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For comatose survivors of out-of-hospital cardiac arrest (OHCA), accurate neuroprognostication enables shared decision-making and avoids premature or unnecessarily delayed withdrawal of life-sustaining treatment. Guidelines recommend a multimodal approach requiring at least two independent poor-prognostic criteria, of which neuron-specific enolase (NSE) is currently the primary endorsed serum biomarker. NSE is not consistently used, and guideline adherence remains variable internationally. To evaluate whether locally processed NSE improved guideline-concordant neuroprognostication and decision-making timelines after OHCA. A single-centre retrospective before-and-after study at an Australian quaternary intensive care unit (ICU) compared control (January 2022-July 2024) and intervention (August 2024-March 2026) periods. Sixty-nine comatose adults who underwent withdrawal of life-sustaining treatment on neurological grounds after OHCA were included. The primary outcome was guideline-concordant neuroprognostication (≥2 multimodal poor-prognostic criteria). Secondary outcomes were time to clinical determination of a poor neurological prognosis and prognostic disclosure to the family. Guideline-concordant neuroprognostication increased from 35.9% (14/39) to 63.3% (19/30), an absolute increase of 27.4% (p = 0.030). Cumulative sum analysis showed sustained improvement throughout the intervention period. Time to clinical determination of a poor neurological prognosis (87.0 vs 88.4 h, p = 0.66) and prognostic disclosure to the family (91.6 vs 92.4 h, p = 0.69) were unchanged. Implementation of locally processed NSE was associated with a statistically significant increase in guideline-concordant multimodal neuroprognostication. Decision-making timelines were unchanged, consistent with prognostication being shaped by human and system-level factors beyond diagnostic availability. NSE availability was not associated with earlier withdrawal of life-sustaining treatment.

Market authorization applications that do not obtain authorization after CHMP review, whether through a formal negative opinion or pre-opinion withdrawal, remain poorly characterized at a systems level, despite substantial strategic, and commercial implications for applicants, and the broader impact on public-health. We conducted a retrospective descriptive analysis of 47 Article 8[3] new marketing authorization applications (MAAs) evaluated by the CHMP between 2021 and 2025, comprising 16 applications with a formal negative CHMP opinion and 31 withdrawn applications with an underlying negative benefit-risk assessment. Public assessment documents were reviewed, and documented CHMP concerns were scored across four predefined domains: CMC, non-clinical, clinical, and regulatory/procedural, including subsequent secondary sub-categorization to allow for more detail. Procedural timelines, re-examination outcomes, and multi-domain co-occurrence patterns were also summarized. Findings were summarized descriptively using counts, percentages, and procedural-duration comparisons. Withdrawn and refused MAAs showed comparable product profiles and similar rates of orphan designation. Withdrawals occurred throughout all phases of the assessment procedure, reflecting different points at which applicants considered continuation no longer viable. Across both cohorts, procedural timelines frequently exceeded theoretical EMA benchmarks, with the excess concentrated in clock-stop phases. Clinical concerns were the most frequently documented domain, observed in 16/16 refused applications (100%) and 28/31 withdrawals (90%). Within the clinical domain, the secondary categories study-design concerns and insufficient evidence of efficacy were the most common findings and frequently co-occurred. Compared with refusals, withdrawals showed a broader deficiency profile, more often involving multiple domains, particularly CMC and regulatory/procedural concerns in addition to clinical deficiencies. These observations suggest that unsuccessful outcomes in this cohort were commonly associated with limitations in evidence generation, dossier readiness, and alignment between regulatory pathway and evidence maturity. Earlier cross-domain readiness assessment may help applicants identify major unresolved deficiencies before or during CHMP review.

