The cost-effectiveness of remote rehabilitation for survivors following critical illness after intensive care unit (ICU) care is unknown. To evaluate the cost-effectiveness of remote multicomponent rehabilitation compared with standard care following discharge from hospital after an ICU admission. This economic evaluation was conducted within a pragmatic, multicenter, assessor-blinded trial comparing remote rehabilitation delivered online with standard care after discharge from ICU from both National Health Service (NHS) and Personal Social Services (PSS) and societal perspectives over a 6-month time horizon. The trial was conducted from December 2022 to November 2025. The setting was 52 NHS hospitals in the United Kingdom. Participants were adults (aged ≥18 years) within 12 weeks of discharge from hospital that included an ICU admission for critical illness, requiring mechanical ventilation for 48 hours or longer. A remotely delivered rehabilitation program or standard care. Costs including using questionnaires and microcosting approach (in 2024 UK pounds sterling) and quality-adjusted life-years (QALYs), derived directly from trial data, were calculated per group and reported in terms of incremental cost per QALY gained. A total of 429 participants (245 men [57%]; mean [SD] age, 55.4 [13.9] years) were enrolled, including 231 (54%) in the intervention group and 198 (46%) in the standard group. From a UK NHS-PSS perspective, the rehabilitation intervention was associated with increased mean costs (£1250; 95% CI, £562-£1938) and QALYs (0.023; 95% CI, 0.007-0.040) per participant, compared with the standard care group. Incremental cost-effectiveness ratio (ICER) was £54 034 per QALY. The probability of rehabilitation intervention being cost-effective was 3% and 11% at UK willingness-to-pay thresholds of £20 000 and £30 000 per QALY, respectively. The intervention was cost-effective for patients with mechanical ventilation for 7 days or less (ICER, £21 476 per QALY) or if a societal perspective was adopted (ICER, £6341 per QALY). In this economic analysis, among ICU survivors overall, a remotely delivered multicomponent rehabilitation program was not cost-effective from a UK NHS-PSS perspective. Cost-effectiveness was more favorable from a societal perspective and for patients receiving mechanical ventilation for 7 days or less. For rehabilitation interventions to be both clinically and cost-effective a precision medicine approach to medical and psychosocial health care interventions is needed once patients are home from hospital.
To examine Finnish community pharmacy owners' readiness to adopt innovations and its association with implementation of digital and remote services during the first wave of the COVID-19 pandemic (December 2019-October 2020). A nationwide cross-sectional survey was conducted among all private community pharmacy owners in Finland in October-November 2020. A study-specific electronic questionnaire assessed changes in digital and remote service provision. Innovation readiness was measured using a validated instrument based on Rogers' Diffusion of Innovations theory, and pharmacies were classified as early or late adopters. Data were analysed using chi-square tests, Wilcoxon signed-rank tests, and multivariable ordinal logistic regression. Responses were received from 175 of 619 pharmacies (28%). Remote service provision increased significantly. Availability of medicine pick-up lockers rose from 21% to 39% (p < 0.001), while online pharmacy services increased from 25% to 34% (p < 0.001). According to Rogers' adopter categories, 43% of pharmacies were classified as early adopters. These pharmacies offered a broader range of digital services than late adopters (p < 0.01). Innovation readiness was higher among pharmacy owners younger than 50 years than among those aged 50-59 years (p = 0.009) and ≥60 years (p = 0.039). Pharmacies dispensing more than 100,000 prescriptions annually showed greater willingness to adopt innovations than those dispensing fewer than 40,000 (p = 0.016). Innovation readiness was significantly associated with remote service adoption. Finnish community pharmacies rapidly expanded digital and remote services in response to COVID-19. Innovation readiness was an important determinant of service development, although the low response rate may have overestimated innovativeness.
