An 8-week Forced-rate Aerobic Cycling Program Improves Cardiorespiratory Fitness in Persons With Chronic Stroke: A Randomized Controlled Trial.

OBJECTIVE: To examine the cardiorespiratory effects of a forced-rate aerobic exercise (FE) intervention among individuals with chronic stroke compared with an upper extremity repetitive task practice (UE RTP) control group. DESIGN: Secondary analysis of data from a randomized controlled trial. SETTING: Research laboratory. PARTICIPANTS: Individuals with chronic stroke (N=60). INTERVENTIONS: Participants completed 24 sessions of FE followed by RTP (FE+RTP, N=30) or time matched RTP alone (N=30). The FE+RTP group was prescribed exercise at 60%-80% of heart rate reserve on a motorized stationary cycle ergometer for 45 minutes followed by 45 minutes of RTP. The control group completed 90 minutes of RTP. MAIN OUTCOME MEASURES: Metabolic exercise stress tests on a cycle ergometer were conducted at baseline and post-intervention. Outcomes included peak oxygen consumption (peak V̇o2) and anaerobic threshold (AT). RESULTS: Fifty participants completed the study intervention and pre/post stress tests. The FE+RTP group demonstrated significantly greater improvements in peak V̇o2 from 16.4±5.7 to 18.3±6.4 mL/min/kg compared with the RTP group (17.0±5.6 to 17.2±5.6 mL/min/kg, P=.020) and significantly greater improvements in AT from 10.3±2.8 to 11.5±3.6 mL/min/kg compared with the RTP group (10.8±3.9 to 10.4±3.2 mL/min/kg, P=.020). In analyzing predictors of post-intervention peak V̇o2, the multivariable linear regression model did not reveal a significant effect of age, sex, body mass index, or beta blocker usage. Similarly, bivariate linear regression models for the FE group only did not find any exercise variables (aerobic intensity, power, or cycling cadence) to be significant predictors of peak V̇o2. CONCLUSIONS: While the aerobic exercise intervention was integrated into rehabilitation to improve UE motor recovery, it was also effective in eliciting significant and meaningful improvements in cardiorespiratory fitness. This novel rehabilitation model may be an effective approach to improve motor and cardiorespiratory function in persons recovering from stroke.

An exploration of how gender, political affiliation, or religious identity is associated with comfort and perceptions of controversial topics in bioethics.

Bioethics is an important aspect of understanding the relationship between science and society, but studies have not yet examined undergraduate student experiences and comfort in bioethics courses. In this study, we investigated undergraduate bioethics students' support of and comfort when learning three controversial bioethics topics: gene editing, abortion, and physician-assisted suicide (PAS). Furthermore, student identity has been shown to influence how students perceive and learn about controversial topics at the intersection of science and society. So, we explored how students' religious affiliation, gender, or political affiliation was associated with their support of and comfort when learning about gene editing, abortion, and PAS. We found that most students entered bioethics with moderated viewpoints on controversial topics but that there were differences in students' tendency to support each topic based on their gender, religion, and political affiliation. We also saw differences in student comfort levels based on identity: women reported lower comfort than men when learning about gene editing, religious students were less comfortable than nonreligious students when learning about abortion and PAS, and nonliberal students were less comfortable than liberal students when learning about abortion. Students cited that the controversy surrounding these topics and a personal hesitancy to discuss them caused discomfort. These findings indicate that identity impacts comfort and support in a way similar to that previously shown in the public. Thus, it may be important for instructors to consider student identity when teaching bioethics topics to maximize student comfort, ultimately encouraging thoughtful consideration and engagement with these topics.

A qualitative study of midwives' perceptions on using video-calling in early labor.

