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Assessing the suitability of unconditioned buildings for adaptive reuse as archival storages, particularly with respect to their microclimate behaviour, remains a complex and evolving methodological challenge. This study proposes a data-driven method using indoor and outdoor climate data to assess whether unconditioned buildings can be adaptively reused for specific functions (e.g., archival), based on their microclimate behaviour. The multi-step approach includes quality check, stationarity analysis, temporal decomposition, and buffering capacity analysis. This is applied to 5 years (2020-2024) of air temperature (T) and relative humidity (RH) data (approximately 14 600 observations) from 10 thermohygrometers in the "Library Section for Special Collections (LSSC)" within "Dora I" (Trondheim, Norway), where conservation conditions of paper-based objects are considered satisfactory. Results indicate a very stable indoor climate with no significant trends or abrupt changes, with a mean temperature (T) and mixing ratio (MR) values of 17 ± 2 °C and 6 ± 1 g/kg respectively, and very low short-term variability, suggesting consistent conservation conditions and reduced need for active climate control. Indoor T and MR show delayed responses to outdoor conditions (up to 70 and 50 days), and buffering factors of 0.2 and 0.4, respectively, reflecting thermal inertia and moisture buffering. The proposed method captures the limited impact of site management on indoor climate and reveals structure-specific dynamics often overlooked in commonly applied evaluations.

Solid-state spins are promising as interfaces from stationary qubits to single photons for quantum communication technologies. Semiconductor quantum dots have excellent optical coherence, exhibit near-unity collection efficiencies when coupled to photonic structures, and possess long-lived spins for quantum memory. However, the incompatibility of performing optical spin control and single-shot readout simultaneously has been a challenge faced by almost all solid-state emitters. To overcome this, we leverage light-hole mixing to realize a highly asymmetric lambda system in a negatively charged heavy-hole exciton in Faraday configuration. By compensating GHz-scale differential Stark shifts, induced by unequal coupling to Raman control fields, and by performing nuclear-spin cooling, we achieve quantum control of an electron-spin qubit with a π-pulse contrast of 97.4% while preserving spin-selective optical transitions with a cyclicity of 471 (50). We demonstrate this scheme for both GaAs and InGaAs quantum dots, and show that it is compatible with the operation of a nuclear quantum memory. Our approach thus enables repeated emission of indistinguishable photons together with qubit control, as required for single-shot readout, photonic cluster-state generation, and quantum repeater technologies.

Volatile aromatic hydrocarbons, including benzene, toluene, ethylbenzene, and xylenes (BTEX), are widely used in paint manufacturing and can create occupational health hazards because of their toxicity and high volatility. This study assessed personal and exposure levels of BTEX compounds among workers in small- and medium-sized paint factories in Jeddah, Saudi Arabia. Air samples were collected using charcoal tubes and analyzed by gas chromatography with a flame ionization detector (GC-FID). Statistical analyses, including correlation and principal component analysis (PCA), were used to identify emission patterns and likely exposure sources. Benzene was not detected in any samples, whereas toluene, ethylbenzene, and xylenes were consistently present and frequently exceeded occupational exposure limits set by ACGIH and OSHA. The highest mean concentrations were found in mixing, grinding, and packaging operations, suggesting inadequate ventilation and direct solvent handling. Strong correlations between ethylbenzene and xylenes indicated shared emission sources from mixed solvent formulations. PCA showed that exposure variability was mainly process-related, with distinct components linked to blending and hardener-related activities. Chronic exposure to these levels may cause neurological, hepatic, and hematological effects, especially in workers with limited protection. The study highlights the need for engineering controls, worker training, and substitution with low-VOC or water-based products.

