Provision of E-Cigarettes for Smoking Cessation in Pregnancy: Perceptions and Experiences of Pregnant Women from Two UK Sites.

INTRODUCTION: Smoking in pregnancy is associated with negative health outcomes for both mothers and babies; e-cigarettes, which contain nicotine without hazardous tobacco, may offer an additional smoking cessation strategy for pregnant women. Although e-cigarettes are being increasingly offered within services, there is limited understanding about whether e-cigarettes can improve smoking cessation support for pregnant individuals. This study aimed to explore service users' experiences of using e-cigarettes as a tool for smoking cessation during pregnancy. METHODS: Semi-structured interviews were conducted with 14 women who had accepted one of two pilots and were analysed using inductive reflexive thematic analysis. The findings from each site were integrated to develop qualitative insight. RESULTS: Participants largely had positive perceptions of the free and easy-to-use e-cigarette, preferring it to nicotine replacement therapies. The desire to have a healthy pregnancy and baby and the inclusion of non-judgemental behavioural support facilitated motivation to quit. Many participants reduced or quit tobacco use, with positive social and health implications reported. However, numerous barriers to quitting were present and intentions about long-term quitting of combustible cigarettes and e-cigarettes were mixed and uncertain. CONCLUSIONS: Providing e-cigarettes within smoking cessation services was indicated to be a positive and effective strategy for pregnant women trying to quit tobacco. However, numerous barriers to quitting and staying quit remained, suggesting scope for further improvements to smoking cessation support for pregnant women.

Implementing E-Cigarettes as an Alternate Smoking Cessation Tool during Pregnancy: A Process Evaluation at Two UK Sites.

Smoking during pregnancy increases the risk of adverse maternal and foetal health outcomes, with effective smoking cessation support important. E-cigarette use in the general population has increased rapidly in recent years, with their use viewed as an alternate, additional offer to nicotine-replacement therapy and behavioural support. However, their use in pregnancy has limited investigation. This study aimed to understand how two e-cigarette pilots for pregnant women were delivered and implemented. Referrals to the general stop smoking in pregnancy service, as well as pilot enrolment, engagement and outcomes were recorded. Seven professionals involved in pilot 2 design, setup and/or delivery took part in semi-structured interviews informed by the Consolidated Framework for Implementation Research (CFIR). Transcripts were deductively coded into CFIR. In total, 124 of 296 women accessed at least one visit after being contacted and offered the e-cigarette pilot (Pilot 1: N = 99, Pilot 2: N = 25). In Pilot 2, 13 (of 25) reached 4 weeks, and common reasons for withdrawal by 12 weeks included relapse, loss of contact and no further support wanted. Forty-five (36.3%) validated quits were reported (Pilot 1: 32 of 99 (32.3%); Pilot 2: 13 of 25 (52%)). Facilitators included regular communication and the advisors physically taking e-cigarettes to home visits. Barriers included misalignment between the pilot and the standard treatment offer and availability of the staff resource. Enrolment to both pilots was demonstrated, with greater enrolment in one pilot and notable quit rates among women across both pilots. The perceived role of e-cigarettes for pregnant women varied, and a lack of staff resources explained some challenges. Adaptations may be needed during scale-up, including additional resources and the alignment of the e-cigarette provision to standard treatment.

Ayahuasca and Dimethyltryptamine Adverse Events and Toxicity Analysis: A Systematic Thematic Review.

The objective of this paper is to conduct a systematic thematic review of adverse events, safety, and toxicity of traditional ayahuasca plant preparations and its main psychoactive alkaloids (dimethyltryptamine [DMT], harmine, harmaline, and tetrahydroharmine), including discussing clinical considerations (within clinical trials or approved settings). A systematic literature search of preclinical, clinical, epidemiological, and pharmacovigilance data (as well as pertinent reviews and case studies) was conducted for articles using the electronic databases of PubMed and Web of Science (to 6 July 2023) and PsycINFO, ClinicalTrials.gov, and Embase (to 21 September 2022) and included articles in English in peer-reviewed journals. Additionally, reference lists were searched. Due to the breadth of the area covered, we presented the relevant data in a thematic format. Our searches revealed 78 relevant articles. Data showed that ayahuasca or DMT is generally safe; however, some adverse human events have been reported. Animal models using higher doses of ayahuasca have shown abortifacient and teratogenic effects. Isolated harmala alkaloid studies have also revealed evidence of potential toxicity at higher doses, which may increase with co-administration with certain medications. Harmaline revealed the most issues in preclinical models. Nevertheless, animal models involving higher-dose synthetic isolates may not necessarily be able to be extrapolated to human use of therapeutic doses of plant-based extracts. Serious adverse effects are rarely reported within healthy populations, indicating an acceptable safety profile for the traditional use of ayahuasca and DMT in controlled settings. Further randomized, controlled trials with judicious blinding, larger samples, and longer duration are needed.

