Somatic symptoms are closely linked to health anxiety, and anxiety sensitivity is often described as a trait-like amplifier of responses to bodily sensations. Metacognitive beliefs operate at a higher-order level and may influence the conditions under which this amplification is observed. A cross-sectional survey was completed by 564 university students, who reported on somatic symptom burden (PHQ-15), anxiety sensitivity focused on physical concerns (ASI-3 Physical), metacognitive beliefs about biased thinking (MCQ-HA Biased Thinking), and health anxiety (SHAI). Pearson correlations and regression-based conditional process analyses were used to estimate a two-way moderation model and a three-way moderated moderation model (PROCESS Models 1 and 3) with 5,000 bootstrap samples and Johnson-Neyman probing. Somatic symptoms, anxiety sensitivity, and biased-thinking beliefs were all positively associated with health anxiety. The two-way interaction between somatic symptoms and anxiety sensitivity was not clearly supported. A small but statistically significant three-way interaction indicated that anxiety sensitivity strengthened the somatic symptom to health anxiety association only at higher levels of biased-thinking beliefs, a range that applied to roughly one quarter of the sample. These findings provide preliminary support for the idea that anxiety sensitivity may act as a conditional vulnerability, increasing the impact of somatic symptoms on health anxiety primarily when metacognitive beliefs about biased thinking are high.
Psychological resilience and self-regulation are key psychological constructs that support learners' adaptation to challenges. Resilience provides the motivational foundation for persistence, while self-regulation enables planning, monitoring, and adjustment of strategies. Computational thinking (CT) represents a higher-order cognitive framework that includes creativity, algorithmic thinking, collaboration, critical thinking, and problem solving. This study examines the mediating role of self-regulation in the relationship between psychological resilience and CT among pre-service mathematics teachers. Participants were 336 pre-service mathematics teachers from two state universities in Türkiye. Data were collected using the Psychological Resilience Scale, the Self-Regulation Scale, and the Computational Thinking Skills Scale. Confirmatory factor analyses supported the validity and reliability of the measures. Correlation analyses examined the associations among constructs, and mediation was tested using PROCESS Macro (Model 4) with controls for gender and grade level. Psychological resilience was positively associated with CT skills (r = 0.34, p < 0.001) and self-regulation (r = 0.41, p < 0.001). Self-regulation was also positively associated with CT skills (r = 0.36, p < 0.001). Mediation analyses showed that including self-regulation reduced the associations between resilience and CT sub-dimensions, though they remained significant, indicating partial mediation. Bootstrap analyses confirmed significant indirect effects across all CT sub-dimensions. Findings suggest that psychological resilience is related to CT skills both directly and indirectly through self-regulation. Self-regulation acts as a mechanism that channels resilient tendencies into goal-directed strategies, thereby enhancing CT. These results underscore the value of integrating resilience, self-regulation, and CT into teacher education programs to promote adaptability and 21st-century skills.
Attitudes on socially consequential issues are often resistant to direct persuasion. Paradoxical thinking is a persuasion technique that presents exaggerated or absurd arguments for a position that may make people object to and reduce resistance to persuasion attempts. Across three preregistered experiments, we tested the effects of absurd paradoxical messages regarding attitudes toward prostitution. In Studies 1-2, paradoxical pro-prostitution messages produced reductions in favorable attitudes toward prostitution relative to conventional negative messages, and indirectly predicted willingness to support restrictive policy action through attitudinal change. Study 3 provided a process-focused test, showing that disagreement with the paradoxical message predicted reduced favorable attitudes toward prostitution, which were associated with greater willingness to support restrictive policy action. These findings provide evidence for the effectiveness of paradoxical arguments in a moralized social issue, while highlighting boundary conditions and the need for further research.