BACKGROUND: Decisions made in early labor influence the outcomes of childbirth for women and infants. Telephone assessment during labor, the current norm in many settings, has been found to be a source of dissatisfaction for women and can present challenges for midwives. The aim of this qualitative study was to explore midwives' views on the potential of video-calling as a method for assessing women in early labor. METHODS: A series of 8 midwife focus groups (n = 45) and interviews (n = 4) in the Midlands region of England and the mid-South and Northeast regions of the United States were completed. Audio recordings were transcribed verbatim and coded using content analysis. Coding diagrams were used to help develop major themes in the data. RESULTS: Midwives were generally positive about the potential of video-calling in early labor and using visual cues to make more accurate assessments and to enhance trust. Some midwives expressed concerns about privacy, both for themselves and for women, and issues of accessibility. They suggested strategies for implementation and further research, such as the need for a private space in birth facilities and training for both staff and service users. CONCLUSIONS: Video-calling was seen as a viable option for assessment of women in early labor with some particular challenges related to implementation. This research focused on midwives' views; the views of women and their families should also be considered. There is a lack of evidence on the clinical and cost effectiveness of video-calling in maternity care and further research is warranted.

Mitogen-activated protein kinase (MAPK) dynamics determine cell fate in the yeast mating response.

In the yeast Saccharomyces cerevisiae, the exposure to mating pheromone activates a prototypic mitogen-activated protein kinase (MAPK) cascade and triggers a dose-dependent differentiation response. Whereas a high pheromone dose induces growth arrest and formation of a shmoo-like morphology in yeast cells, lower pheromone doses elicit elongated cell growth. Previous population-level analysis has revealed that the MAPK Fus3 plays an important role in mediating this differentiation switch. To further investigate how Fus3 controls the fate decision process at the single-cell level, we developed a specific translocation-based reporter for monitoring Fus3 activity in individual live cells. Using this reporter, we observed strikingly different dynamic patterns of Fus3 activation in single cells differentiated into distinct fates. Cells committed to growth arrest and shmoo formation exhibited sustained Fus3 activation. In contrast, most cells undergoing elongated growth showed either a delayed gradual increase or pulsatile dynamics of Fus3 activity. Furthermore, we found that chemically perturbing Fus3 dynamics with a specific inhibitor could effectively redirect the mating differentiation, confirming the causative role of Fus3 dynamics in driving cell fate decisions. MAPKs mediate proliferation and differentiation signals in mammals and are therapeutic targets in many cancers. Our results highlight the importance of MAPK dynamics in regulating single-cell responses and open up the possibility that MAPK signaling dynamics could be a pharmacological target in therapeutic interventions.

Goal-orientated cognitive rehabilitation for dementias associated with Parkinson's disease-A pilot randomised controlled trial.

OBJECTIVE: To examine the appropriateness and feasibility of cognitive rehabilitation for people with dementias associated with Parkinson's in a pilot randomised controlled study. METHODS: This was a single-blind pilot randomised controlled trial of goal-oriented cognitive rehabilitation for dementias associated with Parkinson's. After goal setting, participants were randomised to cognitive rehabilitation (n = 10), relaxation therapy (n = 10), or treatment-as-usual (n = 9). Primary outcomes were ratings of goal attainment and satisfaction with goal attainment. Secondary outcomes included quality of life, mood, cognition, health status, everyday functioning, and carers' ratings of goal attainment and their own quality of life and stress levels. Assessments were at 2 and 6 months following randomisation. RESULTS: At 2 months, cognitive rehabilitation was superior to treatment-as-usual and relaxation therapy for the primary outcomes of self-rated goal attainment (d = 1.63 and d = 1.82, respectively) and self-rated satisfaction with goal attainment (d = 2.04 and d = 1.84). At 6 months, cognitive rehabilitation remained superior to treatment-as-usual (d = 1.36) and relaxation therapy (d = 1.77) for self-rated goal attainment. Cognitive rehabilitation was superior to treatment as usual and/or relaxation therapy in a number of secondary outcomes at 2 months (mood, self-efficacy, social domain of quality of life, carers' ratings of participants' goal attainment) and at 6 months (delayed recall, health status, quality of life, carer ratings of participants' goal attainment). Carers receiving cognitive rehabilitation reported better quality of life, health status, and lower stress than those allocated to treatment-as-usual. CONCLUSIONS: Cognitive rehabilitation is feasible and potentially effective for dementias associated with Parkinson's disease.