The relationship between loneliness and depression among college students: Mining data derived from passive sensing.

Background: While there is recognition of the relationship between loneliness and depression, specific behavioural patterns distinguishing both are still not well understood. Objectives: Our objective is to identify distinct behavioural patterns of loneliness and depression from a passively collected dataset of college students, understand their similarities and interrelationships and assess their effectiveness in identifying loneliness and depression. Methods: Utilizing the StudentLife dataset, we applied regression analysis to determine associations with self-reported loneliness and depression. Mediation analysis interprets the relationship between the two conditions, and machine learning models predict loneliness and depression based on behavioural indicators. Results: Distinct behavioural patterns emerged: high evening screen time (OR = 1.45, p = 0.002) and high overall phone usage (OR = 1.50, p = 0.003) were associated with more loneliness, whereas depression was significantly associated with fewer screen unlocks (OR = 0.75, p = 0.044) and visits to fewer unique places (OR = 0.85, p = 0.023). Longer durations of physical activity (OR = 0.72, p = 0.014) and sleep (OR = 0.46, p = 0.002) are linked to a lower risk of both loneliness and depression. Mediation analysis revealed that loneliness significantly increases the likelihood of depression by 48%. The prediction accuracy of our XGBoost-based machine learning approach was 82.43% for loneliness and 79.43% for depression. Conclusion: Our findings show that high evening screen time and overall phone usage are significantly associated with increased loneliness, while fewer screen unlocks and visits to fewer unique places are significantly related to depression. The findings can help in developing targeted interventions to promote well-being and mental health in students.

Development of a novel clinical support tool for active surveillance of low risk papillary thyroid cancer.

Background: Active surveillance (AS) is an alternative to surgery in select patients with very low risk papillary thyroid cancer (PTC). Many clinicians feel ill-equipped in selecting appropriate patients. We aimed to 1) Develop an evidence-based web delivered decision support tool to assist clinicians in identifying patients appropriate for AS; and 2) Evaluate the prevalence of patients suitable for AS in a tertiary high volume thyroid cancer centre. Method: A REDCap web based clinical support tool was developed utilising evidence-based characteristics for AS suitability available to clinicals during initial assessment. A retrospective database was interrogated for patients who underwent hemithyroidectomy between 2012 - 2021 with final histopathology demonstrating PTC. Patients with PTCs>2cm, missing data, benign disease on surgical histopathology or incidental PTC were excluded. Results: Between 2012 - 2021, 763 patients underwent hemithyroidectomy with final histopathology confirming PTC. Of these, 316 patients were excluded (missing data, incidental PTC, concomitant hyperparathyroidism were most common reasons for exclusion) and 114/447 remaining patients had a pre-operative fine needle aspirate (FNA) of Bethesda V or VI (high likelihood of malignancy). Using the tool, 59/114 (52%) met criteria for AS. The majority of patients were female (85% vs 15% male); median age 36 years (range 19 - 78). Following initial surgery, 10/59 patients had a completion thyroidectomy, with 4/10 demonstrating malignancy in contralateral lobe and eight of those patients undergoing I131 ablation. During a median follow up of over 3 years, 49/59 (83%) did not require further surgery or intervention with no patients developing recurrence. A subgroup analysis with second radiology assessment excluded 4/59 patients as meeting criteria for AS based on presence of ETE on preoperative ultrasound. None of these 4 patients had completion thyroidectomy. Conclusion: Our clinical support tool identifies patients with PTC potentially suitable for AS which could be utilised during initial patient assessment. In a retrospective cohort of patients who had hemithyroidectomy for PTC with a pre-operative FNA diagnosis of Bethesda V or VI, 55/114 (48%) patients may have been suitable for AS. Prospective validation studies are required for implementation of the tool in clinical practice.

Ayahuasca: A review of historical, pharmacological, and therapeutic aspects.