Artificial riffles are increasingly used in river renaturalization to stabilize incised channels and enhance habitat diversity. However, their long-term structural stability remains under-researched, particularly in reservoir-impacted systems. This study evaluates the nine-year persistence of 12 artificial and 4 seminatural riffles in the regulated upland Bóbr River (Poland) using RTK GPS field surveys, hydraulic and grain size measurements, and hydromorphological assessments (River Habitat Survey). The results demonstrate a clear divergence in evolution based on construction quality. Well-executed riffles (n = 6) maintained high morphological and hydraulic stability (p > 0.05) throughout the monitoring period (2015-2023). In contrast, poorly-executed structures (n = 10) underwent significant degradation, characterized by a significant increase in mean channel depth (p = 0.037) and flow velocity (p = 0.014). In these structures, the winnowing of finer fractions led to a coarsening of the substrate, with the median grain size of the riffle runs increasing from 35 mm to 78 mm, resulting in a fragmented 'dragon's teeth' morphology. While artificial riffles proved to be a durable and nature-friendly alternative to traditional bed-stabilization works, their long-term success is strictly dependent on adherence to design grain size distributions (D50, D84) and proper substrate mixing. These findings provide critical technical benchmarks for the sustainable renaturalization of incised, gravel-bed upland rivers.

Shield tunnel launching adjacent to a river is a typical high-risk problem in urban underground engineering. As a novel reinforcement method for launching shafts, TRD (Trench cutting Re-mixing Deep wall) has been widely applied in shield launching projects, while its stability evolution and failure mechanism remain insufficiently understood. To address this issue, a coupled theoretical model based on Mindlin's elastic solution and the rigorous limit equilibrium method is proposed for stability analysis. Considering the high computational complexity and time consumption of conventional coupled analysis methods, the XGBoost machine learning algorithm is further introduced based on the proposed theoretical model to establish a nonlinear mapping relationship between input parameters and the safety factor, thereby enabling rapid intelligent assessment of excavation stability under complex working conditions. Furthermore, the SHAP method is employed to improve the interpretability of the prediction model by identifying the contribution of different parameters to the safety factor and validating the results against theoretical sensitivity analyses. The results indicate that the shear strength reduction coefficient of the TRD-reinforced zone (ke) has the most significant influence on the safety factor, with a contribution ratio of 65%. The horizontal vibration coefficient (kc) contributes approximately 20%, while the influences of shield thrust (P) and advancement distance (L) are relatively minor. During shield advancement, the evolution of the safety factor can be divided into three stages: rapid adjustment, high-impact dominance, and low-impact stabilization. The system gradually reaches a stable state after the shield advances approximately 15 m. The proposed method can provide theoretical support for the optimal design of TRD reinforcement, safety control during shield launching, and rapid on-site construction safety management.

Pharmacists, while central to medication safety, face underestimated risks due to their daily exposure to toxic and explosive substances. In compounding pharmacies, handling carcinogenic, mutagenic, and reprotoxic (CMR) substances such as chemotherapy drugs, anesthetic gases, antibiotics, and hormones poses significant health hazards. These substances can cause environmental and secondary contamination through fine powder dispersion or volatile vapors, leading to indirect exposure even with standard protective gear. Explosive and fire risks also abound, especially with volatile solvents like ethanol, acetone, and ethyl ether. These substances are flammable and require careful storage and handling. Accidental chemical reactions, such as the mixing of acids and bases or contact between unstable compounds like picric acid and friction, can result in toxic gas release or explosions. To mitigate these dangers, pharmacies must implement strict preventive measures. This includes the use of fume hoods, appropriate personal protective equipment (PPE), and standardized protocols for hazardous drug preparation. Flammable substances must be stored in ventilated, ATEX-compliant cabinets, and chemicals clearly labeled with updated safety data sheets (SDS). Safe waste management and continuous staff training are also essential. Current challenges, such as drug shortages, force pharmacies to work with unfamiliar raw materials, increasing the risk of accidents. A notable example is potassium clavulanate, a fine powder prone to dust explosions if not carefully managed. Ultimately, ensuring pharmacist safety requires a culture of vigilance, continuous education, and adherence to safety protocols to manage both toxicological and explosive risks effectively.