Medical laboratories in Nigeria are pivotal for national health security but operate under severe infrastructural deficits and a high disease burden. Traditional Quality Control (QC) methods are prevalent but reactive and fail to address the high proportion of errors occurring in pre- and post-analytical phases. This necessitates a strategic shift toward Risk-Based Thinking (RBT) as mandated by the new ISO 15189:2022 standard to bridge the gap between international requirements and local environmental volatility. This review assesses the current state of laboratory quality in Nigeria and evaluates the applicability of RBT frameworks (ISO 15189:2022 and CLSI EP23) in resource-limited settings. It aims to identify structural and cultural implementation barriers and propose actionable mitigation strategies. This comprehensive narrative review utilized a systematic search strategy across PubMed, Scopus, and AJOL covering 2010-2025. Data from 85 identified sources, including 66 studies selected using a defined criticality matrix, were synthesized using the Plan-Do-Check-Act (PDCA) framework operationalized with specific quality indicators to contrast regulatory expectations with operational realities. The sector is polarized, with elite private and donor-funded public laboratories driving accreditation (representing only 26 facilities or < 0.5% of the sector), while the majority struggle with a punitive blame culture, the "Japa" syndrome workforce crisis, and erratic power supply. RBT frameworks like Parvin's Risk Management Index offer tools to quantify these unique environmental risks and enable targeted resource allocation. Case studies from EL-LAB and HVL, alongside adaptive lessons from the COVID-19 pandemic, demonstrate that RBT facilitates resilience by scientifically validating investments in solar energy and staff competence to mitigate local hazards. Transitioning to RBT is critical for Nigerian laboratories to move from reactive compliance to proactive resilience. By managing risks like power instability and supply chain volatility, laboratories can effectively optimize scarce resources through data-driven mitigation to ensure patient safety.
This case highlights the importance of suspicion of pulmonary embolism (PE) even after low-dose combined oral contraceptive pills (LD-OCPs) and early diagnosis and prompt thrombolytic therapy administration, especially in resource-constrained settings such as Bangladesh. A 40-year-old female of Asian origin, Class I obese (BMI 32 kg/m2), presented to the emergency department with acute severe dyspnea, pleuritic chest pain, and palpitations. Her medical history was notable for obesity and hypertension, which had been managed with antihypertensive medication for the past 3 years. Additionally, she had been taking a LD-OCP for 4 months for menstrual irregularity. Despite initial management with low-molecular-weight heparin and supportive measures, the patient's condition rapidly deteriorated to severe cardiogenic shock, necessitating urgent intervention. Thrombolytic therapy with alteplase was administered, which significantly improved the patient's hemodynamic status. Follow-up imaging revealed a reduction in the thrombus burden and resolution of deep vein thrombosis. This case highlights the critical role of early diagnosis and prompt thrombolytic therapy, such as alteplase, in managing acute PE. Rapid intervention can prevent severe complications. Clinicians must maintain high suspicion in symptomatic patients, especially women on hormonal therapy, and use timely diagnostics like D-dimer and CT angiography. In resource-limited settings, the timely administration of thrombolytic agents such as alteplase can significantly improve patient outcomes, as demonstrated in this case.
In the post-truth era, the widespread use of social media and algorithmic recommendation technology has gradually made the influence of emotions and beliefs surpass objective facts. College students are particularly vulnerable to emotional and one-sided information, posing severe challenges to their ethical judgment. To address this issue, this study proposes and validates a dual-dimensional model based on critical thinking and emotional education. The aim is to systematically enhance college students' ethical judgment through collaborative intervention in cognitive and emotional dimensions. The study adopts a randomized controlled experiment design, selecting 600 college students to be divided into a dual-dimensional intervention group, a single-dimensional intervention group, and a control group. The effects are evaluated through pre-tests, post-intervention tests, and follow-up tests. The results show that the ethical judgment of the dual-dimensional intervention group significantly improves compared to the single-dimensional intervention group, and emotional education uniquely contributes to the emotional dimension of ethical judgment. Furthermore, post-truth sensitivity negatively moderates the intervention effect, indicating that individuals with a higher reliance on emotional information benefit relatively limitedly. This study not only fills the gap in ethical education research in the post-truth environment but also provides a modular and quantifiable intervention program for university curriculum design, possessing significant theoretical value and practical implications.
