Eccentric phase duration in resistance training influences internal load and recovery dynamics, yet its specific neuromechanical effects remain unclear. This review aimed to synthesize experimental evidence from single-bout eccentric-only and eccentric-phase-tempo-manipulated resistance exercise protocols to determine how controlled eccentric-phase tempo affects acute neuromuscular fatigue, indirect markers of exercise-induced muscle damage, and short-term recovery outcomes measured from immediately post-exercise to 7 days after in healthy adults with clearly described physical activity or training status, including competitive athletes, resistance-trained individuals, and recreationally active adults when otherwise eligible. Following PRISMA 2020 guidelines, PubMed, Scopus, and Web of Science were searched from inception without language or date limits. Eligible studies were experimental trials in healthy adults with clearly reported physical activity or training status performing either eccentric-only exercise or resistance exercise in which eccentric-phase duration was explicitly manipulated and measurable. Because coupled eccentric-concentric protocols may introduce concentric fatigue, contraction structure was extracted and used as an interpretive subgroup rather than assuming all studies represented eccentric-only exercise. Studies were required to report at least one prespecified single-bout acute neuromechanical, fatigue-related, muscle-damage, or recovery outcome within 0-168 h, corresponding to the immediate to 7-day post-exercise period, after the exercise bout. Primary outcomes were maximal voluntary contraction, muscle stiffness indices, reactive strength index, delayed-onset muscle soreness, biochemical markers of damage, and muscle oxygenation within 0-168 h post-exercise. Chronic adaptations to eccentric training, such as long-term hypertrophy, strength gain, or tendon remodeling, were outside the primary scope unless studies reported eligible acute or recovery outcomes attributable to a controlled eccentric-tempo manipulation. Risk of bias was evaluated using RoB 2 or ROBINS-I, and data were summarized descriptively by tempo and time frame. Seventeen studies met inclusion criteria. Explosive-to-fast eccentric conditions, corresponding to < 1 s and 1-2.9 s eccentric phases, were more often associated with greater immediate fatigue and transient performance loss, whereas moderate-to-slow eccentric conditions, corresponding to 3-5.9 s and 6-9.9 s eccentric phases, generally increased time under tension, metabolic stress, and perceived exertion. When total work or load was equalized, differences between tempos generally diminished. Overall risk of bias was moderate. Within the available bout-level evidence, eccentric tempo appears to modulate acute fatigue, mechanical performance, perceptual responses, and short-term recovery mainly through time-under-tension, total work, and protocol-context effects. osf.io/e2598 in 04-11-2025.
Maternal mortality remains a major public health concern in low-resource settings. Birth preparedness and complication readiness (BPCR) is an established strategy to improve timely care-seeking and reduce preventable maternal and neonatal complications. Utilizing Accredited Social Health Activists (ASHAs) to deliver BPCR interventions may strengthen community-level implementation; however, evidence on feasibility and acceptability is limited. To assess the feasibility and acceptability of an ASHA training strategy for community-level delivery of BPCR interventions in North Karnataka, India. A quasi-experimental pre-post interventional study was conducted among 100 ASHAs from two Primary Health Centres (PHCs) and one Community Health Centre (CHC). All eligible ASHAs who provided informed consent were included using complete enumeration sampling. Baseline BPCR-related knowledge and practice data were collected through face-to-face interviews. ASHAs then received structured BPCR training delivered through a Birth Planner-a pictorial educational pamphlet-over three interactive sessions at 3-, 6-, and 12-month intervals. Post-intervention assessment was conducted using the same questionnaire. Pre- and post-intervention scores were compared using paired t-tests, and effect sizes were estimated using Cohen's dz. Mean baseline knowledge scores for pregnancy, labour and childbirth, and postpartum danger signs were 31.55, 27.11, and 27.27, respectively, increasing to 73.45, 53.22, and 59.27 following the intervention. Self-reported practice scores for birth preparedness improved from 49.33 at baseline to 99.67 post-intervention. All improvements were statistically significant (p < 0.001) with large to very large effect sizes (Cohen's dz ≥ 1.31), indicating feasibility and high acceptance of BPCR implementation through structured ASHA training. Structured BPCR training using a simple, pictorial Birth Planner was feasible and acceptable among ASHAs in a rural district of North Karnataka, resulting in significant improvements in self-reported BPCR knowledge and practices. These findings, while limited by the pre-post design and single-district context, support ASHA-led BPCR integration within the National Health Mission. Future multi-site controlled studies are warranted to assess generalizability and long-term impact on maternal and neonatal health outcomes.
