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Lassa virus is endemic in many West African countries and has significant epidemic/pandemic potential. The Coalition for Epidemic Preparedness Innovations (CEPI) Centralized Laboratory Network (CLN) is developing validated, harmonized methods to support and accelerate vaccine development in the event of an outbreak. We present here the development and validation of an assay to quantify anti-Lassa virus neutralizing antibodies. As the method uses a pseudotyped virus (PV) instead of authentic Lassa virus-a pathogen listed as hazard group 4-it can be performed at a lower containment level, making it widely accessible especially in those regions where Lassa fever is circulating. A recombinant vesicular stomatitis virus (rVSV)-based pseudotyped virus neutralization assay (PVNA) was developed. A working standard was prepared and calibrated against the International Standard (IS) for Lassa virus neutralizing antibodies, enabling results to be expressed in International Units. The method was validated according to the International Council for Harmonisation (ICH) Q2(R2) guidelines. The rVSV-based PVNA was successfully developed and validated. The analytical range of the assay was established as 10-100 IU/mL, and seropositive samples from a Lassa vaccine clinical trial fell within this range. Results from the PVNA showed direct correlation with results obtained from authentic virus neutralization methods. The method was, therefore, concluded to be fit-for-purpose. We have successfully developed and validated a PVNA for the quantification of neutralizing antibodies against Lassa virus. We have also provided a practical example of how to calibrate a serological method to the WHO International Standard to achieve greater harmonization and comparability between studies. The method is now being transferred to partner laboratories within the CLN to enable harmonized testing of clinical trial samples and support the development and evaluation of Lassa vaccine candidates.

Urban pipeline infrastructure plays a vital role in ensuring the operational efficiency and service reliability of modern utility systems, especially in industrial regions. While previous studies have focused primarily on pipe failure prediction, limited research has addressed the forecasting of key pipeline performance indicators such as velocity, pressure, and head loss within the context of infrastructure asset management. This study investigates the performance of advanced machine learning (ML) models, PSO-ANN, Genetic CNN, Quantum SVR, Fuzzy Logic Tree, and Bayesian GPR, in predicting three critical output variables: velocity, head loss, and pressure. A dataset comprising 91 instances with geometric and hydraulic descriptors was employed, and descriptive statistics revealed significant variability in flow-dependent parameters. SHAP-based sensitivity analysis highlighted elevation (0.9287) as the dominant factor for pressure prediction, while flow rate (0.4574) and diameter (0.2273) strongly influenced head loss. For velocity, flow rate (0.1139) emerged as the most influential, though other parameters also contributed, justifying their inclusion in the modeling framework. The models were trained using data from the Gadhra Water Distribution Network (District Metered Area-03) in East Singhbhum, Jamshedpur, India. Model evaluation was conducted using R², RMSE, MAE, and MAPE. Results demonstrated a clear performance hierarchy, with Bayesian GPR and Fuzzy Logic Tree exhibiting superior accuracy and stability (R² ≥ 0.98, RMSE ≤ 0.06, MAPE ≤ 0.13), whereas PSO-ANN and Genetic CNN showed relatively weaker performance. The near-perfect R² observed for Fuzzy Logic Tree reflects the small dataset size and its high capacity, highlighting that generalization may be limited in larger or unseen datasets. The analysis of regressor plots, residual distributions, and normalized accuracy matrices further validated these findings. Overall, the study establishes Bayesian GPR and Fuzzy Logic Tree as robust predictive tools for hydraulic modeling while acknowledging dataset constraints that may affect generalization.

Many people with major depressive disorder (MDD) undergo a lengthy process of trial-and-error before finding a medication that works well for them. Pharmacogenomic (PGx) testing for MDD can help find a suitable antidepressant faster. However, concerns about health equity, and data privacy and security need to be considered before implementing the test. In Fall 2024, 30 individuals attended a four-day public deliberation in Vancouver, British Columbia (BC) to provide direction on implementing PGx testing for MDD in BC's publicly funded healthcare system. Participants were recruited to represent a diversity of perspectives and experiences of British Columbians. Information supports included expert speakers and a background booklet. Event transcripts were analyzed using thematic analysis (both inductive and reflexive), while also accounting for participants' knowledge gains over time. Participants adopted four policy-relevant positions on implementation: 1) PGx test results should be treated like other lab results; 2) stored in electronic medical records; 3) shared with patients and healthcare professionals in the circle of care; and 4) education about the test will facilitate its widespread use. Participants' positions represent informed, civic-minded, and policy-relevant priorities for the acceptable adoption of PGx testing for MDD in the BC healthcare system and elsewhere.