Ultrasound as a technology of reassurance? How pregnant women and health care professionals articulate ultrasound reassurance and its limitations.

The premise that ultrasound technologies provide reassurance for pregnant women is well-rehearsed. However, there has been little research about how this reassurance is articulated and understood by both expectant mothers and health care professionals. In this article, we draw on two qualitative UK studies to explore the salience of ultrasound reassurance to women's pregnancy experiences whilst highlighting issues around articulation and silence. Specifically, we capture how expectant parents express a general need for reassurance and how visualisation and the conduct of professionals have a crucial role to play in accomplishing a sense of reassurance. We also explore how professionals have ambiguities about the relationship between ultrasound and reassurance, and how they subsequently articulate reassurance to expectant mothers. By bringing two studies together, we take a broad perspectival view of how gaps and silences within the discourse of ultrasound reassurance leave the claims made for ultrasound as a technology of reassurance unchallenged. Finally, we explore the implications this can have for women's experiences of pregnancy and health care professionals' practices.

Why do women seek ultrasound scans from commercial providers during pregnancy?

The commercial availability of ultrasound scans for pregnant women has been controversial yet little is known about why women make use of such services. This article reports on semi-structured interviews with women in the UK who have booked a commercial scan, focusing on the reasons women gave for booking commercially provided ultrasound during a low-risk pregnancy. Participants' reasons for booking a scan are presented in five categories: finding out the sex of the foetus; reassurance; seeing the baby; acquiring keepsakes and facilitating bonding. Our analysis demonstrates that women's reasons for booking commercial scans are often multiple and are shaped by experiences of antenatal care as well as powerful cultural discourses related to 'good' parenting and the use of technology in pregnancy. Sociological and public debate about the availability of commercial ultrasound and its social and personal impacts should consider the wider sociocultural context that structures women's choices to make use of such services.

The Warwick Patient Experiences Framework: patient-based evidence in clinical guidelines.

OBJECTIVE: This paper presents the development of the Warwick Patient Experiences Framework (WaPEF) and describes how it informed the development of the NICE Guidance and Quality Standard, 'Patient experience in adult NHS services: improving the experience of care for people using adult NHS services'. DESIGN: The WaPEF was developed using a thematic qualitative overview that utilized a systematic review approach. Search strategies were developed, inclusion and exclusion criteria developed and data extracted from papers. RESULTS: The WaPEF identifies seven key generic themes that are important to a high-quality patient experience: patient as active participant, responsiveness of services, an individualized approach, lived experience, continuity of care and relationships, communication, information and support. CONCLUSIONS: The WaPEF is the first patient experiences framework with an explicit link to an underpinning patient evidence base, linking themes and sub-themes with specific references. The WaPEF informed the structure and content of the NICE Patient Experiences Guidance. The guidance, published in February 2012, will form a key part of the NHS Outcomes Framework in the UK for the future evaluation of health and social care. The proposed framework could be adapted to other country contexts and settings.

Ableism, Code-Switching, and Camouflaging: A Letter to the Editor on Gerlach-Houck and DeThorne (2023).

