To evaluate health care utilization in veterans with Alzheimer disease (AD) in the Veterans Affairs health system (VAHS). This retrospective analysis identified veterans with AD using clinical notes extracted from the VAHS electronic health record from fiscal years 2010 to 2019. The first note identifying AD was the index date. Health care utilization in veterans with AD and a 1:1 matched comparison group without AD was evaluated at 2 years preindex, 1 year preindex, 1 year post index, and 2 years post index. From clinical notes, we identified 571,671 veterans with AD and 571,671 for the comparison group (overall: mean age, 74 years; 96% male; 75% White). In those with AD, outpatient visits per patient per year peaked 1 year post index at 67 and remained elevated 2 years post index at 57; without AD, the rate was approximately 19 at all time points. Hospitalization rates peaked at 1 year post index with AD but were lower and generally stable without AD. Nursing home utilization was relatively low overall. Veterans meeting the 2-code criteria (n = 56,305), defined as having 2 diagnostic codes for AD recorded at least 30 days apart, had consistently higher utilization than veterans without AD (especially post index). Veterans with AD have higher health care utilization than veterans without AD, especially around the time of AD diagnosis.
High-intensity interval exercise (HIIE) improves cardiorespiratory fitness through cardiac and skeletal muscle adaptations; however, the relationship between microvascular function and local skeletal muscle oxygenation during HIIE is unclear. Near-infrared spectroscopy at the vastus lateralis (∆ from baseline) was used to assess microvascular function pre- and post-HIIE and oxygenation throughout HIIE (n = 22 enrolled; n = 19 reported with complete oxygenation data, 27 ± 6 yrs., 42% female). HIIE consisted of twelve, 1-min intervals at 85% of peak power output while microvascular function was assessed using vascular occlusion-reperfusion. During HIIE, despite no change in the deoxygenation time constant tau (τ) (all p > 0.059), deoxygenation magnitude progressively increased at intervals 6 and 8 (both p < 0.011) and was greater at interval 11 compared to 1 (-49 ± 13 vs. -41 ± 19%, p = 0.033). Similarly, there was no change in the reoxygenation τ (all p > 0.753) while reoxygenation magnitude was immediately attenuated from interval 2 compared to 1 (-14 ± 18 vs. -6 ± 12%, p = 0.007) and was less at both intervals 6 and 11 compared to 1 (both p < 0.004). Microvascular function assessed as the 2-min hypersaturation area under the curve (AUC) was lower 15 min post- and 2 h post-HIIE compared to pre-exercise (both p ≤ 0.025), while the 10 s saturation upslope remained unchanged when controlling for the occlusion nadir (p = 0.212). The 2-min AUC (ρ = 0.659, p = 0.003) and 10 s upslope (r = 0.481, p = 0.043) correlated with peak cardiorespiratory fitness but were not related to reoxygenation outcomes (all p ≥ 0.113). These findings describe the acute oxygenation environment of HIIE while suggesting that sustained microvascular vasodilation may be lower post-HIIE.
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 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 < 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.
Mosquito larvae feed on microbes growing on decomposing organic matter, which in cities is often limited to a finite amount of allochthonous leaf litter in artificial container habitats. Curiously, field surveys in US cities consistently document a mismatch between blocks with the greatest mosquito infestations and blocks where their plant resources are most plentiful, with variation shaped by socioeconomic factors. We gathered leaves characteristic of socioeconomically diverse blocks in Baltimore, Maryland, and Washington, DC, to create lab mesocosms for two common mosquito species, Aedes albopictus (Skuse) and Culex pipiens (Linnaeus). We reared mosquitoes at varying densities to assess the effects of leaf litter composition on survival, development time, and body size, from which we calculated population performance and effects on competition. We also investigated traits of the leaf litter and aquatic environment. Leaf litter containing at least one non-native species, including the mix common on low-income blocks (nonnative trees Ailanthus altissima and Paulownia tomentosa) and the mix common across the region (native tree Juglans nigra and nonnative tree Morus alba) improved mosquito outcomes compared to the native leaf litter common on high-income blocks (native trees Acer rubrum and Ulmus americana) and also alleviated competitive effects on development time, perhaps making coexistence more likely. The three litter types showed significant differences in C:N ratio, decay rate, and tannin/lignin concentration but not in microbial abundance. These results offer a mechanistic explanation for previously observed socioeconomic patterns in urban mosquito populations and point toward novel strategies for mosquito control through vegetation management.