This study examines differences between major city and regional and remote participants in engagement in a digital alcohol support intervention (Daybreak), risky drinking, and psychological distress and tests the mediating role of psychological distress. This was a longitudinal, observational cohort study of Daybreak participants between January 2019 and December 2024 (N = 12,824). Outcomes were risky drinking and psychological distress. Ordered logistic regression examined associations between the outcomes and program engagement, and multilevel generalized structural equation modeling tested mediation by psychological distress. At 6 months, risky drinking scores declined by 42% in major city participants and 57% in regional and remote participants. High engagement in reacting to posts reduced risky drinking in both metro (OR = 0.47, 95% CI 0.27-0.80) and regional and remote areas (OR = 0.42, 95% CI 0.18-0.99). High engagement in post sharing was associated with lower odds of high risky drinking only in major city participants (OR = 0.56, 95% CI 0.33-0.98). In regional areas, participants who aimed to quit drinking at registration had lower risky drinking (OR = 0.72, 95% CI 0.53-0.99), while longer program inactivity increased odds of psychological distress (OR = 1.95, 95% CI 1.13-3.38). Psychological distress mediated 56% of the association between post reactions and risky drinking in major city participants and 33% in regional and remote participants. Distinct engagement pathways across regional and remote and major city settings suggest the need for more flexible digital program designs. Psychological distress, as a partial mediator, should be both a treatment target and a mechanism of change.
High-acuity Medicare beneficiaries with annual expenditures exceeding $12,000 disproportionately drive the total cost of care (TCOC) through preventable acute utilization and are natural candidates for value-based and shared savings arrangements. Whether remote patient monitoring (RPM) produces near-term TCOC reductions in this cost-stratified population has been insufficiently evaluated in real-world practice. A retrospective pre-post cohort analysis was conducted among 597 Medicare beneficiaries enrolled for at least 5 months in a technology-enabled RPM program, each with annualized preenrollment TCOC ≥$12,000. Patients received a cellular-enabled blood pressure monitor linked to a HIPAA-compliant platform staffed by licensed care navigators. The primary outcome was change in annualized TCOC over the 12 months before and after program initiation. Given right-skewed cost distribution (skewness = 4.47), the Wilcoxon signed-rank test was the primary inferential procedure. Secondary outcomes included per-1,000-patient rates of emergency department (ED) visits, inpatient hospitalizations, and 30-day readmissions. The mean age was 76.6 ± 8.2 years; 55.6% were female. The median annualized TCOC declined from $25,956 to $11,792, a reduction of $10,932 per patient (Wilcoxon p < 0.001; rank-biserial r = 0.47). The mean TCOC fell from $39,291 to $27,255 (p < 0.001). ED visits declined 19.9% (p < 0.001) and inpatient hospitalizations 40.9% (p < 0.001). Reductions were significant across all four baseline cost quartiles. Baseline TCOC was the dominant predictor of postenrollment costs (β = 0.50; p < 0.001; R2 = 0.23). At $100 per member per month, estimated net savings were $6.47 million (ROI: 9.0:1). Short-term RPM participation was associated with substantial reductions in TCOC and acute utilization among high-acuity Medicare beneficiaries, supporting RPM as a viable intervention to advance this population toward value-based care models. Prospective controlled evaluation is warranted to establish causal attribution.