Degenerative lumbar spine pathology manifesting as radiculopathy and neurogenic claudication often leads to impaired postural stability, compensatory movement strategies, and increased fall risk. Conventional clinical assessments and patient-reported outcomes inadequately characterize dynamic balance dysfunction and postural control deficits that persist after surgical intervention. To objectively quantify changes in postural stability, balance effort, and Cone of Economy (CoE) control following lumbar decompression surgery in patients with radiculopathy and neurogenic claudication using high-resolution three-dimensional motion analysis. Prospective, single-center cohort study. Thirty-six adults (mean age 70.1 &#xb1; 11.4 years) with symptomatic degenerative lumbar spinal stenosis undergoing open decompression surgery. Postural sway and stability metrics, including CoE dimensions, center-of-pressure (CoP) and center-of-mass (CoM) excursion, sway path and velocity, phase-plane stability, frequency-domain characteristics, and joint-level compensatory excursions, along with patient-reported outcomes (Oswestry Disability Index, PROMIS, Tampa Scale of Kinesiophobia). Participants completed standardized three-dimensional balance assessments one week before and three months after decompression using a 41-marker motion capture system synchronized to dual force plates. Mixed-effects models tested pre- to postoperative changes, accounting for age, BMI, and repeated measures with false discovery rate correction for multiple comparisons. Lumbar decompression was associated with significant improvements in mediolateral postural control. Center-of-pressure mediolateral sway decreased from 2.24 &#xb1; 0.92 cm to 1.70 &#xb1; 0.69 cm (p&#x202f;=&#x202f;0.007), head coronal sway from 3.29 &#xb1; 1.11 cm to 2.38 &#xb1; 0.87 cm (p&#x202f;=&#x202f;0.001), and CoM coronal sway from 1.85 &#xb1; 0.74 cm to 1.40 &#xb1; 0.63 cm (p&#x202f;=&#x202f;0.009). Expanded balance metrics demonstrated reductions in total head sway path area (9.55 &#xb1; 3.12&#x202f;&#x2192;&#x202f;6.47 &#xb1; 2.41; p&#x202f;=&#x202f;0.001), improved phase-plane stability (p < 0.001), and decreased low- and mid-frequency sway power (p &#x2264; 0.014). Compensatory strategies at the cervical spine, lumbar coronal motion, pelvis, and hips were significantly reduced postoperatively, while knee and ankle kinematics were maintained. Patient-reported disability and pain interference improved (ODI -16.8, PROMIS Pain -8.2; both p < 0.001), with significant reductions in kinesiophobia (TSK -7.1; p < 0.001). Lumbar decompression was associated with quantifiable improvements in postural stability and balance efficiency. High-resolution sway and CoE metrics provide objective, mechanistic biomarkers of functional recovery that complement traditional patient-reported outcomes. These findings support the potential role of dynamic balance assessment in postoperative evaluation and rehabilitation planning to reduce fall risk and optimize functional outcomes after lumbar spinal decompression.