Ayahuasca is a psychedelic plant brew originating from the Amazon rainforest. It is formed from two basic components, the Banisteriopsis caapi vine and a plant containing the potent psychedelic dimethyltryptamine (DMT), usually Psychotria viridis. Here we review the history of ayahuasca and describe recent work on its pharmacology, phenomenological responses, and clinical applications. There has been a significant increase in interest in ayahuasca since the turn of the millennium. Anecdotal evidence varies significantly, ranging from evangelical accounts to horror stories involving physical and psychological harm. The effects of the brew on personality and mental health outcomes are discussed in this review. Furthermore, phenomenological analyses of the ayahuasca experience are explored. Ayahuasca is a promising psychedelic agent that warrants greater empirical attention regarding its basic neurochemical mechanisms of action and potential therapeutic application.

GPC3-Unc5 receptor complex structure and role in cell migration.

Neural migration is a critical step during brain development that requires the interactions of cell-surface guidance receptors. Cancer cells often hijack these mechanisms to disseminate. Here, we reveal crystal structures of Uncoordinated-5 receptor D (Unc5D) in complex with morphogen receptor glypican-3 (GPC3), forming an octameric glycoprotein complex. In the complex, four Unc5D molecules pack into an antiparallel bundle, flanked by four GPC3 molecules. Central glycan-glycan interactions are formed by N-linked glycans emanating from GPC3 (N241 in human) and C-mannosylated tryptophans of the Unc5D thrombospondin-like domains. MD simulations, mass spectrometry and structure-based mutants validate the crystallographic data. Anti-GPC3 nanobodies enhance or weaken Unc5-GPC3 binding and, together with mutant proteins, show that Unc5/GPC3 guide migrating pyramidal neurons in the mouse cortex, and cancer cells in an embryonic xenograft neuroblastoma model. The results demonstrate a conserved structural mechanism of cell guidance, where finely balanced Unc5-GPC3 interactions regulate cell migration.

Characterization of optically thin cells and experimental liquid crystals.

The current development of new liquid crystal devices often requires the use of thin cells and new experimental materials. Characterizing these devices and materials with optical methods can be challenging if (1) the total phase lag is small ("thin cells") or (2) the liquid crystal optical and dielectric properties are only partially known. We explore the limitations of these two challenges for efficient characterization and assessment of new, to the best of our knowledge, liquid crystal devices. We show that it is possible to extract a wealth of liquid crystal parameters even for cells with a phase lag of ΔΦ≈π, such as E7 liquid crystal in a 1.5 µm cell, using cross-polarized intensity measurements. The reliability of the optical method is also demonstrated for liquid crystals without precise values of dielectric or refractive index coefficients.

COVID-19 vaccination uptake in 441 socially and ethnically diverse pregnant women.

OBJECTIVE: To explore COVID-19 vaccination uptake, facilitators and barriers in ethnically-diverse pregnant women. DESIGN AND SETTING: An anonymous quality improvement questionnaire survey exploring COVID-19 vaccination uptake, causes of vaccine hesitancy and trusted sources of information among pregnant women in two acute district general hospitals in England (Berkshire and Surrey) between 1.9.21 and 28.2.22. POPULATION: 441 pregnant women attending routine antenatal clinic appointments. METHODS: Consented pregnant women completed the survey either electronically using a QR code or on paper. Descriptive data were summarised and free text responses were thematically analysed. RESULTS: 441 pregnant women, mean age 32 years (range 17-44), completed the survey. Twenty-six percent were from ethnic minority groups, and 31% had a co-morbid health condition. Most respondents (66.2%) had been vaccinated against COVID-19 with at least one dose (White British 71.9%, Asian 67.9%, White-other 63.6%, Black 33%). The most common reasons for not being vaccinated were concerns about effects on the unborn baby and future pregnancies, anxiety about possible adverse impact on the mother, not enough known about the vaccine, and lack of trust in vaccines. Comments included: "I'd rather not risk injecting the unknown into my body", and "I don't trust it." Although 23% used social media for information on COVID-19 vaccination, the most trusted sources were the patient's GP and midwife (43%) and official health-related websites such as NHS (39%). CONCLUSIONS: A third of these pregnant women had not been vaccinated against COVID-19. Trusted health professionals like midwives and GPs could have a crucial role in increasing vaccination uptake.

Multi-disciplinary Evaluation of Sexual Assault Referral Centres (SARCs) for better Health (MESARCH): protocol for a 1-year cohort study examining health, well-being and cost outcomes in adult survivors of sexual assault attending SARCs in England.