Physical literacy (PL) has emerged as an important framework for understanding children's and adolescents' motivation, confidence, physical competence, knowledge, and engagement in lifelong physical activity. Although youth physical literacy research has expanded rapidly, limited bibliometric evidence has systematically mapped its global development, intellectual structure, and emerging thematic trends. This study aimed to examine the evolution of youth physical literacy research from 2000 to 2025 and identify major research themes, collaboration patterns, and emerging directions. A bibliometric analysis was conducted using records retrieved from the Web of Science Core Collection and Scopus databases within a multi-database validation framework. After data cleaning, deduplication, and exclusion of records outside the study period, 856 publications published between 2000 and 2025 were included. Bibliometrix, VOSviewer, and CiteSpace were used to examine publication trends, collaboration networks, influential contributors, keyword co-occurrence patterns, thematic clusters, timeline evolution, and burst keywords. Youth physical literacy research showed a sustained increase in publications, particularly after 2015. Canada, Australia, China, the United States, and the United Kingdom were among the most productive countries. Keyword and cluster analyses identified major themes related to physical education, motor competence, physical activity, physical competence, assessment and validation, fitness, health literacy, and public health. Timeline and burst analyses further suggested increasing attention to psychological, educational, and well-being-related themes within the youth physical literacy literature. Cross-database comparison showed consistent patterns in publication trends, leading contributors, and core thematic structures, supporting the robustness of the identified research patterns. This study provides a systematic and validated mapping of the global research landscape of youth physical literacy from 2000 to 2025. The findings suggest that youth physical literacy research has expanded from physical education, motor competence, and assessment-oriented topics toward broader educational, psychosocial, and health-related themes. These results offer a knowledge map for researchers, educators, and policymakers interested in advancing youth physical literacy in educational contexts and supporting holistic student development.

Evaluation of medical education is essential for ensuring the quality of health professional training. However, conventional evaluation approaches often lack objectivity, scalability, and longitudinal assessment capacity. Virtual reality (VR) and artificial intelligence (AI) are increasingly integrated into medical education, yet their application in educational evaluation has not been systematically characterized. To examine research trends, thematic evolution, and emerging directions in VR- and AI-enabled medical education evaluation, a bibliometric analysis was conducted. Publications indexed in the Web of Science Core Collection between January 1, 2015, and December 31, 2025, were retrieved using predefined search terms related to VR, AI, medical education, and evaluation. Eligible English-language articles and reviews were analyzed using CiteSpace (version 6.4.R2). Annual publication and citation trends, country collaboration patterns, and cited journals were assessed. Research themes and frontiers were examined through keyword co-occurrence, clustering, burst detection, and timeline analyses. A total of 695 publications were included. Annual publications and citations increased steadily, with accelerated growth after 2020. The United States, Germany, China, England, and Canada produced the highest number of publications, whereas Belgium, Egypt, Sweden, Singapore, and Switzerland demonstrated high collaboration centrality. Influential cited journals were concentrated in medical education and simulation-based training domains. Keyword analyses identified major themes including surgical education, VR simulation, clinical reasoning, decision support, and residency and undergraduate education. Burst and timeline analyses indicated a progression from early simulation-based skill validation toward learner-centered performance evaluation and, more recently, quality-oriented and curriculum-level assessment. Research on VR- and AI-enabled medical education evaluation has expanded rapidly and evolved from technical skill assessment toward comprehensive, competency-oriented, and quality-focused evaluation. These findings highlight the growing role of emerging technologies in shaping future global medical education evaluation frameworks.

Malaria transmission relies on sporozoite formation in the mosquito midgut and subsequent salivary gland (SG) invasion. Despite their importance, the cell biology of these processes remains poorly understood. We apply mosquito tissue ultrastructure expansion microscopy (MoTissU-ExM), which physically expands infected mosquito tissues while preserving host and parasite ultrastructure. MoTissU-ExM reveals parasite structures and organelles, including features previously seen only by electron microscopy and novel structures not observed before. We use MoTissU-ExM to investigate sporozoite formation and SG invasion, focusing on rhoptries-secretory organelles critical for host cell invasion. We establish a timeline for rhoptry biogenesis, show that two rhoptries are consumed during SG invasion, and provide the first evidence that rhoptry pairs are specialized for different invasion events. We further characterize RON11 as the first protein involved in sporozoite rhoptry biogenesis; its disruption produces sporozoites that specifically fail to invade SG epithelial cells, blocking parasite transmission.

