Endocrine disrupting chemicals (EDCs) that interfere with estrogenic, androgenic, thyroidal and steroidogenic (EATS) pathways, as well as non-EATS pathways, should be identified and classified under EU chemical regulations. Identifying and classifying obesogenic EDCs is particularly challenging, as they are typically regulated through non-EATS mechanisms and lack standardized test methods and guidance for evaluation. This review evaluates fish models of obesity, synthesizes current evidence on chemical effects on fish adipogenesis, and discusses the regulatory challenges associated with EDC identification and classification. Diet-induced obesity (DIO) fish models have been developed in species such as zebrafish, medaka, tilapia, rainbow trout, and others. However, the composition and quantity of diets in these studies vary significantly. Notably, the high calorie diet used to induce obesity in one zebrafish experiment may be equivalent to the control diet in another. Fat accumulation in fish has been studied in pharmaceuticals, bioactive chemicals, biocides, pesticides, and industrial chemicals. Body weight, body mass index (BMI), condition factor, and various endpoints derived from adipose tissue are commonly used to investigate obesity-related effects in fish. However, body weight alone may not reliably indicate adiposity. Obesity in fish is not explicitly addressed in existing OECD test guidelines. A mode of action (MOA) analysis is needed to identify and classify obesogenic EDCs. Both EATS and non-EATS pathways should be evaluated to establish biological plausibility regarding effects on population relevant obesogenic endpoints in fish. The challenges of using fish models of obesity are discussed, along with recommendations for incorporating relevant obesity related endpoints into test guidelines.
Ethylbenzene (EB) was placed on List 2 for Tier 1 endocrine screening in the U.S. EPA's two-tiered Endocrine Disruptor Screening Program (EDSP) and was scheduled for evaluation under TSCA. Results of toxicology studies on EB were used to evaluate estrogen, androgen, thyroid, and steroidogenic (EATS) endpoints by a Weight of Evidence (WoE) methodology, as required by U.S. EPA and OECD guidelines for evaluating a chemical's endocrine disruptive potential. The WoE method involved problem formulation, systematic literature search and selection, data quality evaluation, relevance weighting of endpoint data, and application of specific interpretive criteria. Data on EB were sufficient to assess its effects on endpoints that would be expected to respond to chemicals that operate via EATS modes of action (MoAs) in various screening assays (Tier 1) and toxicity tests (Tier 2) that evaluate reproduction, development, and sub-chronic and chronic toxicity. In those studies, EB produced a pattern of responses inconsistent with the responses that would be expected for hormones and chemicals known to operate via EATS MoAs. Endocrine-sensitive endpoints that respond to EB administration generally do so only at dose levels above its kinetic maximum dose, indicating a lack of relevance to potential effects at lower dose levels in either the test species or humans. This comprehensive WoE evaluation demonstrates that EB lacks the potential to exhibit endocrine disruptive properties and cannot be deemed an endocrine disruptor or potential endocrine disruptor. Because this WoE evaluation was based largely on Tier 2-level studies of the type considered by the U.S. EPA and OECD to be more definitive than results of Tier 1 EDSP screening results, no additional useful information would be obtained by subjecting EB to further endocrine screening. As such, further endocrine screening of EB would be unjustified from animal welfare perspectives. This analysis supports a regulatory decision to halt further testing of EB for endocrine disruption unless unique and compelling data to the contrary arise. See also the graphical abstract(Fig. 1).
Background: Dysphagia is prevalent among nursing-home residents and contributes to complications such as aspiration pneumonia, malnutrition, and diminished quality of life. Nurses' knowledge and attitudes strongly influence care quality, yet few validated tools exist to assess these domains in long-term care. Objective: This study aimed to develop and validate the Evaluating Attitudes, Training and Skills in Dysphagia Care (EATS) Questionnaire for nursing home nurses in Singapore. Methods: A cross-sectional study involving 111 nurses from three nursing homes was conducted. The EATS questionnaire was adapted from a hospice-based tool, refined through experts' and users' feedback, and subjected to psychometric testing. Analyses included item difficulty and discrimination for the knowledge component, exploratory factor analysis for the attitude component, and internal-consistency reliability. Construct validity was examined by comparing knowledge and attitude scores across nursing seniority and experience. Results: The final questionnaire comprised 22 knowledge and 18 attitude items that loaded onto three factors-Barriers to Dysphagia Care, Patients' Preferences and Nurses' Confidence, and Personal Choice. The attitude scale showed moderate internal consistency, and the knowledge items demonstrated acceptable performance for discrete factual content. Senior nurses scored higher in knowledge, confirming construct validity. The tool revealed persistent misconceptions and gaps in recognising subtle clinical signs of dysphagia. Conclusions: The EATS Questionnaire is a valid and pragmatic instrument for assessing dysphagia-related knowledge and attitudes among nursing home nurses. It provides actionable insights for designing targeted education and improving resident safety in long-term care settings.
