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The Ludeman Family Center for Women' s Health Research (Ludeman Center) at the University of Colorado (cwhr@ucdenver.edu) organized its 4th National Conference at The Broadmoor Hotel in Colorado Springs, CO. The research presentations and discussions from the three-day October 2024 conference addressed sex differences across the life span with a focus on cardio-metabolism and mental health. Over one hundred thirty participants, including scientists, clinicians, policy makers, advocacy group leaders and federal agency representatives participated in the meeting. In this manuscript, we briefly summarize the conference scientific presentations made at the 2024 meeting which were organized into 3-day sessions as well as poster sessions.

Visa inequities in global health have moved from the margins of academic discourse to the centre of a growing reform agenda. While recent literature has established that visa regimes function as structural determinants of global health participation, a critical gap remains: the solution pathways proposed to date remain dispersed across commentaries, editorials and toolkits rather than consolidated into a coordinated operational framework that institutions, conference bodies and funders can act on at scale. This Essay consolidates and builds on that emerging consensus to propose a Global Mobility Equity Framework comprising four interdependent and scalable domains: equitable convening, inclusive participation infrastructure, institutional accountability and distributed visa support systems. Drawing on documented cases spanning the International AIDS Conference, the World Health Summit, the Consortium of Universities for Global Health, and clinical training pathways for foreign medical graduates, we demonstrate that visa barriers impose cascading professional, financial and institutional costs that are systemic in pattern rather than exceptional in nature. We further show that virtual and hybrid conferencing, while promising, does not independently resolve underlying inequities related to connectivity, time zones, language access and the networking disparities that shape career trajectories. The framework we propose is not a restatement of the structural critique as that ground has been well covered. It is a citable, implementable operational response designed to guide coordinated action across global health's institutional landscape. Adopting this framework is a necessary condition for a more representative and effective global health system.

The Japanese Gastroenterological Endoscopy Society (JGES) established four core sessions on endoscopic treatment for upper gastrointestinal diseases under the theme 'Innovative Therapeutic Endoscopy' between 2023 and 2024. This review summarizes these sessions and compiles them as a conference report. At the 105th JGES Core Session, 14 studies were presented as frontiers of treatment for upper gastrointestinal stenosis. At the 106th JGES Core Session, 13 research findings were presented as developments of new endoscopic techniques for the management of neoplastic lesions in the upper digestive tract. At the 107th JGES Core Session, reports were presented from 14 institutions concerning innovations in therapeutic endoscopy, including endoscopic treatment advancements for upper gastrointestinal diseases in internal medicine and surgery. At the 108th JGES Core Session, research from 11 institutions was presented on endoscopic treatment for upper gastrointestinal bleeding. These four core sessions enabled us to recognize the current state of treatment and management approaches for neoplastic lesions, strictures, and bleeding in the upper gastrointestinal tract, and to clarify future challenges. We hope this will contribute to the advancement of upper gastrointestinal endoscopic therapy.

People living with rare diseases in Africa face substantial barriers to accessing healthcare services, including delayed diagnoses, limited treatment options and fragmented care systems. The main objective of the scoping review is to explore and map existing interventions designed to improve access to healthcare services for individuals living with rare diseases across the African continent. Design: The scoping review will be conducted using the Arksey and O'Malley framework, further refined by the enhancements proposed by Levac and colleagues. The process will follow six key stages: (1) identifying the research question, (2) identifying relevant studies, (3) selecting eligible studies, (4) charting the data, (5) collating, summarising and reporting the results, and (6) stakeholder consultation. A comprehensive search strategy will be implemented across several electronic databases, including PubMed, Scopus and Web of Science. Additionally, grey literature sources such as conference abstracts and institutional reports will be included. Studies will be eligible if they were conducted in Africa, published between 2004 and 2024 and focused on interventions aimed at improving access to healthcare for people living with rare diseases. Two independent reviewers will screen all titles, abstracts and full texts, with disagreements resolved through discussion or a third reviewer. Data will be extracted using a standardised extraction form. The protocol has obtained waiver from the ethics committee of Sefako Makgatho Health Sciences University (SMUREC/M/365/2025). The findings will provide valuable insights for physicians, laboratory scientists, researchers and policymakers, highlighting pragmatic and cost-effective strategies to enhance healthcare access for individuals with rare diseases in Africa. Results will be disseminated through peer-reviewed publications, policy briefs, conference presentations and stakeholder engagement activities.

