance from violence captured using similar tools as outlined in Part I, including risk assessment tools; arrest or prosecutions data; case notes; and qualitative or quantitative data relating to recidivism. Secondary outcomes will also be comparable to Part I, and might include measures included in tools used to assess the risk of violence, such as the Historical, Clinical, and Risk Management‐20 (HCR‐20) scale : In line with Part I, implementation will be evaluated by reviewing evidence related to the different elements of implementation as outlined in Section Question 3 will examine outcomes relating to countering violence; and Question 4 will examine outcomes relating implementation. The outcomes relevant to these questions will be comparable to those used to assess effectiveness (Q1) and implementation (Q2) in Part I:4.1.2The main point of departure between Parts I and II will be the study designs included, as Part II will only include systematic reviews and meta‐analyses. The methodology for Part II has been informed by the Cochrane methodological guidelines for conducting an ‘overview of reviews’ .○The specific sources used to identify literature.○The process of screening studies.○The number of records identified through the initial searches.○The number of unique records included in the review.Authors must use an –systematic coding and analysis of included studies.○The methods of coding and analysis should be clearly outlined, and justified.○Where relevant, methods used to conduct meta‐analysis must be specified.Authors must have conducted a In line with the Campbell collaboration definition of a systematic review,To capture the most comprehensive range of evidence, systematic reviews including randomised and nonrandomised research designs will be included in Part II.4.1.3Qualitative research will not be included in Part II of the review.4.1.4Both peer‐reviewed and non‐peer‐reviewed/grey literature studies will be included in Part II.4.1.5case management interventions and/or components of case management interventions  with the aim of preventing engagement in, or promoting disengagement from collective or interpersonal violence. Interventions must meet two inclusion criteria:1.case management intervention as presented above, although the specific term used to describe the tailoring of interventions to individual cases may vary across different fields.They must focus on individuals and meet the definition of a 2.prevent violent offending or reoffending. Interventions seeking to tackle both collective and interpersonal violence will be included:a.Collective Violence: Physical, psychological or sexual violence perpetrated by those acting as part of a collective such as gang‐related violence  against other people .The –Data domain will be added to ensure that the searches only capture studies referencing a review or meta‐analysis.A The key word search strategy for identifying literature for Part II of the review will be adapted from the Part I key word search strategy outlined above in the following ways:Cochrane, Campbell and PROSPERO databases will also be searched for relevant systematic reviews as they are the most comprehensive online databases of systematic reviews.Key word searches will be conducted in the same databases used for Part I  on its website.4.2.3Several members of the advisory board for this review have a strong knowledge of research in the broader field of violence prevention. Once the initial stages of literature searching as outlined above have been completed, members of the advisory board will be contacted to identify any potentially relevant reviews that have yet to be identified.4.3The search strategy for non‐English language systematic reviews will mirror the search strategy used to identify primary research during Part I of the review.4.4The screening process for English and non‐English language systematic reviews will mirror the respective screening processes used for screening primary research studies during Part. I. The abstract and full‐text screening tools used during Part II (see Appendix II) are based on the tools used in Part II, but they have been adapted for the screening of systematic reviews.4.5The full text of included reviews will be coded using a process that aligns with that used in Part I. A separate data extraction and coding tool has been developed to guide the full text coding of reviews identified during Part II of the review (see Appendix III). This tool will capture relevant details about each individual review; descriptive information about the specific interventions, tools and/or approaches examined by each review; and the results of any quantitative or qualitative evidence synthesis or meta‐analysis.A key difference between Part I and Part II relates to how different case management approaches will be coded. The coding of approaches in Part I uses pre‐defined codes that map onto the case management theory of change outlined in Section A citation matrix ;–Consideration of risk of bias when interpreting the results of the review; and–Assessment of presence and likely impact of publication bias.Included reviews will be assessed using validated AMSTAR (A MeaSurement Tool to Assess systematic Reviews) quality assessment tool  case management approaches; (b) case management tools; and (c) stages of the case management process as outlined above. Each summary will include:Evidence relating to the effectiveness of tools and approaches in countering violence (Q3) and the process of implementing different tools and approaches (Q4) will be analysed and summarised separately. The analysis of both research questions will consist of four stages:4.8.2Answering Q5 as outlined above rests on developing a robust approach for identifying the most salient findings from research in the broader field of violence prevention for counter‐radicalisation work. This approach will be informed by existing studies that have discussed the comparability between these different fields. One of the most comprehensive discussions of this type is found in a RAND report exploring the ‘transferability and applicability of gang evaluation methodologies to counter‐violent radicalisation’. This report argues that lessons from gang‐related interventions are transferable to interventions seeking to counter radicalisation to violence because ‘[t]here are some key parallels between gangs and radicalisation, pertaining to demographics, recruitment, group dynamics, behaviour and desistance’  supported through case management interventions seeking to counter radicalisation to violence ?–Engagement: Are the processes by which individuals become involved in the form of violence targeted by the tool/approach comparable to processes of radicalisation?–Disengagement: Are the processes by which individuals disengage from the form of violence targeted by the tool/approach comparable to the processes by which individuals disengage from violent extremism?–Intervention: How comparable is the tool/approach to those used to counter radicalisation to violence ?–Feasibility: Could the tools and approaches used feasibly be applied to interventions seeking to counter radicalisation to violence? Why/why not?In line with this body of research, the transferability of research examining tools and approaches seeking to counter other forms of violence will be assessed by asking the following questions of the evidence collected from studies included in Part II of the review. These questions have been informed by a checklist for assessing the transferability of the findings of systematic reviews to end‐users developed by Munthe‐Kaas et al. :–Demogengagement and disengagement is likely to be particularly challenging given that a) there is no single process by which individuals become engaged in, or disengage from, violent extremism; and b) these individualised processes of engagement and disengagement will not always directly map onto the processes by which individuals become involved in, and desist from, other forms of violence. However, models of engagement in, and disengagement from, violent offending more broadly ;–drivers that:○operate at different levels of analysis ○are specific to the individual and/or the context in which they operate;Shaped by the intersection of different push and pull factors or –mechanisms of change that are:○Informed by the presence (or absence) of specific risk/protective factors.○Reliant on agency ;Underpinned by specific –outcomes;Are marked by specific attitudinal, motivational or behavioural –contextual factors that can inhibit or facilitate these processes.Are dependent on Assessing the transferability of tools and approaches in relation to the domains of 4.9Content: Marsden, Lewis, Cherney, Zeuthen.Systematic review methods: Marsden, Lewis, Cherney, Zeuthen.Statistical analysis: Brandsch.Information retrieval: Marsden, Lewis, Zeuthen, Lubrano, Bélanger, Zubareva.4.10Adrian Cherney has been involved in the evaluation of case‐managed programs targeting radicalised individuals in Australia and the publication of papers that are likely to be included in this review. However, Cherney will not be involved in the screening or coding of studies.4.11We plan to submit the final review by 20th February 2023.Supporting information.Click here for additional data file.


