The purpose of this paper is to discuss voice memos - where participants privately record their spoken responses to qualitative prompts on their smartphones - as a low-burden strategy for qualitative data collection. Collecting primary data has become increasingly challenging for social and behavioral scientists, both in recruiting research participants and securing quality and complete data. Qualitative data collection can pose even greater challenges due to it being time-consuming, cognitively taxing, and potentially socially undesirable for participants. We contend voice memos may be an opportune way of overcoming some of these challenges and describe our experience successfully collecting voice memo data as part of a community-based research study. We share insights on our procedures to collect voice memo data, including the survey tool and logic that could be repurposed for future studies, feasibility of collecting these data, quality of data collected via voice memos, and lessons learned from the process.
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Predicting the pathogenic consequences of protein mutations is a cornerstone of precision medicine, yet it remains a formidable challenge for transmembrane proteins (TMPs), a clinically vital class of drug targets. Existing computational methods are often hampered by their reliance on evolutionary data and fail to model TMP-specific biophysical constraints. Here, we introduce Memo-Patho, a deep learning framework for robust, alignment-free pathogenicity prediction of TMP variants. The core innovation is a within-protein, label-informed supervised contrastive pretraining strategy that learns sequence-encoded biophysical signatures distinguishing pathogenic and benign variants by directly comparing them within the same protein context. By fusing sequence-level representations from protein language models with local structural proxies derived from sequence, Memo-Patho achieves accurate predictions without multiple sequence alignments or experimental structures. Across diverse TMP benchmarks and under protein-level group splits, Memo-Patho consistently outperforms leading predictors, achieving up to 0.93 accuracy, and it transfers to an independent KCNQ1 ion-channel cohort without re-training. Its resource-efficient, alignment-free design enables routine large-scale screening when evolutionary or structural data are sparse. Conceptually, Memo-Patho addresses a key gap by directly learning discriminative, sequence-anchored signatures pertinent to TMP-specific constraints, offering a principled and generalizable foundation for research-use clinical variant triage and proteome-wide mutation-effect modeling.
Methanotrophs are key microbial regulators of soil methane (CH4) sinks, but the global impact of their functional gene abundance on CH4 oxidation remains unquantified. This gap limits the integration of key functional genes abundance parameters (e.g., pmoA) into soil CH4 sink model. We integrated meta-analysis, machine learning, and process-based modeling to assess the relationship between pmoA gene abundance and soil CH4 uptake. Our developed Functional Gene Abundance-Based Methanotrophy Model (FGA-MeMo) incorporates pmoA as a proxy for CH4 oxidation capacity, significantly improving model simulations. FGA-MeMo estimates global upland soil CH4 uptake at 45.74 ± 0.26 Tg year-1, which is 56%-58% higher than MeMo model. Under SSP5-8.5 scenario, this increases to 64.68 ± 0.35 Tg year-1 by 2100, with mid- and high-latitude regions showing enhanced CH4 oxidation due to greater pmoA abundance. These findings highlight the importance of integrating microbial functional genes into Earth system models for improved CH4 cycle predictions.
Wanting composes flexibly with knowing: we can want to know, want to know what someone wants, and so on. In this paper, we develop a goal representation that allows for this type of rich integration between goals and other theory-of-mind concepts. We extend the memo programming language, which is specialized for theory-of-mind reasoning, with a new syntactic construct called "wants" that represents goals. To implement "wants," we borrow an idea from programming language theory: the notion of a "continuation," which allows reasoning about possible future states of a program. We show that the new "wants" construct can be composed with other memo primitives to represent a wide variety of interesting goals, and we discuss what the design of this construct can teach us about the concept of desire more broadly.