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Home-based interventions can support fruit and vegetable (FV) consumption in young children. Although their effectiveness is well documented, real-life implementation experiences remain understudied; such knowledge is crucial for sustained and scalable impact. Citizen science offers a promising approach for collecting large-scale, practice-based insights into how such interventions are used in daily life. This study used a contributory citizen science approach to explore caregivers' experiences with the in-home implementation of "Miffy eats the rainbow!" and their perceptions of its effectiveness in supporting children's FV acceptance at home. A total of 42,000 sticker sheets were distributed across 420 Dutch retail locations, supported by a national media campaign. Caregivers who used the method at least once were invited to complete an online questionnaire assessing implementation outcomes (acceptability, appropriateness, feasibility, sustainability) and perceived effects on children's FV enjoyment, variety, and amount. Quantitative data were analyzed using descriptive statistics and ANOVA (by food fussiness); qualitative responses were thematically analyzed using an inductive approach. A total of 209 caregivers participated (response rate: 0.5%). Implementation experiences were rated positively, with over 90% agreeing the method was fun (4.5 ± 0.6), easy to use (4.4 ± 0.7), and time efficient (4.3 ± 0.7). Ratings remained consistently high across all food fussiness levels. Perceived effects on children's FV enjoyment, amount, and variety were slightly positive, with mean scores ranging from 3.2 ± 1.0 to 3.6 ± 1.0. Qualitative responses provided additional insights into benefits, implementation strategies, and barriers. "Miffy eats the rainbow!" was positively received by self-selected caregivers, with high implementation ratings suggesting potential for broader in-home application. However, the very low response rate highlights challenges in achieving voluntary participation and raises concerns about selection bias. Future efforts should aim to promote inclusive engagement and evaluate long-term use across more diverse populations.
Infective endocarditis (IE) rates have risen sharply, spurred by injection drug use (IDU). Public health interventions to prevent infectious complications of IDU have primarily focused on communicable diseases, such as HIV and viral hepatitis. We assessed patients' knowledge of IE in relation to IDU practice. From 2021 to 2022, we conducted in-person semi-structured interviews (SSIs) with 16 adults hospitalized with IDU-related IE at an academic medical center in North Carolina. SSIs explored participants' knowledge and experience of IE and IDU practices. The SSIs were audio-recorded, transcribed verbatim, and thematically coded. We identified 4 primary themes: limited knowledge of IE; nonspecific IE symptoms; injection behavior and infection prevention; and knowledge of other IDU-related infections, such as hepatitis C virus (HCV) and HIV. Most patients reported little or no knowledge of IE before hospitalization despite previously having soft tissue infections, such as skin abscesses. Presentations were heterogeneous, with many patients not recognizing their symptoms as IE, and often delaying seeking care. In contrast to limited information about IE, all patients reported prior testing for HIV and HCV. While many expressed the importance of not reusing injection equipment, many patients reported reusing injection equipment nonetheless, and several specifically reported that they take no dedicated precautions to prevent infections. Our findings suggest prior to hospitalizations, knowledge of IE, its symptoms, and prevention is limited among persons who inject drugs who acquire IE. Our study indicates an urgent need to disseminate public health messages regarding preventing IDU-related invasive bacterial infections and providing access to sterile equipment to prevent bacterial infections.