The SARS-CoV-2 pandemic has catalyzed a widespread mental health crisis, impacting millions of people. This study aimed to compare three brief remote psychological treatments for healthcare workers with emotional distress during the SARS-CoV-2 pandemic. Nationwide three-arm randomized clinical trial in Brazil. We included healthcare professionals with high levels of anxiety, depression, or irritability, as defined by Patient-Reported Outcomes Measurement Information System (PROMIS). Participants were randomized to single-session psychoeducation group plus weekly pre-recorded videos for four weeks (SSI-ET), brief cognitive behavioral telepsychotherapy group (B-CBT, four sessions), or brief interpersonal telepsychotherapy (B-IPT, four sessions). The primary outcome was the proportion of participants with a 50% reduction in T-scores in PROMIS scales at one-month. Of the 3328 volunteers assessed for eligibility, 999 participants were enrolled, from May 19th 2020 to December 31st 2021, and allocated to SSI-ET (n=342), B-CBT (n=323), or B-IPT (n=334). All groups showed significant symptom reductions in the one-month assessment that were maintained over the three and six-month follow-ups (Cohen's d range=0.94-1.36), with no significant difference between groups. The proportion of responders were 46.5%, 43.7%, and 44.6% for SSI-ET, B-CBT, and B-IPT, respectively. Our results do not indicate that therapeutic interventions with higher number of sessions and with more specialized therapeutic components offer advantages in alleviating emotional distress, particularly among healthcare workers facing epidemic emergencies. These results have critical implications for planning interventions for crisis responses, especially in settings with limited resources.
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1,4-Dioxane is a widespread groundwater contaminant frequently co-occurring with chlorinated solvents. The group-6 propane monooxygenase (PRM) from Mycobacterium dioxanotrophicus PH-06 degrades dioxane efficiently, yet the molecular determinants underlying its broad substrate spectrum and inhibition behavior remain unresolved. Here, we combined AlphaFold2-based structure prediction, molecular docking, and alchemical free energy calculations to systematically characterize ligand binding in PH-06 PRM. The catalytic center (residues 87-265), coordinated by two histidines and four glutamates, exhibited calculated binding free energies for five substrates (C2-C4 alkanes and cyclic ethers) that significantly correlated with experimentally determined degradation rates (p < 0.05), supporting the ability of ligand binding thermodynamics to capture major substrate-recognition trends in PH-06 PRM. In addition, we identified a remote binding site (residues 329-446) approximately 30 Å from the catalytic center. Thermodynamic analysis indicates that this remote site can attract methane and ethane, potentially limiting their access to the catalytic center. Comparative binding analyses of three common chlorinated solvent inhibitors (i.e., trichloroethylene [TCE], 1,1-dichloroethylene [DCE], and 1,1,1-trichloroethane [TCA]) revealed distinct site preferences consistent with their experimentally observed inhibition modes. Noncompetitive inhibitors (DCE and TCA) displayed stronger affinity for the remote site, whereas the competitive inhibitor TCE exhibited comparable affinity for both binding regions. Sequence conservation, contact probability analysis, and Gene Ontology enrichment further suggest the structural relevance of the remote site and its possible role in ligand recognition and inhibitor selectivity. These findings demonstrate that the AlphaFold-guided free energy calculations can capture experimentally observed substrate and inhibitor trends in PH-06 PRM, while identifying a remote ligand-binding pocket that warrants further mechanistic investigation.
This study aimed to describe rural data from the Australian National Study of Mental Health and Wellbeing survey (2020-2022) to assess strengths-based questions, differences by rurality, and factors associated with excellent social connectedness. Survey questions were mapped to the Rural Strengths Socioecological Framework. Descriptive and logistic analyses assessed rural adults' use of strengths by remoteness and presence of affective/anxiety disorders in the past 12 months. Logistic regression explored factors associated with social connectedness. Survey questions reflected some strengths within the Framework including self-management techniques, family and friend support, social connectedness, and health care personnel. However, questions were primarily framed using a deficit perspective and many strengths from the Framework (i.e. nature, rural norms, culture, and lay personnel) were absent. Most strengths did not differ significantly between levels of rurality, though making healthy diet choices (as a self-management technique) was significantly lower in remote areas. Adults without affective/anxiety disorders more often reported good social support and self-efficacy. Conversely, those with affective/anxiety disorders were more likely to self-manage and access consultations for mental health. Excellent social connectedness was associated with better mental health. The survey questions reflected limited strengths. Future surveys should include a broader range of strengths-based questions spanning the extent of the Rural Strengths Socioecological Framework. Healthy diet choices as a self-management tool in remote areas may need to be prioritised. Findings also suggest the need for targeted approaches to protect, improve, or leverage social connectedness for those with more severe illness in rural areas.