To investigate the gene sequence, protein structure, and impact of the variant on glycosyltransferase B (GTB) structural stability in a patient with a ABO*Bw.28 subtype. A 33-year-old man with mixed hemorrhoids, confirmed as ABO*Bw.28 by genetic sequencing at the Second Affiliated Hospital of Wenzhou Medical University on December 8, 2022 was selected as study subject. ABO phenotyping was performed using tube test, microcolumn gel assay, and absorption-elution test. Genetic testing was conducted by PCR-direct sequencing, with haplotype confirmation by TOPO-TA cloning. Homology modeling was performed using PyMOL, and 100 ns molecular dynamics simulations of wild-type and mutant GTB were conducted using GROMACS to assess root-mean-square deviation (RMSD), radius of gyration (Rg), solventaccessible surface area (SASA), hydrogen bonds, and binding free energy. This study was approved by the Medical Ethics Committee of the hospital (Ethics No.: 2021-K-289-01). Serological tests revealed characteristics of Bw subtype. ABO gene sequencing identified a c.541T>C variant in exon 7, resulting in p.Trp181Arg substitution. Haplotype analysis confirmed presence of the ABO*Bw.28 allele. Molecular modeling showed that the Trp181Arg substitution largely abolished hydrophobic interactions with the UDP-galactose (UDP-Gal) ligand and reduced the number of active site hydrogen bonds (wildtype: 2 ~ 8; variant: 1 ~ 6). Molecular dynamics simulation suggested increased binding free energy from 11.586 kcal/mol (wild type) to 4.680 kcal/mol (variant), indicating a disrupted local hydrogen bond network and reduced conformational stability and substrate binding affinity. This study has identified a case with a c.541T>C (p.Trp181Arg) ABO variant. The variant may disrupt the hydrophobic interactions and local hydrogen bond network, reducing GTB catalytic domain stability and B antigen expression, thus providing a molecular basis for the Bw.28 subtype.

Data on treatment options and patient-reported outcomes (PROs) for bilateral condylar fractures (BCFx) are limited. The study purpose was to report on clinical outcomes and PROs for 3 BCFx treatments: surgical (both sides), nonsurgical (both sides), and combined surgical and nonsurgical treatment. A retrospective cohort study derived from the 'BCFx registry' (a prospective longitudinal observational registry study). The sample was composed of subjects who presented for BCFx management from March 2017 to August 2022. The exposure variable is the 3 treatments: surgical (both sides), nonsurgical (both sides), and combined surgical and nonsurgical treatment. The outcome variable was therapeutic response measured using mandibular mobility index, occlusal status, and pain numeric rating scale (NRS) on each side at 6 weeks and 3 months. The covariates were age, sex, post-treatment maxillomandibular fixation use, same-level condylar fractures, symphysis fracture, and displacement. Within treatment group changes in outcomes at 6 weeks and 3 months were computed. No between treatment group comparisons were made. Mixed-effect models (mobility score, pain NRS) and generalized estimating equations models (occlusal status, pain [Yes/No]) were performed, adjusting for covariates. Statistical significance was set at P < .05. The sample was composed of 226 subjects with a mean age of 38.8 (17.4) years and 148 (65.5%) were male; 61 (27.0%) received surgical, 123 (54.4%) nonsurgical, and 42 (18.6%) combined treatments. The mean change (SD) in mandibular mobility index from 6 weeks to 3 months was -1.9 (2.0) in the surgical, -1.9 (1.9) in the nonsurgical, and -2.0 (2.3) in the combined group (all P < .01). The proportion of subjects with abnormal occlusion decreased from 25.8% (54/209) at 6 weeks to 18.6% (38/204) at 3 months (P < .01). Pain NRS decreased bilaterally within all treatment groups (P < .01). Multivariable models confirmed statistically significant improvements in outcomes over follow-up. Within each treatment category, all assessed outcomes improved over 3 months in subjects with BCFx. Each treatment option has unique benefits; clinicians must assess the patient's condition to select the best treatment approach.

Magnetic biomonitoring employing lichens transplants is a non-invasive and low-cost method to evaluate airborne particulate matter (PM) pollution originated from urban traffic. Within a preventive conservation framework, this approach enables the identification of potential conservation risks in cultural heritage sites, assessing the accumulation of vehicular particulate matter (PM) by means of outdoor vs. indoor mixed designs of lichen exposure. The present study was designed to assess the indoor deposition of traffic-related PM within the 16th-century Jer&#xf3;nimos Monastery in Lisbon, employing lichen transplants exposed during two distinct periods of 11weeks each. Several magnetic measurements and analyses - including magnetic susceptibility, isothermal remanent magnetization acquisition, hysteresis loops and First-Order-Reversal-Curve (FORC) diagrams - were combined to infer the PM granulometry and to disentangle the emission sources. Magnetite-like particles constituted the dominant component of the magnetic PM, the highest concentration outdoors along the street and near the entrance and the southern fa&#xe7;ade of the Jer&#xf3;nimos Monastery. The hysteresis parameters indicated a mixed magnetic granulometry, with coarser metallic particles mainly accumulated outdoors. The application of magnetic analytical techniques provided a robust framework to infer the very limited diffusion of vehicular-derived PM inside the Jer&#xf3;nimos Monastery.

