Hasil untuk "General. Including alchemy"

Corona Morató-Cecchini, David Rodríguez-González, Lucía Celada et al.

The development of photocurable hydrogel biomaterial inks with suitable rheology, low cytotoxicity, and tuneable mechanical properties is essential for reliable biofabrication. This study aimed to formulate PEGDA–gelatine–collagen inks using lithium phenyl-2,4,6-trimethylbenzoylphosphinate (LAP) as photoinitiator. Rheological characterisation and flow-model fitting were performed, mechanical stiffness modulation under different light intensities was evaluated, complex structures were printed using direct extrusion and FRESH methodologies, and PEGDA/LAP extractables were quantified by NMR after controlled washing procedures. In vitro assays assessed cell viability and proliferation on the resulting scaffolds. The Herschel–Bulkley model best described the flow behaviour across formulations; while viscoelastic measurements showed that increasing light intensity progressively enhanced hydrogel stiffness, enabling fine control over final mechanical properties. NMR analysis showed that washing removed a substantial fraction of residual LAP, in agreement with the biological findings: fibroblasts failed to survive on unwashed scaffolds but exhibited robust proliferation and recovered their characteristic elongated morphology on washed constructs. Among all inks, PeGeCol_10_2 provided the best combination of shear-thinning behaviour, structural integrity, low residual photoinitiator, and tuneable mechanics. Using this formulation, we successfully printed large anatomical models with high fidelity and excellent handling properties, underscoring its potential for soft-tissue prosthetics and broader tissue-engineering applications.

Emre Cebeci, Büşra Yüksel, Reyhan Aliusta et al.

Background: Gum Arabic (GA) is a natural polysaccharide widely recognized for its antioxidant and anti-inflammatory properties; however, its functional behavior as a biopolymeric gel and the mechanisms underlying its selective effects on cancer-related redox microenvironments remain insufficiently characterized. It is imperative to note that the interaction between its physicochemical properties and its biological activity in colorectal cancer remains to be fully clarified. Methods: This study aimed to evaluate the antineoplastic potential of GA in human colorectal cancer (CRC) cell lines (HT-29 and HCT-116) compared to normal fibroblasts (MRC-5) using the MTS assay. Oxidative stress-related molecular responses were assessed by quantitative PCR analysis of GPX4, GSTA2, CAT, NFKB, and SOD1 expression. In parallel, extracellular concentrations of key metal ions (Fe²⁺, Zn²⁺, Mn²⁺, Mg²⁺, Cu²⁺, and Al³⁺) were quantified following GA exposure. To establish its functional gel characteristics, rheological measurements were performed to assess viscosity and shear-dependent behavior, and USP-compliant in vitro kinetic studies were conducted to evaluate time-dependent release properties. Results: GA induced dose-dependent cytotoxicity in HT-29 and HCT-116 colorectal cancer cells, while MRC-5 fibroblasts exhibited comparatively higher viability across the tested concentration range, indicating reduced sensitivity in normal cells. Rheological analysis revealed concentration- and ion-dependent viscoelastic behavior, identifying a 10% (<i>w</i>/<i>w</i>) GA formulation as optimal due to its balanced low-shear viscosity and controlled shear-thinning properties. Kinetic studies demonstrated a defined, diffusion-governed release profile under physiologically relevant conditions. At the molecular level, significant upregulation of GPX4 and GSTA2 was observed in both cancer cell lines, whereas NFKB expression increased selectively in HT-29 cells, with no notable changes in CAT or SOD1 expression. Additionally, GA treatment resulted in marked increases in Fe²⁺, Zn²⁺, and Mn²⁺ levels, indicating modulation of the redox–ionic microenvironment. Conclusions: These findings demonstrate that GA functions as a natural, ion-responsive biopolymeric system with defined rheological and kinetic properties, capable of selectively targeting colorectal cancer cells through coordinated genetic and ionic regulation of oxidative stress. Collectively, the results position GA as a promising functional gel-based platform for future redox-modulated therapeutic strategies in colorectal cancer.

