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Pregnancy-related anxiety can adversely affect maternal and fetal health; therefore, understanding its related factors is essential. This study aimed to determine the cognitive-psychological predictors of pregnancy-related anxiety among pregnant women. This cross-sectional study was conducted on 400 pregnant women who were covered by urban comprehensive health service centers in Urmia. Data were collected using a demographic questionnaire; the Pregnancy-Related Anxiety Questionnaire-Revised (PRAQ-R2); the Edinburgh Postnatal Depression Scale (EPDS); the Multidimensional Scale of Perceived Social Support (MSPSS); the Childbirth Self-Efficacy Inventory (CBSEI); and the Maternal Health Literacy and Pregnancy Outcome Questionnaire (MHLAPQ). The data were analyzed using SPSS version 16. A p-value of less than 0.05 was considered statistically significant. The mean age of participants was 26.53 ± 4.87 years. The mean pregnancy-related anxiety score was 28.03 ± 9.08. Among the subscales of pregnancy-related anxiety, the lowest mean score was associated with concerns about own appearance, while the highest mean score was linked to fear of childbirth. Depression during pregnancy (B = 0.821, β = 0.523, p < 0.001) and childbirth self-efficacy (B = - 0.048, β = -0.176, p < 0.001) were significant predictors of pregnancy-related anxiety, whereas perceived social support and maternal health literacy were not significant predictors. The cognitive-psychological variables examined explained approximately 34% of the variance in pregnancy-related anxiety. The results showed a moderate level of pregnancy-related anxiety in the study population. Therefore, it is recommended to incorporate early screening for pregnancy-related anxiety and its related factors into routine care. Furthermore, appropriate interventions should be implemented to reduce pregnancy-related anxiety by addressing its predictors.
Professional attitudes and behavior are critical for effective physiotherapy and patient-centered care. Communication skills and mental well-being may influence professional conduct, particularly during the early years of professional practice. However, evidence regarding their relationship remains limited. This study aimed to examine the relationship of communication skills and mental well-being with professional attitudes and behavior in early-career physiotherapists and to determine the extent to which these variables predict professional attitudes and behavior. The study included 72 physiotherapists with five years or less of professional experience who voluntarily participated. This cross-sectional study assessed professional attitudes and behavior using the Attitude Scale Toward the Physiotherapy Profession, communication skills using the Communication Skills Scale for Healthcare Professionals and mental well-being using the short form of the Warwick - Edinburgh Mental Well-being Scale. Pearson correlation analysis was conducted to examine relationships between variables, and multiple linear regression analysis was performed to identify independent predictors of professional attitudes and behavior. Professional attitudes and behavior were positively correlated with communication skills (r = 0.383, p < .001) and mental well-being (r = 0.373, p = .001). Multiple linear regression analysis indicated that communication skills (β = 0.334, p = .002) and mental well-being (β = 0.323, p = .003) were significant independent predictors, together explaining 24.9% of the variance in professional attitudes and behavior. The findings indicate that communication skills and mental well-being are important independent predictors of professional attitudes and behavior among early-career physiotherapists. The results suggest the need to integrate interpersonal and psychological competencies into professional education alongside technical training to support the development of professional attitudes and behaviors.
The Edinburgh Pipe Phantom (EPP) is a test-object developed to measure the imaging performance of ultrasound scanners. It is manufactured from the International Electrotechnical Commission (IEC) agar-based tissue-mimicking material (TMM) into which a range of fluid-filled pipes are molded. In this study we investigated the impact of increasing freeze-thaw (F/T) cycles on the acoustic properties of the IEC TMM to explore whether F/T modifications to the material allow for multimaterial phantom design. This study aims to acoustically characterize the IEC TMM over the frequency range 3.5 to 50 MHz, after undergoing 0-3 freeze-thaw cycles. Samples of the IEC agar-based TMM were manufactured and subjected to 0-3 F/T cycles, with a cycle consisting of 12 hours at -18°C followed by controlled thawing for a further 12 hours. The acoustic properties were measured using an acoustic macroscope, across the 3.5-50 MHz frequency range and samples were later observed using an optical microscope. Statistical significance was assessed at the 95% confidence level. The acoustic attenuation across F/T cycles remained unchanged within experimental error, with a mean value of 0.54 ± 0.04 dB·cm-1·MHz-1. The speed of sound of the samples however significantly increased with each cycle, from 1502.6 ± 14.7 ms-1 (0 cycle) to 1554.8 ± 10.3 ms-1 (3 cycles). Microscopic analysis revealed cracks throughout the samples. This study suggests that despite freeze-thaw induced changes in its structure and speed of sound, the acoustic attenuation of the IEC agar-based TMM remained stable for up to 3 F/T cycles, suggesting potential for multimaterial phantom development, although further work is required to assess imaging performance and stability.
