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This study investigates the processing of two Chinese reflexives, ziji ('self') and ta-ziji ('s/he-self'), in structural contexts that support plain anaphor and intensifier interpretations, respectively. Two self-paced reading experiments were conducted to examine the interpretive patterns. Converging evidence from post-reading acceptability judgments and reading times showed that, in contexts supporting plain anaphor readings, both reflexives exhibited locality biases. However, in structural contexts that enforce intensifier readings, the processing patterns changed. These findings highlight the different processing profiles of the two reflexives and provide new insights into how discourse and syntactic constraints interact during online reflexive resolution.
To explore stakeholder perspectives on care coordination barriers and facilitators in regionalised neuro-oncology delivery, using brain tumours as a model for examining complex care pathways serving mixed rural-urban populations. Reflexive thematic analysis of semistructured interviews from stakeholders across the neuro-oncology care pathway was used to identify themes of care system strengths, barriers to effective service delivery and priorities for system improvement. Regionalised Canadian health system serving one of Ontario's largest catchment areas, characterised by predominantly rural populations and substantial geographic distances to tertiary care. 36 stakeholders purposively sampled to represent diverse roles across the care pathway, including family caregivers (n=6), healthcare providers from multiple specialties and care settings (n=28) and Indigenous community advisors (n=2). Thematic analysis identified seven themes organised within two broad domains: care system strengths and barriers to care continuity. Care system strengths included three themes: responsive palliative care integration, provider dedication and compassionate commitment, and intra-institutional coordination infrastructure. Barriers to care continuity included four themes: insufficient pathway standardisation across settings; inadequate educational infrastructure for patients, families and providers; absent cross-institutional coordination infrastructure and limited regional clinical trial access. Participants described relatively coordinated processes within the tertiary centre, while communication and follow-up were more fragmented at interfaces with referring hospitals and community services, with participants describing patients becoming 'lost in transitions'. Findings reveal how regionalised cancer systems can achieve localised coordination while experiencing fragmentation at interfaces between organisations. Participants described relatively coordinated processes within the tertiary centre, alongside more fragmented communication and follow-up across interfaces with referring hospitals and community services. These stakeholder perspectives highlight potential directions for service redesign, including standardised pathways, shared information systems and clearer cross-site accountability structures, which warrant future evaluation alongside consideration of resource allocation and local feasibility. Brain tumours, requiring rapid multidisciplinary coordination, expose these interface failures with clarity, offering transferable insights for improving integrated cancer care in regionalised health systems serving geographically dispersed populations.
Cardioneuroablation (CNA), defined as endocardial catheter ablation of atrial ganglionated plexi within the intrinsic cardiac autonomic nervous system, has emerged as a mechanism-directed therapy for cardioinhibitory reflex syncope and functional bradyarrhythmias. By attenuating postganglionic parasympathetic input to the sinoatrial and atrioventricular nodes, CNA targets the autonomic substrate of cardioinhibition rather than merely treating its bradycardic consequence. Over the past two decades, the evidence base has progressed from pioneering single-center experiences to multicenter registries, systematic reviews, meta-analyses, and randomized clinical trials, with reported freedom from recurrent syncope of approximately 80-94% in carefully selected patients at medium-term follow-up. This state-of-the-art narrative review summarizes the rationale, anatomy, patient-selection principles, mapping and ablation strategies, procedural endpoints, clinical outcomes, safety profile, and emerging applications of CNA. Particular emphasis is placed on the unresolved questions that will define the future of the field: the absence, to date, of adequately powered sham-controlled efficacy data; the lack of a universally validated intraprocedural endpoint; the biological and clinical significance of vagal reinnervation; and the gap between expert-center and broader real-world outcomes. Current evidence supports CNA as a promising, anatomically grounded neuromodulatory therapy, but its transition from expert-center innovation to guideline-endorsed treatment will depend on rigorous patient selection, standardized procedural endpoints, and the results of ongoing randomized trials.