Ovarian cancer (OC) remains one of the leading causes of gynecologic cancer mortality, largely due to late diagnosis, frequent relapse, and the emergence of chemoresistance. An important but often-overlooked contributor to treatment failure is the heterogeneous penetration of anticancer drugs within tumors. Structural and biochemical barriers-including abnormal vasculature, elevated interstitial pressure, dense extracellular matrix, drug efflux transporters, and malignant ascites-generate steep intratumoral concentration gradients that conventional preclinical models fail to capture. As a result, systemic pharmacokinetic measurements frequently provide limited insight into tumor-level drug exposure. Patient-derived organoids (PDOs) have emerged as physiologically relevant 3D models that preserve the genetic, architectural, and functional characteristics of the original tumor. These systems enable controlled investigation of pharmacokinetic and pharmacodynamic processes, including drug penetration, metabolism, retention, and exposure-response relationships. Adding cell-free malignant ascites supernatant enhances PDOs' ability to mimic the metastatic peritoneal microenvironment of OC. This review discusses recent advances in PDO technologies and examines how PDO-derived data can inform intratumoral pharmacokinetics and dosing strategies using physiologically based pharmacokinetic modeling and in vitro-in vivo extrapolation. Emerging hybrid platforms, including organoid-on-chip systems, vascularized co-cultures, and multi-omics integration, are crucial to improve translational prediction and support precision oncology.
Digitalization can be an important strategy for upholding medical services in rural areas in the face of demographic change and a looming shortage of skilled care workers. An online health community (OHC) can strengthen self-management and health literacy and serve as a digital interface between citizens and medical service providers. We investigated the viewpoints of elderly people in southern Saxony-Anhalt towards digitalization in general and their willingness (or lack thereof) to participate in a future OHC. Therefore, we conducted 20 semi-structured interviews and five focus groups with elderly people. In addition, two expert interviews were conducted to assess regional contextual factors. Data were evaluated using reflexive thematic analysis. Participants experience changes in their everyday life brought about by digitalization which they perceive as a source of uncertainty that threatens their identity. They fear that digital technologies will cause a loss of authenticity in their personal relationships and express concerns about sharing content digitally with unknown others. Furthermore, participants feel pressured to acquire digital skills. Yet, they also fear exclusion from participating in digital technologies. However, participants use digital technologies for pragmatic reasons and view them as potential solutions for existing problems, such as overcoming spatial distance. Participants' everyday experiences with digital technologies and their pragmatic attitudes towards using them may have a positive impact on OHC participation. In addition to known barriers such as security concerns, the pervasiveness of digitalization in everyday life, however, unsettles participants, which might have a negative impact on their participation in an OHC.
Preceptors are essential partners in pharmacy education, supporting experiential learning that represents approximately 25-33% of pharmacy curricula and a substantial portion of residency training experiences. Effective interactions between preceptors and learners are essential for learner success; however, many preceptors lack formal training in providing support and addressing learners' holistic needs, including professional development and well-being. The Joint Commission of Pharmacy Practitioners' Pharmacists' Patient Care Process (PPCP), updated in 2025, offers a standardized approach to patient care delivery in any setting. This manuscript proposes a novel. Preceptor-Learner Care Process (PLCP), adapted from the PPCP framework, as a standardized, structured, and repeatable framework to guide the preceptor-learner relationship in experiential education and to support intentional learner development. The PLCP provides preceptors a systematic approach to collect, assess, plan, implement, and follow-up on learner-specific challenges or opportunities. This framework integrates clinical skills, professionalism, communication, emotional intelligence, and situational and self-awareness enabling preceptors to provide consistent and individualized approaches to learner-specific development.