When a child dies in a pediatric intensive care unit (PICU) from a sudden or unexpected cause such as trauma or sepsis, intense grief felt by the child's family can cause sustained psychosocial impacts. Supporting unexpectedly bereaved families with evidence-based bereavement care is key to improving grief outcomes, and understanding their specific needs is essential to inform the delivery of bereavement care in PICUs. To understand what is known about (1) bereavement care needs of families who have experienced the unexpected death of a child in a PICU, and (2) approaches to address families' needs. An integrative review was systematically conducted with the protocol registered a priori on the Open Science Framework. Original peer-reviewed research articles relating to relatives of children who died an unexpected death in a PICU were included from OVID Medline, PsycINFO, CINAHL, SCOPUS, and ProQuest, along with guidelines from Google© searching. Articles were critically appraised using Critical Appraisal Skill Program, Mixed Methods Appraisal Tool, and Appraisal of Guidelines, Research and Evaluation II checklists, and data were synthesized using the constant comparison method. Twenty-nine original research articles (15 qualitative, 11 quantitative, 1 mixed method, and 2 secondary analyses) and five guidelines were included in this review. Three original articles focused on unexpected child death exclusively. From the findings of all 34 articles, four linked themes were identified: (1) connection and (2) communication with PICU clinicians, (3) awareness of the impacts of unexpected death, and (4) emotional and physical support for family members. Unexpectedly bereaved family members' needs included close relationships with clinicians and caring support before and after their child's death, including ongoing follow-up from the PICU. Further targeted research is needed to better understand the specific needs of unexpectedly bereaved families, gain diverse and representative evidence in this area, and develop innovative, evidence-based interventions to improve bereavement outcomes for the whole family.

Background: Culturally and Racially Marginalised (CaRM) communities in Australia encounter subtle and covert forms of prejudice, commonly referred to as "new racism". Within healthcare settings, these experiences can shape trust, engagement, and patterns of help-seeking. Mental health nurses are often the first point of contact in care delivery, and their ability to recognise, respond to, and mitigate the impacts of new racism is critical for fostering therapeutic relationships and supporting equitable access. Understanding how CaRM communities perceive the conditions that influence their mental health service use is fundamental for informing more equitable and culturally responsive care. Objective: This study explored the viewpoints of CaRM community members regarding the factors they consider important for addressing new racism in healthcare systems and supporting engagement with mental health services. Design: Q methodology was used to identify statistically derived viewpoints that reflect shared viewpoints about the conditions perceived as critical for addressing the impacts of new racism on mental health service use. Setting: Participants were recruited from culturally and linguistically diverse communities across Australia through community settings, social media, and professional networks. Participants: Thirty-five individuals from CaRM backgrounds completed the Q-sort. Methods: This Q methodology consisted of five steps: (1) set up of the Q-sorting instrument, (2) selection of participants, (3) data collection, (4) factor analysis, and (5) factor interpretation. Results: Three distinct viewpoints were identified: (1) raising awareness of mental health issues within CaRM communities (community-focused), (2) providing visible anti-racism and culturally safe services (service-focused), and (3) recognising and formally addressing new racism within healthcare systems (policy-focused). Conclusions: This study offers the first empirically derived, community-informed set of viewpoints on addressing new racism in Australian mental healthcare. While exploratory, the findings highlight multi-level considerations that are potentially relevant to mental health nursing practice, and may be useful to inform future research, policy development, and service redesign aimed at strengthening cultural responsiveness and equity in mental health systems.