Krishi Patel, Derya Ozhava, Yong Mao

Cartilage damage is common in sports injuries and cartilage-related diseases, such as degenerative joint and rheumatic disorders. Autologous chondrocyte implantation (ACI) is a widely used cell-based therapy for repairing cartilage damage in clinical practice. In this procedure, a patient’s chondrocytes are isolated, cultured in vitro to expand the cell population, and then implanted into the damaged site. However, in vitro expansion of chondrocytes on standard 2D culture surfaces leads to dedifferentiation (loss of the chondrocyte phenotype), and the delivery of detached cells has proven to be ineffective. To overcome these limitations, the matrix-assisted ACI (MACI) procedure was developed. In MACI, matrices such as hydrogels and microspheres are used as cell carriers or scaffolds to deliver expanded chondrocytes, enhancing cell viability and precision delivery. To streamline the two key steps of MACI—cell expansion and delivery—this study aims to investigate various configurations of gelatin-based hydrogels for their potential to support both cell expansion and delivery as a single step. This study evaluated gelatin microspheres (Gel MS), micronized photo-crosslinked GelMA microparticles (GelMA MP), and bulky GelMA hydrogels containing cells (GelMA HG). Cell growth, maintenance of the chondrocyte phenotype, and cartilage extracellular matrix (ECM) production were assessed in pellet cultures for cells grown on/in these carriers, compared with cells cultured on tissue culture-treated polystyrene (TCP). Our results demonstrate that normal human knee articular chondrocytes exhibit robust growth on Gel MS and form aggregates enriched with glycosaminoglycan-rich ECM. Gel MS outperformed both GelMA MP and GelMA HG as a cell carrier by both supporting long-term cell growth with reduced dedifferentiation and precision delivery.

Jiahui Li, Yang Zhang, Weidong Song et al.

The reliable integration of high-performance noble metal interfaces with flexible substrates is a key requirement for wearable electronics. However, achieving uniform, mechanically robust and functionally active coatings on fabric surfaces remains highly challenging. This study reports the atomic-layered-deposition (ALD) growth of platinum (Pt) on textile at low temperatures. Through ozone plasma-assisted activation technology, Pt nucleation can be achieved at 100 °C, forming a dense and defect-suppressed Pt layer that substantially increases the surface oxygen functional groups and enhances binding affinity. The resulting Pt layer also significantly enhances the adsorption behavior and sensing performance of Ti₃C₂T_x MXene gel inks on textile. At the atomic scale, the engineered Pt–MXene interface promotes stronger adsorption of MXene sheets and establishes efficient electron/ion transport pathways within the gel network. Ultimately, the conductive textile treated with Pt functionalized layers (MXene/Pt@textile) exhibits significantly enhanced sensing sensitivity and signal stability, enabling precise detection of human motions, pressure, and subtle physiological vibrations. The synergistic effect of ALD Pt layers and MXene gel inks creates a textile platform combining robustness, breathability, and high responsiveness.

Elisa Canazza, Miriam Grauso, Dasha Mihaylova et al.

Inulin, a type of fructan primarily extracted from chicory, Jerusalem artichoke, and dahlia, is a prebiotic dietary fiber increasingly valued for its multifunctional roles in food systems. Beyond its well-established nutritional benefits linked to gut microbiota modulation and metabolic health, inulin also provides unique techno-functional properties that make it a versatile structuring ingredient. This review emphasizes inulin’s ability to form gel-like networks and emulsion gels, examining the mechanisms of gelation and the influence of chain length, degree of polymerization, and processing conditions on gel stability and performance. Inulin-based gels act as effective fat replacers, texture modifiers, and carriers of bioactive compounds, supporting the reformulation of foods with reduced fat and sugar while maintaining desirable texture and sensory quality. Applications span a wide range of food systems, including dairy, meat, bakery, confectionery, plant-based, and gluten-free products, where inulin contributes to enhanced structure, stability, and palatability. Furthermore, the potential to obtain inulin from agro-industrial by-products strengthens its role in sustainable food design within a circular economy framework. By integrating nutritional, structural, and technological functionalities, inulin and inulin-based gels emerge as promising tools for the development of innovative and health-oriented food products.

Praveen Kumar Dhankar, Safiqul Islam, Saibal Ray et al.

