Heading date is a pivotal agronomic trait that governs regional adaptation and grain yield in rice (Oryza sativa L.). The CCT domain‑containing protein OsBBX19 (also known as OsCCT22) has been previously identified as a heading‑date regulator. In this study, we further report the molecular functional characterization of OsBBX19. Overexpression of OsBBX19 delayed heading under both short-day conditions (SDs) and long-day conditions (LDs). GUS staining and RT-qPCR analyses revealed that OsBBX19 was constitutively expressed across various organs, and that its overexpression significantly suppressed the expression of Hd3a, RFT1, and Ehd1 while increasing Ghd7 expression, suggesting that OsBBX19 is associated with the Ghd7-Ehd1-Hd3a/RFT1 flowering pathway. We also demonstrated that OsBBX19 physically interacts with CONSTANS-like protein interacting protein 1 (CPIP1). Haplotype analysis revealed significant indica-japonica differentiation of OsBBX19, and the frequency of Hap3 and Hap5 increased during the improvement process of indica rice. Collectively, our results provide additional insights into the molecular mechanism by which OsBBX19 regulates heading date in rice, offering potential genetic resources for breeding optimization. The online version contains supplementary material available at 10.1007/s11032-026-01681-6.
Cortical areas involved in self-motion perception process cues from multiple sensory modalities, primarily visual and vestibular, alongside choice-related activity. Neurons in these regions often respond to combinations of these factors - demonstrating a high degree of mixed selectivity. Moreover, self-motion is inherently dynamic, with each cue - visual and vestibular - comprising a mix of distinct motion signals, such as velocity and acceleration, that evolve over time. Here, we developed a time-varying targeted dimensionality reduction (tTDR) method to expose these dynamic motion and choice-related signals in neuronal populations. We applied this approach to recordings from the ventral intraparietal cortex (VIP), dorsal medial superior temporal cortex (MSTd), and parietoinsular vestibular cortex (PIVC), in six male rhesus macaques, performing a task of heading discrimination. Distinct configurations of dynamic signals were seen in the population activity across the different cortical areas. VIP exhibited all components - namely, velocity and acceleration, for visual and vestibular cues, along with strong choice-related signals that rose early and remained elevated throughout the stimulus period, well before the choice was reported. By contrast, MSTd and PIVC had weaker and later choice-related activity. MSTd primarily exhibited visual signals (velocity more than acceleration) with weak vestibular signals. PIVC predominantly exhibited vestibular signals (velocity and acceleration), yet visual signals were nonetheless present. The distinct configurations of time-varying parameters across VIP, MSTd, and PIVC, likely reflect different functional specializations in heading discrimination.Significance statement This study extends the targeted dimensionality reduction method to incorporate time-varying stimulus components. Applied to neuronal data recorded during heading discrimination, this enabled dissociation of velocity, acceleration, and choice signals in population activity, revealing clear differences between cortical areas: VIP, MSTd, and PIVC. VIP reflects motion parameters across modalities, with early and robust supramodal choice signals; MSTd predominantly encodes visual velocity with weaker vestibular and choice-related activity; and PIVC specializes in vestibular motion, with reliable encoding of both velocity and acceleration, with modest visual and late-onset choice activity. These findings reveal complementary specializations across multisensory cortical areas that together support robust heading perception and flexible decision-making.
Repetitive head impacts from soccer heading may cause subclinical brain alterations, but the magnitude and consistency of neuroimaging abnormalities remain uncertain. A systematic review and meta-analysis of brain MRI studies in soccer players was performed. Diffusion MRI was the primary outcome; magnetic resonance spectroscopy (MRS) and structural MRI morphometry were secondary outcomes. Thirteen independent studies were included. Five diffusion MRI studies (n≈300 players) were synthesised using Fisher's z. Soccer heading exposure was associated with significant white-matter microstructural alteration (pooled Fisher's z - 0.73, 95% CI - 1.02 to - 0.44), corresponding to an equivalent correlation of r≈ - 0.62 and a standard mean difference of approximately - 1.5. Between-study heterogeneity was moderate (I2≈68%). Individual studies reported increased radial or axial diffusivity (Hedges g up to + 3.00) or reduced fractional anisotropy (z range - 0.27 to - 1.40). Four morphometry studies showed small, non-significant differences in cortical thickness or volume (pooled Hedges g - 0.10, 95% CI - 0.22 to 0.10). Four MRS studies demonstrated predominantly increased choline- and myo-inositol-related metabolites (Hedges g ≈0·3-0·8), with minimal or inconsistent N-acetylaspartate change. Soccer heading is associated with moderate-to-large effect sizes in diffusion MRI metrics of white-matter microstructure, whereas metabolic and structural MRI findings are smaller, less consistent, and of uncertain clinical significance. This meta-analysis provides the first quantitative evidence that soccer heading is associated with a robust, moderate-to-large diffusion MRI signal of white-matter microstructural alteration. It further shows that diffusion MRI is more sensitive than spectroscopy or structural morphometry for detecting subclinical brain effects of repetitive head impacts.