This study aimed to investigate whether the probiotic Lactobacillus rhamnosus GG (LGG) (alone or combined with high-intensity interval training (HIIT)) could improve cognitive, electrophysiological changes, oxidative stress and metabolic parameters in HFD-fed rats. Rats were randomly divided into four groups (n = 8): HFD group, HFD + LGG group, HFD+ HIIT group, and HFD + LGG+ HIIT group. Rats were fed HFD daily for a period of 16 weeks, during which LGG (1 × 1010 colony forming unit (CFU)/ rats, orally), and HIIT protocol were administered four times a week on alternating days. At the end of study, assessment of social behavior, memory function, and Long-term potential (LTP) were performed using three-chambered apparatus, Y-maze task, and electrophysiology technique, respectively. Next, oxidative stress, lipid profiles, and liver enzymes were evaluated with routine kits. Both LGG and HIIT alone or in combination improved working memory, social memory, and LTP in HFD-fed rats. In addition, both LGG and HIIT alone or in combination increased the hippocampal levels of superoxide dismutase, catalase, and increased the serum levels of high-density lipoprotein (HDL), and decreased the serum levels of leptin, triglyceride, cholesterol, low-density lipoprotein (LDL), aspartate transaminase (AST), alanine transaminase (ALT), and alkaline phosphatase (ALP) in HFD-fed rats. The combination of LGG and HIIT provides a multi-pathway intervention that improves HFD-induced memory impairments by concurrently targeting oxidative stress, dyslipidemia, and hippocampal synaptic function. This supports the potential of combined lifestyle and microbiome-based therapies for preventing metabolic and cognitive disorders.
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PARTNERS is a model of care that was co-designed with service users and carers to address the needs of people with severe mental illness to receive better support in primary care. Taking learning from a randomised controlled trial and process evaluation of this complex person-centred goal and coaching-based approach to care, our aim was to understand better the challenges of implementing PARTNERS in complex dynamic service delivery systems. We identified two Integrated Care Systems that were interested in adopting the PARTNERS model of care. We trained practitioners to adopt PARTNERS to their local settings and provided meta-supervision (supervision of supervisors). We examined the implementation period that covered site engagement, training of staff and initial delivery of the new PARTNERS model of care, undertaking a qualitative realist evaluation informed by the Consolidated Framework for Implementation Research (CFIR). Data collection involved semi-structured interviews with 10 System Change Leads, Supervisors, and trained intervention practitioners or 'Care Partners'; augmented by observations of supervision and practice within the systems and collation of documents. Analysis was qualitative informed by a realist approach and the CFIR. Analysis identified complex overlapping configurations of teams and roles within them, leadership, and individual characteristics influenced the systems' ability to implement the PARTNERS model of care. The presence or absence of leadership was instrumental in providing clarity regarding where the delivery of PARTNERS sat within newly emerging systems and was an important indicator of successful implementation. Collaborative leadership and supervision, alongside training tailored to the needs of individual practitioners, increased or decreased perceived self-efficacy amongst individual practitioners and their confidence in delivering the PARTNERS model of care. We identified that both internal and external supervision and system leadership are crucial to the implementation of PARTNERS, backed up by training delivered by a clinician and people with lived experience, to ensure that this new model of care is embedded in everyday practice. It is likely that the absence of any one of these mechanisms could make implementation and sustainability of the PARTNERS model challenging. Not applicable.
A decision coach (DC) is a trained healthcare professional who provides non-directive support to patients in health-related decision-making. The decision coach role can be integrated into shared decision-making (SDM) processes, but is not an inherent component of SDM, as both may be applied independently depending on the clinical context. Numerous trained DCs are nurses who have transitioned from their roles as patient educators to knowledgeable, skilled decision facilitators. Thus, developing core competencies has become increasingly crucial for DC training, especially patient-centered care in nursing education. This study aimed to evaluate DC competencies in SDM by examining accessibility, performance, and perceived directional relationships among competency domains. This mixed-methods study combined a narrative literature review and expert consultations to identify key DC competency criteria. Subsequently, a cross-sectional questionnaire survey was administered to healthcare professionals at two hospitals in Taiwan between April 2023 and February 2024. Accessibility-performance analysis (APA) and the decision-making trial and evaluation laboratory (DEMATEL)-based network relation map (NRM) approach were applied to evaluate competency accessibility, performance, and perceived directional relationships across domains. A total of 149 healthcare professionals, including physicians, nurses, and other clinical staff, completed the valid questionnaires. The reliability of the overall criteria was measured at 0.965. The findings suggest that the professional knowledge (PK) aspect demonstrated perceived directional associations with the outcome evaluation (OE), process management (PM), and guidance skills (GS) aspects within the network structure, whereas the GS aspect was more likely to be associated with other competency domains. Each of the four aspects has a criterion critical to improving DCs' competencies: value (PK1), listening skill (GS2), shared decision-making resources (PM3), and practical decision-making results (OE3). From healthcare professionals' perspectives, professional knowledge was the competency domain most closely associated with perceived directional relationships among other competency aspects within the network structure. The integrated APA-NRM approach delivers evidence-based prioritization and practical pathways for developing DC competencies and guiding training strategies. Not applicable.