All 17 of Nevada's counties carry a federal Health Professional Shortage Area (HPSA) designation, straining the state's capacity to deliver care remotely. This narrative review examines four dimensions of that capacity. It asks how telehealth is regulated and used, how far health information exchange and electronic health records have spread, whether broadband can support remote care, and what role artificial intelligence (AI) and remote patient monitoring (RPM) now play. Throughout, it considers how the state's workforce shortages, geography, and demographic diversity shape both demand for digital health and the barriers to it, with attention to equity. Four databases (PubMed/MEDLINE, CINAHL, Scopus, Google Scholar) were searched alongside federal, state, and policy grey literature for English-language sources from January 2015 to March 2026, yielding 88 sources, 40 peer-reviewed. Nevada has enacted comparatively expansive telehealth legislation, including conditional payment parity made permanent under Senate Bill 119 (2023); however, the limited utilization evidence shows uptake varying by race, ethnicity, and language. The sole statewide HIE operates under an opt-in consent model that constrains data availability, and roughly 100,000 Nevadans lack wireline broadband at the federal benchmark speed, concentrated in rural areas. AI and RPM are being deployed in rural settings without published evaluation, and nearly all peer-reviewed evidence on Nevada's digital health derives from a single study. Nevada's policy framework has outpaced its infrastructure and equity conditions; closing that gap requires coordinated action across HIE consent reform, broadband-telehealth alignment, Medicaid RPM reimbursement, and community-level investment in digital literacy and language access.
Plastic pollution is an ever-growing concern around the globe, with current research portraying the presence of contaminants even in previously pristine regions. Especially small particles, micro- and nanoplastics, can be dispersed over long stretches by atmospheric transport, reaching even the most remote areas of the planet. This study aims to portray current levels of nanoplastic contamination (< 1 μm) by analyzing snow samples from high-altitude glaciers in the European Alps (2300-3800 m) via TD-PTR-MS. We were able to detect six common plastic pollutants, with PE and PP contributing over 60% of the total mass concentration measured across all sites. On average, nanoplastic concentrations of 85 ng mL- 1 (range: 3.6 ± 12 ng mL- 1 - 470 ± 76 ng mL- 1) were detected at sampled glacier surfaces. Access to these remote regions was enabled through a citizen-science initiative, involving trained mountaineers for sample collection. The results were applied to atmospheric modelling, highlighting possible point sources of contamination. While agriculture and local plastic factories were revealed as potential sources of nanoplastics, spatial and temporal limitations complicated comparison inside the sample cluster.
This study presents a comprehensive 15-year (2009-2023) assessment of persistent organic pollutants (POPs) in the Spanish atmosphere to evaluate the Stockholm Convention's effectiveness. Polyurethane foam passive samplers were deployed across 23 sites to monitor legacy pesticides and industrial chemicals. Results reveal a concentration hierarchy dominated by hexachlorobenzene (HCB), which accounted for a median of 41% of the ∑POP concentrations and displayed a remote-enriched spatial pattern characteristic of global distillation. In contrast, legacy pesticides and indicator polychlorinated biphenyls (iPCBs) were influenced by temperature-dependent secondary volatilization from historically contaminated soils, as indicated by Clausius-Clapeyron analyses. These compounds frequently exhibited an unexpected urban enrichment likely associated with heat island effects, while polybrominated diphenyl ethers (PBDEs) displayed a pronounced urban gradient (a 35-fold increase from remote baselines) driven by the late-regulated BDE-209. Long-term temporal analyses underscore a sharp regulatory dichotomy. Early-banned compounds, such as endosulfan, HCB and dichlorodiphenyltrichloroethane (DDT), and lighter PBDEs, are experiencing rapid environmental depletion, with significant annual declines of up to -33%. Conversely, pentachlorobenzene (PeCB), iPCBs, and BDE-209 show stalled or locally increasing trends (up to +20%), sustained by unintentional combustion, active consumer goods, and regulatory lag times. Altitudinal profiling across Tenerife sites highlights this divergence: coastal areas reflect local secondary emissions, whereas high-altitude observations confirm the progressive clearance of the global free troposphere. Overall, these findings provide new insights into the spatial and temporal dynamics of atmospheric POPs, reaffirming the role of long-term monitoring in guiding international abatement strategies.