Mental health issues have become a major concern in universities worldwide, including in Indonesia. Various mental health challenges experienced by students can trigger crises, such as urges to self-harm or even suicidal ideation. Such crises require immediate intervention. However, access to mental health emergency services remains limited and lacks standardized guidelines. This study aims to explore participants' experiences in handling mental health emergencies in university settings, with the hope of providing insights for the development of standardized mental health emergency service guidelines. Data collection was conducted through focus group discussions involving six psychologists working in university-based mental health practices. The collected data were analyzed using reflective thematic analysis. Through reflective thematic analysis, four primary themes emerged, namely the understanding and interpreting crisis; navigating crisis assessment in complex situation; professional responses in crisis intervention; and challenges in managing crises. The findings of this study reveal the complexity of understanding and managing psychological crisis cases, including significant challenges in doing so effectively. These findings are consistent with previous research on psychological services and provide insights into how to manage clients experiencing crises. These insights make a valuable contribution to the development of regulations and the implementation of standardized mental health crisis services in higher education institutions. Overall, this study demonstrates that crisis management in university mental health services involves diverse understandings of crisis, varied intervention practices, and multiple practical challenges. These findings highlight the importance of developing clearer frameworks to support mental health emergency services in higher education.
Acromegaly may impair balance and increase fall risk. We aimed to evaluate postural stability, fall risk, and vestibulo-ocular reflex function in patients with acromegaly and to assess the effects of a balance-oriented exercise program. Single-center, prospective case-control study with an exercise intervention. Thirty-two patients with acromegaly (15 active, 17 inactive) and 32 age-, sex-, and body mass index-matched sedentary healthy controls were enrolled. Balance was assessed using computerized dynamic posturography along the anterior-posterior (AP) and medial-lateral (ML) axes. Vestibulo-ocular reflex function was evaluated with the video head impulse test. Clinical assessments included the Berg Balance Scale, International Falls Efficacy Scale, and Dizziness Handicap Inventory-Short Form. Fifteen patients with balance impairment completed an 8-week home-based exercise program, with outcomes reassessed afterward. Patients had lower preference AP, visual ML, vestibular ML, and global AP/ML scores than controls (P < .01). Berg Balance Scale scores were lower, whereas fall risk, fear-of-falling, and dizziness scores were higher in patients (P < .05). Fourier analysis demonstrated increased sway amplitudes with low-frequency dominance under static and dynamic conditions (P < .05). Global AP/ML scores were lower in active than inactive patients (P < .05). Vestibulo-ocular reflex gains were similar between groups (P > .05). Exercise significantly improved balance and clinical scale scores (P < .05). Balance impairment and increased fall risk may occur in acromegaly, likely due to deficits in central sensory integration. Balance-oriented rehabilitation may improve postural control and reduce fall risk in this population.
Background/Objectives: Fibromyalgia (FM) is a chronic pain condition characterized by widespread pain, fatigue, sleep disturbances, and psychosocial challenges. Although physiotherapists play a key role in FM management, little is known about how biopsychosocial principles are applied in clinical practice. This study explored physiotherapists' clinical reasoning, therapeutic strategies, and approaches to promoting adherence and functional recovery in FM. Methods: A qualitative study was conducted within a constructivist-interpretative paradigm. Thirteen physiotherapists with experience in FM management across different healthcare settings in Spain participated in semi-structured interviews. Participants were recruited through purposive and snowball sampling. Interviews were audio-recorded, transcribed verbatim, and analyzed using reflexive thematic analysis following Braun and Clarke's framework. Methodological rigor was ensured through reflexive engagement among researchers with differing backgrounds, reflexive practice, and adherence to COREQ guidelines. Results: Three overarching themes and seven sub-themes were identified. Clinical validation emerged as a key strategy to reduce uncertainty and facilitate engagement. Therapeutic goals were progressively shifted from pain reduction toward function, autonomy, and participation. Pain neuroscience education and individualized exercise were identified as the main therapeutic strategies, while group-based interventions promoted social support, motivation, and adherence. Lifestyle recommendations, including stable routines, social participation, and work adaptation, complemented treatment. Conclusions: Physiotherapists perceive FM management as a multidimensional process extending beyond symptom reduction. Validation, pain neuroscience education, individualized exercise, and group-based support appear to facilitate adherence, self-management, and functional recovery within a biopsychosocial framework.