In this study we explore the cosmic holographic principle, as proposed by Fischler and Susskind~\cite{Fischler}, within the framework of $(2 + 1)$-dimensional cosmological models. A generalized equation of state is employed, given by $p = (ζ- 1)(ρ+ ρ_0)$, where $ζ$ and $ρ_0$ are treated as two free parameters. The analysis confirms the validity of the holographic principle in all flat and open universes. However, for a $(2 + 1)$-dimensional closed universe, we apply the method proposed by Kaloper and Linde~\cite{Kaloper}, and observe that the holographic principle is generally not satisfied. Furthermore, we examine the stability of the proposed model using the Markov chain Monte Carlo (MCMC) method, and estimate the best-fit values for the model parameters based on observational Hubble data sets.

Michael Timothy Bennett

Artificial general intelligence (AGI) is an established field of research. Yet some have questioned if the term still has meaning. AGI has been subject to so much hype and speculation it has become something of a Rorschach test. Melanie Mitchell argues the debate will only be settled through long term, scientific investigation. To that end here is a short, accessible and provocative overview of AGI. I compare definitions of intelligence, settling on intelligence in terms of adaptation and AGI as an artificial scientist. Taking my cue from Sutton's Bitter Lesson I describe two foundational tools used to build adaptive systems: search and approximation. I compare pros, cons, hybrids and architectures like o3, AlphaGo, AERA, NARS and Hyperon. I then discuss overall meta-approaches to making systems behave more intelligently. I divide them into scale-maxing, simp-maxing, w-maxing based on the Bitter Lesson, Ockham's and Bennett's Razors. These maximise resources, simplicity of form, and the weakness of constraints on functionality. I discuss examples including AIXI, the free energy principle and The Embiggening of language models. I conclude that though scale-maxed approximation dominates, AGI will be a fusion of tools and meta-approaches. The Embiggening was enabled by improvements in hardware. Now the bottlenecks are sample and energy efficiency.

Jae-Geun Park, Sang-Jin Ye, Seon-Min Oh et al.

Short-chain glucan aggregates (SCGA), a type of resistant starch (RS) Ⅲ, is produced by debranching amylopectin with pullulanase and inducing self-assembly. Despite its low digestibility and high RS content, SCGA has not been applied to real food systems, especially noodles. The objective of this study was to determine the feasibility of low-digestible noodles using SCGA and to evaluate their quality characteristics and in vitro digestibility of starch gel. SCGA-noodles (SN) were prepared by substituting 0, 10, 20, and 25% of wheat flour with SCGA, and non-digestible maltodextrin (NMD) replaced 7% of the flour for comparison. Adding SCGA increased L- and b-values of the dough, resulting in a brighter appearance, while the NMD increased a-values. The substitution with SCGA weakened the gluten network, reducing dough and texture properties. Notably, cooked SN25 broke immediately in the tensile test, indicating substitution up to 20% is feasible in noodles. NMD7 formed sticky dough and showed extensive elongation without breaking. SN20 and SN25 significantly increased RS content and decreased the estimated glycemic index (eGI) compared to the control. However, NMD7 did not significantly reduce in vitro starch digestibility. In conclusion, this research confirmed the potential of SCGA as a low-digestible ingredient for noodles and other food applications.

Kyrylo Tsymbaliuk, Оlena Martsynko, Viktoriya Dyakonenko et al.

Synthesis methods were developed, five new coordination compounds were isolated and investigated: [M(phen)3]4[Ge6(μ-OH)4(μ-O)2(μ-hedp)6]*хСН3СООН*nH2O (M= Fe (1), x= 0, n= 20; Co (2), x= 2, n= 30; Ni (3), x= 2, n= 26), [Cu(phen)2(H2O)]2[Cu(phen)(H2O)3]2[Ge6(μ-OH)4(μ-O)2 (μ-hedp)6]*16H2O (4), [Zn(phen)2(H2O)2]2[Zn(phen)(H2O)4]2[Ge6(μ-OH)4(μ-O)2(μ-hedp)6]*18H2O (5), were Н4hedp - 1-hydroxyethane-1,1-diphosphonic acid, phen - 1,10-phenanthroline. It was found that the complexes belong to the cation-anion type, consisting of the hexanuclear complex anion, in which Ge atoms are connected by three types of bridging ligands (hydroxy-, oxo-, and 1-hydroxyethane-1,1-diphosphonate), and phenanthroline-containing cations of different compositions depending on the 3d-metal. Synthesized substances in crystals are organic-inorganic hybrid ensembles with three-dimensional networks formed by numerous intermolecular hydrogen bonds between complex cations, anions, and water of crystallization molecules.