Atelectasis is common during general anaesthesia and contributes to postoperative pulmonary complications. Despite preventive strategies targeting established underlying mechanisms, extensive atelectasis still often occurs, suggesting that additional factors may be involved. We tested the hypothesis that hypotension contributes to atelectasis formation during anaesthesia. We conducted a randomised, evaluator-blinded crossover study in 12 anaesthetised, mechanically ventilated pigs under conditions simulating anaesthesia induction, in which preoxygenation was followed by either normotension or profound hypotension induced with nitroprusside. The primary outcome was total atelectasis volume, measured by computed tomography. Pulmonary blood flow distribution was assessed using [15O]-water positron emission tomography. Atelectasis volume was greater during induced hypotension (median MAP 46 mmHg [interquartile range: 43-49]), compared with normotension (median MAP 85 mmHg [81-93]) in 11 of 12 pigs (median difference 20 ml [95% CI 9-38]; P<0.001). During hypotension, pulmonary blood flow was redistributed towards the dorsal lung regions, with hypotension resulting in a ratio of dorsal to total pulmonary blood flow of 182% (170-186), compared with 129% (104-150) with normotension. Mixed venous oxygen saturation was lower during hypotension (43% [27-53]) compared with normotension (48% [44-56]). In this experimental model of anaesthesia induction, profound hypotension increased atelectasis compared with normotension. The findings are consistent with redistribution of pulmonary blood flow with low oxygen saturation towards dorsal lung regions that are prone to develop absorption atelectasis. Hypotension during induction of general anaesthesia might therefore be a hitherto unrecognised contributor to pulmonary atelectasis. www.animalstudyregistry.org (https://doi.org/10.17590/asr.0000369).

This study establishes an in vitro protocol using the EpiOral three-dimensional human buccal oral mucosal model to assess potential irritation from oral medical devices and their leachables. EpiOral tissues were exposed to test substances (e.g., methyl acetate, Triton X-100, sodium lauryl sulfate (SLS), phosphoric acid, benzalkonium chloride) at concentrations relevant to dental materials, with exposure time for 50% tissue viability (ET-50) calculated from viability assays at 1, 4, and 18&#x202f;h. The application volumes of the test substances (40&#x202f;&#x3bc;L and 100&#x202f;&#x3bc;L), vehicle controls (saline, sesame oil), and a 50% viability cut-off were validated using linear mixed models (LMM), post-hoc comparisons, and ROC analysis with Youden's index. ET-50 assays correctly classified the test irritants: strong (e.g. SLS, phosphoric acid, ET-50&#x202f;<&#x202f;1&#x202f;h), moderate (hydrogen peroxide, 1.12&#x202f;h), and non-irritants (e.g., glycerol, polyethylene glycol >18&#x202f;h). No significant viability differences occurred between 40&#x202f;&#x3bc;L and 100&#x202f;&#x3bc;L for most substances (p&#x202f;>&#x202f;0.05), except hydrogen peroxide. Using a 50% viability cut-off for irritancy classification, all tested substances were correctly classified in this exploratory dataset (sensitivity/specificity&#x202f;=&#x202f;1.000). The in vitro testing protocol using the EpiOral model provides a structured experimental approach for oral mucosal irritation assessment. Under the conditions evaluated in this study, a 100&#x202f;&#x3bc;L application volume and a 50% viability threshold were found to be appropriate.