Background: Modern hematology analyzers integrate multiparametric technologies and adaptive flagging algorithms to support rapid detection of abnormal leukocyte populations. The Sysmex XN-9100 employs the White Blood Cell Differential (WDF) channel for first-line screening and the White Precursor Cell (WPC) channel as a reflex test for improved detection of blasts and abnormal lymphocytes. Although widely implemented, the real-world diagnostic performance and workflow implications of this integrated strategy remain incompletely characterized. Objectives: To evaluate, in a large real-world cohort, the performance of the Sysmex XN-9100 WDF-WPC workflow, focusing on its diagnostic accuracy, its capability to identify pathological cases within the WDF-negative population, and its potential implications for blood smear review workload optimization. Methods: A retrospective analysis was performed on 4531 consecutive routine blood samples reviewed between February and June 2025. All samples were analyzed using the Sysmex XN-9100. WDF-positive cases ("Blasts/Abnormal lymphocytes?") underwent reflex WPC testing ("Blasts?" and "Abnormal lymphocytes?"). Peripheral blood smear morphology, based on the evaluation of 200 leukocytes using the DI-60 digital imaging system, constituted the reference standard. Diagnostic performance metrics, including sensitivity, specificity, predictive values, likelihood ratios, accuracy, and ROC analysis, were calculated for WDF and WPC channels using both individual and aggregated flag evaluations. Results: The WDF-B/AL (White Blood Cell Differential Channel-"Blasts/Abnormal lymphocytes?") flag demonstrated high sensitivity (88.24%) and negative predictive value (92.73%), supporting its role as an effective first-line screening tool, although specificity was limited (48.87%; AUC = 0.75). Unlike most previous studies, our workflow allowed evaluation of pathological cases occurring within the WDF-negative population, providing a realistic estimate of the false-negative burden. Disaggregated WPC analysis revealed complementary diagnostic profiles: WPC-B (White Precursor Cell Channel-"Blasts?") showed higher specificity (77.71%) and overall discriminative performance (AUC = 0.81), whereas WPC-AL (White Precursor Cell Channel-"Abnormal lymphocytes?") achieved higher sensitivity (92.18%) and negative predictive value (95.99%). Aggregated evaluation of WPC flags (logical OR) maximized sensitivity (92.68%) and reduced false-negative cases, supporting the role of the WPC channel as a second-level diagnostic safety net. Furthermore, within the integrated laboratory workflow, WPC-negative results may support the optimization of manual smear-review allocation when interpreted together with predefined institutional smear-review criteria, while maintaining diagnostic safety. Conclusions: The Sysmex XN-9100 WDF-WPC workflow constitutes a multilayered high-sensitivity screening strategy that prioritizes abnormality detection while optimizing laboratory efficiency. The complementary behavior of WPC-B and WPC-AL enhances overall workflow safety, whereas evaluation of WDF-negative pathological cases provides a more realistic assessment of screening performance than conventional reflex-based studies. Beyond analytical accuracy, the workflow may contribute to balancing diagnostic reliability, patient safety, and resource utilization in high-volume laboratory practice.
Trauma-informed care (TIC) is an essential framework for nursing practice, yet its integration into undergraduate nursing education remains limited. Trauma-informed educational practices extend TIC principles to teaching and learning contexts and have the potential to transform nursing education by addressing student well-being and reducing secondary traumatic stress. However, little is known about how nurse educators understand and implement TIC in undergraduate nursing programs. This study explored Ontario nurse educators' knowledge about TIC and its potential to transform undergraduate nursing education through trauma-informed educational practices. This interpretive descriptive qualitative study was guided by Transformational Learning Theory. Undergraduate baccalaureate nursing programs in Ontario, Canada. A purposive sample of nurse educators (n = 28) with at least two years of teaching experience in undergraduate nursing education. Phase one survey data supported recruitment and theoretical sampling. Semi-structured interviews were conducted and analyzed using reflexive thematic analysis. Data collection and analysis occurred iteratively, with coding supported by NVivo 14®. Reflexive thematic analysis generated key themes related to trauma-informed educational practices. This manuscript presents the third theme, Innovative Pedagogical Strategies, and its three subthemes: 1) Using Creative Learning Strategies to Grow Self-Awareness, highlighting experiential, arts-based, Indigenous pedagogies, and simulation to scaffold trauma-informed perspectives; (2) Creating Brave Spaces, emphasizing psychological safety, relational teaching, and proactive preparation for emotionally challenging content; and (3) Role Modelling Trauma-Informed Approaches to Enhance Application. A conceptual model is presented to illustrate how these intersecting trauma-informed teaching strategies promote transformational learning and support students' capacity to apply TIC principles in practice. Trauma-informed pedagogy offers a transformative lens for nursing education, prioritizing student well-being and advancing equity. Faculty development and structural supports are essential to prepare educators for this shift. Trauma-informed educational practices can catalyze cultural change in nursing, benefiting learners and the profession.