Parasite transmission can be disrupted when their free-living larval stages are consumed by non-host organisms. Yet, the contribution of benthic scrapers to this process remains insufficiently explored. Here, we experimentally assessed the ability of the North American pulmonate snail Physa acuta to reduce the abundance of free-living digenean larvae - cercariae of Diplostomum sp. and Trichobilharzia sp., and adolescariae of Notocotylus sp. - and evaluated how this effect is modulated by snail body size and colonisation by other organisms. Larval consumption by P. acuta occurred in all treatments and was highest for settled Notocotylus sp. adolescariae, particularly among larger individuals. The extent of larval reduction varied with infection by digenean metacercariae (xiphidiometacercariae), which either enhanced or inhibited feeding depending on parasite identity. It also varied with colonisation by Chaetogaster limnaei limnaei, whose presence increased the ingestion of planktonic cercariae, likely due to the combined feeding activity of the snail and its commensal oligochaete. Most snails harboured metacercariae, indicating that P. acuta frequently functions as a second intermediate host in its non-native range. Our findings highlight the dual ecological role of P. acuta - both as a consumer of free-living parasite stages and as a competent host. This trophic interaction may disrupt parasite transmission while providing nutritional benefits that support the ecological success and spread of this non-native species. Conversely, by serving as a host, P. acuta may facilitate the persistence and dissemination of parasitic taxa in invaded ecosystems.
Research has produced a substantial and expanding body of evidence-based practices (EBPs), encompassing interventions, programmes, clinical guidelines, protocols, care pathways and models of care supported by the best available evidence. Despite this, healthcare delivery is still frequently characterised as insufficiently evidence-based, reflecting a persistent gap between what is known to be effective and what is routinely implemented in practice. Traditional explanations only partially account for this gap, often overlooking culture as a critical yet under-theorized influence. Culture is a learned phenomenon rooted in social contexts, encompassing shared norms, values, beliefs and assumptions that define a group, whether a team, profession or organization. This paper argues that the uptake and sustainability of EBPs are profoundly shaped by cultural dynamics operating across three key layers: organizational, professional and disciplinary. Organizational culture shapes openness to change, learning and psychological safety, influencing whether EBPs are seen as improvements or burdens. Professional cultures, rooted in education and identity, affect how physicians, nurses and other professionals apply guidelines and protocols. Disciplinary cultures, tied to clinical environments (e.g. emergency, intensive, mental health, palliative care), also shape how EBPs are received. Enhancing cultural responsiveness requires aligning EBPs with the shared norms, values, beliefs and assumptions of the intended users. Strategies include fostering clinician engagement in the development of EBPs, cultural competence, local adaptation and leveraging cultural champions. Implementation of EBPs is shaped by culture, not solely by the strength of evidence or implementation strategies. Organizational, professional and disciplinary cultures interact to influence how EBPs are interpreted, accepted, adapted or resisted in practice, helping to explain persistent variation in uptake. Misalignment between EBPs and prevailing norms, values, beliefs and assumptions undermines implementation even when evidence is strong.
Fungus-growing ants maintain an ectosymbiotic microbial garden, an intertwined mesh of fungal symbiont hyphae and microbiota growing through plant substrates. Here, we investigate how different plant diets influence the garden lignocellulosic profile, and whether the microbiota respond to dietary changes. Colonies of Atta sexdens were provided with four different dietary regimens, varying in fiber composition and nutritional content. Diet changed the garden lignocellulosic profile, also influencing the microbial taxonomic composition. The diet of only leaves enriched the garden in Bacillus and Weissella, while a diet of only fruits/cereals lead to a Carnimonas and Mesoplasma enrichment; diets mixing leaves and fruits/cereals intermittently and alternatively enriched the garden in Bacillus, Mesoplasma, and Weissella. The fungal crop development and the spatial distribution of the microbiota and biofilm also varied according to the diet. Our findings suggest that diet has a pivotal role in determining whether ant colonies function optimally and remain healthy.
Tumor necrosis factor (TNF), type I interferons (IFNs), and autophagy are important biological processes, but their interactions in inflammation have not been explored. In this issue of Immunity, Priem et al. reveal that ATG9A-mediated autophagy curbs skin inflammation by suppressing STING activation and Z-DNA binding protein 1 (ZBP1)-dependent cell death.