Local government is central to addressing determinants of public health and must use evidence to make effective decisions. In England, local government typically does not have research infrastructure to enable this; an emerging strategy to overcome this challenge is embedding public health researchers. Expectations of embedded researchers (ERs) are often ambitious and long-term (i.e. changing culture towards evidence), with markers of change lacking, making it difficult to measure progress. Aims: to (i) better describe the rationale for our ER roles, (ii) better understand strategies ERs use and (iii) put forward a framework to track changes resulting from ER roles. A qualitative, self-reflective study was carried out by five ERs (authors). Data collection (April 2023-January 2024) comprised three stages: (1) initial discussion and written reflections, (2) reflective memo-writing, and (3) peer-to-peer interviews. Data was analysed using a hybrid approach, thematic analysis and the Framework Method, alongside an iterative process of interpretation through team discussion. A framework about how ERs can contribute towards changes in evidence application in local government was developed. Relationships were identified as key. Four common relational strategies by ERs were identified to enable change: (1) reflect on context and tailor communication approaches, (2) collaborate across boundaries, (3) be visible/accessible and (4) create space to reflect and learn. Short-term markers of changes in relationships (e.g. ER expertise is seen, valued, and trusted, and relational networks are built) and markers of subsequent changes in evidence use (e.g. mindsets that seek research and evidence, critical thinking) were identified. A novel ER framework was developed (four relational strategies with markers of subsequent change), which can be used and tested in future research, evaluation, and practice: to develop clearer theories of change for ER initiatives, help ERs develop confidence in their roles and/or develop clearer ER job specifications and objectives. Local governments play an important role in improving public health, but in England, they often lack the research resources needed to make evidence-based decisions. One way to address this challenge is by placing public health researchers directly within local government teams. These embedded researchers (ERs) are often expected to create long-term changes, like encouraging a culture that uses research to inform decisions. However, it can be hard to measure progress in the short-term. This study aimed to (1) examine the purpose of ERs in local government and (2) develop a framework to track short-term changes resulting from ER work. The study was carried out by five ERs between April 2023 and January 2024. Data was collected through discussions, personal reflections, written memos, and interviews among the researchers and analysed using a structured approach to identify common themes. A framework about how ERs contribute towards long-term changes in evidence use in local government was developed with relationships identified as key. Four common approaches were found to enable long-term change: (1) adapting communication to the local context, (2) collaborating across different teams, (3) being visible and accessible to staff and (4) creating opportunities for reflection and learning. In the short-term, relationship changes can be identified by markers such as ER expertise being seen, valued, and trusted, and ERs helping to build networks within the organisation. Subsequent change in evidence use can be identified by markers such as staff starting to seek out research and evidence, think critically and use evidence more in decision-making. The study produced a new framework showing how ERs can support evidence use in local government. It outlines practical strategies and early markers of change. This framework can help future ERs understand their role, guide their work, and be tested in research and practice to improve evidence-informed decision-making.
Young Children's Participation and Environment Measure (YC-PEM) is a promising electronic patient-reported outcome (e-PRO) that could support family-centred care during service plan development in early intervention (EI), but prior implementation research has been limited to a single programme and state despite state level variability in EI administration. This study aims to identify shared and localised determinants and strategies for scaling YC-PEM e-PRO implementation in EI systems across multiple programmes and states. This study used an explanatory-sequential mixed-methods case study design to engage EI stakeholders (leaders (n=4), providers (n=19) and caregivers (n=13)) across two of three geographical bands in the case state. Data were collected via virtual semi-structured interviews and focus groups, with stakeholders first rating and then explaining their responses to how helpful and easy it would be to implement the YC-PEM e-PRO option within their routine EI workflow. Transcripts were content analysed using a hybrid deductive and inductive approach to yield one analytical memo per EI stakeholder group that underwent team review and participant validation, followed by mapping of memo content to an established implementation research logic model that had been populated with content specific to another state. All 37 EI stakeholders rated the YC-PEM e-PRO option as helpful, while most stakeholders rated it as somewhat or not easy to implement within their EI workflow. They confirmed the continued relevance of nine known determinants (four supports, five barriers) and introduced four new determinants (two supports, two barriers) for localised implementation in their state. Stakeholders confirmed and further refined the scope of two strategies and introduced one new potential strategy to support its localised implementation within their state. Both shared and localised determinants and corresponding strategies are relevant to advance YC-PEM e-PRO implementation across state and local EI programmes with varied data system capabilities, organisational readiness and provider resources. NCT04562038.