Medical radiation practitioners (MRPs) participate in continuous professional development (CPD) to update their knowledge, skills, safety standards and patient care. The Medical Radiation Practice Board of Australia (MRPBA) recommends that practitioners participate in a variety of activities and to incorporate the use of collaborative learning tools. The aim of this research was to investigate the value, use and workplace supports for online and face‐to‐face collaborative learning for CPD.A cross‐sectional online survey of Australian MRPs was conducted. The questionnaire was distributed via e‐blast from the Australian Society of Medical Imaging and Radiation Therapy (ASMIRT) to members.P > 0.05). The majority of MRPs regularly attend conferences  with those working in a metropolitan location more likely to attend. MRPs are supported by their workplace to attend conferences through the provision of paid leave , funding  and to a lesser extent travel expense . More than half  of the participants use social media for CPD with Facebook being the most frequently used and most useful online platform. The most common reasons for using social media for CPD were accessibility to information , little geographical limitations  and ease of use .A total of 115 completed questionnaires were received. Seminars, workshops and conferences were the most valued collaborative learning tools, with no significant difference in ranking observed .To maintain registration with the Australian Health Practitioner Regulation Agency (AHPRA) medical radiation practitioners (MRPs) must participate in continuous professional development (CPD). Seminars, workshops and conferences were ranked by MRPs the most valued collaborative learning tools and no significant difference was indicated ( Medical radiation practitioners (MRPs) inclusive of radiographers and radiation therapists participate in continuous professional development (CPD) to update their knowledge, skills, competency, safety standards and improve their patient care.Collaborative learning can be defined as a group of individuals coming together with various levels of knowledge to learn from and with others and work towards a common goal.With advances in technology professional development, opportunities have expanded. MRPs have gained access to online platforms and information in the form of web pages, journal articles, online books, blogs, images and videos, as well as interactive platforms such as social media to meet their professional learning needs.What collaborative learning tools are most frequently utilised by MRPs for CPD?What value is attributed to these tools? And does it vary by geographic workplace location?How does the workplace support the use of collaborative learning tools for CPD?The aim of this study was to better understand the current value and use of collaborative learning tools, including social media, in CPD activities of MRPs. In particular, this paper examined the following research questions.The University Human Research Ethics Committee (2019‐2146) approved the project, including its design and recruitment methods.A cross‐sectional online survey design was utilised, with data collected through Qualtrics™ . The questionnaire was developed after a critical review of the literature, and pilot tested with four Australian MRPs to enhance clarity and coverage of content before it was operationalised. The questionnaire consisted of four key sections: (1) participant demographics, (2) use of collaborative learning tool including social media for CPD, (3) value of these tools for CPD and (4) workplace supports. The questions included 5‐point Likert scales for example usefulness (extremely useful [1] – not useful [5]) and value ranking (least important [1] to most important [5]).Australian MRPs were invited to participate in the study, anonymously via online survey. The introduction to the survey provided participants with information outlining the aims, requirements and confidentiality of the study. Informed consent was obtained in the first item of the online survey, with respondents able to exit at this point if they so preferred. A link to the survey was distributed through an e‐blast to members of the Australian Society of Medical Imaging and Radiation Therapists (ASMIRT) in November 2019. As the link to the survey was electronic, further distribution of the survey link by e‐blast recipients may have occurred. Medical radiation students were excluded from the study as they are not required to undertake CPD.Using the total population of individuals who held membership with ASMIRT (7054)The data were uploaded to SPSS statistics . Descriptive and inferential statistics were used to analyse the data. Percentages were applied to describe the overall number of practitioners using collaborative learning for CPD and workplace support for CPD. The collected demographic data allowed for cross‐tabulations to determine whether associations existed across workplace demographics. Differences between groups were examined using chi‐square analysis, and where cell size was <5, Fisher’s exact test was utilised. A Friedman test was conducted on survey data to obtain an overall ranking of the importance MRPs attribute to collaborative learning tools for CPD, (1)‐for all participants and (2)‐for participants belonging to rural and remote workplaces as the literature identified rural and remote practitioners having reduced access to traditional face‐to‐face learning offerings. A p‐value less than 0.05 was the level for statistical significance used throughout the analysis.This survey received 121 responses, of which 7 were incomplete, resulting in 115 completed and valid responses. Data on demographics of respondents are presented in Table n = 103), ‘Online learning’  and ‘Reading articles’ . Statistically significant differences for participation in CPD activities were observed across workplace demographics (Table P < 0.05) for attendance at seminars, participation in online learning, provision of additional study time and attendance at journal clubs.CPD activities undertaken in the workplace by MRPs are presented in Table n = 73), with 36% (n = 41) attending more than once a year, and 28% (n = 32) attending one every two years (Table n = 32) or one every two years .Respondents were asked about their attendance at conferences. Most participants regularly attend conferences  of participants reported using social media for CPD. Facebook was the most frequently used platform for CPD with 20% (n = 10) using it daily and 23% (n = 12) at least once a week. Instagram and LinkedIn were also utilised for CPD purposes, primarily on a monthly basis. Across all listed social media platforms  and YouTube  were considered the most useful social media platforms for CPD.Frequency of use Table  and usefms Table , most pan = 41) of participants indicated online behaviour to be professional, and 41% (n = 28) selected neither professional nor unprofessional. The most common uses of social media for CPD were following professional organisation pages , connecting with other MRPs , connecting with other health professionals  and using social media to record CPD points . The most common reasons for social media use were accessibility to information  little geographical limitations  and ease of use . Participants who do not use social media to connect with other professionals (n = 45) provided reasons such as that they do not like to mix their professional and private life , do not have time  or have privacy concerns .Participants were asked about their experience with online professional behaviour as well as their reasons for using social media for CPD. When describing online professional behaviour, no participants that use social media platforms for CPD found online behaviour to be unprofessional, 59% , as well as participants from rural and remote workplaces . Post hoc pairwise comparison adjusted by Bonferroni correction for multiple tests indicated that the difference in ranking between seminars, workshops and conferences was not statistically significant for