Home telemonitoring programs are increasingly used to support older adults living with chronic conditions such as heart failure (HF). While these interventions show promise for improving health outcomes and reducing care burden, their effectiveness depends largely on how patients and caregivers integrate digital technologies into everyday life and care relationships. However, relatively few studies have examined these experiences using conceptual frameworks that capture both functional and relational dimensions of care. This study aimed to explore the experiences of older adults and their informal caregivers participating in a home telemonitoring program for HF. Drawing on the Person-Based Approach and the Person-Centered Practice frameworks, we examined how participants engaged with both the technofunctional and relational aspects of the intervention. We conducted a qualitative study involving 34 patients, 28 informal caregivers, and 20 nurses across 3 primary care organizations in Quebec, Canada. The 6-month intervention included 4 connected devices used by patients (smartwatch, Bluetooth-enabled scale, voice-activated tablet, and a smart pill dispenser [xPill; Domedic]) and a mobile app for caregivers, complemented by remote nursing follow-up. Nurses reviewed patient data through a clinical dashboard at least once daily during weekday daytime shifts. Data were collected through semistructured interviews and field notes and analyzed using directed content analysis. Participants' experiences revealed both enabling and constraining factors across 2 key dimensions. Technofunctional engagement was shaped by digital literacy, emotional responses to the technology, alignment with daily routines, and access to technical or caregiver support. Relational aspects of care were influenced by perceived professional presence, opportunities for communication and shared decision-making, and the degree of emotional reassurance provided by remote monitoring. While many participants reported increased confidence and a sense of being supported, others experienced frustration, fatigue, or disengagement when the system disrupted routines or when feedback from clinicians was perceived as limited. Engagement with home telemonitoring technologies among older adults depends not only on usability but also on the relational context in which these technologies are embedded. Combining technofunctional and relational perspectives provides a more comprehensive understanding of how telemonitoring interventions are experienced and highlights the importance of personalized support, reliable technology, and sustained clinical engagement to promote meaningful adoption.

Deep brain stimulation (DBS) of the ventral capsule/ventral striatum (VC/VS) can benefit patients with treatment-refractory obsessive-compulsive disorder (OCD). However, time to respond post-operatively ranges from weeks to over a year. We examined neuroanatomical determinants of this variability. We studied 16 treatment-refractory OCD patients who responded to VC/VS DBS, classifying them as rapid (≤3 months) or slow (>3 months) responders. We compared contact locations along anterior-posterior, dorsal-ventral, and medial-lateral axes. In 11 patients with diffusion-weighted magnetic resonance imaging (dMRI), we utilized volumes of tissue activated (VTAs) for both initial and most recent effective DBS settings to filter tractograms of the anterior limb of the internal capsule to 11 predefined prefrontal cortical regions. We analyzed streamline counts as a proxy for connectivity strength with mixed-effects models. Rapid (n=8) and slow (n=8) responders exhibited a clear bimodal distribution of time-to-response, supported by a Bayesian Information Criterion difference (Δ BIC) of 9.14. Rapid responders' right-hemisphere contacts were positioned more superiorly, and there was a trend toward their left-hemisphere contacts being positioned more posteriorly. Connectivity fingerprints and mixed-effects modeling showed greater dorsolateral prefrontal cortex engagement in rapid responders than in slow responders, whereas slow responders showed enhanced central orbitofrontal cortex connectivity over time. Variability in VC/VS contact placement corresponds to distinct prefrontal cortical connectivity patterns and response timelines. Patient-specific targeting and connectivity-informed programming may accelerate response to treatment.