Non-heading Chinese cabbage (NHCC) is a highly economically valuable leafy vegetable widely grown in Asian regions. However, it undergoes rapid leaf yellowing and wilting during postharvest storage, which subsequently cause rapid quality decline and loss of nutritional components. Abscisic acid (ABA) promotes postharvest leaf senescence, while hydrogen-rich water (HRW) is widely used in postharvest preservation due to its excellent antioxidant properties; yet, the mechanism through which they interact to regulate postharvest senescence in NHCC remains unclear. Herein we found that exogenous HRW effectively delayed dark- and ABA-induced postharvest leaf senescence in NHCC, significantly maintained chlorophyll content, inhibited oxidative damage, and preserve nutritional components such as soluble sugars and vitamin C. The underlying mechanism was HRW inhibiting chlorophyll degradation by repressing the expression of chlorophyll catabolic genes like NYC1, NYE1, and PPH1. Meanwhile, HRW effectively lowered the accumulation of MDA and H2O2, elevated both the enzymatic activities and transcript abundance of SOD and CAT, and downregulated the transcript levels of RbohB, RbohC, RbohD, and RbohE, thereby maintaining reactive oxygen species (ROS) homeostasis. In addition, HRW negatively regulated ABA biosynthesis by inhibiting the transcript levels of ABA1, ABA2 and ABA3, while promoting the transcription of CYP707A1, CYP707A2 and CYP707A3. It also dampened the transcript abundance of ABA signaling components including PYL5, ABI1, and ABF3, thus blocking ABA signal transduction and alleviating its senescence-promoting effect. Collectively, this study confirms that HRW mitigates leaf senescence induced under dark and ABA conditions in NHCC via multiple synergistic pathways.
Evidence indicates females may be more susceptible to sports-related concussion with worse and prolonged symptom severity according to menstrual cycle phase. We investigated whether menstrual cycle phases influence non-concussive heading kinematics in elite female footballers, and whether these impacts affect an athlete's cognition. Five eumenorrheic elite female footballers (Mage = 23 ± 4 years) participated in a 16-week proof-of-concept study wherein menstrual cycle phases were tracked, and cognition was monitored. Participants performed a weekly controlled heading drill by heading a ball thrown from 5 m away. Head accelerations were measured using custom-moulded PROTECHT instrumented mouthguards. 256 headers revealed no significant differences in head acceleration across the various phases of the menstrual cycle. However, change in cognitive performance was related to heading completion and menstrual phase. Hormonal fluctuations during the menstrual cycle may influence cognition independent of head impact biomechanics among elite female athletes, under controlled conditions. We note that our study also demonstrated the safety and efficacy of the mouthguard equipment employed here, as well as the ease with which the protocol was received by the athletes. These outcomes should be considered when implementing future research with larger cohorts and the inclusion of match-related heading.
Brassinosteroid (BR) signaling plays a critical role in rice (Oryza sativa L.) grain development. GLYCOGEN SYNTHASE KINASE 3 (OsGSK3), a negative regulator of BR signaling, suppresses the transcriptional activity of OsBZR1 through phosphorylation. In this study, we employed a phosphoproteomic approach to construct an OsGSK3-mediated regulatory network. Within this network, we identified FLOWERING CONTROL LOCUS A (OsFCA) as a positive regulator of BR signaling and grain length, with m-Osfca mutants exhibiting significantly lower sensitivity to brassinolide treatment. Importantly, OsGSK3 interacts with and phosphorylates OsFCA on serine residues S43 and S45, and then forms condensates via liquid-liquid phase separation. Phosphorylated OsFCA promotes the translocation of the OsGSK3-OsFCA complex into the cytoplasm. Within the cytoplasm, OsGSK3 and OsFCA no longer exist in a condensate state. This mechanism provides precise regulation of grain length in rice. Notably, Osfca mutants are late-flowering, with OsFCA promoting heading under long-day conditions by repressing the expression of Grain number, plant height and heading date 7 (Ghd7) while activating that of Early heading date 1 (Ehd1), Heading date 3a (Hd3a), and RICE FLOWERING LOCUS T 1 (RFT1), which is potentially modulated by OsGSK3. This study clarifies the BR signaling transduction network by identifying OsFCA as a positive BR signaling component that regulates grain development and heading date, providing theoretical foundations for molecular breeding design in rice.