Community-based palliative care has been widely studied worldwide, yet the developmental trajectory of this field remains unclear. In this study, we aimed to elucidate current research focuses, emerging hotspots, and trends in community-based palliative care through bibliometric and visual analyses. This study involved bibliometric analysis, combined with visual knowledge mapping of the retrieved literature. Data were retrieved from the Web of Science Core Collection for publica1tions from 2015 to 2025. Bibliometric networks were visualized using CiteSpace and VOSviewer. The reporting framework for this study complies with the Preferred Reporting Items for Bibliometric Analysis guidelines. Overall, 1,180 publications on community-based palliative care were examined. Annual publication output showed a continuous upward trend, with the United States contributing the largest number of publications (330 articles). The institution with the highest research output was the University of Edinburgh. BMC Palliative Care was the most productive journal. Four core research topics were identified: (a) community-based palliative care services and practice; (b) palliative care and health outcomes among older adults with chronic diseases in the community; (c) advance care planning and decision-making; and (d) barriers to and training in palliative care among community health workers. Publications on community-based palliative care have increased steadily since 2015, indicating growing academic interest in the field. The United States and Western Europe lead this domain, supported by strong presence of prominent researchers and leading research institutions. Several cohesive, high-output author groups have emerged, reflecting the development of well-connected research collaborations. Although existing research primarily centers on four core topics, "interviews," "framework," "family physicians," "lung," and "dementia" may represent emerging research frontiers.
Children and adolescents with classical Hodgkin lymphoma have a progression-free survival (PFS) rate of ≥ 90% with current treatments. The current challenge is to reduce adverse late-effects while maintaining high survival. Distinguishing lung involvement (Stage IV) from benign lung lesions remains a staging challenge in pediatric Hodgkin lymphoma (pHL). This study analyzed the prevalence, morphological patterns, and prognostic impact of lung lesions on progression-free survival (PFS) within the EuroNet-PHL-C1 trial. A retrospective analysis was conducted on chest CT scans from 1,298 pHL patients enrolled in the EuroNet-PHL-C1 trial. Patients were stratified by established treatment groups (TG-1, TG-2, TG-3). Lesions were classified by morphological pattern, and Kaplan-Meier analysis was used to compare 60-month PFS between groups with and without lung lesions. Lung lesions were identified in 60.2% (782/1298) of patients, with nodules being the predominant pattern (89%). In the combined TG-1 and TG-2 cohort (early/intermediate stages), the presence of any lung lesion correlated with significantly lower 5-year PFS (85.5% vs. 91.7%; p = 0.0197). Importantly, this lower PFS was driven by non-nodule morphologies. In the TG-3 (advanced stage) cohort, neither the presence of lung lesions nor stage IV classification significantly affected PFS. Lung lesions are highly prevalent in pHL. However, the presence of pulmonary nodules does not confer an inferior prognosis. The prognostic impact of lung lesions is primarily limited to non-nodule patterns in early-stage disease. These findings suggest that incorporating morphological patterns may be beneficial for refining risk stratification in future pHL trials.
African animal trypanosomosis poses a significant threat to livestock health and agricultural productivity across sub-Saharan Africa. Isometamidium chloride is the only available drug that is both prophylactic and curative. Despite sustained reports of resistance since the 1970s, a definitive molecular mechanism of resistance remains unresolved in the clinically relevant pathogen species Trypanosoma congolense. In this study, the role of a putative drug/metabolite transporter protein, TcoDMT, was validated via the analysis of in vitro-derived mutants, showing that expression levels of this protein correlated strongly with isometamidium sensitivity. Functional analyses revealed that the protein is a cell surface phenanthridine transporter and, notably, copy number variation correlates with isometamidium sensitivity in T. congolense field isolates. This study validates, for the first time, a plasma membrane transporter with a defined role in phenanthridine action and resistance, advancing our understanding of drug resistance mechanisms in parasitic protists, and informing strategies to combat animal trypanosomosis.