Health-related quality of life (HRQoL) is frequently impaired in cirrhosis. Among the most critical components of reduced HRQoL in cirrhosis is disturbed sleep. Despite the importance of sleep in cirrhosis and overall health, sleep is rarely clinically assessed and the specific aspects of sleep which drive reduced wellbeing are understudied. Remote monitoring with wearable technology may facilitate sleep assessment and targeted intervention. We enrolled 119 participants with cirrhosis across two academic medical centers and collected baseline clinical, cognitive and laboratory assessment and 6 months of longitudinal wearable tracking with an Oura Ring. HRQoL was assessed with the Chronic Liver Disease Questionnaire (CLDQ) and subjective sleep quality with the Pittsburgh Sleep Quality Index. Association of sleep metrics with HRQoL and subjective sleep was assessed in multivariable mixed effects model, with mediation analysis further analyzing the relationship. Across analysis of 12516 sleep episodes in 88 participants who completed all assessments and ≥14 valid sleep nights, there was a strong association between measured sleep and reported sleep quality as well as HRQoL, with reduction in sleep efficiency, overall sleep time, and sleep regularity index (SRI). In adjusted mediation analyses, SRI was the strongest mediator (49.9% total mediation effect, ACME = - 0.093, p<0.001) of the relationship between liver disease severity (as measured by Child-Turcotte-Pugh Score) and CLDQ. In a large prospective study of remote sleep monitoring in liver disease, we found that sleep regularity had a strong association with patient-reported sleep quality and wellbeing, and was the strongest sleep metric mediating the relationship between progressive liver disease and overall HRQoL. These findings suggest the potential for circadian-targeted interventions in patients with cirrhosis. Sleep impairment is a major contributor to reduced wellbeing in cirrhosis, but existing sleep assessments often are too cumbersome to be used clinically and fail to capture long-term sleep patterns and circadian disruption. Using six months of wearable-derived sleep data, this study identifies sleep irregularity, as captured by the Sleep Regularity Index, as the sleep metric most strongly associated with patient reported sleep and overall wellbeing impairment. These findings suggest that sleep regularity, a marker of circadian rhythm dysfunction, may be an important digital biomarker for progressive worsening in cirrhosis and highlight a possible target for future interventions. If validated in future studies, wearable monitoring of sleep could provide clinicians and researchers a scalable approach for identifying patients with cirrhosis at increased risk for impaired wellbeing through sleep disturbance and monitor response to treatment.
Salmonellosis contributes to a significant burden on global healthcare systems. The impact of this foodborne bacterium is more pronounced when the infection is invasive, leading to bacteraemia and sepsis. Studies on invasive salmonellosis are few, and there is an urgent need to understand the spatial distribution of bacteraemia and the different contributing serotypes. To describe the spatial and temporal distribution of Salmonella bacteraemia in Queensland from 2010 to 2019 and identify high-risk areas and demographic groups. A retrospective population-based spatiotemporal analysis was conducted using laboratory-confirmed Salmonella bacteraemia notifications. Standardised incidence ratios (SIRs) were estimated at the postcode level using indirect standardisation with age and sex as stratification variables. A Besag-York-Mollè (BYM) Poisson model was used to estimate posterior mean relative risks (RRs), assess spatial clustering and identify hotspots. The highest risk was observed in children aged 0-10 years (RR = 2.36, 95% CI: 2.00-2.78), and males had a 24% higher risk than females (RR = 1.24, 95% CI: 1.10-1.40). Across the study period, approximately 39% of postcode areas exceeded RR > 1.5. The three most common Salmonella serotypes also exhibited notable spatial heterogeneity. We found that Tropical North QLD (RR ranges from 1.6 to 5.39) and the outback areas of Central QLD (RR ranges from 1.8 to 6.19) were high-risk areas for bacteraemia. Salmonella bacteraemia in QLD shows substantial spatial and demographic heterogeneity, with clear hotspots in remote and tropical regions, supporting targeted, serotype-informed surveillance and prevention strategies, particularly for children and males in high-risk areas.