A. Siriwardena, Vanessa Botan, N. Williams et al.

Background Differential attainment has previously been suggested as being due to subjective bias because of racial discrimination in clinical skills assessments. Aim To investigate differential attainment in all UK general practice licensing tests comparing ethnic minority with White doctors. Design and setting Observational study of doctors in GP specialty training in the UK. Method Data were analysed from doctors’ selection in 2016 to the end of GP training, linking selection, licensing, and demographic data to develop multivariable logistic regression models. Predictors of pass rates were identified for each assessment. Results A total of 3429 doctors entering GP specialty training in 2016 were included, with doctors of different sex (female 63.81% versus male 36.19%), ethnic group (White British 53.95%, minority ethnic 43.04%, and mixed 3.01%), country of primary medical qualification (UK 76.76% versus non-UK 23.24%), and declared disability (disability declared 11.98% versus not declared 88.02%). Multi-Specialty Recruitment Assessment (MSRA) scores were highly predictive for GP training end-point assessments, including the Applied Knowledge Test (AKT), Clinical Skills Assessment (CSA), Recorded Consultation Assessment (RCA), and Workplace-Based Assessment (WPBA) and Annual Review of Competency Progression (ARCP). Ethnic minority doctors did significantly better compared with White British doctors in the AKT (odds ratio [OR] 2.05, 95% confidence interval [CI] = 1.03 to 4.10, P = 0.042). There were no significant differences on other assessments: CSA (OR 0.72, 95% CI = 0.43 to 1.20, P = 0.201), RCA (OR 0.48, 95% CI = 0.18 to 1.32, P = 0.156), or WPBA—ARCP (OR 0.70, 95% CI = 0.49 to 1.01, P = 0.057). Conclusion Ethnic background did not reduce the chance of passing GP licensing tests once sex, place of primary medical qualification, declared disability, and MSRA scores were accounted for.

U-Ting Chiu, Bo-Fan Lee, Ling-Ning Ko et al.

We have previously demonstrated the potential of gelatin films as a memory device, offering a novel approach for writing, reading, and erasing through the manipulation of gelatin structure and bound water content. Here, we discovered that incorporating a bacteriorhodopsin (BR)–lipid membrane into the gelatin devices can further increase the electron conductivity of the polypeptide-bound water network and the ON/OFF ratio of the device by two folds. Our photocurrent measurements show that the BR incorporated in the membrane sandwiched in a gelatin device can generate a net proton flow from the counter side to the deposited side of the membrane. This leads to the establishment of non-electroneutrality on the gelatin films adjacent to the BR-incorporated membrane. Our Raman spectroscopy results show that BR proton pumping in the ON state gelatin device increases the bound water presence and promotes polypeptide unwinding compared to devices without BR. These findings suggest that the non-electroneutrality induced by BR proton pumping can increase the extent of polypeptide unwinding within the gelatin matrix, consequently trapping more bound water within the gelatin-bound water network. The resulting rise in hydrogen bonds could expand electron transfer routes, thereby enhancing the electron conductivity of the memory device in the ON state.

Antonio Pérez-Moreno, Manuel Piñero, Rafael Fernández-Montesinos et al.