PURPOSE: This letter to the editor is in response to the Gerlach-Houck and DeThorne (2023) epilogue regarding their proposal for speech-language pathologists to offer Autistic code-switching (Autistic masking and camouflage) as a viable, non-ableist social communication tool that Autistic clients may choose to use in "high-stakes" social situations. In connection with Autistic code-switching, the authors reference "the debate" regarding code-switching in "African American Vernacular English speakers," specifically, whether "standard" English should be encouraged as a way to access "conventional forms of success." CONCLUSION: Professionally training Autistic clients to "code-switch" with the goal of improving the client's chances of accessing conventional forms of success is essentially training Autistic masking and camouflaging. This type of therapy reinforces to both the Autistic client, as well as society, the position that hiding a person's Autistic traits is a pathway to acceptance and success. Autistic camouflaging has detrimental ramifications for mental health outcomes; perpetuates both internalized and societal stigma; hinders bias and discrimination deconstruction; reinforces ableist values; and fails to dismantle power inequities and social barriers that lead to marginalization, oppression, and exclusion.

The language of marketing hyperbole and consumer perception-The case of Glasgow.

The aim of the study was to explore the potential of a timed word association task to generate detailed insights into the perception of Glasgow city and its people which could inform destination and brand marketing. Destination marketers have a challenge to convey the tourist destination image to attract and satisfy the expectations of its visitors. Yet destination perceptions are often the result of multiple tourist visitor experiences at a location, neglecting the voice of the resident. The extent to which word associations varied by participants' relationship to Glasgow was identified in terms of Aaker's brand personality scale, an extension of personality research on brands and destinations. Surveying of 1,219 UK participants generated a total of 5,993 terms (city; 1,144 unique) and 5,034 terms (people; 944 unique). The value of capturing the perceptions of a destination by its residents is identified. The results showed that the city of Glasgow was often described as cold and busy, while the people were primarily described as friendly and funny. Evidence was found in support of dual-processing theory suggesting word associations based on lived experiences of a city may be generated later (in terms of the order in which the terms were generated) in a word association task, while common linguistic associations (e.g. synonyms, antonyms, hierarchies etc.) tend to be generated earlier in the task. As hypothesised, analyses revealed a significant relationship between several of the Aaker-dimensions of brand personality, and the consumers' relationship to Glasgow, extending marketing research with an empirical approach to identifying differences in the perceived personality of a destination. The study offers a practical, fast, and replicable method for destination marketers to study consumer perception at scale, which is currently not widely utilised in this field. In particular, the use of semantic distance and word embeddings provides a readily available approach to automatically categorise content derived from word associations studies, or indeed, any text-based content. In contrast, financial investment in non-validated branding and destination marketing campaigns appear to be increasingly problematic. Advances were made in testing an approach to interpreting word associations through the lens of linguistic and situated simulation (LASS) theory to provide deeper analysis to both categorise and interpret consumers' perception. Traditional approaches to tourism marketing and destination branding rarely provide such a level of analytical appraisal. The analysis presented in this paper challenges the orthodoxy and validity of investment in brand and destination marketing at a city level and the potential for word association tasks to be used as a valuable alternative method to create more effective destination marketing and branding.

'Wakey wakey baby': narrating four-dimensional (4D) bonding scans.

Commercial companies market 4D ultrasound scans to expectant parents for the stated purpose of reassurance, to promote bonding, and to get 'baby's first picture'. This article describes in detail the process of commercial 4D scanning in the UK, paying particular attention to the discursive exchanges in the scan room. It is argued that sonographers and clients engage in a process of 'collaborative coding' that, despite the realism of 4D, is essential to making the imagery on the screen personally and socially meaningful. While sonographers first help clients to get their bearings, expectant parents and others often engage in a complex process of narrating the images on the screen as they are created. The capacities of 4D ultrasound to image facial features and movements inform stories about fetal experience and family resemblances as well as enabling playfully imagined interactions with the fetus. While these stories are primarily based in experiences of the visual, there is also evidence that pregnant women seek to map the image onto their bodies and to reintroduce some elements of their embodied experiences into the narratives.

Sources and levels of copper affect liver copper profile, intestinal morphology and cecal microbiota population of broiler chickens fed wheat-soybean meal diets.