Melatonin has chronobiotic, antioxidant, anti-inflammatory, and neuromodulatory properties, and its oral effects may vary according to formulation. This study compared conventional melatonin with a lipid-multiparticulate (LMP) formulation in two acute pharmacological mouse paradigms. Eighty-four male BALB/c mice were assigned to caffeine-evoked cortical activity or pentobarbital-induced sedative-hypnotic experiments. Mice received caffeine (7.5 mg/kg, i.p.) alone or with standard or LMP-melatonin (10 or 20 mg/kg, oral). ECoG recorded cortical electrical activity under urethane anaesthesia. In a separate cohort, latency to and duration of pentobarbital-induced loss of the righting reflex were measured. Circulating neurochemical and redox markers, as well as neurotransmitter- and inflammation-related gene and protein expression, were evaluated. Caffeine increased spike frequency and altered ECoG amplitude, together with unfavorable changes in circulating neurochemical and redox markers and in neurotransmitter receptor- and inflammation-related outcomes. Both melatonin formulations attenuated several of these changes in a dose-dependent manner, with the strongest effects generally observed in the high-dose LMP-melatonin group. Compared with conventional melatonin, LMP-melatonin produced greater modulation of ECoG activity, circulating biochemical markers, neurotransmitter-receptor expression, and IL-6 and TNF-α-related outcomes. LMP-melatonin also produced a greater reduction in the latency to and a greater prolongation of the duration of pentobarbital-induced loss of the righting reflex. LMP-melatonin produced greater formulation-dependent effects than conventional melatonin on caffeine-evoked cortical electrical activity, pentobarbital-induced sedative-hypnotic responses, and selected biochemical and molecular outcomes. However, pharmacokinetic exposure, physiological sleep stages, sleep architecture, sleep quality, and direct measures of neuronal injury were not assessed. Therefore, the findings do not directly establish enhanced bioavailability, physiological sleep promotion, or neuroprotection.
Generative AI (GenAI) is increasingly integrated into clinical learning and practice. However, medical students often lack the competencies required for safe and critical use, including prompt design, output verification, and recognition of limitations. Educational interventions that integrate GenAI with clinical reasoning frameworks remain limited. This study evaluated a structured, theory-informed workshop integrating GenAI, prompt engineering, and clinical reasoning education to enhance medical students' self-perceived AI literacy and collaborative learning attitudes, and to assess whether patient-centered orientation changed following intensive AI exposure. We conducted a single-group, pre-post, explanatory sequential mixed methods study with fifth-year medical students enrolled at an academic medical center between April 2024 and May 2025. The 3-hour workshop comprised 6 modules integrating clinical reasoning, cognitive-bias awareness, verification-oriented GenAI use, and hands-on prompt engineering and centered on ChatGPT (OpenAI). Quantitative outcomes were self-reported measures from a 20-item self-report AI-literacy questionnaire adapted from the Meta AI Literacy Scale and were examined with exploratory and confirmatory factor analysis, the 6-item Patient-Practitioner Orientation Scale-Short, and a modified Collaborative Learning Attitude Scale (CLAS). Pre-post change was assessed using 2-tailed paired t tests with Benjamini-Hochberg correction and Cohen d; the Patient-Practitioner Orientation Scale-Short and CLAS were available for a subsample (n=46). Qualitative data from 6 interviews and 17 reflective narratives were analyzed using reflexive thematic analysis and integrated with the quantitative findings. Among 150 eligible students, 139 (92.7%) completed paired AI-literacy assessments. Self-perceived AI literacy improved across all domains (Cohen d=0.69-0.93, all P<.001; all remaining significant after false discovery rate correction), and collaborative learning attitudes increased substantially (d=0.94, P<.001). Patient-centered orientation showed no significant change (d=0.03); however, baseline scores were concentrated at the favorable end of the scale (a floor/restricted-range effect), and the subsample analysis was underpowered (minimum detectable dz=0.42), so this null result is inconclusive rather than evidence of unchanged orientation. Gains did not differ by sex or across the sequential cohorts. Reflexive thematic analysis (interviews: n=6; reflections: n=17) identified five themes and one emergent theme describing a shift toward verification-oriented GenAI use: (1) understanding GenAI capabilities and limitations, (2) prompt-engineering skill development, (3) calibrated trust through verification, (4) GenAI-supported communication and collaboration, and (5) ethical considerations, with emerging reconceptualization of professional identity. A brief, theory-informed educational intervention integrating GenAI with clinical reasoning was associated with medium-to-large improvements in self-perceived AI literacy and collaborative attitudes. No detectable change in patient-centered orientation was observed; however, this finding should be interpreted as inconclusive, given measurement and power constraints. Embedding verification practices within clinical reasoning frameworks may offer a scalable approach for preparing physicians for responsible human-AI collaboration. Future studies should incorporate comparative designs, performance-based assessments, and longitudinal follow-up.