Intertemporal decision-making ability influences adherence to health behavior and clinical outcomes in patients with chronic diseases. However, its concept remains insufficiently defined. This study aimed to identify the key attributes, antecedents, consequences, and empirical referents of intertemporal decision-making ability in patients with chronic diseases. The Walker and Avant's concept analysis method was used. A systematic search for studies on intertemporal decision-making ability in patients with chronic diseases was conducted across the following databases: PubMed, Web of Science, CINAHL, Embase, PsycINFO, and the China National Knowledge Infrastructure (CNKI). The search covered literature from the beginning until January 2026. A total of 35 articles were included. Four defining attributes of intertemporal decision-making ability in patients with chronic diseases were identified: impulse control, emotional self-regulation, future health valuation, and future-oriented thinking and planning. Antecedents included economic factors, knowledge level, perceived health competence, disease status, emotional status, personality traits, and time perspective, while its consequences encompassed improved psychological status, adherence, and clinical outcomes. Intertemporal decision-making ability in patients with chronic diseases is a multidimensional psychological construct. A thorough examination of this concept can facilitate the development of appropriate assessment instruments and stratified interventions. In clinical practice, healthcare providers can deliver individualized interventions based on patients' specific deficient attributes, using strategies such as immediate rewards, environmental restructuring, health education, and episodic future thinking training to enhance intertemporal decision-making ability, thereby improving adherence to health behaviors and optimizing clinical outcomes.
The impact of different teaching methods on clinical reasoning and clinical decision-making of dentistry students: a systematic review. Journal of Dental Education, 2026, 90(1), pp.33-42 DESIGN: This systematic review examined evidence on educational interventions aimed at developing clinical reasoning and decision-making skills in undergraduate dental students. Searches of PubMed, MEDLINE (Ovid), Cochrane Library, and Scopus were conducted to 15 September 2023. Eighteen studies met the inclusion criteria for qualitative synthesis. Study designs included cross-sectional and case-control approaches. PRISMA guidance was followed, and a flow diagram was provided. Eligible studies were English-language reports evaluating clinical reasoning or decision making in undergraduate dental students. Studies involving qualified dentists, other healthcare professions, all review types, and non-peer-reviewed or grey literature were excluded. Two reviewers independently extracted data, resolving discrepancies by consensus. Methodological quality was assessed using the Quality Assessment Tool for Quantitative Studies. From 1118 records, 18 studies were included. Most studies originated from Asia, with limited representation from Europe. Topics spanned oral medicine, prosthodontics, restorative dentistry, and endodontics. Most studies were rated 'weak,' reflecting limitations in sampling methods, confounding, and outcome measurement. No meta-analysis was feasible; findings were synthesised narratively across the different educational approaches. The emerging evidence does however suggest that interactive, technology-enabled methods (such as virtual patients, AI-assisted modules, mobile applications, integrated curricula, and team-based learning) may enhance aspects of clinical reasoning and decision making compared with traditional lectures or small-group discussions. However, effects were inconsistent, typically based on proxy measures such as self-confidence ratings, diagnostic thinking inventories, or think-aloud assessments. Definitions of "traditional" versus "new" teaching methods were often unclear, as was the conceptual relationship between clinical reasoning and clinical decision making. The review suggests that educational strategies grounded in psychosocial rather than solely biomedical frameworks may support the development of clinical reasoning and decision-making abilities in undergraduate dental students. The overall strength of evidence is limited by heterogeneity, small sample sizes, non-validated outcomes, and variable terminology. High-quality studies employing standardised, robust measures of clinical reasoning are needed to guide future curriculum development.
The link between type 2 diabetes (T2D) and obesity is well established; guidelines for treating T2D include recommendations to support healthy weight reduction. This study explored the perspectives of people in the US and Canada with T2D across BMI categories regarding the perceived value of reaching a lower weight and how this would impact their lives. A quantitative cross-sectional survey informed by a targeted literature review and qualitative interviews was administered in English to adults in the US and Canada with T2D. Enrollment ensured a sample representative of the T2D population by BMI (per US census data). The survey explored weight management experience, impacts of T2D and weight on quality of life (QOL), and perceived value of 5%/10%/20% weight reductions. Results were summarized descriptively. Chi-squared tests and t-tests assessed significant differences between BMI categories (p<0.05). The 746 participants had a mean (SD) BMI of 32.8 kg/m2 (8.2). Nearly all (93%) felt weight management was important to managing their T2D, regardless of BMI. Most (66%) reported currently thinking about and trying to lose weight at least multiple times each week over the last 2 years, especially those with higher BMIs (p<0.001). Higher BMI was also associated with more impacts of weight on T2D (emotional well-being, medical/health complications, physical/mobility limitations, sleep, daily activities, social and financial). Participants with higher BMIs desired greater weight reduction than those with lower BMIs when defining dream, achievable, acceptable and unsuccessful weight goals and were more likely to expect positive and meaningful impacts on their life with 5%/10%/20% weight reductions. Participants with T2D positively valued weight reduction and anticipate it to lead to improvements in their overall T2D management and QOL. As the percentage of weight reduction increased, those with higher BMIs perceived greater meaningfulness and more positive impacts.