Dispersal enables species to track climate change by facilitating range shifts and colonization, yet successful post-dispersal establishment is often constrained by ecological niche mismatches. The mechanisms underlying this constraint remain poorly understood due to a lack of molecular evidence, limiting our ability to predict climate-induced range dynamics. Here, we integrate biogeographic analysis with macroecological insights to investigate how ecology shapes genomic divergence, local adaptation, and climate resilience in Debregeasia orientalis C. J. Chen, a dominant riparian shrub distributed across multiple biodiversity hotspots in southwestern China. Based on whole genome sequencing data from 332 individuals, we identify three genetically distinct groups: two diverged during the early Last Glacial period, and one originated through hybridization more recently. Despite both historical and ongoing opportunities for gene flow, strong genetic differentiation persists among the three groups. This differentiation is supported by clear niche divergence among the three groups and by genomic signatures of local adaptation, including selective sweeps related to hypoxia tolerance, thermal adaptation, and anthropogenic pressures. Together, these findings indicate that post-dispersal niche filtering limits the merging of these lineages. Genomic offset projections reveal asymmetric vulnerabilities to future climate scenarios, with one lineage particularly maladapted under projected shifts. These findings highlight niche-driven adaptation as a primary determinant of both historical divergence and contemporary resilience. Collectively, this study presents a framework linking post-dispersal ecological filtering to long-term genomic divergence, offering new insights into how niche filtering maintains genetic structure under rapid environmental change.
Bradykinin is a nonapeptide of the kinin family with vasoactive and proinflammatory activities. While generation of kinins is mainly driven by activation of the contact system and plasma or tissue kallikreins, additional independent cascades contribute to their formation. Kinins mediate their effects through the constitutively expressed bradykinin B2 receptor and the inducible bradykinin B1 receptor. Bradykinin is the most studied kinin peptide mainly due to its potential role in the vascular system and exerts its effects mainly via the bradykinin B2 receptor. Kinins have been implicated in the pathogenesis of multiple types of angioedema as well as of various conditions, such as allergic mast cell-mediated skin diseases, cardiovascular and respiratory pathologies. This review summarizes our current knowledge of the biology, regulation, and functions of kinins and their receptors as well the emerging evidence on the various mechanisms involved in bradykinin formation and their relevance in disease pathogenesis. The review focuses on the clinical evidence on the roles of bradykinin and of the bradykinin B2 receptor in various conditions, and the potential to develop novel strategies targeting the bradykinin B2 receptor for management of bradykinin-mediated diseases.
BackgroundCerebrospinal fluid (CSF) spectrophotometry is well-established in the UK for measuring CSF bilirubin and oxyhaemoglobin to aid in the diagnosis of subarachnoid haemorrhage. Although it is known that some antibiotics and large amounts of oxyhaemoglobin interfere in the spectrophotometric analysis of CSF bilirubin, there is little published evidence about the impact of such interferences.MethodsExperimental samples were distributed to participants in the UK National External Quality Assessment Service (NEQAS) for Immunology, Immunochemistry and Allergy EQA programme for CSF haem pigments. Distribution 244 consisted of a pair of matched samples but with sample 244-2 containing an increased amount of oxyhaemoglobin compared to sample 244-1. Distribution 251 consisted of a pair of matched samples but with sample 251-2 containing additional doxycycline at a concentration of 0.5 µg/mL compared to sample 251-1. Participants analysed the samples spectrophotometrically and absorbance values were returned to UK NEQAS.ResultsThe net bilirubin absorbance (NBA) was significantly reduced in the presence of both interferants; adding 0.6% oxyhaemoglobin decreased the NBA by a mean of 55.9% and adding 0.5 µg/mL doxycycline decreased the NBA by a mean of 14.3%. Wilcoxon signed rank tests showed the NBA was significantly different for sample 2 compared to sample 1 for both distributions.ConclusionsIncreased amounts of oxyhaemoglobin and the presence of doxycycline can both negatively interfere with NBA. The interference is subtle and difficult to detect but has the potential to change a true positive result to a false negative, highlighting a significant limitation of the CSF spectrophotometry technique.