Orofacial clefts are among the most common congenital anomalies worldwide, affecting approximately 1 in 700 live births. Despite surgical repair, most children require long-term speech therapy; parental perspectives on accessing and continuing this therapy remain poorly documented in Low resource contexts. To explore the facilitators and barriers influencing access to and continuation of speech therapy for children with CP within the low resource context. A qualitative descriptive design was employed. Semi-structured interviews were conducted with 32 caregivers (15 mothers, 17 fathers) of children with non-syndromic cleft palate (all post-palate repair) at a tertiary cleft care centre, (November 2023-July 2025). Purposive sampling ensured variation in child age, urban/rural residence, and therapy status. Sixteen interviews were conducted in-person (mean duration 20 min) and 16 by telephone (mean duration 18 min) by a single Speech-Language Pathologist interviewer. All interviews were conducted in Hindi. Data were analysed using Braun and Clarke's (2006) six-phase reflexive thematic analysis by two independent coders. Member-checking was conducted with six purposively selected participants to validate findings. Four themes were identified: (1) Information deficit as a barrier-28/32 (87.5%) caregivers reported inadequate guidance at diagnosis or post-surgery (mean importance 4.5 ± 0.8); (2) Structural, geographic, and financial barriers-20/32 (62.5%) reported challenges attending therapy (mean importance 3.8 ± 0.9), with a distinct urban/rural pattern; (3) Perceived therapy outcomes as a facilitator-all 32 participants discussed visible speech progress as the primary motivator for continuation (mean importance 4.7 ± 0.6); and (4) Social, emotional, and cultural impact-22/32 (68.8%) described stigma, psychosocial burden, and protective family support (mean importance 4.2 ± 0.7). Continuity of speech therapy is contingent on timely information, accessible care models, and empowered family engagement. Structured information at diagnosis, teletherapy, community rehabilitation worker models, and parent-implemented home programmes represent actionable, context-appropriate solutions. What is already known on this subject Existing research on cleft palate (CP) in low- and middle-income countries (LMICs), highlights significant barriers to speech therapy access, such as limited local SLP providers, financial constraints, long travel distances, and resource shortages. Studies document high unmet needs for rehabilitative care, delayed intervention, and caregiver concerns about speech outcomes, social impacts, and information gaps at diagnosis. Qualitative work from LMICs has explored general parental experiences, psychosocial challenges, and treatment pathways, but caregiver perspectives specifically on facilitators and barriers to initiating and continuing speech therapy remain limited. What this study adds to existing knowledge This qualitative study provides novel, in-depth insights from 32 LMICs caregivers on facilitators and barriers to accessing and continuing speech therapy for children with non-syndromic cleft palate in a high-burden LMIC setting. Using reflexive thematic analysis, it identifies four key themes: information deficits delaying early engagement; structural/geographic/financial barriers with urban-rural contrasts; perceived therapy benefits as the main continuation driver; and broader social/emotional/cultural impacts. It offers the first detailed, context-specific exploration of these issues from a tertiary centre perspective. What are the potential or actual clinical implications of this study? Findings underscore the need for improved information delivery at diagnosis to promote early SLP referral and engagement. Clinicians should address urban-rural disparities through targeted strategies, such as telepractice or community outreach for geographic/financial barriers. Emphasizing observable therapy benefits may enhance continuation rates. Recommendations include multidisciplinary training for non-specialists, culturally sensitive guidance, policy support for affordable SLP services, and community programs to reduce stigma and emotional burden-ultimately improving access, adherence, and outcomes in resource-constrained LMIC settings. Information deficits at diagnosis are a major barrier to early speech therapy engagement for children with cleft palate in LMICs-clinicians should prioritize clear, timely education. Structural and geographic barriers differ markedly between urban and rural caregivers; telepractice and community outreach may improve access and continuation. Perceived positive therapy outcomes strongly facilitate ongoing attendance-emphasizing observable benefits can enhance adherence in resource-limited settings.