AI technologies increasingly influence dental education, but their instructional value, stakeholder perspectives, and institutional implications require further study. To synthesise evidence on AI's impact in undergraduate dental education, focusing on learning outcomes, stakeholder perspectives, and curriculum design. Following PRISMA 2020 guidelines, researchers searched PubMed, Scopus, Web of Science, IEEE Xplore, and Google Scholar for articles published between January 2015 and February 2025. Eligibility followed an adapted PECO framework: undergraduate dental students or faculty (Population); AI use in teaching, clinical training, or administration (Exposure); conventional or non-AI digital methods (Comparator); and outcomes including knowledge retention, skills, critical thinking, stakeholder perspectives, and curriculum effectiveness (Outcome). The initial pool of 402 references underwent systematic screening, quality appraisal, and AI-focused refinement across four stages, resulting in a final dataset of 107 studies meeting a minimum quality threshold (≥ 3) using validated appraisal tools. AI-powered educational resources, including adaptive learning platforms, intelligent tutoring systems, and generative AI tools, improved knowledge retention, technical skills, and clinical decision-making. Students benefited from personalised feedback, adaptive instruction, and increased engagement. Faculty expressed cautious optimism, tempered by gaps in training, technical readiness, and ethical guidance. Adoption patterns were shaped by generational, cultural, and infrastructural factors. AI enhances cognitive, technical, and clinical learning while complementing traditional instruction. Successful integration requires structured faculty development, clear ethical frameworks, institutional support, and close collaboration among educators, researchers, and technologists to ensure AI supports, rather than replaces, core clinical training and professional decision-making. Coordinated strategies addressing pedagogy, technical competence, and ethics will maximise AI's educational impact and support sustainable curriculum transformation in dental education.
Myxedema psychosis or "myxedema madness" is a rare, treatable, but potentially fatal neuropsychiatric manifestation of severe hypothyroidism. This case report presents a 46-year-old, unemployed, childless woman with progressive deterioration of her health over the last six months, including progressive lethargy, social withdrawal, poor intake, irritability, sound sensitivity, auditory hallucinations, urine and fecal incontinence, and complete neglect of personal hygiene. She had undergone total thyroidectomy and parathyroidectomy for which she was on levothyroxine, which she had discontinued. On physical examination, she was disoriented, having disorganized thinking, false belief of having cancer, fecal soiling, non-pitting edema of the lower limbs, and rigidity of the upper and lower limbs. Laboratory investigations showed hypoglycemia, hypokalemia, hypophosphatemia, severe hypothyroidism, and low morning cortisol. The CT scan of the brain revealed symmetrical calcification of bilateral basal ganglia, thalami, right corona radiata, and bifrontal subcortical white matter. She was started on levothyroxine, hydrocortisone, and aripiprazole. On day 16, she developed catatonic features, for which she was treated with lorazepam and aripiprazole, resulting in gradual improvement.
Generative artificial intelligence (GenAI) chatbots powered by large language models (LLMs) are becoming increasingly integrated into health and medical research workflows, offering researchers new tools to enhance efficiency, support innovation, and assist with knowledge translation. Although their use in health and medical research is expanding rapidly, the practical application of these tools across the broader health and medical research landscape remains complex and evolving. Health and medical researchers often engage with complex study designs, theoretical frameworks, and population needs, all of which require thoughtful, effective and responsible use when involving AI tools. This 10-chapter guide serves as a practical, evidence-informed resource for health and medical researchers to engage effectively and responsibly with GenAI chatbots through the practice of prompt engineering, the design of clear, structured, and purposeful prompts that guide GenAI chatbot outputs. It presents strategies to improve prompt quality and adapt GenAI chatbot interactions to the varied methodological and disciplinary contexts found across health and medical research. The article outlines a structured framework for how GenAI chatbots can be applied throughout the research cycle, including research question development, study design, literature searching, querying for appropriate reporting guidelines and appraisal tools, quantitative and qualitative data analysis, writing and dissemination, and implementation. AI-generated content should be treated as a preliminary draft and must always be reviewed, verified against credible sources, and aligned with disciplinary standards. Risks such as hallucinated content, embedded biases, and ethical challenges are addressed, particularly in sensitive or high-stakes settings. Transparency in AI use and researcher accountability are essential. While GenAI chatbots have the potential to expand access to research support and foster innovation, they cannot replace critical thinking, methodological rigour, or contextual understanding. Instead, they should augment, not replace, human expertise. This guide encourages effective and responsible use of GenAI chatbots and support their thoughtful integration into the health and medical research process.