Forty-one states in the United States that adopted Medicaid expansion through the Affordable Care Act reached historically low rates of uninsured that have endured through 2025. The One Big Beautiful Bill Act (OBBBA) signed into law on 4 July 2025 contains numerous provisions that place Medicaid expansion coverage at risk. Resulting changes to Medicaid expansion include work requirements, a decrease in federal match funds for expansion programs, cost-sharing fees for recipients, stricter eligibility requirements, more frequent re-enrollment periods, and limitations on family planning services provided by organizations that also provide abortion services. Because each state with Medicaid expansion has implemented this program differently, states will be impacted differently and with various timelines. The impact of OBBBA on Medicaid expansion in the state of New Hampshire is discussed in detail and examined from the perspective of a community mental health center. Nursing implications are discussed within the framework of Fawcett and Russell's conceptual model of nursing and health policy. Recommendations for advocacy and the nurse's role as an important stakeholder are discussed.

Personalized vaccines provide the advantage of patient-specific antigen selection to optimize immune responses, a strategy extensively explored in oncology through neoantigen-targeted peptide, mRNA, and dendritic cell platforms. Peptide vaccines provide simplicity and stability though often elicit limited cytotoxic T-cell responses. What is more, mRNA vaccines lead to rapid, multiplexed neoantigen delivery, endogenous antigen processing and eventually improved immunogenic coverage. Dendritic cell-based vaccines have the potency to prime potent T-cells although this technology requires labor-intensive manufacturing and extensive production timelines. Integration with immune checkpoint inhibitors, adoptive cell therapies, and oncolytic viruses further enhances efficacy, suggesting that rational combinations may be more effective than single modalities. Recent advances in sequencing, computational epitope prediction, and bioinformatics pipelines have facilitated neoantigen prioritization and DC vaccine design, enabling more rapid and precise personalization. Hybrid vaccination strategies, such as ex-vivo mRNA-electroporated dendritic cells and in-vivo DC-targeted platforms, bridge the gap between manufacturing feasibility and potent immune activation. Emerging technologies, including AI-driven neoepitope prediction, receptor-targeted antigen delivery, biomaterial-based modulation, and distributed mRNA manufacturing, seem to be promising approaches to accelerate personalized vaccine development in future. From another point of view, lessons learned from the COVID-19 pandemic accelerated the development, large-scale deployment, and validation of mRNA vaccine platforms for infectious diseases. Host HLA diversity, prior immune history, and viral evolution create heterogeneity in immune responses, highlighting opportunities for semi-personalized or adaptive strategies. In this review, we provide a landscape of personalized vaccines, with a focus on DC-based platforms, and explore translational lessons for viral pathogens. A conceptual framework linking cancer immunotherapy and infectious disease preparedness is proposed, emphasizing hybrid personalization approaches, rapid manufacturing, and AI-enabled epitope selection. This perspective highlights how convergence of immunology, computational biology, and advanced vaccine technologies could expand the scope of personalized vaccination, from oncology to future epidemic and pandemic scenarios as well as the current challenges.