Super dosing copper (Cu) has long been used as an alternative to antibiotic growth-promoters in broiler chickens' diet to improve gut health. This study was designed to compare nutritional and growth-promoting levels of Cu hydroxychloride (CH) with CuSO4 on gut health bio-markers and liver mineral profile of broiler chickens. Ross 308 chicks (n = 864) were randomly assigned to eight treatments, as basal diet containing no supplemental Cu; the basal diet with 15 or 200 mg/kg Cu as CuSO4; or 15, 50, 100, 150 or 200 mg/kg Cu from CH. The highest liver Cu content was observed in birds fed the diets with 200 mg/kg CuSO4 (P < 0.01). Serum FITC-d concentration as the leaky gut marker, and liver malondialdehyde concentration were not affected. Copper level or source had no effect on cecal short chain fatty acid and the mRNA expression of five jejunal genes involved in gut integrity. Negative linear responses of Cu were observed on Lactobacillus (P = 0.032), Bacteroides (P = 0.033), and Enterobacteriaceae (P = 0.028) counts. The jejunal villus height increased in birds fed CH at 200 and 100 mg/kg (P < 0.05). Increasing Cu levels, linearly and quadratically (P < 0.001), increased Cu excretion.

Christianity as a Concealable Stigmatized Identity (CSI) among Biology Graduate Students.

Recent research has begun to explore the experiences of Christian undergraduates and faculty in biology to illuminate reasons for their underrepresentation. In this study, we focused on the experiences of graduate students and explored Christianity as a concealable stigmatized identity (CSI) in the biology community. We constructed interview questions using this CSI framework, which originates in social psychology, to research the experiences of those with stigmatized identities that could be hidden. We analyzed interviews from 33 Christian graduate students who were enrolled in biology programs and found that many Christian graduate students believe the biology community holds strong negative stereotypes against Christians and worry those negative stereotypes will be applied to them as individuals. We found that students conceal their Christian identities to avoid negative stereotypes and reveal their identities to counteract negative stereotypes. Despite these experiences, students recognize their value as boundary spanners between the majority secular scientific community and majority Christian public. Finally, we found that Christian students report that other identities they have, including ethnicity, gender, nationality, and LGBTQ+ identities, can either increase or decrease the relevance of their Christian identities within the biology community.

A New Measure of Students' Perceived Conflict between Evolution and Religion (PCoRE) Is a Stronger Predictor of Evolution Acceptance than Understanding or Religiosity.

Evolution is controversial among students and religiosity, religious affiliation, understanding of evolution, and demographics are predictors of evolution acceptance. However, quantitative research has not explored the unique impact of student perceived conflict between their religion and evolution as a major factor influencing evolution acceptance. We developed an instrument with validity evidence called "Perceived Conflict between Evolution and Religion" (PCoRE). Using this measure, we find that, among students in 26 biology courses in 11 states, adding student perceived conflict between their religion and evolution to linear mixed models more than doubled the capacity of the models to predict evolution acceptance compared with models that only included religiosity, religious affiliation, understanding of evolution, and demographics. Student perceived conflict between evolution and their religion was the strongest predictor of evolution acceptance among all variables and mediated the impact of religiosity on evolution acceptance. These results build upon prior literature that suggests that reducing perceived conflict between students' religious beliefs and evolution can help raise evolution acceptance levels. Further, these results indicate that including measures of perceived conflict between religion and evolution in evolution acceptance studies in the future is important.

Muslim undergraduate biology students' evolution acceptance in the United States.