Cardiac rehabilitation (CR) aims to enhance cardiovascular health and quality of life, as well as survival through structured exercise training, lifestyle education, cardiovascular risk factor management, and psychosocial support. Despite growing evidence linking sleep disorders, poor sleep health, and circadian rhythm disruption to impaired cardiac recovery, reduced exercise adherence, and increased adverse cardiovascular events, systematic assessment and management of sleep and circadian health remain underutilized in CR programs. In this narrative review, we aim to explore and characterize the gap and address the potential benefits of incorporating sleep and circadian rhythm assessment into CR practice. Sleep disorders commonly encountered in patients undergoing CR, including obstructive sleep apnea, central sleep apnea, and insomnia, may adversely affect CR participation, functional recovery, and cardiovascular prognosis. Practical strategies include routine sleep screening with validated assessment tools, selective use of objective sleep assessments, sleep hygiene education, chronotype-informed exercise scheduling, and referral pathways to sleep medicine specialists. Integrating sleep-circadian considerations into CR may enhance cardiac recovery, improve exercise tolerance and adherence, and support more comprehensive, personalized secondary prevention strategies. Artificial intelligence may further support early detection of sleep disturbances, individualized exercise prescription, remote monitoring, and precision CR approaches integrating sleep and circadian health.
Equitable access to healthcare services is a core principle of Brazil's Unified Health System and remains a persistent challenge in territories marked by social and geographic inequalities, such as the Brazilian Amazon. In this region, vast distances, logistical barriers, and socioeconomic disparities converge to limit the effectiveness of public health policies. The present study aimed to examine individual, organizational, and territorial factors associated with self-reported healthcare access among quilombola rural and riverside communities in Santarém, Brazilian Amazon, using conventional statistical and machine-learning approaches. This cross-sectional, community-based cross-sectional survey included 512 adults from nine Amazonian communities. Data were collected through structured interviews and analyzed using Python-based computational workflows. Supervised and unsupervised algorithms, multilevel logistic modeling, and principal component analysis (PCA) were employed. Five predictive models (Decision Tree, Random Forest, Gradient Boosting, Logistic Ridge, and Logistic Lasso) were compared using AUC, accuracy, sensitivity, and specificity, with performance reported for cross-validation in the training set and the held-out test set. A Social Vulnerability Index (SVI) was derived from PCA. Access and problem-resolution rates varied among communities, ranging from 42.9% to 100% and from 54.5% to 100%, respectively. Predictive discrimination was limited in the held-out test set (AUC 0.482-0.586), indicating poor generalizability for individual-level prediction. At the community level (n ≥ 10), the SVI was negatively correlated with access (r ≈ -0.53). Healthcare access in the Brazilian Amazon reflects intertwined territorial and social constraints. Computational approaches can complement conventional analyses by integrating multi-level information to support equity-oriented planning in remote settings.