Many countries recommend 3-monthly chlamydia/gonorrhoea screening for gay, bisexual and other men who have sex with men (GBMSM). Evidence about the limited impact of frequent, asymptomatic gonorrhoea/chlamydia screening on population prevalence, coupled with concerns about overburdened health services and antimicrobial resistance (from frequent treatment), calls into question current approaches to asymptomatic screening. We explored sexual health professionals/experts' arguments in favour/against reducing asymptomatic screening using Polis (www.Pol.is), an online, crowdsourcing tool for understanding what large groups think. Recruited via global peak bodies/networks, 99 individuals in the field of sexually transmitted infections (STIs) (43.4 % clinicians, 35.4% researchers) primarily from Australasia (41.4%), UK/Europe (29.3%) and North America (22.2%) participated. Ninety-one statements were submitted in favour/against reduced screening for GBMSM (eg, 'Bisexual men who don't test regularly risk putting women at risk'). Participants voted on submitted statements (agree/disagree/pass). Statements with ≥80% agreement were considered as 'strong' support, 70%-79% 'moderate' and ≤69% 'mixed'. Statements were grouped using content analysis to assess support for clusters of related statements. There was 'mixed support' for statements on: (1) the impact of screening in reducing prevalence; (2) whether asymptomatic infections pose clinical harm/necessitate treatment; and (3) risk of antimicrobial resistance. Statements advocating for 6-monthly screening received 'moderate support', with arguments centring on resource use. Participants 'strongly supported' the need for community engagement and maintaining frequent HIV/syphilis screening. While there were mixed opinions about relative utility, risks and harms of reducing chlamydia/gonorrhoea screening for GBMSM, arguments relating to resource constraints may provide common ground for policy changes.
Adult T-cell leukemia/lymphoma (ATLL) is a rare, human T-lymphotropic virus type 1 (HTLV-1)-driven neoplasm that is often underrecognized in low-endemic regions. We describe a 23-year-old man with an eight-year history of chronic dry cough who later developed weight loss, night sweats, odynophagia, and dyspnea. CT revealed cervical/supraclavicular lymphadenopathy with innumerable pulmonary micronodules, interlobular septal thickening, and ground-glass opacities; abdominal imaging showed hepatosplenomegaly, ascites, and extensive retroperitoneal/mesenteric adenopathy. HTLV-1 ELISA and confirmatory Western blot were positive. Excisional lymph node biopsy demonstrated diffuse architectural effacement by atypical T cells with a CD3+, CD4+, CD5+, CD25+, CD7-, granzyme B+ immunophenotype and a ~90% Ki-67 index, establishing lymphomatous-type ATLL with a cytotoxic profile. Despite rapid recognition, the patient deteriorated and died from respiratory failure 15 days after diagnosis, before chemotherapy could begin. This lung-predominant presentation in a young adult illustrates how ATLL can mimic chronic pulmonary disease and evade early detection outside endemic areas. Clinicians should prioritize early tissue acquisition and a minimal T-cell panel (CD3, CD4, CD25, CD7, Ki-67); a CD4+CD25+ phenotype with CD7 loss should prompt HTLV-1 testing irrespective of geography. Streamlined access to immunophenotyping and confirmatory HTLV-1 assays is essential to reduce diagnostic delays and improve outcomes. When a long-lasting cough hid a rare blood cancer in a young adult This report describes a 23-year-old man who had a dry cough for eight years. Over time he also developed weight loss, night sweats, trouble swallowing, and shortness of breath. Scans showed enlarged lymph nodes in the neck and abdomen and many small spots in the lungs. Common infections were ruled out. A surgical sample of a swollen lymph node confirmed a rare blood cancer called adult T-cell leukemia/lymphoma (ATLL). ATLL is caused by infection with a virus named human T-lymphotropic virus type 1 (HTLV-1). The virus is common in some parts of the world but uncommon in many others. Because of this, doctors outside high-risk regions may not think of ATLL right away—especially when symptoms seem to come from the lungs and blood tests are not striking. This can delay diagnosis. Our case shows that ATLL can look like a chronic lung disease for