all participants (P > 0.05) as well as those from rural and remote workplaces (P > 0.05). In contrast, difference in ranking for social media groups and journal clubs with seminars , workshops  and conferences , respectively, was statistically significant, with the exception of social media group conferences for practitioners from rural and remote locations (P = 0.083).A Friedman test was performed to obtain the overall ranking of importance MRPs attribute to collaborative learning tool for CPD Table . There wn = 92) reported they were able to undertake CPD during work hours either through dedicated time allocation  or in an unofficial capacity . Difference in dedicated time allocation across health sector was evident  with 58% (n = 41) of participants working within the public health sector allocated dedicated time for CPD, compared to 33% (n = 14) in the private sector. Geographic location also was associated with the provision of dedicated time for CPD during work hours  with MRPs in metropolitan  and regional  workplaces afforded this benefit compared with their colleagues employed in rural or remote locations .The majority of respondents  have all or the majority of their travel expenses paid for by their workplace, and 29% (n = 30) have no travel paid. A percentage (13–20%) of participants were unsure of workplace supports which may be available to them to attend conferences.Workplaces can also support MRP attendance at conferences through the provision of financial support and leave. Most workplaces were observed to provide funding and paid leave for conferences if staff members were presenting or attending Table . Only 20Demographic data were used to determine the representativeness of the sample population to the Australian population of registered MRPs.P = 0.025) and conferences  respondents) for CPD and lower use of YouTube  than that of Boyd et al.More than half of the MRPs in this study participate in online learning using social media. Facebook was most frequently accessed and considered the most useful platform for CPD, while LinkedIn and Instagram were used less frequently on a monthly basis for CPD Tables  and 5. BThe high ranking of seminars and conferences observed in this current study accords with previous researchP < 0.001). Previous studies have also identified that funding and cost are major barriers to undertaking certain CPD activities.Over half of the participants within this study were officially or unofficially allocated time for CPD activities during work hours Table . MRPs wiGeographic location can influence access to learning opportunities. The results from this current study identified that MRPs in rural or remote locations receive less funding, paid leave and travel expenses to attend conferences than those in metropolitan locations. Lee et al.n = 45) also identified that they do not like to mix their professional and private life and had privacy concerns. Despite these noted barriers, the majority of respondents reported that when using social media for CPD purposes, the online behaviour encountered was professional.The majority of respondents using social media for CPD in this current study reported that social media provided easy access to information, was considered to be time efficient and low cost with no limitations such as geographical location. Using social media as it is less time‐consuming has previously been reported.It is recognised that the value of collaborative learning tools identified in this study may have changed dramatically due to COVID‐19. Face‐to‐face collaborative learning has been more restricted and as a result online or remote learning has become widely adopted.n = 115), resulting in a 9% margin of error.A number of limitations are associated with this study. Firstly, sample size was small (Medical radiation practitioners currently utilise both face‐to‐face and online collaborative learning tools to meet their CPD needs. Face‐to‐face collaborative learning tools are highly utilised and valued by MRPs. Barriers including time, funding and location can be a deterrent to participation in face‐to‐face learning. Social media platforms for CPD can potentially eliminate these barriers providing easy to access information regardless of geographical location and connection with other professionals. While CPD is an individual requirement for registration,The authors declare no conflict of interest.


Journal of Genetic Counseling, 26, 1388; Krieger et al., 2018, Journal of Genetic Counseling, 26, 1388; Lara‐Otero et al., 2019, Health Communication, 34, 1608; Rosenbaum et al., 2020, Journal of Genetic Counseling, 29, 352). This study utilized a quantitative approach to allow for sampling of larger populations and to simultaneously understand current perspectives of GCs and HIs regarding each other's and their own roles within a genetic counseling session. GC and HI participants from the United States were recruited via email to complete an online survey with questions regarding interactions prior to a session, roles during a session, and opportunities for collaboration and constraints in the working relationship. Descriptive and inferential statistics were utilized to analyze responses of GCs and HIs. 130 GC and 40 HI participants were included in this study. There were statistically significant differences (p < .001) in responses between GC and HI participants on the expected distribution of roles during a session in advocacy, psychosocial and cultural domains. Additionally, this study identified that HI desired resources and training regarding genetics and genetic counseling are currently not being met. To our knowledge, this is the largest study to simultaneously survey GC and HI perspectives on these topics. Our findings suggest the need for greater communication and collaboration between GCs and HIs to ensure high‐quality care for patients with LEP. Integrating a pre‐session meeting between the GC and HI for sessions with patients with LEP and increasing education for GCs and HIs on the roles each group brings into a session is warranted to optimize this collaborative relationship and patient care.Genetic counselors (GCs) and healthcare interpreters (HIs) are key members of the healthcare team when providing genetic counseling services to patients with Limited English Proficiency (LEP); however, the working relationship between GCs and HIs and the role each member plays within a genetic counseling session is unclear. Previous studies assessing this relationship have been qualitative and limited in sample size (Agather et al., 2018,   Genetic counselors and HIs are key members of the healthcare team when providing genetic counseling services to patients with LEP; however, the working relationship between GCs and HIs and the role each member plays within a genetic counseling session is unclear. Previous studies assessing this relationship have been qualitative and limited in sample size and generalizability.This is the first study to our knowledge to utilize a quantitative approach to directly compare current perspectives of GCs and HIs regarding each other's and their own roles within a genetic counseling session. This study reveals the differing opinions between GCs and HIs on who they believe roles should fall to and constraints experienced in working with one another. Key areas to improve the working relationship were also identified to provide optimal quality care for patients with LEP.1Genetic counselors (GCs) are trained to deliver complex genetic concepts and psychosocial counseling to their patients. When working with patients with Limited English Proficiency (LEP), these components can become even more difficult to convey accurately while simultaneously assessing comprehension for English‐speaking GCs. Patients with LEP are characterized as individuals who have limited ability to read, write, speak, and understand English  assess the collaborative relationship between HIs and GCs, (b) examine HIs’ and GCs’ perceptions of their own and each other's roles surrounding a genetic counseling session, and (c) evaluate