Transcranial focused ultrasound stimulation (TUS) has emerged as a promising tool for noninvasive neuromodulation. However, the specific effects of stimulation parameters on neural activity remain incompletely understood. This study investigates how variations in TUS pulse repetition frequency (PRF) and pulse duration (PD) influence neural activity in the rat motor cortex. In vivo extracellular recordings were performed in anesthetized rats using 32-channel silicon probes while TUS was applied over the motor cortex. We systematically varied PRF (25, 50, 500 and 2000 Hz) and PD (50, 100, 200, 400 and 800 &#x3bc;s) and quantified changes in spike rate and extracellular action potential (EAP) shape. Control experiments included sonication of the visual cortex (V1) and the electrode holding bar. Effects were analyzed using linear mixed-effects models with Bonferroni-corrected post hoc testing. TUS caused a significant increase in spike rate at 500 Hz PRF when the PD was set at 200 &#x3bc;s. When PRF was set at 50 Hz, spike rate increase at 800 &#x3bc;s was significantly higher than at 50 &#x3bc;s and 100 &#x3bc;s. Analysis of the EAP revealed small but significant parameter-dependent changes in action potential shape. When the most effective excitatory parameters (500 Hz PRF, 800 &#x3bc;s PD) were combined, a larger spike rate increase was observed in the motor cortex, compared with the other tested PRF-PD combinations and a significant change in EAP shape. The same parameters applied in the control conditions caused a smaller spike rate increase in V1 but no significant effect with the bar control, and no EAP changes were detected. These findings offer direct single-unit evidence that TUS can modify spike rate and is associated with subtle shifts in EAP waveform features in a parameter-dependent and region-specific manner. Optimizing PRF and PD is essential for reproducible neuromodulation and for moving TUS toward translational applications.

There is ongoing uncertainty about whether hospital inpatients have become more complex over time, and how this might contribute to strained hospital resources. We examined measures of patient and care complexity for General Internal Medicine (GIM) inpatients over a 7-year period. This retrospective cohort study used individual-level administrative and clinical data for GIM hospitalizations at 21 Ontario hospitals between April 2015 and June 2022. Complexity measures included patient characteristics (e.g., advanced age), patient outcomes (e.g., in-hospital mortality), and resource use (e.g., imaging). Hospitalizations were categorized into complex and non-complex categories and generalized linear mixed-effects models were used to estimate adjusted rate ratios, representing the relative change in the number of monthly admissions in each year for each category compared to 2015-2016. The cohort included 687,512 hospitalizations (median [IQR] age, 73 [57-84] years; 50% female). The volume of admissions grew by 17%, from 103,851 in 2015-2016 to 121,103 in 2021-2022. There was a consistent increase in the use of radiology tests, particularly driven by greater use of CT scans (49% of hospitalizations in 2015-2016, 61% in 2021-2022, adjusted rate ratio 1.45 [CI, 1.40-1.50]) and MRI scans (11% in 2015-2016, 14% in 2021-2022, adjusted rate ratio 1.46 [CI, 1.39-1.54]). Other patient characteristics, processes of care, and outcomes did not consistently change across the study period. The COVID-19 pandemic period (April 2020-June 2022) was associated with increased complexity with respect to hospital length of stay, in-hospital mortality, laboratory testing, and costs of care. GIM admission volume increased over the study period, but patient complexity as measured by the metrics considered here did not show consistent increases. The rising intensity of imaging use without evident changes in patient characteristics or short-term outcomes warrants further investigation.