The summer of 2025 and its historic chikungunya outbreak marked a turning point in the way we approach mosquito-borne viral diseases in Europe, and in particular those which depends on Aedes albopictus, the Asian tiger mosquito, for their transmission. These arboviral infections show a pronounced dependence on global change, owing to complex interactions between very different organisms. Mosquitoes, in particular, are highly sensitive to the effects of climate change. In this context, Aedes albopictus, an invasive species showing substantial adaptability and robustness, continues to expand across Europe, notably in Northern Europe. This mosquito is a key vector, in particular for dengue and chikungunya, whose clinical presentation is often non-specific, complicating diagnosis and the early detection of clusters. Faced with these complex characteristics, the challenge is to organize integrated surveillance that combines entomological monitoring, human surveillance, and adaptation to a situation that is, by its very nature, evolving. In Belgium, entomological surveillance (MEMO+) and mandatory case notification-structured differently across the country's entities-constitute essential yet still improvable pillars of this surveillance. L’été 2025 et son épidémie historique de chikungunya a marqué un tournant dans notre façon d’appréhender les viroses transmises par des moustiques, et en particulier Aedes albopictus, le moustique tigre, en Europe. Ces arboviroses montrent une dépendance marquée aux changements globaux, du fait d’interactions complexes entre organismes très différents. Les moustiques sont, notamment, particulièrement sensibles aux effets des changements climatiques. Dans ce contexte, Aedes albopictus, espèce invasive montrant une adaptabilité et une robustesse importantes, poursuit son expansion en Europe, notamment en Europe du Nord. Ce moustique est un vecteur clé, notamment de la dengue et le chikungunya, dont les présentations cliniques sont souvent peu spécifiques, compliquant le diagnostic et la détection précoce des clusters. Face à ces caractéristiques complexes, l’enjeu est d’organiser une surveillance intégrée combinant veille entomologique, surveillance humaine et adaptation à une situation par essence en évolution. En Belgique, la surveillance entomologique (MEMO+) et la déclaration obligatoire des cas, structurées différemment selon les entités, constituent des piliers essentiels, mais encore perfectibles de cette surveillance.
Background/Objectives: Totally endoscopic mitral valve repair reduces surgical trauma and accelerates recovery but can be technically challenging, particularly for precise annuloplasty suturing. The VirtuoSEW® (LSI Solutions, Victor, NY 14564m, USA) automated annular suturing system was developed to standardize and simplify suture placement. This study was an early evaluation of this technology's safety, efficacy, and feasibility in totally endoscopic microInvasive mitral valve repair (µMVr). Methods: We conducted a retrospective observational study of 20 patients with severe mitral valve disease of various etiologies. All patients underwent mitral valve repair using the VirtuoSEW® system for automated placement of annuloplasty sutures, combined with leaflet resection or chordal management as appropriate. Postoperative outcomes were assessed at one month using echocardiography and clinical evaluation. Perioperative and postoperative complications and early mortality were systematically recorded. Results: VirtuoSEW®-assisted mitral valve repair was safe and effective, achieving complete elimination of severe mitral regurgitation in all patients (N = 20, 100%). Annuloplasty rings included Physio-ring (N = 12, 60%), Memo 3D (N = 4, 20%), and Memo 4D (N = 4, 20%), combined with leaflet repair techniques: leaflet plication (N = 5, 25%), neochordae implantation (N = 7, 35%), sliding plasty (N = 2, 10%), commissural repair (N = 1, 5%), and hemibutterfly repair (N = 1, 5%). Concomitant procedures included: tricuspid valve repair (N = 1, 5%) and atrial septal defect closure (N = 1, 5%). Mitral annulus diameter decreased from 42.0 ± 5.3 mm to 34.2 ± 2.2 mm (p = 0.001). Mean total surgery, cardiopulmonary bypass, and aortic cross-clamp times were 170.3 ± 21.3, 143.4 ± 21.5, and 80.4 ± 7.9 min, respectively. ICU stay was 1.0 ± 0.2 days, with a hospital stay of 8.0 ± 1.9 days. No perioperative complications-including bleeding (N = 0, 0%), stroke (N = 0, 0%), infections (N = 0, 0%), or 30-day mortality (N = 0, 0%)-occurred. Conclusions: µMVR invasive mitral valve repair using the VirtuoSEW® system is safe, effective, and reproducible, as well as compatible with almost all repair techniques, providing complete restoration of valve competence with no early device-related complications. To our knowledge, this is the first clinical study reporting outcomes with this device, supporting its potential to streamline mitral repair and improve procedural efficiency.