Qualitative inquiry is central to nursing and health research, yet many established analytic approaches require substantial time and expertise. These demands can pose challenges for researchers working within constrained timelines and multidisciplinary teams. RRITA, a Rapid, Reflexive, Integrated approach to Thematic Analysis, was developed to address the persistent tension between rigour and feasibility. To introduce RRITA as a reflexive qualitative analysis method, providing a theoretically grounded and practically actionable guide to its implementation. Methodological paper outlining the conceptual foundations, analytic workflow, and applied features of RRITA, illustrated with data from a study on gratitude in palliative care. RRITA comprises seven steps organised around an alternating expand-compress cadence. In steps 1 and 2, researchers formulate a paradigm-aligned research question and define domains to populate the initial structure of the RRITA matrix, the method's central analytic instrument, maintaining a direct line of sight between raw data and analytic output while preserving subtle meanings and complexity. Researchers generate raw data in step 3 and refine them in step 4. Steps 5 and 6 shift to line-by-line inductive coding grounded in participants' accounts, iterative theme construction supported by theme warrants, and active engagement with analytic tensions and discordance. Step 7 culminates in a coherent narrative that integrates thematic articulation and interpretation, illustrative data, the reflexive pivot, and scholarly literature. Throughout the research journey, RRITA supports the systematic scrutiny of researcher subjectivity through the embedded practices of reflexive anchoring and notes. RRITA supports rigorous qualitative analysis through a structured workflow that synthesises key features of reflexive thematic analysis and rapid qualitative approaches. It introduces three integrative analytic innovations: embedded, situated reflexive practices, systematic engagement with discordant data and analytic tensions, and a versioned matrix trail documenting the analytic process from the initial reflexive anchor to final theme construction. RRITA proposes that rigour and accessibility are complementary when supported by thoughtful methodological design. It offers a theoretically grounded approach to qualitative inquiry that fosters interpretive depth while accommodating the practical constraints of nursing and health research. RRITA is particularly suited for clinical inquiry, teaching, and student supervision. Its versioned matrix trail renders analytic reasoning visible and discussable at each step, supporting the development of interpretive competence and the timely generation of high-quality evidence to inform contemporary nursing practice and policy.

Artificial intelligence has the potential to rapidly transform exercise prescription and coaching through machine learning, deep learning, and large language models. However, there is a disconnect between peer-reviewed evidence and real-world deployment in commercial platforms. This narrative review evaluated recent literature (2023-2025) assessing data-driven programming approaches for exercise prescription. Articles were identified across four themes in exercise programming: data integration on wearables and sensors, predictive modeling, chatbots and virtual coaches, and general-use large language models. Current evidence demonstrates the feasibility of artificial intelligence for activity recognition, workload estimation, and short-term performance prediction. However, significant gaps remain in evaluating closed-loop adaptive programming, downstream behavioral outcomes, and long-term effectiveness. Industry systems integrate multimodal data and continuously evolve, operating largely without formal validation. Advancement requires translational research models that bridge academic rigor with industry implementation timelines, prioritize transparency and human-in-the-loop frameworks, and evaluate artificial intelligence as a tool to augment rather than replace professional exercise prescription.

Post-treatment transitions after active cancer care often lack clear ownership, timelines and closure rules, shifting coordination work onto survivors and staff. We aimed to identify how these failures arise and to co-design a handover standard for post-treatment survivorship care. In a two-stage qualitative study, Stage A involved semi-structured interviews with survivors and professionals (n = 65) across head and neck, colorectal and gastrointestinal stromal tumour pathways; Stage B comprised four co-design workshops (n = 21). We identified a mechanism we term mirrored burden, in which routine letters and electronic records fail to make responsibility explicit and both survivors and staff end up chasing care. Co-design produced a four-component handover standard centred on accountable correspondence, a clinically senior survivorship lead practitioner with delegated authority, clinic-based resolution capacity, and equity safeguards for non-digital access and communication needs, plus four equity-stratified audit-ready feasibility indicators for service-level evaluation.