Clarifying nitrogen accumulation and utilization in nitrogen-efficient rice under different ecological conditions can provide a theoretical basis for breeding such rice varieties and optimizing fertilizer management. We conducted a two-factor split-plot field experiment under two contrasting light conditions: low-light and overcast conditions in Dayi, Sichuan, and sufficient-light conditions in Yongsheng, Yunnan. The main plot factor consisted of three nitrogen application levels: no nitrogen application (N0), reduced nitrogen (120 kg·hm-2, N120), and conventional nitrogen (180 kg·hm-2, N180). The subplot factor included 10 rice varieties classified into three nitrogen efficiency types: low-nitrogen high-efficiency type, high-nitrogen high-efficiency type, and other type. We quantified nitrogen accumulation, allocation, translocation, and utilization characteristics by measuring plant dry matter weight and nitrogen content at the full heading and maturity stages. The results showed that nitrogen uptake, accumulation, and utilization in rice are jointly influenced by rice variety, nitrogen fertilizer level, and their interaction effect. Under the ecological conditions of Dayi, low-nitrogen high-efficiency rice performed optimally under the N120 treatment, exhibiting the highest nitrogen content in various organs at maturity. Specifically, leaf nitrogen content was 68.8% higher than that of high-nitrogen high-efficiency rice and 6.8% higher than that of other type. Compared to other type, low-nitrogen high-efficiency rice showed increases of 27.3%-37.7% in pre-heading nitrogen accumulation in stem-sheaths and leaves, and 16.7%-44.4% in the contribution of pre-heading stem-sheath and leaf nitrogen to grains, ultimately leading to a 14.4%-18.9% increase in total nitrogen accumulation. In Yongsheng, high-nitrogen high-efficiency rice performed outstandingly under the N180 treatment, with higher nitrogen content in various organs than other type, showing an average increase of 13.1% at the full heading stage and 8.5% at the maturity stage, respectively. At the maturity stage, nitrogen allocation to panicles increased by 5.2% compared to other type. The nitrogen translocation contribution rate of pre-heading leaves increased by 19.0%-27.5% compared to the other two rice types, ultimately raising total plant nitrogen accumulation by 13.3%-23.8%. In Dayi, the low-nitrogen high-efficiency rice, and in Yongsheng, the high-nitrogen high-efficiency rice, exhibited significantly higher nitrogen fertilizer partial productivity, nitrogen agronomic utilization efficiency, and nitrogen fertilizer recovery efficiency compared to other type. In summary, low-nitrogen high-efficiency rice combined with reduced nitrogen application (N120) is suitable for regions with low-light and overcast conditions such as Dayi, while high-nitrogen high-efficiency rice combined with conventional nitrogen application (N180) is applicable to regions with sufficient light and temperature like Yongsheng. 明确不同生态条件下氮高效水稻氮素积累与利用特性,可为氮高效水稻选育与氮肥高效管理提供理论基础。本研究在弱光寡照的四川大邑和光照充足的云南永胜两种生态条件下开展两因素裂区设计的田间试验,主区设不施氮肥(N0)、氮肥减量(120 kg·hm-2,N120)和氮肥常量(180 kg·hm-2,N180)3个水平,副区为低氮高效、高氮高效和其他型3类共10个不同氮效率水稻品种,测定齐穗期和成熟期植株干物质量与氮含量,分析氮素积累、分配、转运和利用特征。结果表明:水稻氮素吸收、积累和利用受水稻品种、氮肥水平及其互作效应的共同影响。在大邑,低氮高效水稻在N120处理表现最优,成熟期各器官含氮量最高,其中叶片含氮量分别较高氮高效和其他型提高68.8%和6.8%;穗前茎鞘和叶片氮素积累量较其他型水稻提高27.3%～37.7%,穗前茎鞘与叶片氮素对籽粒的贡献率提高16.7%～44.4%,最终使植株氮素总积累量提高14.4%～18.9%。在永胜,高氮高效水稻在N180处理表现突出,各器官含氮量均高于其他型水稻,齐穗期和成熟期分别平均提高13.1%和8.5%;成熟期穗部氮素分配较其他型提高5.2%;穗前叶片氮素转运贡献率比另外两类型水稻提高19.0%～27.5%,最终使植株氮素总积累量提高13.3%～23.8%。大邑的低氮高效和永胜的高氮高效水稻的氮肥偏生产力、农学利用率和氮素回收利用率显著高于其他型。低氮高效水稻配合减量施氮(N120)适用于大邑等弱光寡照地区,高氮高效水稻配合常量施氮(N180)适用于永胜等光温充足地区。.