Collaborative care between optometry and ophthalmology has demonstrated the potential to improve timely access to care. This study examines three settings where real-time optometry-facilitated telehealth was used to expedite specialist eye care in rural and remote Western Australia. Referrals to ophthalmology were triaged to telehealth or face-to-face services. For telehealth, optometrists performed a comprehensive in-person assessment, then facilitated video-consultation with an ophthalmologist during the same attendance for collaborative decision making. In 2023, retrospective chart review was undertaken for ophthalmology services in towns more than 1500&#x2009;km from the capital city. Optometrists performed comprehensive in-person assessments and facilitated telehealth in three settings: hospital, community clinic and visiting outreach. Attendance rates were compared between collaborative telehealth and face-to-face ophthalmology. Follow up outcomes and diagnoses for telehealth consultations were reported. A total of 1876 non-surgical ophthalmology episodes of care were delivered in the 12-month period, of which 1044 (55.7%) were delivered by optometry using telehealth. Of those managed by telehealth, only 83 episodes of care required a subsequent face-to-face ophthalmology consultation. The hospital setting provided the greatest proportion (76.4%) of telehealth. Adjusted logistic regression showed the odds of attendance were 3.6 (95% CI: 2.6-5.0) times higher for telehealth appointments than face-to-face (p&#x2009;<&#x2009;0.001). Surgical rates of outreach ophthalmology were high (30.0 to 74.1% of activity). Common diagnoses in telehealth included cataract, pterygium for direct surgical booking and chronic conditions (glaucoma, diabetic retinopathy) for instituting appropriate management. Collaborative telehealth with optometry improves access to ophthalmology services in rural Australia and should be considered in metropolitan settings and other countries.

Species must acclimate, shift their distribution, or adapt in place in response to anthropogenic climate change. Populations at the low-latitude trailing edge of the species distribution typically experience thermal conditions closest to the upper limit of their thermoregulatory capacity. Landscape and functional genomic approaches provide quantitative measures of risk and adaptive capacity which can inform and prioritise conservation actions. Using low-coverage whole genomes from Canada lynx (Lynx canadensis), we characterised population genomic structure and identified putatively adaptive loci using genotype-environment association analyses across the eastern extent of their distribution. We detected genetic breaks across two previously identified biogeographical barriers, the St. Lawrence River and the Strait of Belle Isle, and found relatively high genome-wide diversity in the Maine population at the southern trailing edge. We identified 759 loci from 329 genes as putatively adaptive, many associated with temperature during warm and dry periods, and functionally enriched in photoreception, circadian entrainment, and temperature regulation. We identified 10 putatively adaptive genes linked to epilepsy, presenting candidate genes underlying reports of idiopathic epilepsy in captive populations of closely related lynx species (L. lynx and L. pardinus). Standing variation in putatively adaptive loci was relatively low in Maine, suggesting that currently advantageous alleles may be fixed. Genomic offset showed lynx in Western Newfoundland and the Gasp&#xe9; Peninsula in Quebec are at the greatest risk of maladaptation under future conditions. Together, these findings highlight the conservation importance of range-edge populations as reservoirs of unique adaptive variation, while also emphasizing their potential vulnerability under continued climate change.

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Musicians demonstrate advantages in acquiring motor sequences, showing faster learning and better explicit sequence knowledge than non-musicians. However, it is unclear whether this advantage extends beyond acquisition to the consolidation phase, which is when newly learned skills stabilize and become resistant to interference. Additionally, while interference from executing competing motor tasks is well-established, less is known about whether purely sensory information presented after learning can disrupt consolidation of a bimodal motor sequence. We investigated how post-acquisition sensory interference affects performance of a learned audio-visual sequence, and whether musical training moderates this vulnerability. Participants first learned an explicit sequence in a serial reaction time task using synchronous, informative audio-visual cues. After a brief consolidation period, they were randomly assigned to one of four observational conditions that manipulated the relationship between auditory and visual streams. Motor performance was then reassessed. Post-acquisition sensory interference impaired subsequent motor performance, but this effect was modality-specific: it was driven primarily by manipulations to the task-relevant visual stream, while auditory interference alone had no credible effect. Distributional analysis revealed that learning involved a strategic shift from reactive to anticipatory responding. Critically, participants with musical training showed a consistently higher reliance on anticipatory responses than those without throughout acquisition, indicating stronger predictive motor control. These findings demonstrate that newly formed sensorimotor memories are selectively vulnerable to interference in task-relevant modalities. Furthermore, our work provides a candidate mechanistic account for the musician advantage in sequence learning, linking it to greater reliance on predictive motor strategies during acquisition.