Patients with low literacy have difficulty completing patient-reported outcomes measures (PROMs). The Multimedia Adaptation Protocol (MAP) guides the process of adapting traditional PROMs to multimedia versions that patients with low literacy can self-administer. We previously executed the first MAP stage, forward adaptation, to adapt the Patient-Reported Outcomes Measurement Information System Upper Extremity (PROMIS-UE) to a multimedia version (multimedia PROMIS-UE). The goal of this study was to refine the multimedia PROMIS-UE via the next MAP stages, back adaptation and qualitative evaluation, to result in a conceptually-equivalent, user-tested multimedia PROMIS-UE ready for psychometric validation. For back adaptation, mixed-literacy and English-speaking participants masked to the PROMIS-UE "translated" multimedia components back to text. We compared text back-adaptations to the original PROMIS-UE, identified areas of non-equivalence, and updated the multimedia PROMIS-UE accordingly. For qualitative evaluation, we used an iterative design process to conduct cycles of testing to assess usability and face validity. We performed analyses including memo writing and framework-guided thematic analysis. Findings were synthesized into usability, functionality, or content-related themes that guided ideation workshops focused on identifying solutions. We recruited 11 participants for back adaptation. We identified areas of non-equivalence between the PROMIS-UE and multimedia PROMIS-UE for 85% of the questions, which were addressed in an updated multimedia PROMIS-UE. We conducted two cycles of qualitative evaluation. We recruited 20 patients and identified 16 themes/challenges: animations unused, audio unused, instructions unclear, instructions unused, difficulty starting questionnaire, response audio button misinterpreted, difficulty with incomplete forms, difficulty submitting answers, purpose of avatars unclear, purpose of smiley scale unclear, difficulty differentiating smileys, inaccurate animation, unclear how to select answer, audio button unused or misinterpreted, confusion with scrolling, and incomplete popup window missed. We updated the multimedia PROMIS-UE after each cycle to address each theme. We developed a conceptually-equivalent, user-tested multimedia PROMIS-UE ready to undergo psychometric testing and validation. This work represents an essential intermediary and preparatory phase of PROM development, is analogous to cross-cultural translation phases intentionally positioned prior to psychometric validation, and advances how PROMs can be adapted to a multimedia format. Ultimately, a validated multimedia PROMIS-UE will expand clinicians' and investigators' abilities to capture patient-reported outcomes in low literacy populations.