Bacterial canker disease (BCD), mainly caused by Pseudomonas syringae pv. syringae (Pss) and P. amygdali pv. morsprunorum (Pam), threatens the Pacific Northwest (PNW) cherry industry. One major cause of young tree death in the PNW is heading-cut infections by Pseudomonas in newly established orchards. While copper has long been used for cut-wound protection, copper resistance in pseudomonads is widespread in the PNW. This study evaluated alternative chemicals and cultural strategies for management of cut-wound infections. Lime sulfur (LS) exhibited concentration- and time-dependent bacteriostatic activity in vitro, with 5-10% LS efficiently reducing Pss and Pam populations within 6h. Clove oil at concentrations equal to or above 0.0625% completely eliminated both pathogens within 30 s. To evaluate the efficacy of alternative chemicals, field trials in 2024 revealed that kasugamycin and oxytetracycline significantly reduced canker development when heading-cuts were performed under hot, dry weather conditions as compared with copper- and latex-paint-based treatments. When heading-cuts were done under cool, humid conditions, oxytetracycline, Actigard, and kasugamycin exhibited better cut-wound protection in terms of canker length. Canker development was more rapid and occurred at a higher frequency in trees pruned under cool, humid conditions compared to those pruned during hot, dry conditions. In 2025 field trials, kasugamycin (Kasumin) again suppressed canker progression, while addition of Vacciplant or additional chemical treatment offered no benefit. Furthermore, when plant tissues were removed at least 12.7 cm below visible cankers, no pathogen can be recovered. Our results indicate that chemical application and weather conditions during heading cut might be crucial in preventing cut-wound pseudomonads infection.
Over the past century, medical education has undergone a profound transformation, evolving from unregulated apprenticeships into a highly structured, competency-based continuum of lifelong learning. This review delineates the centenary changes in global medical education, highlighting the structural, pedagogical, and philosophical milestones that have shaped the modern healthcare workforce. A comprehensive narrative review of historical and contemporary medical education literature was conducted. Electronic databases including PubMed, Scopus, Web of Science, and Google Scholar were searched for peer-reviewed articles, policy declarations, and historical texts published between 1910 and 2025. Search strategies utilized Medical Subject Headings and keywords such as "history of medical education," "competency-based education," "social accountability," "curriculum reform," and "artificial intelligence." The 1910 Flexner Report established the biomedical university-based model, which dominated the 20th century but inadvertently created rigid departmental silos. Subsequent reforms dismantled these silos in favor of integrated, problem-based learning. The 1988 Edinburgh Declaration and the 2010 Lancet Commission catalyzed a paradigm shift toward social accountability, systems-based practice, and Competency-Based Medical Education. Concurrently, regional trajectories in India, Africa, Asia, and Latin America highlight the post-colonial push for standardized, socially responsive curricula. Today, the integration of artificial intelligence and immersive simulations offers unprecedented opportunities for personalized learning, though it presents socio-technical challenges, including the digital divide and algorithmic bias. Additionally, academic medicine faces a crisis in preserving the physician-scientist identity amidst shifting evaluation metrics. To produce an agile workforce capable of meeting the complex epidemiological demands of 2050, medical education must harmonize relentless technological innovation with the humanistic imperative of socially accountable, equitable patient care.