Can you perform an action intentionally if there was only a small chance your action would succeed? Researchers studying the folk concept of intentional action have documented complex patterns of intuitions in these cases. We propose to explain the data in terms of a causal theory of intentional action, according to which people consider an action intentional if there was a strong causal link between the agent's desire for the outcome and the outcome itself. When the outcome of an action is left to chance, people judge that the agent's desire was a weak cause of the outcome; this results in corresponding low intentionality judgment. Supporting our proposal, we find that in situations where people deny that a lucky outcome was brought about intentionally, they also deny that the outcome happened because of the agent's desire for that outcome. Intentionality judgments track causal judgments to a larger extent than they track other factors previously proposed to explain the luck effect. Our findings support the idea that a robust causal link between desire and outcome is a key component of the folk concept of intentional action.
With an ageing population and global attention on how older people are cared for, there is a need to understand how older persons are enabled to participate in care decisions. Enabling and sharing decision making is promoted widely in healthcare, yet evidence demonstrates that shared decision making processes are not effectively translated into practice. The healthcare practice environment plays a key role in shaping how older people are included in their care. Further, residential aged care environments can be more complex, as paternalistic attitudes, rigidity and routine, resourcing, and workplace culture impact person-centred practice and sharing decision making processes. The aim of this research was to explore how the practice environment influences sharing decision making between older persons and nurses in residential aged care. Using person-centred methodology, older persons and nurses were recruited from an Australian residential aged care setting. Information was generated through emotional touchpoint interviews (n = 17; older persons n = 5; nurses n = 6), observations of practice (n = 8), and practice development methods. Creative hermeneutic analysis was used to iteratively interpret the information generated with participants to develop and refine themes, and reflexive journalling and participant dialogue supported analytic rigour. Seven components were found to influence the relational connectedness and sharing decision making between older persons and nurses: affirming personhood, reciprocal trustworthiness, time as presence, intentional way of being, negotiating relational boundaries, organisational values in action, and policies in practice. This research contributes a new perspective of sharing decision making as a relational process continuously influenced by the people, processes, and structures within the practice environment. The practice environment was identified as key to how decision making occurs between older persons and nurses. To support sharing decision making, aged care organisations need flexible policies and workforce models that prioritise relationship building. Nurses should be supported to develop reflective and power sharing practices to enhance emotional intelligence, and have the time to connect meaningfully with older persons. Creating conditions where older people are respected, heard, and genuinely involved in care must be embedded within the elements of the practice environment of residential aged care.
Sea slugs are known as the jewels of the sea, prized by most divers and treasured by underwater photographers. Some species are very rare or difficult to spot, but others are quite common and are often featured in field guides and web pages. However, it is surprising that some of those most common and incredibly beautiful creatures are sometimes undescribed species or, in some cases, misidentified as other species. In this paper, we formally name and describe three of these well-photographed species: Thecacera melkyisp. nov., Thecacerapikachusp. nov. and Nembrotha lorosaesp. nov. all belonging to the family Polyceridae Alder and Hancock, 1845, and collected in East Timor. We perform species delimitation analyses and present their phylogenetic scenario based on two mitochondrial (COI, 16S rRNA) and one nuclear marker (H3). We also reveal a new color morphotype of Nembrotha purpureolineata O'Donoghue, 1924 and highlight two possible undescribed species-one Thecacera J. Fleming, 1828 and one Nembrotha Bergh, 1877. It is essential to continue searching for and fully describing new species, especially in less-studied regions, to understand the true biodiversity of our seas.
Shifting diets away from high levels of meat and dairy is increasingly considered an important part of climate mitigation, yet the best pathways for achieving these reductions without compromising nutrition, health or affordability remain unclear. Here, in a representative sample of Scottish adults, we evaluate 33 pathways to meeting the UK Climate Change Committee's recommendations to reduce meat and dairy consumption by 20% by 2030, increasing to a 35% reduction in meat by 2050. The pathways incorporate existing dietary guidance, and modelled outcomes include intakes of 54 nutrients, obesity, type 2 diabetes, cardiovascular disease, all-cause mortality, diet costs, greenhouse gas emissions, freshwater use, land use and eutrophication. Nearly all pathways were estimated to benefit most nutritional, health and environmental outcomes without increasing diet costs. Benefits were greater when reductions targeted high consumers of red meat and when meat and dairy were replaced gram for gram with foods such as vegetables, beans, eggs and plant-based dairy alternatives.