To investigate the clinical diagnostic features, screening and definitive diagnostic methods of neonatal-onset cblC type methylmalonic acidemia (MMA) combined with homocysteinemia, so as to provide a reference for early clinical identification and diagnosis of this disease. The clinical data of 1 neonate with neonatal-onset cblC type MMA combined with homocysteinemia admitted to our hospital were retrospectively analyzed. Routine laboratory tests, blood tandem mass spectrometry, serum homocysteine test, urinary organic acid analysis, cranial MRI and genetic testing were performed on the neonate. Combined with relevant literature, the clinical features, diagnostic strategies, treatment and prognosis of the disease were reviewed and summarized. The patient was a 20-day-old male neonate, presenting with persistent feeding difficulty and weak response after birth as the main manifestations, accompanied by hypotonia and diminished primitive reflexes, without typical critical signs. Laboratory examinations showed significantly elevated serum homocysteine; blood tandem mass spectrometry revealed increased propionylcarnitine, elevated C3/C2 ratio and decreased methionine; urinary organic acids showed increased methylmalonic acid and methylcitric acid. Cranial MRI showed hyperintensity in the bilateral globus pallidus on T1WI. Genetic testing identified two heterozygous pathogenic variants, c.567dupT and c.609G>A, in the MMACHC gene of the neonate, inherited from the mother and father respectively, conforming to the autosomal recessive inheritance pattern. The patient was finally diagnosed with cblC type MMA combined with homocysteinemia. Neonatal-onset cblC type MMA combined with homocysteinemia has insidious and non-specific clinical manifestations, which are easily confused with other neonatal diseases, leading to missed diagnosis and misdiagnosis. For neonates with unexplained feeding difficulty, poor mental response and abnormal muscle tone, timely metabolic screening including blood tandem mass spectrometry, urinary organic acid analysis and serum homocysteine test should be conducted. Genetic testing is the gold standard for the definitive diagnosis and classification of this disease, and can also provide a basis for genetic counseling and prenatal diagnosis. The implementation of neonatal screening for inherited metabolic diseases and the establishment of a multidisciplinary collaborative diagnosis and treatment model are the keys to achieving early diagnosis and treatment of this disease and improving the prognosis of patients.
Research into the lifeworld experiences of people with dementia increasingly employs a variety of methods and perspectives to access the closed-off inner world of these people. The current contribution reflects the researcher's approach to conduct research with and about people with dementia as part of an interdisciplinary project aiming to establish and maintain a 'person-centered' practice. This article highlights the practice of the interdisciplinary mixed-methods research project "Times Without Care and Encounters: Methodologically Pluralistic Explorations of the Experiences of People with Dementia", which specifically utilizes a plurality of perspectives and methods. The article is written from an 'armchair perspective' and represents a multi-perspective attempt at reflecting on a reflexive methodology. Methodological reflection is inherent to research and becomes particularly valuable when it is explicitly articulated. We have chosen the format of a peer-reviewed journal article to offer interested readers and the German-speaking research community an in-depth examination of our methodological choices and reflection. Multiple and multi-perspective approaches are required for siting a (research) situation in studies with and about people with dementia, as well as for addressing their subjective realities. The associated plurality of data collection and analysis becomes a prerequisite (methodologically and epistemologically) for developing a viable understanding of situations concerning the life, healthcare, support and care of people with dementia.
Termites are social insects that coordinate cooperative behavior through pheromones. Trail pheromones play a central role in foraging and recruitment. Traditionally, termite navigation has often been modeled as a reflexive response to the current gradient of pheromone concentration, implying a stimulus-driven, taxon-type mechanism without necessarily requiring internal spatial representation. However, it remains unclear whether termites can form and utilize spatial information about the location of chemical cues. In this study, we investigated whether previous contact with a trail pheromone can bias termite movement after the pheromone-marked substrate has been removed. In the primary immediate test, entries into the exact target-side circle were not significantly higher in the pheromone condition, indicating that the effect was not a strong immediate return to a precise point. However, across the extended test phase, pheromone-exposed termites showed more entries and inward excursions toward the area where artificial trail pheromone had previously been presented, especially when broader target zones were considered. Together, these results suggest that termites can retain or use coarse spatial information about a previously encountered trail-pheromone cue, resulting in broad spatial bias rather than accurate point revisitation. Our findings extend the traditional view of trail pheromones as purely immediate stimuli by suggesting that pheromone experience can influence later movement after cue removal. This provides a cautious basis for considering how chemical cues may contribute to locale-like navigation in termites.