Inter-organizational networks are increasingly used to address complex health challenges, yet little is known about how "hub" organizations at the center of such networks cultivate relational processes that enable network effectiveness. Drawing on organizational network and collective leadership theories, we examined the relational processes that a structurally central hub organization used to influences a multi-sector network. We used in-depth qualitative methods to study a local health department that served as hub of a network of over 25 organizations establishing new behavioral health crisis response services. Over three years (2022-2025), we collected data through 49 interviews, 21 meeting observations, and 66 days of ethnographic field observations. We found that in its network hub role, the health department engaged in both externally and internally-directed relational processes to orchestrate collective leadership of the inter-organizational network. The hub's function as an orchestrator of collective leadership was prominent across multiple instances in which network goals or network integrity were at risk, pointing to orchestration of collective leadership as a key process through which the hub organization supported network effectiveness. In particular, the hub orchestrated leadership to manage three tensions that arose in its network: 1) sustaining external partners' engagement during service scale-up, 2) managing internal organizational change to deliver network goals, and 3) enabling frontline collaboration across professionals from different network members. Our findings suggest that the ability to orchestrate complex leadership processes is a core competency for successful network hubs, with implications for the technical assistance and timelines needed to support such initiatives.

Healthcare professional recruiting within the Army Medical Department (AMEDD) requires specialized knowledge and strategic outreach. This article describes the outcomes of Army Nurse Corps (ANC) officers in medical recruiting roles. Data from Fiscal Year 2024 (FY24) and Quarters 1 and 2 (Q1/2) of FY25 demonstrate that ANC officers may enhance healthcare professional recruiting efficiency, reduce applicant processing timelines, and improve overall mission achievement. ANC officer's clinical expertise, ability to conduct skills-based outreach events, and familiarity with medical commissioning processes contribute to stronger applicant engagement and throughput. This data although limited, may suggest that expanding the role of ANC officers in recruiting could strengthen the military healthcare workforce pipeline.

Cyclin-dependent kinase inhibitor ( cki-1 ) is associated with cell cycle arrest and cellular quiescence. In Caenorhabditis elegans , glia-to-neuron transdifferentiation of the phasmid socket 1 (PHso1) glia into the phasmid D (PHD) neuron has been previously described across larval stages. Here, we report the post-hatching timeline of PHso1-to-PHD remodeling within L4 substages, including the loss of glial socket morphology and the acquisition of neuronal features well into adulthood. We find that cki-1 expression decreases across L4 substages between 40-50 hours post-hatching in males, while cki-1 remains robustly expressed in hermaphrodite PHso1 cells. Across L3, L4, and adulthood, PHso1 cell proportions change consistently.

Patients' preoperative fears and expectations may help explain why lipoabdominoplasty is overwhelmingly performed under general anesthesia rather than sedation. The aim of this study was to evaluate concordance between preoperative expectations and early postoperative recovery and to assess whether fear of intraoperative pain may explain a preference for general anesthesia over a sedation-based regimen. Single-center, prospective cohort of consecutive outpatients undergoing lipoabdominoplasty (December 2020-June 2025). All procedures used intravenous sedation, tumescent local anesthesia, and a transversus abdominis plane (TAP) block. Demographic data were collected, surgical outcomes were assessed using the BODY-Q questionnaire, and patient-reported anxiety and anesthetic expectations before and after surgery were evaluated with the International Pain Outcomes (IPO) questionnaire. In addition, patient expectations regarding the resumption of daily activities were systematically compared with the actual timelines of their achievement. Thirty-nine patients were included (87% female; mean age 37 ± 11 years; BMI 26.0 ± 3.7 kg/m2). Preoperatively, 56% anticipated intraoperative pain, 28% nausea, and 26% loss of control under anesthesia. Postoperatively, all anesthesia-related concerns were significantly reduced from a median of 3 (4-2) to 1 (1-1) on a scale of 1 to 5. Within 72 h after abdominoplasty, patients typically resume indoor ambulation and stair climbing by Day 1, independent dressing and showering by Day 2, and a brief outdoor walk and preparing a small meal by Day 3. Intravenous sedation with tumescent anesthesia and TAP block met or exceeded preoperative expectations for intraoperative comfort. The median time to resume activities was slightly shorter than anticipated, and anesthesia-related fears-especially intraoperative pain-proved largely unfounded.