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The demand for multifunctional thin-film devices has accelerated the development of scalable fabrication techniques capable of precisely controlling composition, structure, and patterning. However, conventional approaches rely on complex, multi-step processing and harsh conditions, limiting their applicability. Herein, we report a single-step, electrically assisted thermal stamping (EATS) method for the direct and scalable fabrication of carbon-based nanofilms, including reduced graphene oxide (rGO), polytetrafluoroethylene (PTFE), and their nanocomposite films. By applying localized Joule heating to PTFE-embedded carbon paper under ambient conditions, EATS induces graphite exfoliation, GO reduction, and PTFE incorporation, thereby eliminating the need for multi-step processing or harsh environments. The resulting films exhibit tunable thickness, morphology, and composition, governed by EATS power density and duration. EATS enables spatially selective patterning without the need for complex lithographic techniques. The versatility of EATS is demonstrated through the direct fabrication of functional devices: (i) hydrophobic coatings with contact angles tunable from 44.3° to 109.8°, (ii) triboelectric nanogenerators achieving 10.11 mW cm-3 power density with <2.8% variation over 10 000 cycles, and (iii) humidity sensors exhibiting a 3.56% sensing error across 50-100% relative humidity. These results establish EATS as a powerful, lithography-free fabrication platform for multifunctional thin-film devices, offering a generalizable strategy for next-generation electronics.
Atlantoaxial instability (AAI) is complex and challenging to manage due to the biomechanical and neurovascular significance of the craniocervical junction. Posterior fixation remains the gold standard but may be contraindicated or infeasible in select patients. Although anterior transoral/transnasal approaches provide adequate access to the atlantoaxial joints, their deep, narrow, and contaminated surgical corridor may reduce visualization and increase postoperative infection risks. Full-endoscopic anterior retropharyngeal procedures also have blind zones that limit visualization, prevent complete joint decortication, and often require posterior fixation to ensure adequate cervical stabilization. A hybrid open Smith-Robinson exposure augmented by endoscopy and anterior transarticular screw (ATS) fixation may provide a wide, clean surgical corridor with improved visualization and high maneuverability that addresses these limitations. The main aim of this prospective study is to describe and evaluate the preliminary clinical outcomes of EATS (endoscopic-assisted anterior transarticular screw fixation) for managing AAIs. Thirteen patients with radiographically confirmed AAI underwent EATS between April 2024 and December 2025. The procedure consists of anterior Smith-Robinson exposure, fluoroscopic localization, endoscopic-assisted subchondral decortication and bone grafting, and fluoroscopy-guided ATS fixation. Measured outcomes included screw placement accuracy, neurological improvement (American Spinal Injury Association [ASIA] grade and myelopathic symptoms), and time to radiographic arthrodesis. All procedures were completed successfully without any neurovascular complications. Postoperative computer tomography (CT) confirmed accurate screw positioning and satisfactory reduction in all patients. Solid arthrodesis was achieved within 12.4 ± 3.8 weeks. Neck pain, myelopathic symptoms, and ASIA (American Spinal Injury Association) scores significantly improved during follow-up. One postoperative cervical hematoma occurred in a patient receiving low-molecular-weight (LMW) heparin for thromboprophylaxis was recorded. No infections or implant-related complications occurred. EATS is a safe and effective anterior alternative for AAI management. It combines the advantages of the Smith-Robinson approach with enhanced endoscopic visualization and fluoroscopic precision, enabling accurate joint decortication, stable fixation, and early arthrodesis. Larger studies with longer follow-up may be required to validate the overall long-term outcomes and biomechanical efficacy.
Background: Few studies have explored the relationship between constipation and not eating enough to feel satiety. Aim: The study aims to examine the association between constipation and not eating enough to feel satiety. Methods: This cross-sectional study included 189 children 3 to 6 years of age. Constipation was defined as two or fewer defecations per week. To assess the satiety of children, mothers were asked, "Does your child eat until he/she is full every day?" The response options were as follows: "eats every day," "eats occasionally," "neither eats every day nor eats occasionally," "does not eat much," or "does not eat at all." "Eats every day" was defined as eating enough to feel satiety. The other four responses were defined as not eating enough to feel satiety. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using a logistic regression analysis. Results: Thirty-nine (20.6%) children had constipation and 112 (59.3%) children did not eat enough to feel satiety. The association between constipation and not eating enough to feel satiety was significant. The crude OR of constipation for children who did not eat enough to feel satiety was 2.25 (95% CI 1.02-4.96). After adjusting for sex and age, the OR was 2.15 (95% CI 1.01-4.98). After further adjustment for underweight and overweight, the OR was 2.11 (95% CI 0.94-4.76). Conclusion: Not eating enough to feel satiety was associated with constipation independent of sex and age.