the effectiveness of techniques used for improving communication and collaboration between HIs and GCs, as identified in previous research, to ensure optimal quality healthcare for patients with LEP.22.1Genetic counselor participants were recruited through the National Society of Genetic Counselors (NSGC) and American Board of Genetic Counseling, Inc. (ABGC) email listservs. Eligibility for GCs was restricted to those who were board‐certified, had worked as a clinical GC within the past five calendar years (2015–2020), and had worked with a HI at least once.Healthcare interpreter participants were initially recruited through the National Council of Interpreters in Healthcare (NCIHC) email listserv. Eligibility for HIs was restricted to individuals who had interpreted in healthcare within the past five calendar years (2015–2020). In anticipation of low response rate, both HIs who had and had not worked with GCs before were included in this sample. Due to a low initial response rate from HIs, the sampling methodology was adjusted to incorporate both snowball sampling and additional recruitment through smaller, state‐wide interpreter organizations by email Data . This st2.2Recruitment emails for GC participants were initially sent to the NSGC listserv on October 21, 2020, and the survey remained open for three weeks, until November 11, 2020. Recruitment emails for HI participants were initially sent to the NCIHC listserv on October 15, 2020, and the survey remained open just over three weeks until November 7, 2020. The HI survey deadline was extended to November 26, 2020, to recruit additional participants through state‐wide interpreter organizations who had an email address available for contact on their website Data . A reminPotential participants were provided a link via the recruitment email to a survey created through the Northwestern REDCap platform. While matching in structure and content, different survey links were provided to GCs and HIs to allow for verbiage specific to the intended participants. Both surveys were developed by MW and reviewed by four board‐certified GCs. The HI survey was reviewed by an HI who met inclusion criteria. Feedback was incorporated into the survey design prior to launch of the study.The GC and HI survey questions are included as supplemental files Data ; Data S3Survey questions regarding roles performed during sessions were divided into three domains: advocacy, psychosocial and cultural. The domains were developed by comparing the Accreditation Council for Genetic Counseling ACGC,  Core ComParticipants from each group were compensated with the opportunity to be randomly selected via raffle for one of ten available $30 VISA gift cards, for a total of twenty gift cards between both groups. Participants had the opportunity to enter the raffle at the end of the survey by providing their email address. Winners were drawn at random and contacted to receive the gift card via mail.2.3p‐value of <.05 was utilized to determine statistical significance.All statistical analyses were completed using SPSS (Version 26) for Windows. Descriptive statistics were derived to describe survey participant demographics and answer frequencies. Inferential statistics for between‐group comparisons was completed using Mann–Whitney U, chi‐squared, or Fisher's exact test. A 33.1In total, 130 GCs and 40 HIs completed the respective surveys  and 29/29 (100%), respectively Data . Of notep < .001) in responses between GC and HI participants on the importance of providing this information to an HI prior to a session, with a greater proportion of HI participants responding that providing this information prior to a session was ‘Very Important’ than GC participants  and ‘Advocating for patient in the clinical setting’  and ‘Managing Patient Emotions’ , ‘Maintaining understanding of patient's culture’ , ‘Reacting to patient cultural concerns’ , and ‘Assessing relevant patient cultural beliefs’  GC respondents indicated that they have provided resources to HIs Figure . Of thos3.4.2The top three constraints impacting this working relationship as indicated by GC participants were ‘lack of time for patient session’ , ‘HI lack of familiarity with genetic terminology’ , and ‘technology issues (if working with remote interpreter)’ ’ fell mostly to GCs. GCs may expect to initiate a statement to convey empathy to be interpreted by an HI to the patient. However, Gutierrez et al.  found thThis study also explored opportunities and constraints within the working relationship between GCs and HIs, which help to provide additional context to some of the previously discussed data regarding the working relationship. The results revealed that the lack of information from a pre‐session meeting was one of the most common constraints identified by HIs when working with GCs, with the majority of HIs reporting this as a constraint Figure . The preIn addition to the lack of a pre‐session, several constraints were reported by both GCs and HIs on working with each other. Both GCs and HIs identified the lack of HI training in genetics to be one of the most common constraints Figure . Lack ofThere were also several free‐text responses that described very specific negative experiences from each GCs and HIs. Having had prior negative experiences with an HI or GC may negatively impact subsequent interactions with and opinions toward that group. One of the more frequently experienced constraints by GC participants was lack of trust in interpretations made by the HI, while one of the least frequently experienced constraints by HI participants was a lack of trust from a GC of their interpreting Figure . The lacFinally, development and provision of resources may help to combat the above constraints. Only a small minority of GCs in this study have provided resources to a HI, while a majority of HIs who have not received resources from a GC responded they would want to receive these resources Figure . Further4.1Our study is the largest study, to our knowledge, to directly compare GC and HI perspectives of this working relationship using a quantitative methodology; however, there were several limitations. The sample of HIs was smaller than that of GCs and included HIs who had not worked with GCs before to aid with HI sample size. In addition, all HIs participants who had interpreted for a GC had provided interpreting services for an in‐person genetic counseling session, and 65.5% had not interpreted for a GC by any other method. HIs who provide in‐person services within a hospital system are often required to obtain certification and undergo additional training within their departments. Therefore, our sample of HIs who have interpreted for a GC may be overrepresented by HIs who are certified and may have completed training programs to take the NBCMI and CCHI exams, which are standardized exams often required for HIs to work at a healthcare institution. Furthermore, a large portion of HIs was recruited from the Midwest region, which is known to have fewer organizations and available guidelines compared with other regions of the United States. Finally, while female interpreters outnumber male interpreters 7 to 3 in the interpreter workforce, male interpreters were underrepresented in our sample and there may be differences in views not captured in this study  in accordance with the US Federal Policy for the Protection of Human Subjects. An online consent form was utilized at the start of the survey and implied informed consent was obtained for individuals who voluntarily completed the online survey and submitted their responses.No non‐human animal studies were carried out by the authors for this article.The data that supports the findings of this study are available in the supplementary material of this article.Data S1Click here for additional data file.Data S2Click here for additional data file.Data S3Click here for additional data file.Data S4Click here for additional data file.Data S5Click here for additional data file.Data S6‐S7Click here for additional data file.Data S8Click here for additional data file.