A simple, catalytic synthesis of pyrrolidines through the intermolecular cyclisation-homologation of azido-butenes was enabled by a hydroboration, 1,2-metallate rearrangement and B-N/B-H transborylation reaction sequence. Substitution at the C1-C3 positions of the azido-butenes was well tolerated. Extension of this methodology to azido-propenes and azido-pentenes with the aim of accessing azetidines and pyrrolidines respectively revealed the formation of an aza-bora heterocycle and a saturated azido-pentane boronic acid pinacol ester.
Motivational interviewing (MI) is an effective approach for supporting health behaviorchange, but face-to-face delivery is resource-intensive and difficult to scale. Rule-based conversational agents (CAs) can improve access; however, their scripted interactions and limited language flexibility constrain MI delivery. While large language models (LLMs) are increasingly being used for MI coaching, their conversational fidelity and quality compared with human coaches and rule-based CAs remain understudied. This study aimed to describe the development of an LLM-based CA, Artificially Intelligent Motivational Interviewing (Aimi), orchestrated with structured workflows, and to evaluate its feasibility, conversational fidelity, and user perceptions during MI coaching interactions. We developed Aimi using structured LLM workflows designed to enhance MI fidelity. We conducted a within-participants study, where 18 adults interacted with (1) Aimi, (2) a novice MI-trained human coach, and (3) a rule-based CA during live text-based role-play coaching sessions. Transcripts were independently evaluated by an MI expert using the Motivational Interviewing Skill Code, Version 2.0 (MISC-2), to assess MI competency and fidelity. Participants completed a user experience questionnaire to provide general feedback and to assess session alliance, dialogue relevance, empathy, engagement, linguistic quality, and perceived motivation to change. Feedback from users was thematically summarized and categorized under strengths and weaknesses for each approach. Aimi achieved fidelity scores comparable to those of the novice human coach and higher than those of the rule-based CA on summary metrics, including higher reflection-to-question ratios (median 0.84, IQR 0.62-0.92 vs 0.62, IQR 0.42-0.74 vs 0.25, IQR 0.17-0.38), more complex reflections (median 66.67%, IQR 46.97%-76.92% vs 50%, IQR 34.38%-61.88% vs 0.00%, IQR 0%-50%), and greater elicitation of client change talk (median 90.83%, IQR 85.89%-100% vs 73.21%, IQR 63.10%-83.19% vs 66.67%, IQR 57.86%-81.94%). User experience ratings showed no significant differences across conditions. User feedback revealed distinct strengths and limitations across the coaching interactions. Participants described Aimi's interactions as personalized, fluid, and adaptive, though sometimes overly reflective and lengthy. The novice human coach was viewed as empathetic and supportive but slow to respond, whereas the rule-based coach was viewed as efficient and structured yet limited in depth and personalization. This study demonstrates the technical feasibility of structured LLM-workflows for MI coaching and their capacity to maintain conversational fidelity comparable to that of a novice MI-trained human coach. Given the role-play paradigm, single-rater coding, and small convenience sample, these comparative findings should be interpreted as exploratory. Our findings serve as a foundational baseline for the development of scalable behavior change interventions in clinical settings.
Sixteen families were studied from the survey presented here, seven of which were new to Georgia. Of the 62 genera identified, 54 represent new country records. Of the 140 recorded species, 111 are new records for Georgia, whereas 10 are new for science and described here for the first time. The most diverse family was Sphaeroceridae with 39 species, followed by Agromyzidae with 27. Of the newly described species, seven belong to Agromyzidae: Liriomyza priapus Lonsdale, sp. nov.; Phytomyza (Napomyza) alata Lonsdale, sp. nov.; Phytomyza (P.) affinoides Lonsdale, sp. nov.; Phytomyza (P.) orphne Lonsdale, sp. nov.; Phytomyza (P.) pilosinomia Lonsdale, sp. nov.; Phytomyza (P.) skia Lonsdale, sp. nov.; Phytomyza (P.) villosus Lonsdale, sp. nov.; and three to Sphaeroceridae: Copromyza pileus Brice, sp. nov.; Gonioneura lagodekhiensis Brice, sp. nov.; and Terrilimosina irwini Brice, sp. nov.