Community health workers (CHWs) play an important role in delivering essential health services in low- and middle-income countries (LMICs). Training CHWs using digital approaches is on the rise. Although scoping and systematic reviews of digital training have been conducted for medical professionals in high-income countries (HICs), none have been conducted with lay professionals in LMICs, a population with different considerations. This review describes the characteristics of digital training for CHWs and identifies their impact on health services outcomes in LMICs. A scoping review approach based on Arksey and O'Malley's guiding principles was used to retrieve, review, and analyze existing literature. We searched 10 foremost databases using keywords and Medical Subject Headings terms for CHWs, LMICs, and digital learning to identify primary, peer-reviewed studies published up to and including November 26, 2024. An updated search of studies in all the databases was conducted on January 12, 2026, by the research team. No registries were searched. Articles that focused on the provision of digital or blended learning training for CHWs working in LMICs in any disease domain evaluating a learning, implementation, or clinical outcome met the eligibility criteria. Two reviewers (TAT and FA) screened the articles at the title and abstract levels and at full-text review. Study details, study designs, training attributes, technology and CHW descriptions, and outcomes were abstracted using a data-charting form. Descriptive analysis was conducted of the population, training characteristics, and reported outcomes. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for reporting scoping reviews were used. A total of 892 articles were retrieved and screened for eligibility, of which 18 original articles met the inclusion criteria. Most (n=13) were conducted in Asia. Most (n=15) used nonrandomized study designs. The most common attributes included synchronous (n=8), accessible in the community (n=14), use of smartphones (n=6), and accessible online (n=9). The majority reported learning outcomes (n=14), about half reported implementation outcomes (n=10), and only one reported clinical outcomes (n=1). The learning outcomes focused on knowledge gained and were mostly positive. The implementation outcomes included CHW's acceptability and feasibility to use the digital training approach. The clinical outcome was effectiveness. We found few evaluations of digital training for CHWs in LMICs, in spite of a proliferation of such trainings. Digital trainings had a broad range of attributes. Many evaluations had knowledge, acceptability, and feasibility outcomes. However, other learning outcomes (eg, attitudes and skills), implementation outcomes (eg, appropriateness and fidelity), and clinical outcomes were rare. Most lacked experimental designs. Although the existing evidence suggests that digital training can impact knowledge in lay health workers in LMICs, more rigorous studies with a broader range of outcomes are needed.
Crop breeding assembles genomic variants into cultivars via crossing and selection. Phenotypic selection has improved yield and lodging tolerance but has limited genetic insights. We show how specific genomic variants and their combinations underpin advances in modern rice breeding in Japan. Through genome-wide association study using a multi-parent advanced-generation intercross population derived from four temperate japonica cultivars, we identified 11 quantitative trait loci (QTLs) for key agronomic traits, including days to heading, shoot biomass, panicle length, and culm length under field conditions. GA20ox1, GA20ox2, and Hd1 were among the QTLs, and their natural variants were well conserved in temperate japonica cultivars bred in Japan, underscoring distinct selection pressures at these loci. By integrating genotype data with 5-year yield performance evaluation trials of elite cultivars, we found that cultivars carrying multiple-copy GA20ox1 and functional Hd1, together with non-functional ga20ox2, tended to have shorter culms and higher grain yield than cultivars with multiple-copy GA20ox1, functional Hd1, and GA20ox2. This yield advantage was consistent across latitudes in Japan. These results reveal favorable genotype combinations underlying modern japonica improvement and provide a genomic framework for breeding semi-dwarf, high-yielding cultivars adapted to temperate rice-growing regions in Asia.
While previous expert consensus guidelines by the American College of Critical Medicine recommend serum triglyceride monitoring after two consecutive days of propofol, the most recent Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption guidelines do not address monitoring triglyceride levels in patients on continuous propofol infusions. Recent cohort studies have shown that a majority of patients on continuous propofol lack triglyceride measurements. Our objective was to systematically summarize and compare the reported incidence of pancreatitis, hospital length of stay (LOS), intensive care unit (ICU) LOS, and hospital mortality in patients on continuous propofol infusions who developed hypertriglyceridemia (HTG) compared with those without HTG. Methods included Medical Subject Headings terms and keywords were used to construct a systematic search according to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines involving PubMed, Embase, Web of Science, Cochrane, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Inclusion criteria were papers published in English, since 2000, involving ICU patients ≥18 years old, who were on continuous propofol infusions. Six of the 790 studies identified (2,301 patients) were included. Pooled incidence of HTG was 28% with an average onset of 4.3 days. Both ICU LOS (pooled standardized mean difference (SMD) = 0.37, 95% CI: (0.16, 0.58), p < 0.0001, I² = 47%) and hospital LOS (pooled SMD = 0.21, 95% CI: (0.06, 0.35), p < 0.0001, I² = 0%) were increased in patients who developed HTG. Pooled incidence of pancreatitis was 1.3% with no significant difference between groups. In conclusion, HTG in ICU patients requiring continuous propofol infusions was associated with increased ICU and hospital LOS, with no significant differences in pancreatitis incidence or mortality. While this does not demonstrate causality due to its retrospective nature, it does point to an association of worse outcomes and hypertriglyceridemia in this setting.