Despite the dramatic achievements in malaria control, Bangladesh continues to face persistent transmission in high-endemic regions such as Bandarban in the Chittagong Hill Tracts. One important strategy to close surveillance and case management gaps is to involve the for-profit private sector that serves marginalized populations including high-risk occupational groups and communities facing geographical obstacles. The objectives of this study were to determine the practicality and the effects of involving the private healthcare providers in the national malaria surveillance system in Alikadam Upazila, Bandarban. A One-month pilot study was conducted in March 2023 in 10 for-profit private healthcare facilities in Alikadam Upazila, Bandarban. The providers were trained to do rapid diagnostic tests on suspected malaria patients and to refer positive cases to government or partner NGO facilities. Data on adherence to diagnostic protocols, the detection of malaria cases, the reporting, the referral and patient satisfaction were collected using standard registers, reporting forms and supervision checklists. These data were entered into an electronic database and analysed descriptively. Quality assurance was taken care of by monitoring and evaluation mechanisms, including regular supervisory visits. Rapid diagnostic tests were done on 440 patients in the pilot, and 1.8% were positive of malaria (Plasmodium falciparum and P. vivax were equally distributed). The study period has shown that the private sector has a share of 20% in all the reported cases of malaria in Alikadam. Most of the participants were males (54.6%), and 4.0 percent of the women were pregnant. The level of patient satisfaction was also good as 100 percent of the people who were surveyed claimed that they were confident in the private providers and the referral process. The accuracy of data recording rose as the providers performed better over time with a rate of 37.5 in week one but in the fifth week, it was 87.5. Although these successes have been achieved, referral gaps and lack of financial incentives to the private providers were a challenge. The research highlighted private healthcare providers' potential in malaria surveillance and case detection in remote, vulnerable populations. Integrating them into national programs could strengthen health systems and eradication efforts, but scaling requires addressing challenges like sustained training, financial incentives, and adequate service coverage.
To explore Practice Development interventions and associated contextual factors to understand their impact on patient and staff outcomes and experiences in healthcare settings. Systematic review. Preferred Reporting Items for Systematic Reviews and Meta-analysis informed design, conduct and management. A systematic approach was taken, utilising multiple reviewers and consensus methods. Mixed Methods Appraisal Tool informed quality appraisal. Qualitative findings were analysed using Reflexive Thematic Analysis. Quantitative results are presented as a narrative summary. CINAHL; MEDLINE; PubMed; Scopus; ScienceDirect; Nursing and Allied Health; Cochrane Library; Internurse.com; The Kings Fund; GOV.UK and Trip Database were searched between 1st January 1980 to 5th January 2026. Twenty-nine studies were included. Eighteen studies met all quality assessment criteria. Limited quantitative data was available, and inconsistent outcome measures constrained quantitative analysis. Qualitative analysis generated three themes: (1) Shaping Practice: the interplay of organisational context, culture, and structure, (2) Enablers and constraints in Practice Development, (3) Collective empowerment. Across diverse study designs, the majority of studies indicate that PD contributes positively to staff working environments and the contexts in which patient care is delivered. However, current findings do not demonstrate consistent improvements in clinical outcomes or quality of life. Practice Development may contribute to improvements in care environments for patients and staff, respectively. This review highlights knowledge gaps in the generalisability and transferability of Practice Development that would benefit from further exploration. Practice Development may enhance healthcare environments, but further research is needed to determine if these benefits impact upon clinical outcomes. Preferred Reporting Items for Systematic reviews and Meta-Analyses. No patient or public contribution. PROSPERO registration number: CRD42024557949.