PROMED‐COG project and associated work packages. The project aimes to (1) strengthen the epidemiologic evidence to better understand the potential benefits of combating undernutrition for healthy neurocognitive ageing; (2) increase scientific knowledge on the balance between a protein enriched Mediterranean diet (PROMED) and physical exercise to prevent undernutrition and promote healthy neurocognitive ageing, and generate data on mechanistic pathways; (3) stimulate collaboration and capacity building for nutrition and neurocognitive ageing research in Europe; and (4) develop public and practice recommendations to combat undernutrition and promote healthy neurocognitive ageing in older adults. Findings will provide new and critical insights into the role of undernutrition in neurocognitive ageing, how this role can differ by sex, genetic risk and timing of undernutrition exposure, and how modifications of dietary and physical activity behaviour can reduce the burden of undernutrition and neurodegeneration. The research outcomes will be useful to inform policy and practice about the dietary guidelines of older people and provide insight to industry for the development of food‐based solutions to prevent undernutrition.Dementia is a major public health challenge owing to its increasing prevalence and recognised impact on disability among older adults. Observational data indicate that weight loss is associated with increased dementia risk of 30%–40% and precedes a diagnosis of cognitive impairment or dementia by at least one decade. Although relatively little is known about the mechanisms of unintentional weight loss in dementia, this provides a window of opportunity to intervene with strategies to counteract undernutrition and delay, or prevent, the onset of dementia. This article provides an overview of the  The European population is ageing rapidly with 90.5 million older adults (aged 65 years or older) living within the European Union in 2019 and expected to increase to 129.8 million by 2050  transnational consortium project is funded under the European Horizon 2020 Joint Programming Initiative ‘a Healthy Diet for a Healthy Life’ (JPI HDHL) and the ERA‐NET Cofund ERA‐HDHL, specifically via the PREVNUT call for development of targeted nutrition for prevention of undernutrition for older adults. PROMED‐COG brings together a multidisciplinary scientific team from the UK, Ireland, Italy, The Netherlands and Germany as well as external stakeholders to represent the broader professional societies and patient groups involved in nutrition for public health outlined in Figure The PROMED‐COG are to:Strengthen epidemiologic evidence to better understand the potential benefits of combating undernutrition for healthy neurocognitive ageing.Increase scientific knowledge on the balance between a protein enriched Mediterranean diet (PROMED) and physical exercise to prevent undernutrition and promote healthy neurocognitive ageing and generate data on mechanistic pathways.Stimulate collaboration and capacity building for nutrition and neurocognitive ageing research in Europe.Develop public and practice recommendations to combat undernutrition and promote healthy neurocognitive ageing in older adults.The primary objectives of PROMED‐COG project WPs are summarised in Figure Project objectives will be delivered by five cross‐cutting work packages (WPs) that combine both epidemiological and intervention studies to address gaps in the scientific knowledge and engage stakeholders to translate findings into population dietary and lifestyle recommendations for healthy neurocognitive ageing. www.invo.org.uk), we will recruit a PPI group comprised of older people with lived experience of subjective cognitive decline and/or undernutrition to co‐produce the PROMED‐EX Trial outlined in WP4 and at least one PPI representative will be invited onto the Trial Steering Committee. A further important part of WP1 is to build research capacity for nutrition and cognitive ageing research by training and mentoring early‐stage researchers  in the field of nutrition and cognitive health.The project is coordinated by Queen's University Belfast, working in close collaboration with the other scientific partners to ensure the project runs smoothly. The collaboration agreement and data management plan have been implemented so that scientific excellence and knowledge sharing are maintained throughout the project and all outputs and deliverables are met. This WP will also develop project communications  and will expand the current scientific, stakeholder and public and patient involvement (PPI) representatives' network. Guided by best practice INVOLVE guidelines  is a large‐scale, multi‐centre, longitudinal study on the development of age‐related disease in n = 5628 randomly selected adults aged 65–84 years at baseline and followed for 8 years  is a longitudinal study of determinants of disability in an age‐ and sex‐stratified random sample of n = 3099 mainly community‐dwelling (96%) adults aged ≥65 years followed for 7 years  is a longitudinal study in n = 1604 dementia free community‐dwelling individuals from the Lombardy Region  (aged 40–74 years at enrolment in 1992–1993) and followed over 20 years .WP2 is led by partners from the University of Padova, Italy, and will pool data from three epidemiological Italian cohorts that are considered compatible on the criterion of adequate quality exposure and outcomes .Retrospective data harmonisation will be performed in accordance with guidelines  and physical activity (PA) have been independently associated with a decreased risk of Alzheimer's disease  across the three cohorts. Secondly, WP3 will estimate independent cross‐sectional associations between MedEx and neuroimaging measures  and determine what factors may influence associations, for example socio‐demographic, body composition, inflammatory markers, cardiometabolic risk factors and depression. Data will be drawn from subsamples of two Italian cohorts, PRO.VA (n = 808)  (n = 150) . WP3 will also explore the mechanistic pathways involved in diet‐associated neurocognition, hypothesising that a MedDiet enhances cognitive function and protects against dementia via favourable effects on brain structures, inflammatory markers and body composition, mediated by favourable metabolomic profiles (see WP4), and better nutrient intake. Inflammatory markers (C‐reactive protein and interleukin 6 [IL‐6]) and metabolomic analysis will be performed on blood samples from the NutBrain cohort to determine how the MedDiet might influence circulating metabolites and how the metabolites could mediate the associations between diet and neurocognitive measures.WP3 is led by National Research Council (CNR), Italy, and will address these scientific gaps. WP3 will firstly estimate the longitudinal associations between combined MedDiet and PA (MedEx), cognitive decline and risk of dementia using the pooled dataset from It is critical to understand the role of lifestyle interventions for preventing undernutrition and promoting healthy neurocognitive ageing, particularly when implemented at an early stage of disease and in ‘high risk’ populations. The MedDiet is highly palatable and nutrient dense and, in this regard, may be both neuroprotective and helpful in preventing undernutrition. The MedDiet has been associated with reduced risk of nutritional deficiencies  where n = 105 eligible participants will be block randomised into one of three groups: Group 1 (PROMED [n = 35]) will receive personalised dietary advice, written education