Evolution is a prominent component of biology education and remains controversial among college biology students in the United States who are mostly Christian, but science education researchers have not explored the attitudes of Muslim biology students in the United States. To explore perceptions of evolution among Muslim students in the United States, we surveyed 7,909 college students in 52 biology classes in 13 states about their acceptance of evolution, interest in evolution, and understanding of evolution. Muslim students in our sample, on average, did not agree with items that measured acceptance of macroevolution and human evolution. Further, on average, Muslim students agreed, but did not strongly agree with items measuring microevolution acceptance. Controlling for gender, major, race/ethnicity, and international status, we found that the evolution acceptance and interest levels of Muslim students were slightly higher than Protestant students and students who are members of the Church of Jesus Christ of Latter-day Saints. However, Muslim student evolution acceptance levels were significantly lower than Catholic, Jewish, Buddhist, and Hindu students as well as students who did not identify with a religion (agnostic and atheists). Muslim student understanding of evolution was similar to students from other affiliations, but was lower than agnostic and atheist students. We also examined which variables are associated with Muslim student acceptance of evolution and found that higher understanding of evolution and lower religiosity are positive predictors of evolution acceptance among Muslim students, which is similar to the broader population of biology students. These data are the first to document that Muslim students have lower acceptance of evolution compared to students from other affiliations in undergraduate biology classrooms in the United States.

Midwifery students' views and experiences of birth on mainstream factual television.

OBJECTIVES: To investigate midwifery students' experiences of viewing childbirth on mainstream factual television and to explore implications for student career intentions and potential pedagogical uses of television excerpts in midwifery education. DESIGN: Twenty-two undergraduate midwifery students at one of two universities took place in focus groups between February and June 2019. Ethical approval was obtained at both sites. Thematic analysis was employed to generate key themes from the data. SETTING: Two UK universities based in the East Midlands and East Yorkshire regions of England. PARTICIPANTS: Twenty-two midwifery students at any stage of their studies. FINDINGS: Researchers generated four key themes from the data a) Changed Perspectives on Televised Childbirth, b) Representations of Midwives and Social Implications, c) Representation of Childbirth and Social Implications and d) The Role of Televising Childbirth in Midwifery Education. KEY CONCLUSIONS: Midwifery students often experience a change of perspective on birth on television as they acquire new knowledge and skills. They recognise the potential social implications of how childbirth and midwifery are represented on television. Pedagogical use of televised birth has potential benefits but needs further investigation in the context of midwifery education. IMPLICATIONS FOR PRACTICE: Midwifery students are likely to begin their studies with pre-existing views and experiences around how birth is represented on mainstream factual television. They may need support to reflect on these to consider their expectations of the profession, to effectively support childbearing women and to potentially influence future production of media images of childbirth.

Structured hypertension education program for people with type 2 diabetes, the SHED study.

OBJECTIVES: There is enough evidence that patient education and lifestyle modification has shown benefits in diabetes care, however the evidence is less for improving care of hypertension. Our study is the first in the UK to assess the impact of a structured hypertension education program in subjects with type 2 diabetes. DESIGN: Prospective randomised controlled study. SETTING AND INTERVENTION: From a diabetes clinic in a district and general hospital in UK 132 participants were equally randomised into intervention group and control group. Intervention included a once weekly education session for 4 weeks together with home blood pressure monitoring and dose changes in antihypertensives. Base line data was recorded with follow up after 3 and 6 months. RESULTS: More participants achieved target BP in the intervention group versus control. This difference appeared early at the 3rd months (48.8% versus 20.4% respectively, p = 0.007) and remained at the 6th month (58.1% versus 20.4% respectively, p < 0.001). The change in number of pills was significantly lower in the intervention group. The mean increase in antihypertensive pills was 0.22 ± 0.48 (13 ± 30% increase) in the intervention group versus 0.62 ± 0.68 (41 ± 60% increase) in the routine group (p = 0.014), denoting less need to escalate treatment. CONCLUSION: We demonstrated that our structured education program has led to a significantly higher percentage of participants achieving the BP target, early after intervention, together with a significant reduction in the number of antihypertensive pills.

An Exploration across Institution Types of Undergraduate Life Sciences Student Decisions to Stay in or Leave an Academic-Year Research Experience.