Medical residents frequently experience anxiety, depression, burnout and suicidal ideation. Existing support strategies have shown limited benefit. The Impact de la Pair-Aidance Étudiante sur la Santé Mentale des internes de Médecine de première année (PAESSM) study will evaluate whether embedding Mental Health First Aid (MHFA)-trained peer supporters within a first-year residency cohort is associated with improved mental well-being and reduced psychological distress over 12 months. PAESSM is a non-randomised controlled mixed-methods quasi-experimental study in Lyon, France involving the two Lyon medical schools. Two contemporaneous cohorts will be followed for 12 months: first-year residents exposed to a structured peer-support programme and second-year residents receiving usual support resources without a structured peer-support network. About 430 residents are eligible in each cohort, with anticipated enrolment of approximately 260 per group. In the intervention cohort, around 10% of first-year residents will complete certified MHFA training and act as peer supporters. Online questionnaires will be administered at baseline and at 3, 6, 9 and 12 months. The primary outcome is 12-month mental well-being measured by the Warwick-Edinburgh Mental Well-Being Scale. Secondary outcomes include anxiety and depression symptoms, suicidal ideation, job strain and help-seeking behaviours. The primary analysis will use longitudinal targeted maximum likelihood estimation adjusted for prespecified baseline covariates and informative censoring. Sensitivity analyses will include mixed-effects models and complete-case analyses. A qualitative sub-study will explore peer supporters' experiences and implementation processes. Ethical approval was obtained from the Comité de Protection des Personnes Nord-Ouest IV (Ref: 2025-A01549-40). In accordance with French legislation applicable to minimal-risk research, formal written informed consent was waived and participants will provide documented non-opposition before inclusion. Findings will be disseminated through peer-reviewed publications, conference presentations and communication with institutional stakeholders and residents. NCT07161284.

To establish expert consensus on the diagnostic approach, treatment strategies, and fitness-to-dive assessment for divers with paranasal sinus disease, addressing the current lack of specific guidelines for this frequent diving-related disorder. A rapid, conference-based modified Delphi process was conducted with a panel of 14 Dutch otorhinolaryngologists, including four certified diving medicine specialists. Consensus was defined as more than 80% agreement. The panel achieved consensus on recommendations across four domains. For diagnosis, a comprehensive ENT evaluation including nasal endoscopy is recommended; low-dose CT-imaging is advised for persistent or recurrent cases to identify anatomical obstructions. Primary management is conservative, adhering to EPOS guidelines. Functional endoscopic sinus surgery (FESS) is reserved for cases refractory to medical therapy, particularly those with anatomical obstruction. Postoperatively, it is advised to refrain from diving for a minimum of 8 weeks. Return to diving requires confirmed mucosal healing via endoscopy and a test dive under controlled conditions. This Delphi-based consensus provides practical, evidence-informed guidance for clinicians, bridging the gap in formal guidelines and promoting uniform evaluation and treatment strategies within diving medicine.