Chitosan (CS) is a natural biopolymer that shows promise as a biomaterial for bone-tissue regeneration. However, because of their limited ability to induce cell differentiation and high degradation rate, among other drawbacks associated with its use, the creation of CS-based biomaterials remains a problem in bone tissue engineering research. Here we aimed to reduce these disadvantages while retaining the benefits of potential CS biomaterial by combining it with silica to provide sufficient additional structural support for bone regeneration. In this work, CS-silica xerogel and aerogel hybrids with 8 wt.% CS content, designated SCS8X and SCS8A, respectively, were prepared by sol-gel method, either by direct solvent evaporation at the atmospheric pressure or by supercritical drying in CO₂, respectively. As reported in previous studies, it was confirmed that both types of mesoporous materials exhibited large surface areas (821 m²g⁻¹–858 m²g⁻¹) and outstanding bioactivity, as well as osteoconductive properties. In addition to silica and chitosan, the inclusion of 10 wt.% of tricalcium phosphate (TCP), designated SCS8T10X, was also considered, which stimulates a fast bioactive response of the xerogel surface. The results here obtained also demonstrate that xerogels induced earlier cell differentiation than the aerogels with identical composition. In conclusion, our study shows that the sol-gel synthesis of CS-silica xerogels and aerogels enhances not only their bioactive response, but also osteoconduction and cell differentiation properties. Therefore, these new biomaterials should provide adequate secretion of the osteoid for a fast bone regeneration.

Muzammil Talib, Muhammad Ashir Nabeel, Shahbaz Ul Haq et al.

Postpartum infection of the uterus by pathogenic bacteria is exacerbated due to a lack of sufficient epidemiological studies and evidence-based therapeutics. Therefore, this study was planned to find the prevalence, risk factors, and drug-resistance profile of <i>S. aureus</i> and <i>E. coli</i> isolated from bovine endometritis and to evaluate the antibacterial potential of sodium alginate-based antibiotics and nanoparticles. The study revealed 34.21% <i>S. aureus</i> and 31.57% <i>E. coli,</i> whereas most of the assumed risk factors presented significant association in this study. <i>S. aureus</i> showed the highest resistance against fusidic acid (60%) and cefoxitin (50%), while the highest resistance in <i>E. coli</i> was found against fusidic acid (60%), gentamicin (60%), chloramphenicol (50%), and cefoxitin (50%). Tylosin coupled with MgO nanoparticles stabilized in sodium alginate gel (Tylo + MgO + gel) presented significantly lower minimum inhibitory concentration (MIC) against <i>E. coli</i>, showing 13.88 ± 4.51 µg/mL after 24 h incubation. On the other hand, gel-based preparations showed MIC as 31.25 ± 0 µg/mL (Tylo + gel + MgO) and 26.04 ± 9.02 µg/mL (Tylo + Gel) against <i>S. aureus</i>. Generally, the MICs of non-gel-based preparations were significantly higher against bacteria except ampicillin against <i>S. aureus</i> in this study. The toxicity analysis of MgO nanoparticles presented 20–80% mortality of snails against a wider range of 0.01 mg/mL–10 mg/mL. The histopathological parameters concluded MgO nanoparticles safe to use on off targets. The current study thus concludes the rise in antimicrobial resistance while the gel-based products appearing as effective antimicrobials with sufficient safety margins for off-targets. The study thus invites further investigation for the development of suitable and affordable modified therapeutics for better health and production of animals.

Melinda Harman, Kevin Champaigne, William Cobb et al.

Injectable surgical sealants and adhesives, such as biologically derived fibrin gels and synthetic hydrogels, are widely used in medical products. While such products adequately adhere to blood proteins and tissue amines, they have poor adhesion with polymer biomaterials used in medical implants. To address these shortcomings, we developed a novel bio-adhesive mesh system utilizing the combined application of two patented technologies: a bifunctional poloxamine hydrogel adhesive and a surface modification technique that provides a poly-glycidyl methacrylate (PGMA) layer grafted with human serum albumin (HSA) to form a highly adhesive protein surface on polymer biomaterials. Our initial in vitro tests confirmed significantly improved adhesive strength for PGMA/HSA grafted polypropylene mesh fixed with the hydrogel adhesive compared to unmodified mesh. Toward the development of our bio-adhesive mesh system for abdominal hernia repair, we evaluated its surgical utility and in vivo performance in a rabbit model with retromuscular repair mimicking the totally extra-peritoneal surgical technique used in humans. We assessed mesh slippage/contraction using gross assessment and imaging, mesh fixation using tensile mechanical testing, and biocompatibility using histology. Compared to polypropylene mesh fixed with fibrin sealant, our bio-adhesive mesh system exhibited superior fixation without the gross bunching or distortion that was observed in the majority (80%) of the fibrin-fixed polypropylene mesh. This was evidenced by tissue integration within the bio-adhesive mesh pores after 42 days of implantation and adhesive strength sufficient to withstand the physiological forces expected in hernia repair applications. These results support the combined use of PGMA/HSA grafted polypropylene and bifunctional poloxamine hydrogel adhesive for medical implant applications.