The promise of computational methods opens new epistemic horizons. Yet, as we discuss in this introduction to the special issue on computational approaches to the histories of alchemy and chemistry, it also brings new epistemic responsibilities. We situate this work within a broader digital and computational history, exploring its relationship with earlier traditions of quantitative history as well as with developments in digital humanities and computational humanities. We distinguish between digital, computational, algorithmic, and AI-driven approaches and we clarify methodological and epistemological concerns that keep the historian firmly in the loop. Claims about computational methods often imply that they enable entirely new modes of inquiry. Yet such sweeping claims can also obscure the limitations and conditions under which these methods operate. This introduction therefore explores both the opportunities and the constraints of computational approaches that more celebratory accounts sometimes overlook. It introduces the individual contributions to the special issue and concludes with a call for responsibility in the adoption of computational methods. We argue for making the histories of alchemy and chemistry more critical, global, and reflexive, while remaining attentive to the assumptions, limitations, and implications of the computational tools we employ.
This study analyzed the outcome of combined ptosis repair with adjunctive subbrow blepharoplasty in a predominantly East Asian population that is frequently characterized by bulky upper eyelid tissue. A retrospective study of 160 eyelids of 80 patients who underwent bilateral aponeurotic ptosis repair with subbrow blepharoplasty at 1 center by 1 surgeon (A.L.) from March 2021 to December 2023 was performed. The mean age of the patients included in the study was 56.5 ± 12.5 years; 95% of the patients were women, and 97.5% were of Chinese ethnicity. There was a statistically significant increase in marginal reflex distance 1 of 2.35 ± 1.15 mm postoperatively (P < 0.001). Postoperatively, the mean lagophthalmos measurement at 3 months was 0.025 ± 0.16 mm. None of the patients had exposure keratopathy or postoperative complications. Three eyelids underwent revision surgery for residual ptosis. The mean subjective grading by patients was 8.6 ± 1.5, and the median score was 8 (interquartile range, 8-10). The mean objective score by the blinded independent observer was 2.6 ± 0.6, with 67.5% and 27.5% achieving an excellent score of 3 and a good score of 2, respectively. The median objective score was 3 (interquartile range, 2-3). Subbrow blepharoplasty is a useful adjunct to ptosis surgery in the East Asian population. It achieves greater tissue debulking and yields a "lighter" aesthetic outcome with good functional results. This technique achieves good subjective patient response and objective observer grading and has low revision and complication rates.
Background: Palliative care is a clinically, relationally and emotionally demanding field. Continuous exposure to suffering and death exposes professionals to compassion fatigue, vicarious trauma and grief, and burnout, while also offering opportunities for compassion satisfaction and meaning-making. How professionals cope is central to sustaining the supporting role in diseases with a poor prognosis. Objectives: To explore the emotional and experiential dimensions of palliative care work and the coping strategies, individual and team-based, that professionals deploy when accompanying patients and families at the end of life. Methods: Reflexive thematic analysis of 16 semi-structured interviews with palliative care professionals (5 physicians, 7 nurses, 3 psychologists, and 1 social-health worker; 14 women and 2 men) recruited from hospices, hospital wards and home-based services in Northern Italy. Sample size was guided by an information power model. Reporting follows the COREQ checklist. Results: Four themes were constructed: (1) the unsustainability of the workload; (2) the pleasure of care between empathic relationship, listening and welcoming; (3) the holistic role of the professional; and (4) the awareness of death. Across themes, participants mobilised a layered repertoire of problem-, emotion- and meaning-focused coping. Narratives fitting a structured moral-distress pattern were comparatively limited in participants' accounts. Conclusions: Sustaining supporting roles in poor-prognosis care may require more than individual resilience; it depends on organisational support-structured supervision, reflective spaces, and communication and emotional training-that makes professionals' largely informal coping work a shared and sustainable resource.