Anxiety and depression impose substantial clinical and economic burdens worldwide, with high prevalence, impaired functioning, and elevated health care costs. Digital self-help interventions offer scalable and potentially cost-effective strategies; however, evidence from rigorously controlled economic evaluations remains sparse. This trial aims to evaluate the effectiveness and cost-effectiveness of 2 Norwegian mental health apps: Tankevirus (cognitive behavioral therapy-based) and Grubl (metacognitive therapy-based), compared with a digital placebo in reducing anxiety and depression symptoms, improving health-related quality of life, and generating quality-adjusted life years. The Mental Health Intervention With Digital Applications (MIND-APP) trial is a 3-arm randomized controlled trial (1:1:1 allocation) conducted fully remotely via a bespoke smartphone research platform. A total of 1000 Norwegian residents aged 16 years or older with mild to moderate symptoms of anxiety and/or depression will be recruited through national digital outreach. Coprimary outcomes are changes in anxiety (Generalized Anxiety Disorder-7) and depression (Patient Health Questionnaire-9) scores from baseline to postintervention (2-4 weeks). Secondary outcomes include health-related quality of life (EQ-5D-5L), quality-adjusted life years accrued over 6 months, functional impairment (Work and Social Adjustment Scale), health care resource use, and adverse events. Incremental cost-effectiveness ratios for Tankevirus and Grubl relative to placebo will be estimated from the perspective of public health services. Funding was secured in April 2025, with ethical approvals, licensing, and app development planned through 2026. Recruitment will commence in 2027, with follow-up through 2027 and early 2028. An extension of the timetable has been approved by the funding agent to allow inclusion of an updated version of the Tankevirus app, which will be ready for testing around May 2027. Results are expected to be published in autumn 2028 and will provide robust evidence on the clinical and economic value of scalable app-based interventions for common mental health disorders. This trial will be among the first large-scale registered reports to combine rigorous clinical and economic evaluation of digital mental health interventions. Findings will inform health policy and resource allocation by determining whether low-cost, app-based programs represent cost-effective solutions for reducing the burden of anxiety and depression. ClinicalTrials.gov NCT07627204; https://clinicaltrials.gov/study/NCT07627204. PRR1-10.2196/84096.
Despite clinical guidelines emphasising coordinated, person-centred care for pregnant women with epilepsy, preventable maternal deaths and suboptimal care continue. To explore the perspectives of women with epilepsy on pregnancy-related care and their views on how to improve it. We conducted semi-structured interviews with eleven women aged 27-39 years who were currently pregnant or had given birth within the last two years. We recruited participants from across the UK. Data were analysed using reflexive thematic analysis. Three main themes were identified. Enabling and supportive care was characterised by supportive healthcare professionals as anchors, proactive preconception counselling, collaboration between providers, a single coordinator of care, and access to specialist expertise. Fragmented and inadequate care included absence of informed decision-making, poor coordination, women being left to correct errors in their own care, encounters lacking empathy, limited epilepsy knowledge among non-specialist staff, and over-reliance on remote contact. Priorities for service improvement included early and direct conversations about risks (including SUDEP), respectful and balanced communication, partnership-based adult-to-adult dialogue, in-person consultations, and coordinated, holistic care that includes mental health support. Despite longstanding guidelines, women with epilepsy continue to experience significant gaps between recommended standards of pregnancy care and service realities. Women describe deficits in early, proactive discussions about medication and risks, informed decision-making, and joined-up care, leaving some to perform unsupported "safety work", correcting errors and mediating between neurology, obstetric and midwifery teams. Improving care requires a commitment to holistic, person-centred support that embeds clear, respectful, two-way communication with women and across services as a core safety practice.