Hadjira Naoui, Mohamed Benalia, Soumaya Hachani et al.

Samples of oils from seven types of Ficus carica L. fruits from Algeria were investigated through determinations of their chemical characteristics, quantifying sterols and tocopherols, and analysis of the fatty acids profiles using gas chromatography, and evaluation of antioxidant activity by 1,1-diphenyl-2-picrylhydrazyl (DPPH) method and total antioxidant activity (TAA) using phosphomolybdenum methods. The results show that acid values ranged from 3.14 to 6.95 mg KOH/g indicating on the high amount of free fatty acids in the figs oils. Neutral lipids occupy a very important proportion of the crude figs oils (NL: 60.30–98.40%) compared to glycolipids (GL: 0.58–28.00%) and phospholipids (PL: 0.40-11.70%). Linoleic (11.70–34.74%) and linolenic (1.15–35.27%) were the major unsaturated fatty acids found in lipid fractions, while the main fraction of saturated fatty acid was palmitic. The tocopherols and sterols contents in fig oils ranged from 14.27 to 108.55 mg α-TE/g lipids and from 0.36 to 2.80 mg CE/g lipids respectively. The best inhibition concentration (IC50) of DPPH antioxidant activity was marked by GL (0.23–1.06 g/L) and PL (0.67–1.23 g/L). The strongest TAA was also marked by GL (IC50: 2.84 to 10.08 g/L) and PL (IC50: 3.73–11.30 g/L). This finding demonstrated for the first time that the studied figs oils possessed good antioxidant activity which may be associated with their alleged health benefits.

Alvaro Mozota Frauca

In this paper I raise a worry about the most extended resolutions of the problem of time of canonical quantizations of general relativity. The reason for this is that these resolutions are based on analogies with deparametrizable models for which the problem can be solved, while I argue in this paper that there are good reasons for doubting about these resolutions when the theory is not deparametrizable, which is the case of general relativity. I introduce an example of a non-deparametrizable model, a double harmonic oscillator system expressed by its Jacobi action, and argue that the problem of time for this model is not solvable, in the sense that its canonical quantization doesn't lead to the quantum theory of two harmonic oscillators and the standard resolutions of the problem of time don't work for this case. I argue that as general relativity is strongly analogous to this model, one should take seriously the view that the canonical quantization of general relativity doesn't lead to a meaningful quantum theory. Finally, I comment that this has an impact on the foundations of different approaches to quantum gravity.

P. Santoso, Martina Sung, Yovita Hartantri et al.

Purpose The coronavirus disease (COVID-19) outbreak has created a global health crisis. Secondary pulmonary bacterial infection is a COVID-19 complication, increasing morbidity and mortality. This study aimed to determine the pathogens, antibiotic susceptibility patterns, and risk factors for mortality in hospitalized COVID-19 patients. Patients and Methods This retrospective study used secondary data from patients’ electronic medical records at Hasan Sadikin General Hospital and Santo Borromeus Hospital between March 2020 and March 2021. Overall, 2230 hospitalized COVID-19 patients were screened, and 182 of them who were hospitalized ≥48 hours with a procalcitonin level of ≥0.25 ng/mL were enrolled. Culture examination was performed on sputum samples to determine pathogen and antibiotic susceptibilities. Univariate and multivariate analyses were used to determine mortality-related risk factors in hospitalized COVID-19 patients. Results The prevalence of secondary pulmonary bacterial infections in COVID-19 patients was 8.2%, with 161/182 pathogen growth from sputum samples. Mainly gram-negative bacteria (64.8%) were present, including Acinetobacter baumannii (31.9%), Klebsiella pneumoniae (19.8%), and Pseudomonas aeruginosa (8.8%). High rate of multidrug-resistant (MDR) pathogens was found among isolate (45.9%), ie carbapenem-resistance A.baumannii (CR-Ab) was 84.2%, extended-spectrum β-lactamase (ESBL) among K. pneumoniae was 61.1%. Secondary infection of MDR pathogens was associated with a higher risk of mortality (AOR 5.63, p = 0.001). Other associated factors were age ≥60 years, ventilator use, and female gender. Conclusion Gram-negative bacteria are the predominant pathogens causing secondary pulmonary bacterial infection in COVID-19 patients, implying nosocomial infection. High resistance to first-line antimicrobial drugs was observed in Gram-negative bacteria and Gram-positive bacteria. High rate of MDR pathogens was found among isolate and was associated with a significant risk of mortality.