Impairment of the phonatory subsystem is a common feature of developmental dysarthria and may contribute to reduced speech intelligibility. However, voice quality is known to vary as a function of speech task, and the relationship between phonatory functioning and intelligibility across elicitation contexts remains poorly understood. This study aimed to&#xa0;(1) examine speech task effects on acoustic measures of voice quality, and (2) investigate task-specific relationships between voice quality and intelligibility in children and adolescents with developmental dysarthria. Participants with developmental dysarthria (n&#xa0;= 31, mean age: 12;3 years) produced speech across three tasks: sustained phonation (/a/), single-word production (picture naming), and spontaneous speech (picture description). Acoustic measures included cepstral peak prominence (CPP), jitter, shimmer, and harmonic-to-noise ratio (HNR), adapted for connected speech contexts. Speech intelligibility was assessed via transcription for single-word productions and listener ratings for connected speech samples. Perceptual voice quality was evaluated using the GRBAS Grade (G) component for sustained phonation. Linear mixed-effects models examined task effects on voice quality and relationships between acoustic measures and intelligibility. Significant task effects were observed for all acoustic measures. Sustained phonation yielded the most favorable voice quality, followed by connected speech, with single-word productions demonstrating the poorest vocal quality. Acoustic measures of sustained phonation were significantly associated with perceptual ratings, supporting their validity. No significant relationships were found between acoustic voice measures and intelligibility at either the word or connected speech levels. Voice quality in developmental dysarthria is strongly influenced by speech task, reflecting differences in motor demands and subsystem integration. Perceptual ratings aligned with acoustic measures during sustained phonation; however, acoustic indices across tasks were not directly associated with intelligibility outcomes. These findings underscore the importance of task selection in voice assessment and suggest that phonatory impairment may not directly capture functional communication outcomes in developmental dysarthria.

Peer support is being integrated into the new maternal mental health services in England to further the development of the recovery approach in relation to loss. Psychological support after miscarriage (pregnancy loss prior to viability) is often overlooked, despite significant psychological morbidity. This systematic review explored the effectiveness of peer support interventions to improve mental health outcomes after miscarriage. Systematic review DATA SOURCES: A comprehensive systematic search across nine databases (MEDLINE, CINAHL, APA PsycINFO, Web of Science (all databases), EMBASE, CENTRAL, LENS.org, British Nursing Index and Health Management Information Consortium) was conducted in June 2025. Grey literature was identified through website searching, contact with topic experts and a national call for evidence. Study designs with a quantitative evaluative component or mixed-methods studies reporting effectiveness were eligible if they involved women and/or partners who had experienced miscarriage and been offered a peer support intervention. Any peer support versus control (no treatment, wait list and usual care) or peer support versus another psychosocial intervention was eligible for inclusion. Studies that report any of the following broad groups of outcomes (whether validated measures or by self-report) were eligible for inclusion: (a) personal recovery, (b) mental health recovery, (c) health service use and (d) social outcomes. Two independent reviewers used standardised methods to search and screen for eligible studies. Of the 4342 titles screened, 100 potentially relevant full-text papers were retrieved and screened resulting in seven randomised controlled trials and two controlled trials identified across 10 papers. Of these, seven did not evaluate a peer-led intervention, one reported only on women who had experienced pregnancy loss later than 24 weeks gestation, and one reported a peer support intervention for those who experienced pregnancy loss at any age of gestation but did not disaggregate data for those who experienced miscarriage. Thus, no studies were eligible for inclusion. This indicates a significant gap in the current literature. The inconsistencies and limitations in existing research approaches are explored in detail. This systematic review has identified an evidence gap as there is currently no robust evidence for the effectiveness of peer support interventions after miscarriage. Given the drive for the inclusion of peer support in new maternal mental health services, there is therefore a need for targeted intervention research to provide reliable evidence to determine effective peer support interventions for this population. CRD42024518248.