This scoping review aims to identify and synthesize evidence on barriers, factors influencing adherence, and interventions to improve adherence to oral chemotherapy in pediatric oncology. Following the PRISMA-ScR guidelines, a scoping review search was conducted across PubMed, Web of Science, Cochrane, OVID, and Scopus databases. Eligible studies included those focusing on pediatric cancer patients prescribed oral chemotherapy and interventions aimed at improving adherence. Studies in English, published from inception to November 2024, were included. Data extraction covered study characteristics, barriers, influencing factors, and strategies for adherence. Results were narratively synthesized under thematic headings. A total of 15 studies met the inclusion criteria, encompassing qualitative, quantitative, and mixed-method designs. Barriers to adherence included emotional challenges (e.g., anxiety, resistance to treatment), medication-related issues (e.g., taste, side effects, complex regimens), and logistical difficulties (e.g., transportation, daily integration). Sociodemographic factors such as caregiver education level, economic status, and family structure significantly influenced adherence. Interventions like medication diaries, daily text reminders, home-based care programs, and caregiver education demonstrated effectiveness in improving adherence. Family and health system-focused strategies emerged as the most impactful approaches. Adherence to oral chemotherapy in pediatric oncology is multifaceted, influenced by emotional, logistical, and educational factors. Effective interventions address these barriers holistically, emphasizing caregiver support and tailored strategies. Future research should focus on developing and validating scalable, culturally sensitive adherence interventions. Given the emotional difficulties and logistical challenges faced by patients and caregivers, nurses play a critical role in maintaining adherence through caregiver education and the use of medication adherence support tools (e.g., medication diaries or text message reminders). Nurse-led family-centered care models and home-based adherence programs have the potential to be effective in improving medication adherence.
Familial hypercholesterolemia (FH) is a genetic condition that significantly increases the risk of coronary artery disease if left unmanaged. Although FH remains underdiagnosed globally, early detection enables timely therapy and reduces cardiovascular risk. Traditional FH criteria, such as the Dutch Lipid Clinic Network and Simon Broome diagnostic criteria, rely on clinical data often missing in real-world practice. Artificial intelligence (AI) offers potential to improve FH case identification. To review recent advances in simplified FH screening criteria, summarize applications of AI models in FH detection, compare model performance, and evaluate limitations and advantages. A literature search was conducted to identify peer-reviewed studies on AI in FH screening, diagnosis, or management. The search used Medical Subject Headings and free-text terms for FH and AI technologies. Titles and abstracts were reviewed, and full texts were assessed if potentially eligible. Machine learning models generally outperform simplified criteria. Logistic regression models remain the most commonly used and are valued for interpretability. Performance comparisons between models are limited by differences in cohort characteristics. Predictive variables commonly used by models include established examples such as family history, lipid profiles, demographics, and prescription records. AI models that leverage electronic health record (EHR) data can outperform traditional criteria, uncover missed cases, and complement cascade screening. Challenges include external validation, workflow integration, and model transparency. To ensure clinical utility, further work is needed to standardize comparison metrics, broaden applicability, increase interpretability, and address EHR integration complexities.
Background/Objectives: Hand hygiene is a cornerstone of infection prevention, yet the extent to which multimodal institutional hand hygiene interventions translate into measurable reductions in healthcare-associated infections (HAIs) remains uncertain. This systematic review aimed to evaluate the association between hospital-wide or multi-ward multimodal hand hygiene interventions and clinical HAI outcomes in acute care hospitals. Methods: A structured literature search was conducted in PubMed, Scopus, Embase, and Google Scholar using a combination of Medical Subject Headings (MeSH) and free-text terms related to hand hygiene, healthcare-associated infections, hospital settings, and intervention strategies. Eligible studies were quasi-experimental designs, including before-after, controlled before-after, and interrupted time-series studies, evaluating multimodal hand hygiene interventions implemented at hospital-wide or multi-ward level and reporting clinical HAI outcomes. Two reviewers independently assessed risk of bias using the ROBINS-I tool, and certainty of evidence across major outcome categories was summarized using GRADE. Results: twelve studies met the inclusion criteria. Overall, multimodal hand hygiene interventions were generally associated with favorable directional trends in clinical outcomes. Reductions were most consistent for broader institutional HAI measures and some device-associated infections, particularly central line-associated bloodstream infections. In contrast, organism-specific outcomes, including methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and Clostridioides difficile, were more heterogeneous across studies and settings. All included studies were judged to be at serious or critical overall risk of bias, primarily because of confounding, lack of contemporaneous controls, co-interventions, and phased implementation. Conclusions: Multimodal hand hygiene programs in acute care hospitals may be associated with improvement in selected clinically relevant HAI outcomes, particularly at the institutional level. However, the overall certainty of evidence remains low to very low, and the strength of inference is limited by the non-randomized nature of the available studies and the difficulty of isolating the independent effect of hand hygiene within complex infection-prevention strategies.