years, even in a young person. We highlight a practical approach that may speed up care in low- and middle-income settings: (1) consider ATLL when long-lasting cough is accompanied by weight loss, night sweats, or swollen lymph nodes; (2) obtain a tissue sample early; and (3) request HTLV-1 testing when suspicion is raised. Clear referral pathways to outside laboratories can help when advanced tests are not available locally. Despite recognition after the biopsy, our patient’s breathing worsened rapidly and he died before treatment could begin. Raising awareness of this unusual presentation may help clinicians reach the diagnosis sooner and improve patient outcomes.
As bioinsecticides, Bacillus thuringiensis (Bt) and the pesticidal proteins produced by this, and other bacteria, have proved to be commercially very successful. Although its basic mechanism of action has been understood for many decades, current literature on this topic often comes across as inconclusive and even contradictory. In an attempt to clarify this, a symposium was held at the 2025 Society of Invertebrate Pathology annual meeting where a number of these topics were discussed with the objective of reaching a consensus opinion. What follows is a summary of the conclusions drawn from that symposium. It is not intended to be a comprehensive review of the subject but rather a condensed synopsis that the various stakeholders involved in insect pest management can use as an indication of current thinking in this area.
This paper presents "Neither/Nor," a philosophical synthesis which defines conceptual and experiential modes of knowing as complementary skills which can be deliberately trained and oscillated. The paper argues that neither theory (concepts) nor practice (experience) alone can suffice for desirable outcomes in personal flourishing or scientific inquiry. Drawing from Western and Eastern philosophical traditions-from ancient skepticism and Buddhism to modern pragmatism and cognitive science-Neither/Nor proposes that "latent Platonism," the unconscious preference for abstract concepts over direct experience, contributes to both personal suffering and intellectual impasses. The paper begins with a concrete example of Type I diabetes management, demonstrating the constant negotiation between abstract formulas and embodied experience required by the disease, before providing five practical principles: (1) regard concepts and experience as trainable skills; (2) commit to oscillation between skills; (3) prioritize relations and processes over objects and states; (4) embrace trial-and-error learning; and (5) employ conditional historicism over linear causal thinking. The Neither/Nor framework demonstrates how these principles can reduce personal suffering, enhance scientific inquiry, and provide a methodology for evaluating diverse philosophical positions pragmatically. Neither/Nor points towards a way of living rather than merely an abstract theory, contributing to both individual flourishing and more flexible approaches to complex societal challenges.
Climate change poses a growing threat to health care systems worldwide, exposing weaknesses in infrastructure, workforce, and governance. Climate risk-defined by the interaction of hazard, exposure, and vulnerability-is both similar to and distinct from other systemic risks that health care systems must manage. We propose a risk-based framework that integrates insights from disaster risk management and health systems thinking to identify adaptation strategies. Our approach emphasizes understanding and addressing the upstream determinants of climate risk, including the intersectoral operating environment and social and environmental vulnerabilities that amplify health impacts. This perspective links climate risk reduction to the broader agenda of health equity. Within the health sector, climate change exerts simultaneous pressure on both demand and supply, challenging systems to move from reactive crisis response toward proactive, risk-informed planning. Established tools-such as strategic investment, workforce planning, and emergency preparedness-can be leveraged to manage climate-related risks while advancing core health policy goals. Framing climate change as a systemic risk encourages the integration of climate considerations into everyday policy and planning and strengthens health care system performance.