Chris Maslen, Rebecca Hodge, Kim Tie et al.

This article gives an overview of constipation and related concerns in people with learning disabilities (LDs) and/or autistic people. It provides recommendations to primary care to help address this issue. It furthers the evidence and importance of recognising and managing constipation as outlined in national guidance.1 Public Health England and the Office for National Statistics estimate that approximately 2.16% of adults and 2.50% of children in the UK have an LD. Autistic spectrum condition (ASC) is reported in approximately 2% of adults and children. It is considered that 30%–70% of people who have an ASC will also have an LD.2 People with LDs die on average 20 years earlier than the general population and suffer much higher rates of physical morbidities.3 The Learning Disabilities Mortality Review (LeDeR) found that 23% of deaths identified constipation as a long-term health problem and 33% were on prescribed laxatives.1 Another study highlighted that, while only 0.5% of the general population are on regular laxatives, this figure is 25.0% of the LD population.4 There are numerous causes for this tendency to constipation. There may be neurological and genetic causes of disordered bowel function. People with LDs may struggle to communicate symptoms and discomfort. Reduced mobility can be a problem especially if the LD is severe. Fluid and diet intake may be not optimum, especially for those with dysphagia. Medication side effects can include constipation, particularly medication with anticholinergic side effects, including opioids and psychotropic and anti-seizure medication. Autistic people (like people with LDs) experience more health inequalities compared with the general population, including higher rates of sleep problems, epilepsy, sensory impairments, allergies, autoimmune disorders, and obesity.5 Autistic people have a two to three decades’ decreased life expectancy and heightened all-cause and injury mortality.6 Atypical eating behaviours are common in those with ASC, with the most frequent being limited food preferences, food texture hypersensitivity, pica, and other unusual patterns, such as eating only one brand of food. Atypical eating behaviours are more common in ASC than in other developmental disabilities and occurrence may be as high as 70.5%.7

S. Dixon, L. Frost, G. Feder et al.

Background The COVID-19 pandemic required general practice to rapidly adapt to remote consultations and assessment of patients, creating new, and exacerbating existing, vulnerabilities for many patients. Aim To explore GP perspectives and concerns about safeguarding practice during the pandemic, focusing on challenges and opportunities created by remote consultation. Design and setting Qualitative interview study. Method Eighteen GPs from Oxford, London, Southampton, Liverpool, Manchester, and Reading were interviewed between June and November 2020, using a flexible topic guide and fictional vignettes to explore child and adult safeguarding scenarios. Interviews were audio-recorded, thematically coded, and analysed. Results GPs worried about missing observational information during remote consultations and that conversations might not be private or safe. Loss of continuity and pooled triage lists were seen as further weakening safeguarding opportunities. GPs experienced remote consulting as more ‘transactional’, with reduced opportunities to explore ‘other reasons’ including new safeguarding needs. However, they also recognised that remote consulting created opportunities for some vulnerable patients. While supporting known vulnerable patients was difficult, identifying new or unknown vulnerabilities was harder still. Most reported that remote consulting during COVID-19 was harder, riskier, and emotionally draining, contributing to increased GP anxiety and reduced job satisfaction. Conclusion The GPs interviewed raised important concerns about how to identify and manage safeguarding in the context of remote consultations. Current guidance recommends face-to-face consultation for safeguarding concerns, but pressure to use remote forms of access (within or beyond the pandemic) and the fact that safeguarding needs may be unknown makes this an issue that warrants urgent attention.