Urinary incontinence (UI) is a significant and common health problem among older women. Exploring their experiences in managing their condition can be an effective way to improve the care process for these patients. Therefore, this study was conducted with the aim of explaining the process of managing urinary incontinence in older women. This qualitative study, employing a grounded theory approach, was conducted from 2019 to 2022 among older women with urinary incontinence. Purposive and theoretical sampling were used, and the participants were selected from older women who referred to comprehensive health centers in Ahvaz. Data were collected using in-depth, unstructured interviews, field notes, and memo writing. A total of 40 interviews were conducted with 37 participants, with each interview lasting approximately 20 to 70 min. The interviews continued until category saturation was reached. Data analysis was performed using the Corbin and Strauss (2008) method, and MAXQDA version 10 software was used to facilitate data management. Through data analysis, 35 initial categories, 10 subcategories, and three main categories were extracted, including: " Inadequacy in the provision of healthcare services," " Psycho-social burnout," and " Adaptive Interaction with the Condition." The main concern of the participants in this study was "A deficit in organizing life threatened by the disease." Ultimately, the core category that emerged from the combination of the categories was " Striving for adaptation and regaining control over the condition," which was the connecting factor for all categories and concepts derived from the research. This study provided valuable findings about the process of managing UI in older women with this condition within our Iranian-Islamic culture, which is significant in the field of providing specialized care to older people in our society. The discovery of concepts that were previously hidden in the lives of these older women due to the nature of the disease seems necessary to provide them with proper and safe care, as well as to help them manage their disease more effectively before it disrupts their natural life process.
Contemporary machine learning models, including large language models, exhibit remarkable capabilities in static tasks yet falter in non-stationary environments due to rigid architectures that hinder continual adaptation and lifelong learning. Building upon the nested learning (NL) paradigm, which decomposes models into multi-level optimization problems with fixed update frequencies, this work proposes Dynamic Nested Hierarchies (DNH) as an extension enabling autonomous structural adaptation. Unlike static nested learning where hierarchy depth and update frequencies are fixed at initialization, DNH introduces three biologically-grounded mechanisms: (1) level addition triggered by meta-loss thresholds, analogous to adult neurogenesis in the hippocampal dentate gyrus; (2) level pruning based on gradient contribution, analogous to synaptic elimination; and (3) frequency modulation driven by local surprise signals, analogous to neural oscillation adaptation. We provide explicit mappings between these mechanisms and neuroplasticity processes, moving beyond superficial analogy to principled design. Through rigorous mathematical formulations, we prove convergence bounds of O(1/T + δ2) in non-stationary environments, expressivity improvements bounded by ϵ ≤ O(1/L t ) + γδ, and sublinear regret O ( T ) compared to static architectures' linear regret. Empirical evaluations on language modeling, continual learning benchmarks-including comparisons with Elastic Weight Consolidation (EWC) and Synaptic Intelligence (SI) as well as modern methods (DER++, MEMO) on Split ImageNet, CLEAR-100, and CORe50-and long-context reasoning validate the theoretical advantages. Comprehensive ablation studies verify the contribution of each component, including the Self-Modifying Memory (SMM) module and Evolutionary Adam (EAdam) optimizer. We provide detailed computational cost analysis and parameter trajectory visualizations demonstrating bounded growth through self-regulating pruning.
Diabetes technologies-including continuous glucose monitoring (CGM), insulin pumps, and hybrid closed-loop systems-have profoundly transformed self-management in type 1 diabetes (T1D). While these technologies offer improved glycemic control and safety, their use in ultraendurance sports introduces specific cognitive, material, and organizational challenges that remain underexplored in digital health research. This study aimed to explore how adults living with T1D experience and use diabetes technologies in ultraendurance sports, with particular attention to tensions between autonomy, mental load, and vulnerability. We conducted semistructured interviews with 13 French-speaking adults with T1D who had completed at least one marathon or ultra-endurance event within the last 5 years and used ≥1 diabetes technology (CGM, pump, or hybrid closed loop). We adopted constructivist grounded theory (Charmaz), using iterative cycles of line-by-line and focused coding, constant comparison, and memo-writing to build and refine analytic categories. Sampling combined purposive strategies through associations and online communities with theoretical orientation (additional participants sought to elaborate emergent categories). Data collection ceased upon theoretical sufficiency, when further interviews no longer yielded substantively new insights for core categories. Two patient partners contributed to question framing, interim sense-checking, and manuscript review. Reporting followed the COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist. Five interrelated categories described how athletes negotiated technology in practice: (1) From episodic control to continuous anticipation (reframing glucose management through real-time visibility); (2) Gains in safety and performance (perceived benefits and expanded possibilities); (3) Redistributed mental work (hyper-vigilance, logistics, device management); (4) Keeping things working when they break (fragility in extreme conditions, redundancy, improvisation, and experiential expertise); and (5) Making diabetes visible (technologies mediating identity, solidarity, and stigma). Across categories, participants articulated a tension between optimization-oriented performance and a user-constructed robustness-the capacity to maintain function under uncertainty through redundancy and adaptive know-how. In ultraendurance contexts, diabetes technologies act as both enablers and obligations: they open participation while shifting and sometimes intensifying cognitive and organizational work. A grounded account centered on robustness-in-use highlights practical implications for clinicians (pre-event routines, redundancy planning), designers (context-aware algorithms; improved physical durability), and policy makers (equitable access and exercise-specific education). These findings underscore the value of constructivist, practice-oriented inquiry to inform digital health tool design and support for people living with chronic illness.