INTRODUCTION: Sexual violence is commonplace and has serious adverse consequences for physical and mental health. Sexual Assault Referral Centres (SARCs) are viewed as a best practice response. Little is known about their effectiveness and cost-effectiveness. Long-term data on the health and well-being of those who have experienced rape and sexual assault are also lacking. METHODS AND ANALYSIS: This is a mixed-methods protocol for a 1-year cohort study aiming to examine the health and well-being in survivors of sexual violence after attending a SARC in England. Quantitative measures are being taken at baseline, 6 and 12 months. Post-traumatic stress (PTS) is the primary outcome (target N=270 at 12-month follow-up). Secondary measures include anxiety, depression, substance use and sexual health and well-being. Using mixed-effects regression, our main analysis will examine whether variation in SARC service delivery and subsequent mental healthcare is associated with improvement in trauma symptoms after 12 months. An economic analysis will compare costs and outcomes associated with different organisational aspects of SARC service delivery and levels of satisfaction with care. A nested qualitative study will employ narrative analysis of transcribed interviews with 30 cohort participants and 20 survivors who have not experienced SARC services. ETHICS AND DISSEMINATION: The research is supported by an independent study steering committee, data monitoring and ethics committee and patient and public involvement (PPI) group. A central guiding principle of the research is that being involved should feel diametrically opposed to being a victim of sexual violence, and be experienced as empowering and supportive. Our PPI representatives are instrumental in this, and our wider stakeholders encourage us to consider the health and well-being of all involved. We will disseminate widely through peer-reviewed articles and non-academic channels to maximise the impact of findings on commissioning of services and support for survivors. TRIAL REGISTRATION NUMBER: ISRCTN30846825.

Loneliness and Social Isolation Detection Using Passive Sensing Techniques: Scoping Review.

BACKGROUND: Loneliness and social isolation are associated with multiple health problems, including depression, functional impairment, and death. Mobile sensing using smartphones and wearable devices, such as fitness trackers or smartwatches, as well as ambient sensors, can be used to acquire data remotely on individuals and their daily routines and behaviors in real time. This has opened new possibilities for the early detection of health and social problems, including loneliness and social isolation. OBJECTIVE: This scoping review aimed to identify and synthesize recent scientific studies that used passive sensing techniques, such as the use of in-home ambient sensors, smartphones, and wearable device sensors, to collect data on device users' daily routines and behaviors to detect loneliness or social isolation. This review also aimed to examine various aspects of these studies, especially target populations, privacy, and validation issues. METHODS: A scoping review was undertaken, following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Studies on the topic under investigation were identified through 6 databases (IEEE Xplore, Scopus, ACM, PubMed, Web of Science, and Embase). The identified studies were screened for the type of passive sensing detection methods for loneliness and social isolation, targeted population, reliability of the detection systems, challenges, and limitations of these detection systems. RESULTS: After conducting the initial search, a total of 40,071 papers were identified. After screening for inclusion and exclusion criteria, 29 (0.07%) studies were included in this scoping review. Most studies (20/29, 69%) used smartphone and wearable technology to detect loneliness or social isolation, and 72% (21/29) of the studies used a validated reference standard to assess the accuracy of passively collected data for detecting loneliness or social isolation. CONCLUSIONS: Despite the growing use of passive sensing technologies for detecting loneliness and social isolation, some substantial gaps still remain in this domain. A population heterogeneity issue exists among several studies, indicating that different demographic characteristics, such as age and differences in participants' behaviors, can affect loneliness and social isolation. In addition, despite extensive personal data collection, relatively few studies have addressed privacy and ethical issues. This review provides uncertain evidence regarding the use of passive sensing to detect loneliness and social isolation. Future research is needed using robust study designs, measures, and examinations of privacy and ethical concerns.

Stalking Behaviors Presented by Ex-Intimate Stalkers: A Victim's Perspective.