The vestibular system is a sensory system within the inner ear and the brain that controls balance and physical coordination. Vestibular stimulation may have an impact on various physiological processes, including breathing, reducing apnea episodes and the need for respiratory support. It has been suggested that targeted vestibular stimulation in premature infants may improve neurodevelopmental outcomes and neuromotor function. To evaluate the benefits and harms of vestibular stimulation for reducing morbidity and promoting development in hospitalized preterm infants. We conducted searches in October 2025 using the following databases: CENTRAL, MEDLINE, Embase, CINAHL, Emcare, Epistemonikos, Directory of Open Access Journals (DOAJ), and three trials registries. We conducted manual searches of conference abstracts, checked the references of systematic reviews and included studies, and searched for errata or retractions related to the included studies. We included randomized controlled trials (RCTs) and quasi-RCTs that evaluated vestibular stimulation in preterm infants compared with no intervention or with other forms of vestibular stimulation. We excluded studies that combined vestibular stimulation with other types of sensory stimulation. Our outcomes of interest were major neurodevelopmental disability at 18 to 24 months' corrected age (cerebral palsy, developmental delay, intellectual impairment, blindness, and sensorineural deafness), death during initial hospitalization, and weight gain (g). We also analyzed additional clinical outcomes reported by the included studies, including intraventricular hemorrhage, duration of hospital stay, number of days until full enteral feeding and number of apnea episodes during exposure to the intervention, which we synthesized where sufficient data were available. We used the Cochrane risk of bias tool, RoB 2. We conducted a meta-analysis using fixed-effect models to calculate risk ratios (RR) with their 95% confidence intervals (CI) for one outcome with dichotomous data - intraventricular hemorrhage (grades 1-4). Heterogeneity calculation was not applicable as we included only one study in each analysis. For other outcomes (weight gain, apnea, number of days until full oral feeding), we were unable to pool the results in meta-analyses because the trials presented data in different ways and at varying time points, or provided only limited data, which we were unable to recalculate for analyses. We synthesized them using synthesis without meta-analysis. We evaluated the certainty of the evidence for all outcomes using the GRADE approach. We included three RCTs and one quasi-RCT, that enrolled a total of 196 infants. One study evaluated vestibular stimulation using an oscillating air mattress; another study evaluated vestibular stimulation with an oscillating waterbed; a third study evaluated rocking; and the final study evaluated stimulation with VestibuGlide (a rocking chair). The comparisons were standard care, standard infant stimulation, and the use of a regular mattress. No studies compared different vestibular stimulation interventions. All four studies included only preterm infants. However, the range of gestational age used as an inclusion criterion varied across the studies. Three studies aimed to assess the effects of vestibular stimulation on neuromuscular develop-ment. Two of these studies also aimed to assess the effects of vestibular stimulation on body weight gain. Two studies aimed to assess the effects of vestibular stimulation on the respiratory system, and one study aimed to evaluate the role of vestibular stimulation on oral feeding functions. We identified three ongoing trials. Vestibular stimulation compared to no intervention No studies reported on major neurodevelopmental disability outcomes (cerebral palsy, developmental delay, intellectual impairment, blindness, or sensorineural deafness). The evidence is very uncertain about the effect of vestibular stimulation on death during initial hospitalization (no events were observed in either the intervention or control groups; 1 study, 122 participants; very low-certainty evidence). The evidence is very uncertain about the effect of vestibular stimulation on intraventricular hemorrhage compared with no intervention (RR 1.33, 95% CI 0.38 to 4.73; 1 study, 122 participants; very low-certainty evidence). No studies reported weight gain as prespecified in the review, however, narrative synthesis of three studies that reported weight gain using different definitions and time points suggested little to no difference between vestibular stimulation and control groups (3 studies, 169 participants, low-certainty evidence). We downgraded the overall certainty of the evidence for these outcomes due to risk of bias and imprecision. No studies reported on the duration of hospital stay, time to full oral feeding, or apnea as defined in our protocol. One vestibular intervention compared to another We found no studies that compared different types of vestibular stimulation. Therefore, it is unclear whether one approach is more effective than another. The evidence is very uncertain about the effect of vestibular stimulation compared to no intervention on death. The evidence suggests that any vestibular stimulation may result in little to no difference in weight gain. No studies reported major neurodevelopmental disability, a critical outcome in this review. Future studies of vestibular stimulation in preterm infants should use adequately powered, parallel‑group randomized controlled designs with clearly defined outcomes and transparent intervention reporting. One review author, ML, received stipends to conduct this review from the Childhood Foundation of the Swedish Order of Freemasons, and the Sällskapet Barnavård, Department of Women's and Children's Health, Karolinska Institute. Protocol available via DOI10.1002/14651858.CD016072.

Implementation science seeks to promote the adoption and sustainment of evidence-based interventions across diverse settings. While technical and organisational determinants of implementation have been extensively studied, relational factors-particularly trust and trustworthiness-remain under-theorised despite being frequently invoked in implementation research. Trust is often embedded implicitly within broader constructs such as stakeholder engagement, partnership quality or acceptability, yet is rarely explicitly defined, systematically measured or positioned clearly within implementation frameworks. No systematic review has comprehensively synthesised how trust functions within implementation science studies. This systematic review protocol follows Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015 guidelines and is registered with PROSPERO. We will conduct a targeted search on Scopus for 14 journals that are recognised by experts as being the most relevant in publishing implementation science literature. Supplemented by hand searching through Global Implementation Research and Applications. Studies examining trust or trustworthiness as a variable (explicitly or implicitly through related constructs) in relation to implementation processes or outcomes will be included. Two reviewers will independently screen titles/abstracts and full texts using Rayyan. Data extraction will capture trust conceptualisation, measurement approaches, levels of operation, constituent perspectives and inferred relationships with implementation outcomes. Quality assessment will use design-appropriate tools (Critical Appraisal Skills Programme for qualitative studies, Mixed Methods Appraisal Tool for mixed-methods). Given anticipated heterogeneity, we will conduct narrative and thematic synthesis rather than meta-analysis, exploring patterns by study design, setting, theoretical underpinnings, implementation phase and trust level. This systematic review of published literature does not require ethical approval. Findings will be disseminated through peer-reviewed publications, conference presentations at implementation science networks and non-technical summaries for community partners and policymakers. PROSPERO 2025 CRD420251270920.