Glucagon-like peptide 1 receptor agonists (GLP-1RAs) facilitate weight loss and reduce pain among individuals with knee osteoarthritis (OA). We investigated attitudes and barriers influencing GLP-1RA use among individuals with knee OA and excess weight to draw distinctions in perspectives between patients with and without GLP-1RA experience. In this cross-sectional qualitative study guided by the Framework Analysis method, we conducted structured interviews with persons with knee OA and excess weight. The moderator's guide included questions about health, weight loss history, and thoughts and experiences related to GLP-1RAs. Of the 286 patients prescreened, 30 completed an interview, after which saturation was reached. Interview transcripts were coded by research assistants using Dedoose software, and themes were identified using inductive analysis, charting, and memo writing. The 30 individuals interviewed were majority female and most self-identified as White. Fifteen participants had current or prior GL-P1RA use, and fifteen had never taken GLP-1RAs. We identified four major themes: (1) health care providers were the primary GLP-1RA information source; (2) most participants recognized that weight loss could contribute to knee pain relief; (3) "ever users" reported overall positive experiences and found GLPA-1RAs helped facilitate healthy lifestyle changes, whereas "never users" more often described medications as a last resort after lifestyle changes fail; and (4) cost was the most significant barrier to GLP-1RA use. We found that perceptions both differed and overlapped among participants with and without prior GLP-1RA use. Clinicians should address potential concerns regarding GLP-1RAs when discussing treatment options with patients with excess weight and knee OA.
Hypertension remains a leading cause of cardiovascular morbidity, mortality, and disability worldwide. It is also a significant modifiable factor contributing to chronic brain damage. Key mechanisms involved in this process include cerebral microangiopathy, endothelial dysfunction, impaired autoregulation of cerebral blood flow, and oxidative stress. These factors play a central role in the development of chronic cerebral ischemia and cognitive impairment. This article reviews published data on the impact of oxidative stress and metabolic disturbances on hypertensive brain injury, as well as current approaches to neuroprotective therapy. Particular attention is given to ethylmethylhydroxypyridine succinate (Mexidol), an agent with a multimodal mechanism of action. Experimental and clinical studies are reviewed, including the results of the randomized placebo-controlled MEMO trial and its subgroup analysis involving patients with hypertension. The evidence presented supports the sequential therapy with Mexidol in this patient population, aimed at preventing the progression of cognitive impairment. Артериальная гипертензия (АГ) остается ведущей причиной сердечно-сосудистой заболеваемости, смертности и потери трудоспособности в мире, а также одним из ключевых модифицируемых факторов хронического повреждения головного мозга. Такие патофизиологические состояния, как микроангиопатия, эндотелиальная дисфункция, нарушение ауторегуляции мозгового кровотока и окислительный стресс лежат в основе формирования хронической ишемии головного мозга и развития когнитивных нарушений (КН). В статье проанализированы литературные данные, посвященные вкладу окислительного стресса и метаболических нарушений в развитии церебрального повреждения при АГ, а также рассмотрены возможности нейропротективной терапии. Особое внимание уделено этилметилгидроксипиридина сукцинату (Мексидол) как препарату, обладающему мультимодальным механизмом действия. Проанализированы экспериментальные и клинические исследования, включая результаты рандомизированного плацебо-контролируемого исследования МЕМО и его субанализа у пациентов с АГ. Представленные данные свидетельствуют о целесообразности последовательной курсовой терапии препаратом Мексидол у пациентов с АГ с целью профилактики прогрессирования КН.