Stalking can be defined as a pattern of repeated, unwanted behaviors by one person to another. These behaviors may take the form of communicative intrusion, third-party contact, and physical or sexual assault. The individual stalking behaviors experienced by victims have been found to differ in every case, specifically dependent on their stalker-victim relationship. Recent tragedies have shown that the police force generally underestimates the risk of ex-intimate stalking and harassment behaviors. This study aims to identify patterns of stalking behaviors from a victim's perspective, specifically, whether there are any patterns of behavior among the ex-intimate stalkers, in comparison with acquaintance or stranger stalkers. Information from the accounts of individuals who had reported unwanted experiences as a result of one of three stalker-victim relationships (ex-intimate, acquaintance, or stranger) was extracted from the National Stalking Helpline database. Analyses were conducted on a sample of 1,626 victims' reports. One-way analysis of variance (ANOVA) and multiple logistic regressions were conducted to establish any common patterns of behavior among the subgroups of stalkers and to ascertain which behaviors increased the odds of being categorized as an ex-intimate stalker. Results indicated that ex-intimate stalkers presented considerably more behaviors than acquaintance or stranger stalkers; some of which included third-party contact, criminal damage, physical assault, and sexual assault. Results also indicated that ex-intimate stalkers presented more severe behaviors than the other subgroups. The majority of stalking behaviors were found to produce a statistically significant predictive contribution to being classed as an ex-intimate stalker. The findings in this study highlight that common misconception surrounding ex-intimate stalking still exists at every level of the Criminal Justice System. Results and implications for future research are discussed.

The effect of equine-assisted therapies on behavioural, psychological and physical symptoms for children with attention deficit/hyperactivity disorder: A systematic review.

BACKGROUND AND PURPOSE: Individuals with attention deficit/hyperactivity disorder (ADHD) experience a variety of challenges in daily life and equine-assisted therapies (EATs) have grown in popularity for children with ADHD. This review aims to examine the effectiveness of EATs on behavioural, psychological and physical symptoms in the treatment of children with ADHD. MATERIALS AND METHODS: A systematic search of databases (Cochrane Library, Embase, Emcare, ERIC, MEDLINE, OTseeker, ProQuest, PsycINFO and Scopus) was conducted in February 2019. Methodological quality of the studies was assessed using a modified McMaster critical appraisal tool. RESULTS: Ten studies met the inclusion criteria and overall, positive trends were identified in behavioural, psychological and physical outcome measures following the participation in an EAT. However, due to methodological constraints, caution is required when interpreting these findings. CONCLUSION: While EAT may offer some positive benefits for children with ADHD, further methodologically robust research is required before definitive recommendations can be made.

Effectiveness of a trauma-informed care psychoeducational program for foster carers - Evaluation of the Fostering Connections Program.

BACKGROUND: The need to improve the quality of foster care training has been highlighted and evidenced-based programs that aim to support foster carers in the care of children who have experienced trauma are warranted. OBJECTIVE: This study aimed to evaluate the effectiveness of the Fostering Connections program, a newly developed trauma-informed care program within the national child welfare agency in Ireland. PARTICIPANTS AND SETTING: The study included 79 foster carers. The Fostering Connections group-based experiential intervention was delivered over a period of 6-weeks in a community-based setting to intervention group participants. METHODS: A quasi-experimental design was used to compare the results of the intervention group (n = 49), to a control group (n = 30,) who received usual care. Standardized assessment measures were used at baseline, 6-weeks on completion, 16 weeks and 15 months post-intervention. Foster carers' knowledge of trauma-informed fostering, tolerance of misbehavior and fostering efficacy, and children's emotional and behavioral difficulties were assessed. RESULTS: Significant improvements were found in foster carers' knowledge of trauma-informed fostering (p < 0.001), tolerance of child misbehavior (p = 0.007) and fostering efficacy (p < 0.001), with effect sizes ranging from medium to large and sustained over fifteen months (ES = 0.07-0.14). Significant improvement was also found in children's emotional and behavioral difficulties at fifteen months (p = 0.019), with a small effect size (ES = 0.05). CONCLUSION: Preliminary evidence suggests that Fostering Connections is potentially an effective intervention in increasing foster carer's capacity to provide children with trauma-informed care.

Cognitive and Sensory Dimensions of Older People's Preferences of Outdoor Spaces for Walking: A Survey Study in Ireland.

BACKGROUND: Physical exercise, particularly walking, benefits healthy ageing. Understanding the environmental circumstances in which exercise occurs is crucial to the promotion of physical activity in older age. Most studies have focused on the structural dimensions of environments that may foster walking; however, individual differences in how older people perceive and interact with outdoor spaces need further attention. This study explored the cognitive and sensory dimensions of preferences of outdoor spaces for walking. METHODS: We invited 112 healthy community-dwelling people aged ≥60 years to complete a survey to test associations between walking preferences and cognitive/sensory vulnerability. A subsample also completed focus groups/walk along interviews to explore qualitatively the cognitive/sensory reasons for outdoor walking preferences. RESULTS: While most participants indicated a preference for outdoor spaces that offer variety and greenery, we observed a complex association between individual cognitive/sensory needs (stimulation seeking vs. avoidance), preferences for social interactions, and the place of residence urbanity level. Furthermore, walking preferences varied based on the purpose of the walk (recreation vs. transportation). CONCLUSIONS: Our findings support an ecological approach to understanding determinants of physical activity in older age, which consider the interaction between individual cognitive processing and the environment.