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The response of the 1,5-tolyl-3-phenyl-6-oxo-verdazyl radical (pTolOV) to pressure in the crystalline state has been investigated using both high-pressure X-ray diffraction techniques and density functional theory (DFT) calculations. Changes in structure, electronic properties such as band gap and density of states, and magnetic exchange interactions have been explored. Structural analysis reveals a phase transition between the P21/n and C2/c space groups between 2.30 and 2.73 GPa, and an accompanying increase in molecular point group symmetry in the solid state structure at higher pressures. Modelling using periodic DFT-based methods reveals no significant energy penalty to this phase transition with a small reduction in the band gap upon increasing pressure due to changes in the intermolecular distances, before a sharp increase in band gap with the changes in intermolecular alignment in the C2/c phase. These variations fall in the range 2.02-1.94 eV, and the radical remains a wide-gap semiconductor in the solid state across the pressure range examined. Further DFT calculations with gas-phase models reveal weak antiferromagnetic exchange interactions occurring in antiparallel π-stacked chains in both phases.
Current understanding of mental health problems among aviation pilots remains limited. Pilots are exposed to distinctive occupational stressors, and when psychological distress occurs, they may be reluctant to disclose symptoms or seek timely assistance because of concerns about stigma, loss of income, licensing restrictions, or medical disqualification from flying. Pilot mental health is therefore not only an occupational health issue, but also a critical component of aviation safety governance. Although the vast majority of mental health conditions do not lead to flight safety events, in rare circumstances, severe psychological crises that remain unidentified or unsupported may result in catastrophic outcomes, including aircraft-assisted pilot suicide. These tragic events underscore the potential safety implications of pilot mental health and highlight the urgent need for greater attention to this critical issue. This article argues that prevention should be centered on system-level measures, including confidential peer support, carefully governed digital tools, destigmatized safety cultures, and harmonized data infrastructures.
Nonpharmacological lifestyle interventions can prevent age-related cognitive decline, but people find adhering to healthy habits challenging. The Aging Well through Interaction and Scientific Education - Action Plan (AgeWISE-AP) program provides brain health and lifestyle group education followed by individualized goal setting sessions modeled on the VA Whole Health model. To use examples of the individualized healthy aging goals and strategies created in the AgeWISE-AP program action-plan sessions to demonstrate the importance of considering what matters most when working toward lifestyle change. Veterans (cognitively intact, age ≥60) in the action-plan component of AgeWISE-AP participated in eight one-on-one sessions to create and implement individualized lifestyle goals to support positive brain health outcomes. Participants (n = 36) developed up to four unique SMART (Specific, Measurable, Achievable, Relevant, Time-bound) brain health goals, generating 120 goals across brain health domains. Case examples demonstrate the process of engagement, goal setting, and implementation. Participation in a nonpharmacological intervention focused on individualized selection of lifestyle changing goals can support healthy brain aging. Understanding what matters most to older adults (their "why"), together with personal interests and activities that motivate them to consistently participate in behavior goals (their "what"), may aid in the success of such interventions.
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.
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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 Aβ 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 Aβ 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.
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.
Accumulation of brain amyloid beta (Aβ), a key pathological hallmark of Alzheimer's disease (AD), begins decades before cognitive symptoms. Being able to predict the risk of Aβ accumulation, or the age at which Aβ exceeds a critical threshold, may enable intervention to delay or prevent onset of AD. Using published genome-wide association studies (GWASs), we developed polygenic scores (PGS) for AD risk (PGSrisk) and resilience (PGSresilience), and tested whether these predicted (i) if an individual is an Aβ accumulator ('Accumulator Status'), and (ii) in accumulators, the age at which brain Aβ exceeds a 20 centiloid (CL) threshold ('Age at onset of Aβ'; AAO-Aβ) in 2175 participants (1158 with AAO-Aβ) from the Alzheimer's Dementia Onset and Progression in International Cohorts (ADOPIC) study. We also performed GWASs on these traits to develop phenotype-specific PGSs. Higher genetic risk of AD predicted increased odds of Aβ accumulation (OR = 1.16; 95% CI = 1.05-1.29; p = 0.003) and younger AAO-Aβ (β = -1.32; SE = 0.31; p = 1.63 × 10-5). Higher genetic resilience to AD predicted later AAO-Aβ (β = 0.91; SE = 0.29; p = 0.002) but did not predict Aβ accumulation. These associations were independent of APOE ε4 status, the strongest genetic risk factor for AD. Phenotype-specific PGSs were not significantly associated with either trait. Polygenic scores, alongside other risk factors, may help identify individuals at risk of accumulating Aβ, and predict the age at which this exceeds a critical threshold. This could provide a window for administering disease-modifying treatment or lifestyle interventions to prevent or delay the onset of AD. National Institutes of Health (R01-AG058676-01A1) and Australian National Health and Medical Research Council (GNT1161706; GNT2001320).