Adaptability is an essential element of professional healthcare practice, yet little is known about how medical students understand and engage with adaptability during their preclinical training. Insight into these early experiences can help uncover the fundamentals of later adaptive expertise. This study explored how preclinical medical students perceive their own adaptability in the context of their academic work. From December 2024 to January 2025, seventeen third-year medical students from three universities in Belgium, the Netherlands, and Portugal participated in semi-structured interviews. We conducted interviews in person or online and recorded, transcribed verbatim, and analyzed them using thematic analysis. A constructivist orientation informed the approach to data collection and interpretation. Coding was iterative and supported by regular team discussions and memo writing. Students described adaptability in two distinct but related ways. The first theme, refining, occurred in situations that were different but came with clear expectations, such as examinations, course structures, or explicit or inferred teacher requirements. In these situations, students described adaptability as adjusting established study strategies and seeking guidance from peers to meet goals they could define clearly. Their actions were cautious and deliberate, influenced by a desire to avoid failure and remain within a context that felt manageable. The second theme, looking for gaps, reflected experiences in situations that were unfamiliar or ambiguous, including early clinical encounters or unexpected challenges. In these situations, students realized their usual strategies were insufficient and described adaptability as stepping back, observing before acting, and asking targeted questions to understand how to proceed. Although these situations often prompted significant learning, students also reported discomfort, uncertainty, and vulnerability, which sometimes led to hesitation or avoidance. These findings highlight the importance of educational environments that acknowledge adaptability as part of learning and provide structured support to help students navigate less predictable situations. Such environments may encourage students to move beyond optimizing familiar strategies and toward the forms of adaptability that underpin the development of adaptive expertise.
We hypothesized that advanced 3-dimensional (3D) echocardiographic assessment of mitral annular dimensions provides a more accurate correlation of surgically implanted annuloplasty ring size compared with conventional 2-dimensional (2D) echocardiography. Prospective, non-interventional study SETTING: Operating room at a tertiary academic medical center PARTICIPANTS: Ninety-nine patients METHODS: Transesophageal echocardiography was performed in patients undergoing surgical mitral valve repair. The 3D datasets of the mitral valve were analyzed using dedicated software for semiautomated measurement (4D MVA; TOMTEC Imaging Systems, Germany). Additionally, mitral annular dimensions were evaluated using conventional 2D images, as well as images derived from multiplanar reconstruction of 3D datasets (3D MPR). Pearson correlation coefficients between echocardiographic measurements and the intraoperatively selected annuloplasty ring size were compared. The strongest correlations with annuloplasty ring size were observed for the mid-systolic anterolateral-posteromedial diameter in 4D MVA (r = 0.706), the end-systolic anterior-posterior diameter in 2D (r = 0.600), and the end-systolic anterior-posterior diameter in 3D MPR (r = 0.662). In the overall cohort, there was no statistically significant difference between the highest correlation coefficients of each imaging modality (4D MVA v 2D; p = 0.059). However, a post hoc comparison including all measurement parameters demonstrated a significant difference between 4D MVA and 2D. Furthermore, subgroup analysis of the Corcym Memo 4D ring model revealed a significant difference (p < 0.001) between the highest correlation coefficients derived from 4D MVA and 2D. Software-based 3D echocardiographic assessment (4D MVA) of the mitral annulus geometry might provide superior accuracy for predicting appropriate annuloplasty ring size compared with conventional 2D measurements, supporting its role in individualized decision-making.