Diflufenican (DFF) is a herbicide registered globally since the mid-1980s and submitted for renewal in the European Union (EU) in 2016. The submission included extensive data from repeat-dose studies, reproductive and developmental toxicity studies and ToxCast/Tox21 high-throughput in vitro screening data to allow an assessment of endocrine adversity and activity. Despite no evidence of estrogen, androgen, thyroid, or steroidogenic (EATS) mediated patterns of adversity, regulatory reviewers deemed the investigations insufficient due to outdated guidelines lacking EATS parameters. Such a shortfall is common for many plant protection products (PPPs) undergoing renewal due to advances in scientific methodology. The EU's stepwise testing strategy addresses this by requiring OECD Level 2 and Level 3 studies to assess activity. If negative, further testing is unnecessary. However, DFF's positive result in the in vitro steroidogenesis assay (Level 2) triggered an OECD Level 5 extended one-generation reproductive toxicity (EOGRT) study. The EOGRT data confirmed previous findings that DFF does not cause endocrine disruption (ED) related adversity. A comprehensive weight of evidence (WoE) assessment of existing data could have sufficed to conclude DFF's lack of ED properties, preventing unnecessary animal testing. This underscores the need to enhance WoE methodologies to better utilize existing data in regulatory evaluations.
While monoclonal antibodies (mAbs) continue to dominate the overall immunotherapy landscape, the field of T-cell-based therapeutics is rapidly evolving. Although chimeric antigen receptor T cells (CAR-T) and bispecific antibodies (BsAbs) currently represent the pillars of T-cell-directed therapy, the complexity of solid tumors demands a more diversified therapeutic arsenal. By combining antibody-mediated tumor targeting with the robust effector function of ex vivo expanded T cells, BsAb-armed T cells (BATs)-also referred to as Ex vivo Armed T cell (EATs)-provide a 'third way' that addresses the unmet needs of solid tumor immunotherapy. They can overcome the quantitative and qualitative deficiencies of endogenous immune effector cells in cancer patients. By offering personalized multi-antigen targetability and the prospect of off-the-shelf therapy, EATs have the potential to address critical challenges, such as poor tumor infiltration, immune escape via heterogeneity and target antigen loss, and treatment-related toxicities like cytokine release syndrome. In this review, we discuss the characteristics of EAT therapy, distinct from CAR-T and BsAb therapy, as an independent and alternative niche. We explore strategies to accelerate their clinical translation, encompassing BsAb optimization, modulation of the tumor microenvironment (TME) and cytokines, and simultaneous engagement of multiple antigens, which are essential for boosting EAT potency and overcoming the limitations of solid tumors. In this evolving landscape, EATs could play a unique and independent role, expanding the CAR-T and BsAb-dominated paradigm to address unmet clinical needs.
Satiety, cravings, and appetite have a behavioral impact on eating and may be associated with obesity. There are limited data evaluating the trajectory of hunger after sleeve gastrectomy (SG) and Roux-en-Y gastric bypass (RYGB). Metabolic and bariatric surgery (MBS) patients were given the Daily Eats questionnaire at their preoperative and postoperative appointments. Daily Eats is a validated survey which asks patients to rate hunger, appetite, cravings, and satiety on a scale of 0-10. Cross-sectional data were obtained at five timepoints including preoperative visits and postoperative appointments at monthly intervals including: 0-12, 12-24, 24-36, and > 36. Average Daily Eats scores in the postoperative setting for SG and RYGB patients were compared using independent sample t-tests with a p-value of < 0.05 indicating significance. There were 3898 Daily Eats questionnaires completed (2334 preoperative, 996 postoperative SG, 568 postoperative RYGB). Patient-reported outcome measures (PROMs) survey compliance was 77% at the time of this study with 2334/2537 (92%) preoperative surveys completed and 1564/2523 (62%) postoperative surveys completed. Patients who underwent SG reported significantly higher scores for hunger (4.87 ± 2.33 vs. 3.53 ± 2.16; p < 0.01) and appetite (5.07 ± 2.05 vs. 3.85 ± 1.76; p < 0.01) at 24-36 months when compared to patients who underwent RYGB. Patients who were > 36 months after SG reported significantly higher scores for hunger (4.58 ± 2.21 vs. 3.94 ± 2.39; p < 0.01) and appetite (4.67 ± 1.90 vs. 4.08 ± 2.27; p < 0.01) when compared to patients who underwent RYGB. Compared to RYGB, patients who underwent SG reported significantly more long-term hunger and appetite. PROMs after MBS may enable tailored postoperative care by procedure and improve preoperative counseling by illustrating how hunger-related sensations evolve differently depending on the surgical procedure.