resources , a home‐delivered supply of key PROMED foods, self‐monitoring tools to facilitate adherence to the intervention and weekly telephone support; Group 2 (PROMED‐EX [n = 35]) will receive the PROMED intervention described above—plus an individually tailored, home‐based exercise programme; and Group 3 (Control [n = 35]) will receive a standard care diet sheet. The active intervention will be delivered over 3 months with extended follow‐up to 6 months (i.e. 3 months after the intervention has ceased).WP4, led by Queen's University Belfast, UK, will test the effect of a protein optimised MedDiet (PROMED), or PROMED + exercise (PROMED‐EX) intervention, on nutritional and cognitive status in older people at risk of undernutrition and cognitive decline, and explore potential mechanisms underlying intervention responsiveness. A single‐blind, parallel group randomised controlled trial (RCT) will be conducted  and have self‐reported decline in cognition. Those who are malnourished, receiving artificial nutritional support, and have major dietary restriction or diagnosis of cognitive impairment/dementia will be excluded. The primary outcome is between‐group difference in MNA score at 3 and 6 months from baseline. Secondary outcomes will include between‐group difference at 3 and 6 months in cognitive function, diet quality, nutritional biomarkers, PA, body composition, physical performance and psychosocial health. WP4 will also explore the acceptability and tolerance of the interventions as well as ability to change diet and exercise behaviours.It is paramount to establish mechanistic pathways by which diet and exercise may act to inform evidence‐based recommendations and pave the way for innovative food solutions to prevent undernutrition. Across studies, we will use metabolomic and biomarker assessments to uncover biological mechanisms underlying how diet can influence nutrition status and neurocognitive ageing, and how PA interacts with nutrition to influence these processes. In WP4, change in metabolomic profile, lipid profile, inflammatory and metabolic biomarkers and metabolic signals will be investigated using a blood sample collected at each study time point.University College Dublin, Ireland, will lead the metabolomic analyses for the project. Metabolomics will be performed using a combination of NMR and LC–MS‐based approaches  to develop: (1) the key public health messages arising from this work; (2) practice recommendations for professionals; and (3) areas for future research and a dissemination strategy to report findings. We anticipate that findings will be published in academic journals, policy briefs and reports for practitioners and external shareholders.https://gdpr‐info.eu/) or the UK GDPR  where applicable. PROMED‐COG partners have agreed a data management plan in compliance with FAIR  data management principles, to which all researchers involved in the project will adhere.All research is compliant with ethical principles and applicable international, EU and national law. Data from the project will be handled, computerised and stored in accordance with the European General Data Protection Regulation (EU) 2016/679 (GDPR) (findability has been optimised by creating a project website (https://www.promed‐cog.com) to communicate research activities across a broad range of audiences. The PROMED‐EX trial has been registered on the ClinicalTrials.gov database (NCT05166564). Furthermore, the study description and variable metadata catalogues will be published during the project and will be discoverable in open access repositories, for example Zenodo (https://zenodo.org/), partner institutions repositories, for example QUB Pure Research portal, and published in the JPIHDHL Meta Database (http://www.jpihdhl.eu) knowledge transfer platform to ensure visibility to the wider research community. Accessibility of research will be maximised via open access publication. Only de‐identified participant data will be published, and participant consent for this will be in place across studies to allow us to share research findings. Intraoperability of generated data will be promoted by ensuring metadata files are available via interchangeable statistical file format. Data will be archived and held securely according to local policies, with guaranteed preservation for 10 years to maximise data sharing and reusability opportunities. Data sharing and biological sample transfer for the purposes of the proposed analyses will also follow institutional guidelines and Material Transfer Agreements where applicable. Existing and new data collected within the project will be anonymised and archived in password‐protected study databases.In brief, project PROMED‐COG project is innovative and novel in scope for several reasons:It offers a novel strategy to understand the cumulative risks of undernutrition for cognitive decline and dementia particularly as processes leading to cognitive decline and dementia may begin, and be affected by, undernutrition earlier in life, yet studies to date have focused on the effects of weight loss at end‐stage disease. The data from the pooling of these epidemiological cohorts will enable us to examine the cumulative risk of undernutrition from the earliest to the latest stages of disease and examine whether the associations differ by sex and genetic risk.The unique focus on diet and physical activity patterns, rather than individual foods or behaviours, allows a ‘real‐world’ evaluation of the potential additive effects of healthy lifestyle behaviours on a range of neurocognitive ageing measures, including neuroimaging biomarkers and cognitive performance across several domains. This approach will facilitate effective translation of the scientific knowledge gained from our project into lifestyle recommendations for public health benefit.For the first time, we will test a complex lifestyle intervention to determine whether adopting a protein‐enriched MedDiet can improve both nutritional status and cognition—an important health outcome for older adults—and whether there are further benefits offered by exercise. This methodological approach will complement the planned epidemiological analyses to generate robust evidence to inform public health recommendations and dietary guidelines.There is integration of state‐of‐the‐art metabolomics, metabolic and nutritional biomarkers to elucidate biological mechanisms underlying how an adapted MedDiet can influence nutrition status and neurocognitive ageing, and how PA can interact with nutrition to modify these processes.The linkage of nutrition and ageing researchers across Europe allows sharing of expertise and knowledge in multi‐domain lifestyle interventions biomarker development and assessment, epidemiology, ageing and cognitive function assessment.The PROMED‐COG project (2021–2023) aims to combine epidemiological and intervention research to provide new and critical insight into the role of undernutrition in neurocognitive ageing, how these effects can differ by sex, genetic risk and timing of undernutrition exposure, and how modifications of dietary and PA behaviour may act to reduce the burden of undernutrition and neurodegeneration. This is of public health importance given the increase in the ageing population across Europe and the link between undernutrition and dementia risk. The resulting scientific knowledge will be translated into public and practice recommendations to prevent undernutrition for healthy neurocognitive ageing in older European citizens.The There are no conflicts of interest to declare.