Studies characterising the immunoglobulin (Ig)-bound microbiota apply varying methodologies, making comparisons difficult. This scoping review synthesised evidence on Ig-microbiota binding patterns in maternal and infant contexts, identified recurrent Ig-bound and -unbound bacteria across studies, and highlighted knowledge gaps for further study. Nine articles investigating Ig-microbiota binding patterns in stool or breastmilk samples in mothers or infants were included. Ig-microbiota associations were influenced by sample type, Ig-subclass, genetics, and diet. The most important antibody was IgA, with partial functional redundancy with IgM, while IgG appeared more selective for pathobionts. Ig-bound taxa in early life included important commensals and pathobionts, with high levels of individuality. Ig-microbiota associations shifted with microbiome maturation, environmental and host factors, resembling adults at around 2 years of age. Transfer of Ig-bound Bifidobacterium through breastmilk may contribute to vertical transmission from mother to infant. Ig-microbiota associations also differed between health and disease states, beyond the overall microbiota. Results were limited by study numbers and a lack of methodological consistency. We propose the standardised term "Ig-Seq" in referring to the technique to study Ig-microbiota binding patterns, and suggest standardisation of laboratory protocols, bioinformatic pipelines, and statistical analyses to improve consistency in Ig-Seq.

Individuals undergoing chemotherapy experience a range of symptoms that can significantly impact their quality of life and treatment outcomes; the prevalence and severity of which can change across their treatment journey. This study aimed to identify and describe the longitudinal symptom experience during the first four months of chemotherapy administration across a range of cancer diagnoses. A prospective longitudinal cohort study was conducted at a cancer centre in Queensland, Australia. Monthly surveys assessed symptoms, distress, and quality of life across 4 months of chemotherapy. A total of 252 participants completed baseline surveys (mean age 61&#x2009;&#xb1;&#x2009;12.3&#xa0;years; 65% female; 40% breast cancer). Participants reported a mean of 22.5&#x2009;&#xb1;&#x2009;9.0 symptoms at baseline, with a statistically significant reduction in symptoms throughout the study period 21.9&#x2009;&#xb1;&#x2009;9.2 symptoms (p&#x2009;=&#x2009;0.002). Fatigue (93%), insomnia (80%), and pain (72%) were most common at baseline and remained highly prevalent throughout the time period. Severe fatigue (25%), pain (15%), and constipation (15%) reduced over time, while peripheral neuropathy and decreased sexual interest increased. This study has produced insights into the high number of symptoms experienced during the initial four months of chemotherapy. Given the impact of symptoms on treatment outcomes, there is a critical need for the development of appropriate assessment tools capable of capturing this broad range of patient symptom experiences. Understanding symptom patterns over time can support early identification of high-risk patients, guide personalised supportive care strategies and optimise treatment tolerance and quality of life during and beyond chemotherapy.

Home care services are under increasing pressure due to population aging, rising chronic disease prevalence, and workforce shortages. Digital health technologies, particularly home telemonitoring systems, are seen as promising tools to detect early clinical deterioration, reduce hospital use, and support continuity of care. However, real-world evidence on the implementation of such technologies in public home care systems remains limited. In 2023-2024, the Quebec Ministry of Health and Social Services funded a pilot to implement a multidevice telemonitoring intervention for older adults with heart failure across three integrated health and social services centers (CISSS). The initiative aimed to assess feasibility, acceptability, and the organizational conditions shaping implementation. This study documents the real-world implementation of a multidevice telemonitoring program from the perspective of home care nurses, with complementary insights from managers. It identifies perceived barriers, enablers, and contextual strategies for adaptation and sustainability. We conducted a qualitative study guided by the iCHECK-DH framework and principles of implementation science. Data sources included 30 semistructured interviews, 19 with home care nurses, and 11 with clinical and administrative managers. The intervention combined four connected devices (ie, Bluetooth scale, smartwatch, xPill adherence system, and voice-activated tablet), monitored by nurses through the Virtuose dashboard. Data were analyzed thematically, focusing on implementation processes, user experience, and organizational integration. The intervention involved 67 patients initially recruited (34 completed the 6-mo intervention) and was implemented across three home care organizations. Qualitative findings were based on 30 semistructured interviews with home care nurses (n=19) and administrative managers (n=11). About 16/21 (76%) of nurses accessed the dashboard daily or near-daily, but challenges included alert fatigue, workflow disruption, and limited integration with clinical systems. Nurses described mixed initial reactions to telemonitoring, valued hands-on training, and emphasized the need for clearer workflows and technical support. Digital tools were seen as clinically useful but added complexity to care delivery. Sustained use required local adaptation, attention to digital literacy, and greater system integration. Relational care remained central to nursing practice, even in digitally supported contexts. Telemonitoring programs can be successfully implemented in public home care settings when supported by strong leadership, responsive training, and adaptive workflows. This study highlights the relational, technical, and organizational dimensions of implementation and offers lessons to inform future scale-up efforts in similar public health systems.