Undergraduate research is one of the most valuable activities an undergraduate can engage in because of its benefits, and studies have shown that longer experiences are more beneficial. However, prior research has illuminated that undergraduates encounter challenges that may cause them to exit research prematurely. These studies have been almost exclusively conducted at research-intensive (R1) institutions, and it is unclear whether such challenges are generalizable to other institution types. To address this, we extended a study previously conducted at public R1 institutions. In the current study, we analyze data from 1262 students across 25 public R1s, 12 private R1s, 30 master's-granting institutions, and 20 primarily undergraduate institutions (PUIs) to assess 1) to what extent institution type predicts students' decisions to persist in undergraduate research and 2) what factors affect students' decisions to either stay in or consider leaving their undergraduate research experiences (UREs) at different institution types. We found students at public R1s are more likely to leave their UREs compared with students at master's-granting institutions and PUIs. However, there are few differences in why students enrolled at different institution types consider leaving or choose to stay in their UREs. This work highlights the importance of studying undergraduate research across institutions.

'The calm before the storm': A qualitative study of fathers' experiences of early labour.

BACKGROUND: Early labour care presents a challenge for maternity services and is a cause of dissatisfaction for women planning birth in an obstetric or midwifery unit who may feel unsupported or unwelcome at their planned place of birth. Little is known about the perspectives of men who support their partner during early labour. METHODS: Opportunity sample offathers (n=12) in the UK who had been present during their partner's labour in the previous twelve months. Semi-structured interviews were audio-recorded and transcribed before thematic analysis. RESULTS: Fathers learned about the stages of labour during antenatal education and felt well prepared for early labour but found their knowledge difficult to apply, and relied on their partners to decide when to travel to the planned place of birth. Early labour was described as the 'calm before the storm' during which they carried out practical tasks or rested to ensure they could fulfil their role when labour progressed. However, men frequently felt 'like a spare part' during the later stages of labour. DISCUSSION: The study has implications for antenatal educators, midwives and others supporting couples during pregnancy and labour. It supports reconsideration of how information about labour progress can be most usefully conveyed to couples. Professionals could acknowledge the value of supportive tasks carried out by fathers that might otherwise be experienced as doing 'nothing'. Further research should recruit more diverse samples of men and same-sex couples. Dyadic data collection methods may be of value.

Disaster victim identification operations with fragmented, burnt, or commingled remains: experience-based recommendations.

Human-made and natural disasters can result in severely fragmented, compromised, and commingled human remains. The related disaster victim identification (DVI) operations are invariably challenging, with the state of the remains potentially precluding some identifications. Practitioners involved in these DVI operations will routinely face logistical, practical, and ethical challenges. This review provides information and guidance derived from first-hand experiences to individuals tasked with managing DVI operations with fragmented human remains. We outline several key issues that should be addressed during disaster preparedness planning and at the outset of an operation, when incident-specific strategies are developed. Specific challenges during recovery and examination of fragmented remains are addressed, highlighting the importance of experienced specialists at the scene and in the mortuary. DNA sample selection and sampling techniques are reviewed, as well as downstream effects of commingling and contamination, which can complicate reconciliation and emphasise the need for rigorous quality control. We also touch on issues that may arise during communication with families. While recommendations are provided, they are not intended as proscriptive policy but rather as an addition to the general recommendations given in the International Criminal Police Organization (INTERPOL) DVI Guide, to inform preparative discussions between government officials, judiciary, police, and forensic specialists.Key pointsA DVI operation for an incident characterised by many fragmented and otherwise compromised human remains poses specific challenges that may prolong and complicate identifications.Specialists should be consulted at the outset to address key issues related to the aim and extent of the operation.Specialist expertise in handling compromised human remains is indispensable at the scene, in the mortuary, during reconciliation, and for quality control.Continuous consultation between representatives from government, the judiciary, law enforcement, the media, and various forensic specialists will prevent unnecessary delay and facilitate accurate and timely communication.