There is limited evidence regarding strategies that policymakers can use to revitalize neighborhoods without contributing to displacement, particularly those involving community advocacy. This study examines how a sample of Latino Catholic parishioners in the eastern Los Angeles area perceive advocacy and neighborhood change before and after participating in a park environmental advocacy training. Two groups with a total of 16 participants (85% women, median age 68) of a faith-based physical activity intervention received a two-day advocacy training in December 2023 and March 2024. The training involved conducting a park audit to identify environmental issues and developing advocacy plans to engage local decision-makers. Participants completed pre- and post-training surveys (n=12) on advocacy knowledge and post-training interviews (n=13; 85% in Spanish) on perceptions of advocacy, neighborhoods, and the training. Interviews were analyzed using a reflexive thematic approach. Participants reported general barriers to advocacy such as lack of time, knowledge, and distrust of government officials. General facilitators included past advocacy success and social responsibility. Although survey results showed no statistically significant change in advocacy knowledge post-intervention in this small sample, interviews suggested that participants experienced increased perceived social cohesion and motivation to engage in future advocacy. Participants described how advocacy could improve neighborhood cohesion and satisfaction. Findings support the role of community-led advocacy in neighborhood revitalization efforts to advance health and environmental equity in Latino communities.
BackgroundLong-term factory work involves repetitive, physically demanding tasks that contribute to musculoskeletal degeneration in later life, particularly affecting the knee and cervical spine among ageing workers. Qualitative evidence on how retired industrial workers perceive occupational strain, arthritis progression and post-retirement rehabilitation remains limited.ObjectiveTo explore the lived experiences of retired factory workers with knee and neck arthritis, focusing on perceived occupational causation, functional limitations and access to post-retirement rehabilitation services.MethodsA qualitative phenomenological design within an interpretivist framework was used. Sixteen retired factory workers aged 57-73 years with clinically diagnosed knee or neck arthritis were purposively sampled from factory panel clinics and community groups. Data were collected via in-depth semi-structured interviews, audio-recorded, transcribed verbatim and analysed using reflexive thematic analysis informed by the COREQ checklist.ResultsSix themes were identified: life-long occupational strain, normalisation and under-reporting of early pain, daily functional limitations, emotional and psychosocial impacts, barriers to accessing post-retirement rehabilitation, and coping strategies including home-based remedies and family support. Participants consistently linked their arthritis to decades of repetitive, physically demanding work and described substantial mobility limitations, psychosocial distress and reduced independence in retirement, alongside limited awareness of and financial barriers to structured physiotherapy.ConclusionsCumulative occupational strain in factory work is associated with late-life musculoskeletal morbidity, functional decline and psychosocial distress among retired workers. Improving ergonomic prevention and ensuring accessible community-based rehabilitation and continuity between occupational health and community services may enhance quality of life for ageing industrial workers.
Social media, a strategy that embeds transformative technology and targeted messaging, is promising for optimizing recruitment in the clinical research enterprise. This study aimed to evaluate recruitment rates and outcomes of Facebook advertisements, a social media-based platform, and explored targeted recruitment messaging among a key population. A convergent parallel mixed-methods design, with secondary data analysis of Facebook advertisements and in-depth, semi-structured interviews (N=15) with recruiters, was conducted. The quantitative analysis included descriptive statistics and bivariate analyses between the conditions of targeted versus general advertisements. The qualitative analysis utilized a five-step reflexive thematic analysis approach. Data analyses were integrated through a joint display. The recruitment rate among those exposed to the targeted advertisements (35%) was higher compared to the general advertisements (27%). A similar trend followed for the interest rate, with targeted advertisements (44%) having higher interest rates than the general advertisements (41%). The thematic analysis generated two themes related to tailored communication and accessible language for recruitment messaging. The integrated joint display elucidated that higher resonance with targeted messaging resulted in better recruitment outcomes. Targeted advertisements resulted in a modestly higher recruitment and interest rate compared to general advertisements on Facebook. Targeted advertisements were nearly twice as cost-effective in recruitment and expressed interest compared to general advertisements. Integrated joint display suggests that targeted advertisements and messaging, with tailored language, enhance recruitment and interest in clinical research with practical significance. Optimizing recruitment strategies is relevant for investigators to reduce obstacles in the clinical research enterprise. Findings suggest this strategy optimizes recruitment for a key population, offering promise for advancing efficient and representative clinical research that can benefit research investigators.