Colleges or schools of pharmacy have tried various ways to prepare students for the residency recruitment process, including didactic courses, curricular tracks, and mentorship programs. The fellowship and residency advising program (FRAP) expanded mentorship to include both faculty and a resident, along with resources and recordings to support students through the residency application process, mock interviews, and phase II match PERSPECTIVE: This commentary describes the use of dual mentorship for residency-bound student pharmacists, utilizing residents from a Teaching and Learning Certificate program and faculty members. Residents are paired with students based primarily on their geographic preferences and clinical interests. Mentors and students follow a residency timeline to keep on track with suggested activities each month. Since resident mentors were added to the FRAP for the class of 2023, match rates at our institution have met or exceeded 90%. This framework of dual mentorship and a repository of resources for student pharmacists pursuing residency may be useful for other institutions to implement.

Background Autism spectrum disorder (ASD) is a complex neurodevelopmental condition associated with impairments in sensory processing, motor coordination, and postural control. A prominent yet underappreciated contributor to these deficits is the persistence of primitive reflexes beyond the expected developmental timeline. Reflexes such as the asymmetrical tonic neck reflex (ATNR), symmetrical tonic neck reflex (STNR), and tonic labyrinthine reflex (TLR) are brainstem-mediated automatisms that, under typical neurodevelopment, integrate within the first year of life. In children with ASD, their persistence disrupts voluntary motor control, sensory modulation, postural stability, and behavioral regulation, thereby amplifying functional limitations across daily activities. Objective This study aimed to evaluate the effectiveness of a structured 12-week reflex integration exercise program on primitive reflex inhibition, motor proficiency, and sensory processing in children with ASD aged four to 10 years. Methods An experimental pre-post interventional design was employed with a sample of 27 children (mean age 6.69 &#xb1; 2.38 years; 74.1% male) diagnosed with mild to moderate ASD, recruited through convenience sampling from a single tertiary care pediatric physiotherapy setting. Participants underwent a structured 12-week reflex integration exercise program targeting the ATNR, STNR, and TLR, delivered across four sessions per week at progressive intensities through three distinct four-week phases. Outcome measures included the Bruininks-Oseretsky Test of Motor Proficiency, Second Edition (BOT-2) for motor outcomes; the Short Sensory Profile (SSP) encompassing Sensory and Behavior subscales for sensory outcomes; and the Sally Goddard Primitive Reflex Testing Protocol for reflex inhibition. Data were analyzed using paired samples t-tests, with Cohen's d computed to quantify effect size. Statistical significance was set at p < 0.05. Results Post-intervention findings demonstrated statistically significant improvements across all outcome domains. Motor proficiency improved markedly, with BOT-2 scores increasing from a pre-intervention mean of 32.41 &#xb1; 5.38 to a post-intervention mean of 40.93 &#xb1; 4.50. Sensory processing difficulties decreased substantially, with SSP Sensory subscale scores reducing from 57.07 &#xb1; 6.29 to 44.67 &#xb1; 4.37 and SSP Behavior subscale scores declining from 82.37 &#xb1; 7.98 to 63.00 &#xb1; 7.50. Significant bilateral inhibition of retained reflexes was demonstrated for the ATNR, STNR, and TLR. Conclusion A structured 12-week reflex integration exercise program produced clinically meaningful and statistically significant improvements in motor proficiency, sensory processing, behavioral regulation, and primitive reflex inhibition in children with ASD aged four to 10 years. The large effect sizes observed across all outcome domains underscore the neurophysiological relevance of targeting retained primitive reflexes as a foundational mechanism for broader sensorimotor development in this population. These preliminary findings suggest that reflex integration exercises may hold promise as a therapeutic component in pediatric physiotherapy for children with ASD; however, randomized controlled trials with larger samples are warranted before definitive clinical recommendations can be made.