Sing&Grow Australia is an evidence-based, federally funded music therapy program that caters to children from birth to 5 years of age and their families across Australia. In the current study, the Sing&Grow program was delivered to families affected by sexual abuse and domestic violence, with a focus on improving parents' capacity to develop secure relationships with their young children. The lifelong effects of trauma, including developmental delays, can prevail if not addressed early in children's lives. Eight parents participated with their children in the Sing&Grow program. Data were generated through semi-structured interviews and analysed using narrative analysis. This approach sought to further understand how involvement in the Sing&Grow program improved parents'/caregivers' self-efficacy to support their child's development using music, responsive parenting skills and subjective wellbeing. The findings from the study highlighted the benefits of participation in the Sing&Grow program for parents, including increased social connectedness, responsiveness, self-efficacy and knowledge to use music as a parenting tool. Importantly, the narratives illuminated how these changes were experienced and understood by the parents within the context of trauma. This study contributes new qualitative knowledge by offering an in-depth narrative account of how trauma-aware, music-based early intervention is experienced by parents and caregivers affected by sexual abuse and domestic violence. Sing&Grow offers parents and caregivers opportunities to integrate positive social and communication skills into parenting and children's daily routines.

The acute respiratory distress syndrome is a heterogenous syndrome characterized by the rapid development of respiratory failure. Nearly 40% of patients who develop ARDS will die, and there is growing interest in identification of biomarkers to identify patients at risk of death and/or inform treatment decisions. Most prior work on biomarkers in ARDS has focused on the plasma compartment, but there is concern that circulating biomarkers may not reflect alveolar pathobiology. The anti-inflammatory microRNA-146a has been shown to be upregulated in inflammatory cells in human bronchoalveolar lavage fluid, but it is not known if these levels correspond with outcomes. We measured miR-146a expression by digital droplet PCR in human biospecimens from four different cohorts of patients with respiratory failure requiring mechanical ventilation - two plasma cohorts, one bronchoalveolar lavage cohort, and one heat moisture exchange (HME) filter fluid cohort. We found that miR-146a was detectible in plasma, bronchoalveolar lavage fluid, and HME fluid. However, only when measured in the alveolar space, was miR-146a expression significantly lower in older adults and those who died. It did not correlate with outcomes when measured in plasma. To our knowledge, this is the first report that nucleotides can be measured in HME fluid and builds upon expanding literature that circulating biomarkers may not reflect complex biology of the alveolar microenvironment during ARDS.

Age acceleration, or the difference between biological and chronological age, is a research area of growing interest, particularly in the field of age-related and neurodegenerative disorders, including Alzheimer's disease (AD). First-generation epigenetic clocks that predict chronological age utilising DNA methylation data were the first to derive estimates of age acceleration, which have been associated with several age-related conditions. More recently, second-generation epigenetic clocks that are predictors of specific traits such as age-related health, disease or morbidity and mortality phenotypes have been developed. These are considered better predictors of health-related traits and show stronger associations with lifespan and mortality than most first-generation clocks. This study aimed to extend on our previous findings of associations of first-generation clocks with hippocampal volume, by investigating the relationship between ten second-generation clocks and brain volumetrics, brain A&#x3b2; burden and cognition in the Australian Imaging, Biomarkers and Lifestyle (AIBL) and Alzheimer's Disease Neuroimaging Initiative (ADNI) cohorts. Significant associations were found between age acceleration, as estimated by the Principal Components PhenoAge (PCPhenoAge) epigenetic clock, and hippocampal volume in the AIBL study, with replication in the ADNI dataset. Several other significant cross-sectional findings were observed between hippocampal volume and GrimAge, PCGrimAge, PCHorvathS2013, PCHorvathS2018 and PCHannumG2013 and between a DNA methylation-derived estimate of telomere length and change in brain A&#x3b2; burden. However, these results were not validated in the ADNI cohort. This investigation of second-generation epigenetic clocks further adds to the body of existing literature on the application of epigenetic clocks in relation to the ageing process and in the development of AD-related traits.