To assess differences in incidence, patient characteristics, and survival outcomes by socioeconomic status [SES] in paediatric out-of-hospital cardiac arrest [pOHCA]. OHCA patients aged <15 years attended by emergency medical services [EMS] in Western Australia [WA] between 2015 and 2024 were identified. SES was classified using the Australian Bureau of Statistics Index of Relative Socio-Economic Disadvantage. SES was assigned based on each patient's residential address and categorised according to WA population-based tertiles (Low, Mid, High). Crude and age-standardised incidence rates per 100,000 population per year were calculated for all pOHCA. Incidence was modelled using negative binomial regression, stratified by SES tertile and paediatric age-group (infant, young child, older child). Survival outcomes (return of spontaneous circulation at hospital arrival [ROSC] and 30-day survival) were descriptively reported by SES tertile. A total of 411 pOHCAs attended by EMS were eligible for inclusion. The crude incidence of pOHCA was 9.03 per 100,000 population per year. Nearly half of all events (n = 201; 48.9%) occurred in children residing in low-SES areas (most disadvantaged). Incidence decreased with increasing socioeconomic advantage. The magnitude of the socioeconomic gradient differed by age (interaction p = 0.015) and was most pronounced in infancy. Overall, 11.7% of children achieved ROSC and 30-day survival was 7.8%, with no consistent socioeconomic differences observed. Socioeconomic disadvantage is strongly associated with higher pOHCA incidence, with the gradient most pronounced in early life. These findings highlight the need to better understand the mechanisms underpinning these disparities.
The impact of a narrow true lumen (NTL) on the outcomes of fenestrated-branched endovascular repair in patients with postdissection thoracoabdominal aortic aneurysms (PD-TAAAs) is underreported. Data from an international, multicenter registry were analyzed, to identify patients treated for PD-TAAAs (2015-2025) at 23 centers. All patients underwent fenestrated-branched endovascular repair using custom or off-the-shelf endografts. NTL was defined by a true lumen diameter <25 mm identified at any aortic level on preoperative computed tomography angiogram. Short-term endpoints compared between NTL and no-NTL patients included technical success, procedural metrics, 30-day mortality, and major adverse events (MAEs). Midterm endpoints included 5-year freedom from aortic adverse events (related mortality, rupture, reintervention, endograft instability) and freedom from target artery instability. Among 544 patients (1705 target vessels), 438 (80%) had an NTL. Device design did not differ between groups (52% branches, 30% fenestrated, and 18% fenestrated-branched combination; P = .053). Patients with an NTL more frequently received bridging stent reinforcement (P < .001), and renal inner branches (P = .038). Septotomy or false lumen occlusion were more often performed in NTLs (27% vs 11%; P = .006). Patients with NTLs had longer operating time (P = .031), fluoroscopy time (P = .007), and a higher dose area product (P = .046). Technical success was 95% in both groups (P = .750). Overall 30-day mortality was 4%, and MAEs occurred in 35%. NTLs did not have a significant impact on MAEs (adjusted odds ratio, 0.84; 95% confidence interval [CI], 0.28-2.76; P = .766). Freedom from any aortic adverse event at 5 years was lower in patents with NTL (73% vs 91%; P = .027), driven primarily by secondary procedures of false lumen embolization (P = .027). Freedom from target vessel instability was 86% ± 4% in the NTL group and 92% ± 4% in the no-NTL group (P = .072). Patients with NTLs had a similar primary patency (97% ± 2% vs 98% ± 2%; P = .380) but lower freedom from target vessel endoleak (89% ± 4% vs 97% ± 3%; P = .006). After adjustment, NTL diameter <10 mm (hazard ratio [HR], 2.45; 95% CI, 1.37-4.36; P = .002) was significantly associated with target artery instability. Use of inner branches (HR, 0.11; 95% CI, 0.02-0.87; P = .035) and bridging stent reinforcement (HR, 0.54; 95% CI, 0.31-0.96; P = .038) were protective. NTL is the most common anatomic presentation in PD-TAAAs and is associated with more complex procedures, but does not affect technical success, mortality, or MAEs. Patients with an NTL experience a higher rate or reinterventions, primarily false lumen embolization. NTL <10 mm is a risk factor for target vessel instability, and reinforcement of bridging stents may be beneficial in these cases.