Intussusception is a surgical emergency that may result in the perforation of the intestinal wall if not immediately treated. Pathologic lead points, such as intestinal duplication, are present in 2.2%–15% of the cases.We describe a 4‐year‐old girl with a necrotic ileoileal intussusception diagnosed with a rare tubular ileal duplication. To ensure the best therapeutic strategy, it is crucial to include small intestinal duplication as a pathological lead point in the differential diagnosis of acute abdomen owing to complicated intussusception. It occurs when a portion of the gastrointestinal tract gets telescoped into another. It can occur in children aged 6 months to 2 years, and the most common type is idiopathic ileocolic intussusception.A triad of vomiting, a palpable abdominal mass, and the passage of currant‐jelly stools are the typical signs that raise clinical suspicion of intussusception.The preferred therapy for noncomplicated intussusception is radiological reduction, which has a 10%–60% failure rate and necessitates surgery in failed situations.22.1A four‐year‐old Afghan refugee girl was admitted to the pediatric ward with acute abdominal pain as her main complaint and no prior medical or surgical history. The symptoms started as intermittent abdominal pain (every 60 min with a duration of 20 min) in the periumbilical and hypogastric areas 3 days ago, accompanied by two episodes of bilious vomiting (last night and 1 hour before admission) and one episode of currant‐jelly stool defecation with no sign of hematochezia. Her complaints were temporarily relieved by taking anticholinergics and antiemetics as self‐treatment.2.2In general appearance, she was an ill child, and physical examination revealed an abdominal distention with a palpable tender mass in the periumbilical area.2.3The laboratory tests revealed leukocytosis , neutrophilia , and a C‐reactive protein of 4.4 mg/dL. Also, urinalysis revealed ketonuria .Ultrasonography confirmed an ileoileal invagination as a doughnut sign with obstructive findings, free abdominopelvic fluid, and no vascular flow in the invaginated loop in Doppler investigations.2.4We performed urgent surgery following fluid resuscitation and the administration of preoperative broad‐spectrum antibiotics due to the patient exhibiting symptoms of peritonitis. The stomach was decompressed using a nasogastric tube while the patient was under general anesthesia. A twisted ileoileal invaginated section was observed at 20 cm from the ileocecal valve during exploratory laparotomy Figure . First, 3Intussusceptions are typically idiopathic, and only 2.2%–15% have pathologic lead points like Meckel's diverticulum (the most common type) or intestinal duplication.Most pathologic lead points present as ileoileocolic intussusceptions, and generally, signs and symptoms are similar; however, due to the large variety of lesions or intestinal malformations, presentations might vary and are frequently nonspecific. Pathologic lead points should be considered, especially in children over 5 years with multiple recurrences or failure of the enema technique for reduction.We recommended that under suspicious circumstances, a primarily negative ultrasonography investigation should never exclude a second repeat ultrasonography.Duplications of the small intestine are common in the ileum and can be cystic or tubular. They differ from Meckel's diverticulum in that they are mostly linked to the mesenteric region of the intestine and consist of two parts as follows: an outer layer of smooth muscle and an inner lining of the gastrointestinal epithelium.As many children with intussusceptions caused by pathologic lead points may present with nonclassic symptoms, a specific diagnosis must be determined by diagnostic examination using radiologic imaging. The best options for confirming intussusception caused by a duplication cyst or lymphoma in the hands of an experienced examiner are ultrasonography and reduction enema, but less so for a Meckel's diverticulum.Treatment of a stable patient with intussusception begins with an enema reduction in the emergency department without contraindications such as perforation or shock signs.Our case presented with the classic symptoms of intussusception, and the ultrasonography findings boosted the suspicion. We identified the tubular type of ileal duplication at the operation, which caused ileoileal intussusception. In the literature, we found a few cases of children with ileoileal intussusception secondary to tubular ileal duplication.4Small intestine duplication should be considered in the differential diagnosis of ileoileocolic or ileoileal intussusception, especially in children over 5 years with failed reduction attempts. Moreover, surgical treatment is imperative for all symptomatic cases.Mehran Monazzami: Writing – review and editing. paria Dehghanian: Writing – review and editing. Hojjat Shaman Zahroodi: Writing – original draft.The authors declare that they have no competing interests in this original work.We confirm that all named authors have read and approved the manuscript. The protection of the intellectual property associated with this manuscript has been our consideration.The authors confirmed that they had gotten all proper patient written consent formats. The parents have given their consent for their images and other clinical Information to be reported in the form. The parents were informed about the confidentiality of the names and initials, and efforts would be made to hide their identity.


Dear Editor:Reflex seizures (RSs) primarily refer to epileptic events that are triggered by external stimuli or an internal mental process.Herein, we report the case of a patient with exercise‐induced seizures along with a review of previously reported cases with exercise‐induced RE Table . Differe1A 15‐year‐old right‐handed boy was referred to our epilepsy unit for diagnostic evaluation. The patient's first seizure occurred at the age of 9 years and commenced with numbness in the extremities soon after he starting running, which was followed by staring and oral and bimanual automatisms that lasted approximately 30 s before regaining consciousness. The patient remained asymptomatic without medication until the age of 12 years when he began experiencing the same symptoms while exercising. He noticed that physical activity was a reliable precipitation in seizure production. Interestingly, the seizures were triggered by rapid repetitive limb movements such as sprinting and fast pedalling and usually occurred within several seconds of initiating exercise. The seizure frequency increased after the age of 15 years, from two or three episodes per month to daily attacks. The patient experienced his first generalized tonic–clonic seizure in April 2021, which was independent of exercise, while he was awake.The patient's birth was preterm but uneventful, with no family history of epilepsy. Neurologic and general physical examinations were normal but 18F‐fluorodeoxyglucose positron emission tomography (PET) scan revealed left frontoparietal lobe hypometabolism Figure . Seven e2In this report, we presented the case of a boy with possible left frontoparietal lobe epilepsy induced by exercise as well as spontaneously occurred seizure. We discuss the possible roles through which exercise may precipitate seizures. The sine qua non of the seizure triggering is the existence of an epilepsy‐prone brain network to ignite a seizure that manifests the same system's functions.All events in our patient were focal seizures without awareness, which is consistent with previous data.In the present case, the extent of physical exercise was proportional to that of the seizures, which were probably precipitated by vigorous rather than gentle exertion. Each patient had a unique exercise type that triggered the epileptic events. The previous instances of seizures in our patient were rather short, with triggers starting within 5–7 s after swaying arms rapidly. The pattern of such rapid movements apparently did not lead to fatigue, suggesting that high‐frequency limb movements raise cortical excitability and reduce the seizure threshold in certain manners. Therefore, seizures triggered by exercise were not only associated with the intensity of movement but also with the frequency of movement. High frequency was probably also a contributing factor to the seizures.The management of RE is similar to that of other epilepsies. ASM are required for most of the patients. Unfortunately, despite the best management efforts, RS can be refractory in a substantial proportion of patients. Only a small fraction of these individuals who remain pharmoco‐resistant may benefit from surgical resection as postoperative outcomes are not generally favourable. As exercise‐induced seizures have more widespread epileptogenic network in terms of seizure initiation and propagation, surgically resecting the network is difficult. Other surgical options, including vagal nerve stimulation and deep brain stimulation, have been widely used in refractory epilepsy,3Herein, we reported the case of an unusual RE triggered by rapid and repetitive limb movements, thereby expanding knowledge on the types of trigger patterns in exercise‐induced epilepsy. Considering the role of exercise in protection against seizure, physical exercise should be encouraged to most patients with epilepsy. However, this is not suitable for patients with exercise‐induced epilepsy, and limiting exercise or modifying the exercise habits may be beneficial for their seizure control.4Kang Wang has contributed to searching the literature and revising the manuscript. Jianfang Zhang is responsible for follow‐up of the patient, drafting the manuscript and clinical evaluation. Yi Li, Caihong Ji and Dengchang Wu have analysed the data and searched the literature. Liping Sun and Xing Zhang are in charge of following up the patient.6This work was supported by the Zhejiang Provincial Natural Science Foundation of China (LY19H090020).7The authors declare no conflict of interest.89Written informed consent was obtained from the parents.10The parents have consented to the submission of the case report to the journal.Video S1Click here for additional data file.