Informed consent is a cornerstone of ethical practice. Eliciting patient questions during informed consent increases patient engagement and understanding, thus enhancing integrity of the consent process. However, a patient in visible pain can add an additional challenge to the informed consent process. The purpose of this research was to examine if and how anesthesiology residents ask for questions from a patient displaying severe pain during an informed consent simulation. Anesthesiology residents recruited from three anesthesia residency programs were video recorded performing an informed consent with a 52-year-old White male simulated patient awaiting urgent repair of a perforated gastric ulcer who was displaying verbal and nonverbal signs of pain. Two independent coders evaluated whether, when and how residents elicited patient questions during the informed consent process. Among a sample of 65 first- and third-year anesthesiology residents, more than 20% of residents did not elicit questions during the informed consent encounter. Those who elicited questions typically did so late in the process, with approximately 10% inviting questions only after the consent form had been signed. Most questions were closed-ended (yes/no questions). Although residents did not typically incorporate the patient's name when eliciting questions, most residents demonstrated eye contact. There were no differences in the number or characteristics of questions elicited based on resident gender or level of training. Our findings suggest there is a need for increased education regarding the purpose and approach to eliciting patient questions during the informed consent process, especially for patients who are experiencing pain. When a patient is about to have surgery, they talk with their doctor about what to expect. Then they must agree to have the surgery and agree to the anesthesia needed for the surgery. This is known as the informed consent process. Patients who are about to have surgery may have a lot of questions for their doctor. It is important for the doctor to ask the patient if they have any questions. This study looked at videos of a training session for anesthesiology residents, who are doctors in advanced training to give anesthesia. In this training session, the anesthesiology residents were asked to get informed consent from a patient. The patient was an actor pretending to be in a lot of pain. This study looked at whether the anesthesiology resident ever asked the patient if he had any questions. Our results show that sometimes the doctors did not ask if the patient had questions. Sometimes the doctors ask after the consent form has been signed. We need to train anesthesiology residents to always ask if the patient has questions before the patient agrees to the surgery and the anesthesia.

Periodontal disease, an inflammatory condition affecting the tissue surrounding the teeth, has been associated with various systemic health issues. Dietary nitrate and nitrite are found in a range of plant and animal foods and, depending upon source, have been linked with both positive and negative health effects, including improved oral health with plant sources. This study aimed to investigate the associations between source-dependent (plant- and animal-sourced) nitrate and nitrite intake and odds of periodontal disease. We explored cross-sectional and longitudinal associations between tertiles of source-dependent nitrate and nitrite intake and the odds of periodontal disease using multivariable logistic regression models (cross-sectional analyses) and generalised estimating equations (longitudinal analyses) in 158,778 and 83,026 participants, respectively, from the UK Biobank. Dietary nitrate/nitrite intake was estimated from 24&#xa0;h dietary assessments and a comprehensive food composition database. Higher intake of plant-derived nitrate was associated with significantly lower odds of periodontal disease in cross-sectional (OR [95%CI]: 0.925 [0.894-0.958]) and longitudinal (OR [95%CI]: 0.880 [0.840-0.921]) analyses compared with lower intakes. A similar pattern of association was observed for plant-derived nitrite. Animal-derived nitrate intake was not associated with odds of periodontal disease. Higher intake of animal-derived nitrite was associated with significantly higher odds of periodontal disease in cross-sectional analyses only (OR [95% CI]: 1.043 [1.009-1.078]). Plant-derived nitrate and nitrite were associated with lower odds of self-reported periodontal disease, whilst animal-derived nitrite showed adverse associations in cross-sectional analyses only. Associations between dietary nitrate and nitrite with oral health outcomes may therefore depend on food source. Further mechanistic and intervention research is needed to test causality.