Propylene oxide (PO) is a high-production-volume chemical widely used as an industrial intermediate and classified as carcinogen and mutagen in humans. Despite its regulatory significance, a comprehensive evaluation of its endocrine-disrupting (ED) potential has not been previously conducted. This review applies a weight-of-evidence (WoE) approach, integrating data from regulatory dossiers, peer-reviewed literature, publicly accessible databases, and in silico predictions to assess whether PO meets internationally accepted ED criteria. Available evidence indicates that PO does not exhibit endocrine activity via estrogenic, androgenic, steroidogenic, thyroid (EATS), or non-EATS pathways, as supported by negative quantitative structure-activity relationship (QSAR) predictions and absence of mechanistic effects in vivo. Similarly, adverse outcomes observed in repeated-dose, reproductive, and developmental toxicity studies were either secondary to systemic toxicity, inconsistent, or unrelated to endocrine modes of action. Epidemiological findings suggesting associations with breast cancer, diabetes, or obesity were limited by methodological uncertainties and lack of causal inference. Collectively, the WoE demonstrates that PO should not be classified as an endocrine-disrupting chemical for humans or wildlife, although data gaps remain for environmental receptors and metabolites.
BACKGROUND: Generalist consumers can eat a variety of foods, but they are not necessarily equally beneficial. Different feeding histories can influence the fitness of genetically similar individuals. Dictyostelium discoideum is a unicellular generalist predator amoeba that eats bacteria. When bacteria are depleted, amoebae enter the social cycle and aggregate to form a fruiting body, in which about a fifth of the amoebae die to form a stalk while the rest form spores at the top of the stalk. RESULTS: In this study, we examined the fitness of D. discoideum when grown on three bacterial prey types: poorly palatable wild-type Pseudomonas vindicans, a more palatable mutant of the same species, and the high-quality food bacterium Klebsiella pneumoniae. We used these three bacteria to examine how feeding history shapes fitness throughout the life cycle by measuring proliferation of amoebae, then following spores through germination, plaque formation, and plaque expansion. Amoebae grew on unpalatable P. vindicans only when seeded at high density, and even then, proliferated more slowly. When amoebae with different feeding histories were mixed and allowed to form chimeric fruiting bodies, those cells fed on palatable versus unpalatable P. vindicans did not differ significantly in their spore contribution, except when under an additional stress of the translational inhibitor G418, which makes cells that previously fed on unpalatable P. vindicans contribute fewer cells in spores. Oddly, the amoebae that fed on the good food bacterium Klebsiella pneumoniae contributed fewer spores when mixed with cells that fed on either of the P. vindicans clones. Surprisingly, though feeding on unpalatable prey was not a hindrance in the social stage, downstream effects were observed. Spores produced on either P. vindicans strain germinated more slowly than those made from amoebae fed on Klebsiella pneumoniae. CONCLUSIONS: Low prey quality strongly affects D. discoideum fitness during the vegetative stage but does not generally lower social competitive ability. Nevertheless, it does affect fitness after the social cycle by reducing the hatching rate of spores.
The coefficient of variation (CV) is employed to develop control charts to measure the relative dispersion of the data. The multivariate coefficient of variation (MCV) chart is used to monitor the CV in Phase-II in a multivariate framework. In this paper, the upward and downward variable sampling interval run sum multivariate coefficient of variation (VSI RS MCV) charts are developed to detect MCV shifts. The developed VSI RS MCV charts are evaluated and compared with their existing MCV and RS MCV counterparts using the average time to signal (ATS), standard deviation of the time to signal (SDTS) and expected average time to signal (EATS) criteria. Optimization programs incorporating the Markov chain methodology are developed in MATLAB to compute the optimal parameters and scores of the developed VSI RS MCV charts that minimize the charts' out-of-control ATS or EATS value. The findings show that the developed VSI RS MCV charts outperform both the existing RS MCV and MCV charts, for all shift sizes, in terms of the out-of-control ATS, SDTS and EATS criteria. An example is provided to elucidate the implementation of the proposed VSI RS MCV charts.