[This corrects the article DOI: 10.3389/fneur.2025.1592879.].
Brain maintenance - the preservation of brain structure or function relevant to cognitive performance - remains challenging to quantify. Here, we propose a domain-general brain maintenance index derived by jointly modelling the longitudinal co-evolution of ageing-related atrophy (via medial temporal lobe to ventricle ratio, MTLV-ratio), white matter hyperintensities (WMH), and global cognition assessed by the preclinical Alzheimer's cognitive composite (PACC5) using latent growth curve modelling. We demonstrate its utility in 543 cognitively unimpaired older adults from the DELCODE cohort, followed annually over four years. We show that changes in MTLV-ratio and WMH additively predict cognitive change. We further show that higher neuroticism, depressive symptoms, lower openness, and faster biological ageing are related to unfavourable domain-specific trajectories and poorer brain maintenance. Our findings highlight the combined relevance of WMH and ageing-related atrophy dynamics for brain maintenance. Maintaining cerebrovascular and mental health alongside cognitive engagement could promote brain maintenance, delay cognitive decline and dementia.
Those at risk of diabetes-related foot ulceration (DFU) must balance sufficient physical activity to maintain glycaemic control and cardiovascular health whilst avoiding excessive trauma to their feet. Our systematic review aimed to assess whether physical inactivity and/or sedentary behaviour affect DFU outcomes. Embase, Medline, and Scopus were searched for peer-reviewed studies using the criteria: ('diabetes' OR 'diabetic') AND ('physical*' OR 'activ*' OR 'inactiv*' OR 'sedentary') AND 'foot' AND 'ulcer', returning 4650 results excluding duplicates. 16 studies were included and assessed for risk of bias using the Newcastle-Ottawa Scale (NOS). Fifteen studies assessed physical inactivity and 1 assessed both inactivity and sedentary behaviour and DFU outcomes. Eleven of 16 (69%) studies reported significantly greater likelihood of DFU in inactive participants. Exploratory meta-analysis suggested physical inactivity to be associated with doubled DFU risk (OR 2.09, 95% CI 1.32-3.32, p = 0.002). Evidence that sedentary behaviour was associated with tripled DFU risk was based on a single prospective cohort and had a high risk of bias (OR 2.95, 95% CI: 1.5-6.4, p = 0.008; n = 175, NOS: poor). Study methodologies were heterogenous (e.g., inconsistent definitions of inactive), with habitual physical activity measured through interviews, patient records, or questionnaires in 14 of 16 studies (NOS rating: poor to fair). Available evidence suggested that physical inactivity and sedentary behaviour were associated with an increased risk of DFU. Further research is needed to develop thresholds for physical inactivity and sedentary behaviour to reduce DFU risk.
Mycolic acids are key components of the mycobacterial cell envelope, contributing to its structural integrity and intrinsic resistance to environmental stress. The polyketide synthase Pks13 catalyzes the final Claisen condensation step in mycolic acid biosynthesis and is conserved across Corynebacteriales. While the catalytic cysteine within the ketosynthase (KS) domain is established as essential for activity, the role of surrounding residues in supporting catalysis remains less well understood. Herein, we utilized a Mycobacterium smegmatis conditional pks13 mutant, and subsequent complemented strains harbouring a plasmid-borne copy of pks13 to probe the functional importance of selected residues within the KS domain from previous structural studies. These site-directed mutagenesis studies identified Asp264 as critical for Pks13 function. The D264A strain showed severely impaired growth along with a pronounced loss of mycolate synthesis and mycolate-containing lipids: trehalose dimycolate (TDM) and trehalose monomycolate (TMM). In contrast, other mutations had either little or no significant effect on cell viability or mycolate synthesis or mycolate-containing lipids. Structural modelling of the KS domain suggests that loss of Asp264 disrupts the local active-site environment, resulting in compaction of the binding pocket and altered conformation of a loop proximal to the catalytic residue Cys267. Together, these findings demonstrate that Asp264 is essential for Pks13 function and likely contributes to maintaining the structural environment of the KS domain.