Skeletal age assessment using hand and wrist X-rays is commonly used to determine the biological maturity of children. It is invaluable when the chronological age is not known or in diagnosing and treating various endocrine, genetic, and developmental disorders as well as in a forensic context. Skeletal age is affected by both internal and external factors, leading to differences in skeletal maturity between children of different ethnicities. Regional studies have even questioned the applicability of current international skeletal age references across ethnicities. A comprehensive literature search will be conducted utilising the PubMed, Scopus, Web of Science, EMBASE, and Ovid online databases to identify existing publications. A combination of Medical Subject Headings (MeSH) terms and keywords, including "Skeletal age", "bone age", "radiograph", and "hand", will be used. Data screening and extraction will be done with Covidence software. Two independent reviewers will screen literature against predefined inclusion and exclusion criteria in abstract and full-text forms. A third reviewer will be consulted if consensus cannot be reached. The process will be reported in whole and presented in a PRISMA flow diagram. Study quality will be assessed by using the JBI critical appraisal tool. A meta-analysis will be conducted. This review will present a comprehensive analysis of existing literature on the applicability of skeletal age assessment methods using hand and wrist radiographs across different ethnicities. Further, this will be highlighting both strengths and gaps in existing knowledge. The inclusion of high-quality data will facilitate a quantitative meta-analysis for the exploration of ethnic differences in skeletal age assessments, ultimately laying the foundation for the development of population-specific reference standards. PROSPERO registration ID CRD42025646662.
Zinc and iron deficiencies are major global health issues, and wheat biofortification offers a promising solution. However, simultaneously improving grain zinc concentration (GZnC), grain iron concentration (GFeC), and yield-related traits remains challenging. This study used 198 F₆ recombinant inbred lines (RILs) derived from a cross between the high-zinc/iron parent 'Manku' and low-zinc parent 'Kachu' developed at CIMMYT, Mexico. The population was phenotyped for GZnC, GFeC, days to heading (DH), plant height (PH), thousand-kernel weight (TKW), and test weight (TW) over two growing seasons. QTL mapping using ICIM-ADD and multi-environment trial (MET) models identified 72 QTLs, with 23 stably expressed across both methods, including QGZnC.cim-7D, QTKW.cim-7B.2, and QDH.cim-5B. Notably, QTL clusters for GZnC/GFeC content and yield traits were found on chromosomes 2B, 5A, and 7D, indicating potential for synergistic improvement. Candidate gene prediction within six QTL intervals associated with GZnC and GFeC identified 17 genes involved in transport or homeostasis, such as zinc transporters, oligopeptide transporters, and glutathione S-transferases. Additionally, 15 promising lines (e.g., KM_618, KM_633, KM_782, KM_791) were selected for biofortification or simultaneous improvement of micronutrient content and yield. These stable QTLs provide a foundation for coordinated enhancement of grain nutrition and yield in wheat breeding. The online version contains supplementary material available at 10.1007/s11032-026-01663-8.