Journal of the International AIDS Society (JIAS) published its first special issue about HIV in transgender populations in 2016 [Our knowledge about HIV among transgender populations has substantially improved since the  in 2016 . These a in 2016 .In keeping with the most recent World AIDS Day call to “end inequalities” as well as the AIDS 2022, the 24th International AIDS Conference theme, “re‐engage and follow the science,” we dedicated this special issue to research that fills important gaps in science and provides data that can be used to end inequities in HIV prevention and care for transgender people. We called for abstracts that fill gaps in knowledge about trans masculine people, gender non‐binary people, transgender people in sub‐Saharan Africa, as well as data on community‐based and clinical interventions. Manuscripts by transgender authors were encouraged. We were excited to receive more than 70 abstracts. Through a careful process of editorial and peer review, we selected 13 quality manuscripts that contribute to the evidence base for advancing equity for transgender people in the HIV response. This issue includes research from countries across the globe, including rare data focused on transgender people in sub‐Saharan Africa; studies inclusive of and/or focused specifically on transgender men; and programmatic data that provide practical insights into potentially effective strategies to engage transgender people in HIV prevention and care. We are delighted that more than half of the manuscripts in this special issue are led or co‐authored by transgender and nonbinary people.We include two manuscripts that address some of the extensive gaps in HIV research focused specifically on the experiences and needs of transgender men. Radix et al. provide one of the largest clinical data sets on HIV prevalence and sexual risk among transgender men in the United States. Data from this relatively diverse sample of 577 transgender men found that White participants were less likely to be tested for HIV, Black participants were more likely to be living with laboratory‐confirmed HIV and HIV prevalence was highest for transgender men who reported having only cisgender male partners [Appenroth and colleagues directly compare self‐reported sexual health outcomes of 122 transgender MSM with more than 22,000 cisgender MSM in Germany . In theiFour manuscripts expand the evidence base on the uptake of HIV testing and prevention among transgender populations. Lacombe‐Duncan et al. examine the prevalence and associated factors for HIV testing among 539 transgender and gender non‐binary people in the Midwestern United States . More thResearch from multiple countries provides insights on HIV prevention strategies used by transgender people. Byrne et al. analysed data from 704 sexually active transgender and non‐binary people in Aotearoa/New Zealand . Most stAguayo‐Romero and colleagues used innovative latent class analyses to examine data from 958 transgender women across the Eastern and Southern United States [n=28 sites) assessing same‐day daily oral PrEP in Brazil, Mexico and Peru provided baseline data for Konda et al.’s study of factors associated with long‐term PrEP engagement and adherence among transgender women (N=494) [A multicentre study ( (N=494) . Over 27n=268) were initiated on PrEP and 97% of those who tested positive for HIV (n=78) were started on ART.We included four manuscripts describing innovative, transgender‐inclusive approaches to HIV service delivery. Two describe differentiated service delivery models in sub‐Saharan Africa , 12. Mwan=687) of the 4829 who tested for HIV had a positive result and 91% of them initiated ART. However, only 28% (n=1165) of those who tested HIV negative accepted PrEP. The success of community‐based peer outreach for PrEP engagement in Zambia and South Africa provides evidence to support this strategy. The differences in PrEP uptake in the two programmes suggest the need for more data to understand what factors influence the success of community outreach for the engagement of transgender people in PrEP.Bothma and colleagues provide programmatic data from dedicated differentiated healthcare centres for transgender people in four South African districts . Unlike Doan et al. describe the implementation of participatory continuous quality improvement and Plan‐Do‐Study Act methods to increase PrEP uptake among transgender women in Vietnam . This apRebchook et al. describe a variety of innovative interventions implemented to increase engagement in HIV care among transgender women of colour in nine sites across the United States, including housing linkages, legal services and peer support . HeterogThe final three articles highlight the history of guideline development and emphasize the importance of best practices for engaging transgender people in HIV research. Given the significant geographic variability in the provision of care and treatment for transgender people across the globe, the World Health Organization (WHO) has a critical role to play in setting the fundamental standards of transgender‐inclusive HIV services. Macdonald and colleagues lay out the history of WHO's evolving role in facilitating quality, gender‐affirming, culturally responsive care for transgender people across the globe . ArticleWhile more data are clearly needed, especially among non‐binary people and transgender men, existing research provides an important road map for action. The articles in this supplement outline the unmet needs of transgender men, describe intervenable barriers and facilitators to HIV engagement and provide evidence of effective programmatic interventions across multiple continents. We hope the manuscripts in this supplement also make clear that the way forward must be led by and meaningfully engage transgender people. If we follow the science and engage communities, we have the necessary tools to end HIV inequities and advance the health and wellbeing of transgender people.The authors declare no competing interests.TP conceived and wrote the initial draft of the manuscript. SLR, NP and BG provided feedback, reviewed and edited the initial draft and approved the final version prior to submission.Publication of this open access special issue was supported by funding from Gilead Sciences, Merck & Co., Inc., and the National Institutes of Health via the HIV Prevention Trials Network. The authors alone are responsible for the views expressed in this issue. They do not necessarily represent the views, decisions or policies of the institutions with which they are affiliated nor any of the funding agencies.