Individual phenotypes strongly affect dispersal. Yet studying the relationship between dispersal tendencies and personality under ecologically relevant conditions is challenging, especially in fish. Laboratory studies lack environmental complexity and scale, while field-based approaches are often unfeasible. We here mimicked dispersal events in fish; encompassing all 3 phases of dispersal (departure, transience, settlement) in a large experimental mesocosm containing breeding sites. Using 3-spined sticklebacks (Gasterosteus aculeatus) tagged with 'Passive Integrated Transponders' (PIT tags), we remotely monitored proxies of dispersal of 2 cohorts, each consisting of 40 individuals of known activity and aggressiveness scores, continuously over 2 wk. We tested whether personality variation explained differences in departure timing, transience movements, settlement success and spatial distribution along the environmental gradient. We found that more active/aggressive individuals dispersed quicker in the mesocosm, spent more time on territories and collected more eggs. However, we did not detect strong phenotype-environment correlations. Our findings emphasize the potential role of personality-dependent dispersal in population dynamics, with specific behavioral types driving dispersal and settlement success. Our mesocosm setup provides unique insights into the dispersal dynamics in a system where detailed observations across all dispersal stages are rare and difficult to obtain. Despite limitations, behavioral experiments in mesocosms serve as a valuable bridge between laboratory and natural systems.
About 3.5 million fishing vessels ply the world's oceans, providing livelihoods and food for millions of people. Sound management is key to fisheries' sustainability, but illegal fishing, along with fishing overcapacity generally and environmental change, are putting many fisheries at risk. Illegal fishing is a globally pervasive yet unevenly distributed phenomenon, manifesting in diverse forms across both small-scale and industrial-scale fleets, the latter accounting for about 82 to 93% of the 8.4 to 15.4 million metric tons global annual illicit marine wild fish seafood trade valued at US$6.2 to 12.2 billion. The massive rise in fishing effort since 1950 has not been matched by adequate regulations and enforcement, especially for industrial-scale fishing in the waters of developing countries. About two-thirds of the illicit trade by value originates from fishing grounds in West Africa (27%), East Asia (24%), and Southeast Asia (16%). Remote sensing and AI technologies are improving detection of illegal fishing, but enforcement remains an issue given its high costs and the relative ease of laundering illegal catch through transshipments at sea, poorly regulated ports, and fraudulent documentation along seafood supply chains. Illegal fishing markets require multilayered policy responses grounded in transparency, international cooperation, and socioeconomic justice. Proposed measures, ranging from mandatory electronic vessel identification and subsidy reform to artisanal fishery protections and stronger port controls, warrant further research into their implementation and effectiveness.
Mitochondrial oxidative damage is one of the factors that contributes to the pathological process of intestinal ischemia/reperfusion (II/R) injury. Glutaredoxin (GRX2), which serves as a crucial protein in maintaining mitochondrial redox homeostasis, affects the activity of downstream proteins through its deglutathionylation effect. Silent information regulator (SIRT3), a crucial deacetylase in mitochondria, has regulatory effects on the activity of various mitochondrial antioxidant enzymes. However, the precise regulatory mechanism underlying SIRT3 enzymatic activity is unknown. Our research is designed to explore GRX2-mediated SIRT3 deglutathionylation's role and mechanism in II/R injury. GRX2 levels decreased after II/R injury, and GRX2 overexpression alleviated II/R-induced intestinal mucosal injury, mitochondrial oxidative damage, damage to mitochondrial structure and function, remote organ injury, and the systemic inflammatory response. GRX2 overexpression substantially decreased the S-glutathionylation of SIRT3 and increased its activity. The results of the incubation of recombinant SIRT3 with glutathione and H2O2 indicated that the S-glutathionylation of SIRT3 inhibited SIRT3 activity. Subsequently, SIRT3 mutant plasmids with cysteine-to-serine substitutions were constructed to screen for the S-glutathionylation sites of SIRT3 among the four cysteine residues in its amino acid sequence. The results demonstrated that C280 and C283 are the SIRT3 S-glutathionylation sites. The results of experiments using ischemic intestines from clinical cases confirmed the relationship between GRX2 and SIRT3. This study demonstrates that GRX2 alleviates mitochondrial oxidative damage following II/R by reversing the S-glutathionylation of SIRT3. GRX2 is an important protective factor against II/R injury, and GRX2-mediated deglutathionylation of SIRT3 alleviates II/R-induced mitochondrial injury and intestinal damage. Antioxid. Redox Signal. 00, 000-000.