Physical exercise has received increasing attention as a complementary approach for managing post-traumatic stress disorder (PTSD). Nevertheless, evidence regarding its effectiveness across different exercise modalities and populations remains mixed. This systematic review and meta-analysis synthesizes findings to assess the impact of structured exercise programs on PTSD symptom severity and to explore potential moderators. Searches of PubMed, Embase, Web of Science, the Cochrane Library, and EBSCOhost-SportDiscus were conducted from inception to 27 September 2025. We included randomized controlled trials in which participants receiving an exercise intervention were compared with those receiving usual care or a control condition without structured physical activity. Subgroup analyses were conducted based on exercise type, participant characteristics, and outcome measures. In addition, a random-effects meta-regression was used to examine whether the total supervised training duration influenced treatment efficacy. Sixteen randomized controlled trials involving 663 participants met the inclusion criteria. Pooled findings indicated that exercise interventions were associated with a significant reduction in PTSD symptoms (Hedges' g = -0.49, 95% CI -0.76 to -0.22). Subgroup analyses suggested that yoga-based interventions and studies involving military populations showed larger effect sizes; however, differences between subgroups were not statistically significant. Training duration did not significantly moderate the treatment outcome. This review provides evidence that physical exercise can effectively reduce PTSD symptoms. Beneficial effects were observed across different exercise modalities and populations, although no statistically significant subgroup differences were identified. These findings support structured exercise as a promising and scalable component of PTSD treatment strategies.

Patients with post-COVID condition (PCC) frequently report reduced quality of life (QoL). This study assessed QoL and health-related QoL (HRQoL) with trajectories within a prospective PCC cohort. The study included adult patients at a PCC clinic. Outcomes were collected at 0, 3, 6, and 12 months. The primary outcome was QoL by Visual Analogue Scale (VAS 0-10). Secondary outcomes included QoL by EUROHIS-QOL-8 and HRQoL by 15D, and patients' symptom perceptions by Somatic Symptom Disorder - B Criteria Scale (SSD-12). Linear mixed models analyzed temporal changes, and trajectory analysis modeled recovery patterns. At baseline, 442 patients participated, with 305 (69.0%) providing follow-up data. Most patients (92.7%) were non-hospitalized. Trajectory analysis of EUROHIS-QOL-8 identified two recovering trajectories (73.8%) and a stable group (26.2%). Stable trajectories were associated with more comorbidities and higher levels of worry-inducing symptom perceptions (mean SSD-12 score 26 out of 48), whereas marked recovery was linked to being employed and having lower SSD-12 (10-13). Mean QoL improved over 12 months from 5.2 to 6.5 on the 0-10 VAS scale and from 3.1 to 3.5 on the EUROHIS-QOL-8 scale of 1-5. HRQoL by 15D increased from 0.76 to 0.80 (scale 0-1). In conclusion, patients with comorbidities and distressing illness beliefs are the most vulnerable group in rehabilitation and require specific attention.

Diaphragm dysfunction is associated with failure to wean from mechanical ventilation. Inspiratory muscle training (IMT) may help improve outcomes for difficult-to-wean patients, yet the optimal approach remains unknown. High load IMT causes a training effect on the extra-diaphragmatic inspiratory muscles, but does not improve weaning success, questioning the utility of frequently cited high intensity IMT loads. Additionally, patients may find IMT unpleasant and distressing due to dyspnoea experienced during IMT. The aim of this study is to define a diaphragm-focused IMT load which is acceptable to patients. This study is designed as a prospective, mixed methods study. Forty difficult to wean, tracheostomised patients on mechanical ventilation will perform IMT at 15, 30, 45 and 60% of their maximal inspiratory pressure (PImax) in a randomised order using a tapered flow resistive loading device (POWERBreathe KH2, POWERBreathe, UK). Electrical activity of the diaphragm will be measured using an oesophageal multipair catheter (NAVA, Getinge, Sweden); extra-diaphragmatic (parasternal, scalene and sternocleidomastoid) muscle activity will be measured using surface electromyography. Patient experience of each load will be explored by measuring perceived breathing difficulty and unpleasantness using 0-10&#x2009;numeric rating scales, verbal or written communication techniques in line with the participants' communication ability, and/or bespoke communication boards co-designed with the study patient and public involvement (PPI) group. Quantitative and qualitative data will be integrated to inform a diaphragm-focused, patient-acceptable IMT load. Ethical approval was obtained from Wales Research Ethics Committee 4 (Reference 25/WA/0242) on 30 October 2025. Results from this study will be presented at scientific meetings and published in peer-reviewed journals. NCT07256821.