The STRATA randomised-controlled trial (RCT) examined the antidepressant sertraline vs placebo for treating anxiety in autistic adults. Autistic people are often assumed to be reluctant to take part in RCTs due to intolerance of their inherent uncertainty. This study aimed to qualitatively examine autistic people's experiences of RCT participation, specifically regarding their random assignment to an antidepressant (sertraline) or placebo for their mental health, whilst blinded to treatment allocation. Semi-structured interviews were undertaken with a purposive sample of 62 STRATA participants. The interviews examined why they chose to take part, why they continued in the trial and/or discontinued medication, and their overall experience of participation. Interviews took place either during participation, or at participants' final trial appointment at 52-weeks post randomisation ('exit interviews'). Data were analysed thematically through a collaborative process, with multiple researchers independently coding, discussing, and refining themes. Interviewees often discussed improved anxiety, attributing changes to believing they were taking sertraline, experiencing the placebo effect, or external factors. Post-analysis unblinding revealed that improved anxiety was discussed equally by participants in both the sertraline and placebo groups. Some participants, including those taking placebo, experienced side effects, which mirrored the types, frequency, and severity seen in the general population. Many were able to manage these and continue, but some discontinued medication as a result. Aspects of trial design and delivery facilitated continuation with the study medication, including frequent appointments, shared control over medication dose, and meaningfully involving autistic people in trial design. Such non-pharmacological factors may enhance therapeutic benefits, and may improve RCT design and therapeutic alliances with autistic people.
Achieving high yield and grain quality in wheat typically requires substantial nitrogen (N) fertiliser application. However, given economic and environmental constraints, it is critical to understand whether growers can reduce N inputs without compromising performance, and whether existing varieties differ in their ability to cope with lower N availability. Using a novel field-based experimental platform, we assessed the performance of fifteen registered wheat varieties under six N regimes and over two seasons with contrasting weather patterns. As expected, yields and grain protein contents both increased with N application, although protein content plateaued at a higher N threshold than yield. We noted higher genotypic differences in N use efficiency (NUE; defined as yield per unit of available N) under zero- N fertiliser applications, revealing intrinsic variation in low-N resilience. N-driven yield increase was more strongly associated with spike number rather than spike weight. Two varieties selected in Denmark where tight fertiliser regulations are in place were included for comparison and could achieve high yield with contrasting strategies; one with low and the other with high spike weight. In addition, using a novel stable isotope field-based method, we could show that under higher N levels, the post-anthesis N uptake was decreased and this trait is critical to achieving positive grain protein deviation (higher increase in grain protein content than expected given its yield). Our findings highlight the necessity of evaluating commercial and pre-breeding wheat germplasm under reduced N conditions to identify genotypes suited to sustainable, lower-input agricultural systems in a changing climate.
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 ± 12.3 years; 65% female; 40% breast cancer). Participants reported a mean of 22.5 ± 9.0 symptoms at baseline, with a statistically significant reduction in symptoms throughout the study period 21.9 ± 9.2 symptoms (p = 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.
Devonian placoderms exhibit exceptional diversity in jaw and dental morphology, making them an ideal system for examining early gnathostome feeding mechanisms. Here, we investigate inferognathal (mandible) function in eight eubrachythoracid arthrodire placoderms from Australia's Late Devonian Gogo Formation. A combination of finite element analysis and quantification of dental surface complexity revealed distinct, size-dependent strategies for processing mechanically resistant materials (durophagy). Taxa with broad, flat dental surfaces experienced low strain during simulated bites, consistent with crushing armoured prey that could be engulfed whole. In contrast, the jaw of the largest taxon combined exceptional structural strength with highly complex, reinforced dentition, enabling force concentration to pierce through armour or shell, and tear apart prey items exceeding its oral capacity. Taxa of intermediate size exhibited higher strain and specialised slicing dentition, consistent with generalist diets or feeding strategies focused on shearing through softer tissues. Consumption of armoured prey in placoderms was therefore governed not by predator size alone, but by the relative size of prey to predator. Hard object feeding in arthrodire placoderms was not a result of a single mechanical solution, but involved several distinct solutions influenced by body size and prey-processing constraints.
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.