Statin therapy is associated with an increased risk of dysglycaemia and new-onset type 2 diabetes, which compromises patient adherence. Ursodeoxycholic acid (UDCA), a hepatoprotective drug, has shown potential for improving glycaemic control, but its role in preventing statin-induced dysglycaemia remains unexplored in prospective randomised trials, particularly in a primary prevention setting. This trial aims to determine whether UDCA coadministration can prevent statin-induced impairment of glucose tolerance. This is an investigator-initiated, prospective, double-blind, randomised, placebo-controlled trial. A total of 128 participants with newly diagnosed hyperlipidaemia and no history of diabetes or cardiovascular events will be enrolled. Participants will be randomly assigned (1:1) to receive either atorvastatin (20 mg/day) plus UDCA (500 mg/day) or atorvastatin plus a matching placebo for 180 days. The primary outcome is the difference in glycated haemoglobin (HbA1c) absolute change from baseline to Day 180 between the intervention and control groups. The secondary outcomes are the difference in the absolute change of cardiometabolic risk factors and body composition between the intervention and control groups from baseline to Day 180. Safety outcomes include adverse events, serious adverse events, abnormal vital signs and abnormal laboratory parameters from baseline to Day 180. Data will be analysed according to the ITT principle. This study has been approved by the Ethics Committee of the First Affiliated Hospital of Xi'an Jiaotong University (No. XJTU1AF2023LSK-149-02). The study findings will be disseminated through peer-reviewed journals, symposiums and conference presentations. NCT06684106.

Acute-on-chronic liver failure (ACLF) is a severe syndrome in patients with chronic liver disease, marked by rapid multi-organ failure and high short-term mortality. Managing ACLF requires intensive care, but standardized global guidelines were previously lacking. The APASL ACLF Research Consortium (AARC) developed this position paper to establish a unified, evidence-based consensus for its critical care management. A global collaboration of 109 experts employed a systematic methodology to address key aspects of ACLF care. Sections were drafted by specialist teams, with recommendations developed using the GRADE system. Draft statements underwent iterative review and refinement, followed by an expert panel consensus process consisting of open show-of-hands voting during the APASL Annual Conference in March 2025 in Beijing and a subsequent anonymous online voting round. The consensus delivers 104 position statements. Key recommendations include using prognostic scores (AARC, CLIF-C ACLF, GIC) for ICU transfer and treatment decisions, and aggressively managing precipitating factors or complications like infections. It details organ-specific support for liver, kidney, and brain failure, advocating for early, targeted antibiotics and careful fluid management. The role of bridging therapies (plasma exchange, artificial liver systems) and nutritional support is emphasized. For transplantation, the guidelines provide criteria for patient selection and timing, particularly for alcohol-related ACLF. The APASL ACLF Beijing Position Paper provides a comprehensive, standardized framework for managing critically sick ACLF patients. Integrating multidisciplinary expertise and current evidence, these guidelines aim to optimize care, inform clinical decisions, and improve survival for this high-risk population. As a few recommendations are supported predominantly by data from different continents, they should therefore be interpreted in local contexts.