Continuity of care with doctors-a matter of life and death? A systematic review of continuity of care and mortality.

OBJECTIVE: Continuity of care is a long-standing feature of healthcare, especially of general practice. It is associated with increased patient satisfaction, increased take-up of health promotion, greater adherence to medical advice and decreased use of hospital services. This review aims to examine whether there is a relationship between the receipt of continuity of doctor care and mortality. DESIGN: Systematic review without meta-analysis. DATA SOURCES: MEDLINE, Embase and the Web of Science, from 1996 to 2017. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Peer-reviewed primary research articles, published in English which reported measured continuity of care received by patients from any kind of doctor, in any setting, in any country, related to measured mortality of those patients. RESULTS: Of the 726 articles identified in searches, 22 fulfilled the eligibility criteria. The studies were all cohort or cross-sectional and most adjusted for multiple potential confounding factors. These studies came from nine countries with very different cultures and health systems. We found such heterogeneity of continuity and mortality measurement methods and time frames that it was not possible to combine the results of studies. However, 18 (81.8%) high-quality studies reported statistically significant reductions in mortality, with increased continuity of care. 16 of these were with all-cause mortality. Three others showed no association and one demonstrated mixed results. These significant protective effects occurred with both generalist and specialist doctors. CONCLUSIONS: This first systematic review reveals that increased continuity of care by doctors is associated with lower mortality rates. Although all the evidence is observational, patients across cultural boundaries appear to benefit from continuity of care with both generalist and specialist doctors. Many of these articles called for continuity to be given a higher priority in healthcare planning. Despite substantial, successive, technical advances in medicine, interpersonal factors remain important. PROSPERO REGISTRATION NUMBER: CRD42016042091.

The symbolic representation of community in social isolation and loneliness among older people: Insights for intervention from a rural Irish case study.

Social isolation and loneliness are common experiences of ageing in rural communities. Policy responses and interventions for social isolation and loneliness in later life are shaped by sociocultural understandings of place, relationships and social interaction. This study examined how representations of rural community in Ireland influenced the focus, relationships and activities within a befriending intervention designed to tackle social isolation and loneliness. Through a qualitative case study conducted in 2014, the symbolic meaning of the intervention was explored using interviews and focus groups with participants (8 befriended, 11 befrienders and 3 community workers) from one befriending programme in rural Ireland. Reflected in the programme was a representation of a rural community in decline with concern for the impact on older people. There was a valuing of the traditional community defined by geographical place, perceptions of similarity among its members, and values of solidarity and mutual support. The befriending intervention represented a commitment to intra-community solidarity and a desire by many for authentic befriending relationships that mirrored understandings of relationships within the traditional community. Identifying and alleviating social isolation and loneliness imply a set of normative values about community and the optimal social relationships within community. This paper proposes that there is a need to consider the role played by understandings of community in shaping context-sensitive interventions to counter social isolation and loneliness in later life.

Supporting ethical use of electronic monitoring for people living with dementia: Social work's role in assessment, decision-making, and review.

Walking outdoors supports health and well-being, but some people living with dementia are at increased risk of getting lost and of harm while missing. Electronic monitoring can potentially play an important preventative role by enabling the person's location to be continuously monitored by caregivers. However, there are considerable ethical concerns arising from electronic monitoring. This paper explores these thematically, drawing attention to its implications for autonomy and liberty; privacy; dignity; the rights and needs of caregivers and families; beneficence and nonmaleficence. Following from this, key questions for consideration in social work assessment are identified. The ethical issues necessitate assessment of the person's unique circumstances and preferences and that of their caregivers, and careful ethical deliberation in decision-making. Social work can play an important role in facilitating inclusive assessment and decision-making, leading to consensus on intervening with electronic monitoring. The need for the ongoing review following implementation is discussed to track whether decisions need modification in light of the experience of usage. In conclusion, while legislative instruments and professional codes of ethics frame social work practice responses, there is need for a nuanced debate about ethical use of electronic monitoring and specific guidance to inform assessment, decision-making, and review.