OBJECTIVE: To synthesize qualitative research exploring patient experiences of lower limb tendinopathies and identify themes to support patient-centered care. DESIGN: Systematic review with thematic synthesis. LITERATURE SEARCH: MEDLINE, EMBASE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and SPORTDiscus were searched from inception to September 2024, using MeSH (Medical Subject Headings) terms and key words. Forward and backward citation tracking of included studies was performed in Web of Science. STUDY SELECTION CRITERIA: Peer-reviewed qualitative studies published at any date and using interviews or focus groups exploring perspectives on common lower limb tendinopathies (plantar heel pain, Achilles tendinopathy, tibialis posterior tendinopathy, patellar tendinopathy, gluteal tendinopathy, or proximal hamstring tendinopathy) were included. Participants of any age were eligible if diagnosed by a health care professional and symptomatic for at least 3 months. DATA SYNTHESIS: Thematic synthesis was conducted using an inductive approach. Two reviewers independently coded data. Descriptive themes were developed, refined through discussion, and structured into final analytical themes. RESULTS: Thirteen studies were included (n = 153; 84 females), with Achilles tendinopathy being the most common focus (n = 70; 7 studies). Ten themes were identified and organized hierarchically. These included psychosocial impacts; activity limitations; knowledge gaps regarding diagnoses, causes, and management; the importance of therapeutic alliance; and mixed treatment experiences. Six of 29 items in the Critical Appraisal Skills Programme Checklist for Qualitative Studies were unmet in over half of the studies. Confidence in findings ranged from low to moderate (GRADE-CERQual [Grading of Recommendations Assessment, Development and Evaluation Confidence in the Evidence from Reviews of Qualitative Research]). CONCLUSION: Lower limb tendinopathies impact patients beyond physical pain, affecting work, daily function, and sports and social participation. These challenges often lead to psychosocial consequences, including frustration, anxiety, and isolation. Strong therapeutic alliances can improve patient experiences and satisfaction with care. J Orthop Sports Phys Ther 2026;56(6):334-345. Epub 23 April 2026. doi:10.2519/jospt.2026.13666.
Agriculture remains the primary source of livelihood for India's rural population, particularly among vulnerable communities including tribal communities, marginal farmers and agricultural labourers. Musculoskeletal disorders (MSDs) represent a significant but under-researched occupational health burden in this population. This scoping review will systematically examine the existing research on musculoskeletal hazards in agriculture across rural India. This will help identify knowledge gaps and provide suggestions for establishing comprehensive occupational health strategies and primary healthcare interventions, particularly for high-risk groups at risk of poor health outcomes. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) guidelines and the Arksey and O'Malley framework will be used to investigate MSDs in rural agricultural communities in India. The PEO (Population, Exposure, Outcome) framework will be used to decide which studies will be included. Relevant Medical Subject Headings terms and keywords will be used for comprehensive literature searches across multiple databases, including MEDLINE, Physiotherapy Evidence Database, Scopus, Web of Science and Cumulative Index to Nursing and Allied Health Literature as well as grey literature sources. Articles written in English and published between January 2010 and December 2026 on farming-related MSDs among adults (18 years and above) in the rural population of India will be included. For data extraction, the study characteristics, demographic features of the population, farming techniques employed, the occurrence and classification of MSDs, risk factors, interventions and the accessibility of healthcare services will be considered. Thereafter, the results will undergo narrative synthesis and thematic analysis to identify research gaps, regional disparities and the policy and practical implications of the research. No primary data will be collected from human participants in this review, so no formal ethical approval is required. Findings will be disseminated through peer-reviewed publication, conference presentations and stakeholder briefings targeted at agricultural health policymakers, rural healthcare providers and public health educators in India. https://doi.org/10.17605/OSF.IO/9YZ6M.
Prognostic models for cardiovascular disease (CVD) risk have commonly included predictors such as cholesterol levels. Mental disorders are robust predictors of CVD and associated mortality, leading to approximately 2-fold increases in risk. This systematic review aimed to narratively summarize the key characteristics, strengths, and limitations of all CVD prediction models that consider mental disorders. A literature search with medical subject headings/key terms related to CVD, mental disorders and prognostic modeling was conducted in Medline and EMBASE. Included studies were: cohort studies of CVD prediction model development, validation, or recalibration that included mental disorders as prognostic factors/covariate(s), or the population of interest. All studies were screened by 2 independent reviewers, followed by data extraction. The Prediction Model Risk Of Bias Assessment Tool was used to critically appraise bias. A narrative synthesis was used to summarize mental disorder and sociodemographic factor/intersectionality inclusion. There were 31 unique models identified (n=35 records including external validations). Considering these, 77% included mental disorders as a covariate, whereby depression and/or anxiety were the most considered (71%, n=22 studies). Most models were published within the last 5 years, included measures of socioeconomic status; however, many models lacked intersectionality considerations. Only one study was identified with a low risk of bias, while the majority had analytic concerns. Depression and/or anxiety were the most commonly considered mental disorders in modeling, despite larger associations with CVD for other disorders. Further CVD prediction modeling should consider a broader array of mental disorders, and limit methodological biases.