Artificial Intelligence (AI) is increasingly explored for medical education, and dermatology, with its visual diagnostic focus, holds promise for AIenhanced learning. However, evidence on its educational effectiveness remains limited and fragmented. This scoping review aimed to assess the evidence base for applications and limitations of AI-based educational tools in dermatology. A systematic search of PubMed, Embase, Web of Science, Scopus, and PsycINFO up to July 2025 was conducted. Data were synthesised narratively, considering types of AI interventions and their assessed outcomes. These were analysed with the Cost, Usability, Credibility, Fairness, Accountability, Transparency, Explainability (CUC-FATE) framework. Study quality was assessed with ROBINS-I and a COSMIN-informed checklist. A total of 827 records were screened, with 360 duplicates removed, yielding 467 studies. Six full-length studies and 1 conference abstract met inclusion criteria, mostly from 2023 to 2025. These explored AI-generated clinical images, Large Language Model-generated vignettes, intelligent tutoring systems, and clinical decision support tools. Content validation studies generally reported favourable ratings for accuracy, clarity, and educational utility, while intervention studies suggested possible benefits for learning performance and diagnostic accuracy. Usability and credibility were commonly assessed, whereas cost, accountability, fairness, transparency, and explainability were rarely examined. Most of the studies reviewed had high risk of bias, small sample sizes, and limited methodological rigour, with significant heterogeneity in examined educational outcomes limiting synthesis. While current initial studies on AI hold promise, this scoping review underscores the need for more robust studies with standardised evaluation frameworks, prioritising ethical principles such as fairness, explainability, and accountability for safe integration in training.

The current global status of breastfeeding is marked by both progress and challenges. Digital health interventions (DHIs) have emerged as a promising new strategy for improving breastfeeding practices, yet evidence regarding their impact on breastfeeding outcomes remains limited. To evaluate the impact of DHIs on breastfeeding practices and outcomes. Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, we searched PubMed, Web of Science, the Cochrane Library, Embase, CINAHL, Scopus, IEEE Xplore, and grey literature databases, from inception to April 2026. We included randomized controlled trials (RCTs) and quasi experimental studies that enrolled pregnant women or lactating mothers using DHIs versus standard care, waiting lists, or placebo. Outcomes were exclusive breastfeeding (EBF) rates, self efficacy, and knowledge. Studies recruiting mothers with infectious diseases or severe substance use disorders, non English publications, unavailable full texts or data, animal studies, letters, conference proceedings and studies rated as "high risk" were excluded. Study quality was evaluated using RoB 2.0 and ROBINS-I tools. Evidence certainty was assessed using GRADE (Grading of Recommendations, Assessment, Development, and Evaluation). We performed analysis using Review Manager 5.4 and R-4.6.0 software, estimated using the Hartung-Knapp-Sidik-Jonkman (HKSJ) random-effects model. Fifty-two studies involving 11,704 participants were included. DHIs were found to improve exclusive breastfeeding rates (at <3 months: relative risk [RR] 1.33, 95% CI 1.18-1.50; 95% prediction interval [PI] 0.85-2.08; P<.001, I&#xb2;=84%; at 3-6 months: RR 1.46; 95% CI 1.22-1.75; 95% PI 0.83-2.55; P<.001, I2=75%; at &#x2265;6 months: RR 1.64, 95% CI 1.27-2.11; 95% PI 0.74-3.62; P<.001, I2=86%) and breastfeeding self-efficacy (standardized mean difference [SMD] 0.67, 95% CI: 0.31-1.03; 95%PI -1.17-2.51; P < .001, I&#xb2; = 95%). No statistically significant effects were observed regarding breastfeeding knowledge. The exploratory results of subgroup analysis suggested that antenatal intervention delivery, intervention duration &#x2265; 3 months, study settings in developing countries, and participants including preterm parturients, adult women, and cesarean delivery mothers could improve the exclusive breastfeeding rate. In contrast, larger effect sizes for breastfeeding self-efficacy were observed among women with intervention duration < 3 months, full-term delivery, and singleton pregnancy. Overall, among the RCTs, 12 were low risk and 30 had some issues. Among the quasi-experimental studies, 3 were low risk and 7 as moderate risk. Evidence certainty ranged from low to moderate. DHIs show promise in improving exclusive breastfeeding rates and breastfeeding self-efficacy. Compared with previous reviews, this review provides a more comprehensive evaluation of DHIs and identifies potential effect modifiers through subgroup analyses, offering updated evidence for digital breastfeeding support. However, moderate risk of bias, substantial heterogeneity, wide 95%PI, and low-to-moderate GRADE certainty warrant cautious interpretation. Further high-quality studies are needed to confirm the effectiveness and optimize the implementation of DHIs in clinical practice. PROSPERO CRD 420251233352; https://www.crd.york.ac.uk/PROSPERO/view/CRD420251233352.