Since the outbreak of the COVID-19 pandemic in 2020, people in Slovenia have faced a series of overlapping crises at both global and national levels, including the Russo-Ukrainian conflict, rising economic costs, and major natural disasters. Although extensive quantitative research has examined pandemic-related mental health outcomes, comparatively little is known about how individuals subjectively perceive multiple overlapping crises, given the cumulative and interactive nature of contemporary crises - situations in which crises across multiple systems become causally entangled and mutually amplify their effects. This study aimed to explore the perceived psychological consequences of multiple overlapping crises among adults in Slovenia, guided by the polycrisis framework. Using a qualitative research design based on Constructivist Grounded Theory, we conducted semi-structured, in-depth interviews between June and November 2023 with 24 participants (16 women, 8 men; mean age 49 years, range 21-76). Interviews were audio-recorded, manually transcribed, and analyzed using ATLAS.ti 24 software. Analysis involved initial and focused coding, constant comparison, and analytic memo-writing, continuing until theoretical saturation was reached. A total of 274 quotations were coded into 16 final codes. Three analytical categories of perceived psychological consequences emerged: duration (short-term vs. long-term), valence (positive vs. negative), and level of impact (individual vs. societal). Short-term consequences were predominantly individual-level experiences tied to the acute pandemic period, including negative outcomes (e.g., stress, mental health decline, social polarization) and positive outcomes (e.g., increased time with close ones, time in nature, reduced pressure). Positive long-term consequences included closer relationships and increased gratitude; negative ones included a reduced sense of safety, distrust in authorities, weaker social ties, and a perceived decline in social cohesion. Based on the analytical findings, we developed the Fortress Wall Model of Psychological Adaptation to Crisis, which conceptualizes the experience of compounding crises as a dynamic, phased psychological process. The findings underscore the need to address people's emotional experiences during acute crisis phases and to maintain monitoring and support of psychological well-being beyond the acute period, as negative consequences - particularly heightened uncertainty, distrust, and a diminished sense of safety - persist long after crises subside and are intensified by subsequent stressors.
Virtual reality (VR) is increasingly recognized as a supportive tool in palliative care due to its potential to promote relaxation, emotional comfort, and spiritual reflection. In Thailand, where end-of-life care is shaped by family relationships, Buddhist beliefs, and the value of a peaceful death, little is known about how VR is perceived in this context. To explore perceptions, emotional and spiritual needs, and anticipated acceptability of VR in end-of-life care among terminally ill patients, family caregivers, and palliative care professionals in Thailand. A qualitative descriptive study was conducted using semi-structured interviews with 15 purposively selected participants, including five terminally ill patients, five family caregivers, and five healthcare professionals. The study focused on anticipated rather than directly experienced use of VR. Interviews were conducted in Thai, audio-recorded, transcribed verbatim, and analyzed using inductive content analysis. Rigor was enhanced through investigator triangulation, reflexive memo writing, peer debriefing, and an audit trail. Four interrelated themes were developed: (1) emotional and existential needs, including longing for home, peace, and unresolved concerns; (2) spirituality and meaning, where VR was perceived as a medium for reflection and religious connection; (3) facilitators and barriers, including perceived benefits alongside concerns about usability, emotional impact, and staff workload; and (4) compassionate innovation, reflecting the potential of VR to support dignity, comfort, and meaning at the end of life. Participants viewed VR not merely as a distraction tool, but as a means of symbolic connection and emotional support. In this Thai palliative care context, VR was perceived as a potentially compassionate and culturally meaningful technology that may support emotional, existential, and spiritual well-being when tailored to patient readiness, cultural values, and clinical feasibility. As findings reflect anticipated perceptions, further research is needed to evaluate its practical, emotional, and ethical impacts in clinical settings.