Effective cardiopulmonary resuscitation (CPR) extends beyond technical proficiency and is influenced by team dynamics, environmental conditions, and clinicians' emotional responses. Although previous studies have examined barriers and facilitators of resuscitation, these factors have often been investigated separately, providing limited understanding of how they interact during real-time resuscitation practice in emergency departments. Exploring these interrelated domains is essential for improving team performance and patient safety in high-acuity emergency settings. This study aimed to explore emergency nurses' perspectives on how team dynamics, environmental conditions, and emotional experiences interact during resuscitation practice in emergency departments. A qualitative descriptive study was conducted with emergency nurses working in adult emergency departments across university, state, training and research, and private hospitals. Data were collected through focus group interviews using purposive criterion sampling and analyzed using inductive content analysis. Thirty-one emergency nurses participated in the study. Analysis identified three interrelated themes encompassing nine subthemes: team dynamics (leadership, staffing adequacy, role clarity), environmental safety (equipment availability, overcrowding, patient transfer, violence risk), and emotional regulation (traumatic exposure and crisis management). These themes illustrate how these domains interact to influence resuscitation practice in high-acuity settings. Resuscitation effectiveness reflects the interaction of team coordination, environmental safety, and emotional regulation within emergency settings. Findings highlight the need for team-based training, environmental organization, and emotional support strategies to strengthen resuscitation practice in emergency departments.
To identify independent risk and protective factors for acupuncture response in community-dwelling patients with chronic low back pain, and to develop and validate a clinical prediction model incorporating traditional Chinese medicine (TCM) diagnostic components, thereby providing a tool for individualized clinical decision-making and risk stratification in community acupuncture practice. A total of 500 patients with chronic non-specific low back pain who received acupuncture treatment at the Ningbo Jiangbei Zhuangqiao Community Health Service Center between January 2023 and November 2025 were retrospectively enrolled. Patients were randomly split into a training cohort (n = 350) for model development and a test cohort (n = 150) for internal validation using a 7:3 ratio. Predictors were selected via LASSO regression, and a multivariable logistic regression model was constructed and presented as a clinical nomogram. SHapley Additive exPlanations (SHAP) analysis was employed to quantify the global importance of features and their directional association with the outcome. Model performance was comprehensively evaluated by assessing discrimination (receiver operating characteristic curve), calibration (calibration curve), clinical utility (decision curve analysis), and generalizability (performance in the internal/external validation sets). Multivariable analysis identified longer disease duration (OR = 1.170), radiating leg pain (OR = 1.998), and the Qi-Stagnation-Blood-Stasis syndrome pattern (OR = 3.701) as independent risk factors for poor acupuncture response (all p < 0.05), while acupoint Weizhong (BL40) selection (OR = 0.267) and combined therapy (OR = 0.214) were independent protective factors. SHAP analysis confirmed disease duration and the Qi-Stagnation-Blood-Stasis pattern as the top contributors to the prediction. The developed nomogram demonstrated excellent discrimination in the training (AUC = 0.819), test (AUC = 0.828), and external validation (AUC = 0.788) cohorts. The model showed good calibration (Hosmer-Lemeshow test p > 0.05) and provided a clear clinical net benefit across a wide threshold probability range (25%-90%). This study identifies a TCM syndrome pattern (Qi-Stagnation-Blood-Stasis) and acupoint selection as independent predictors for acupuncture response in community-based low back pain management. The developed nomogram, integrating TCM and clinical features, demonstrates good predictive performance and clinical utility upon internal and preliminary external validation. Its broader implementation requires further confirmation through larger, multicenter prospective studies and could be enhanced by the future integration of objective biomarkers.
Mentorship is considered essential in residency training, yet its structure and quality in Japan remain unclear. We conducted a nationwide, multi-center descriptive study of postgraduate year (PGY) 1-2 residents who completed both the General Medicine In-Training Examination (GM-ITE) and a formal mentorship survey in 2024. Residents who declined participation, provided no response to the survey, had incomplete survey responses, or did not have a formal mentor were excluded. Of 9,179 residents who took the GM-ITE, 3,877 from 570 hospitals were analyzed. Most reported having one mentor (71.6%), and mentors were predominantly male (72.9%). Only 61.0% of programs offered lectures on mentorship. Overall, 46.1% of residents did not perceive feedback as specific or actionable, whereas 69.3% reported trusting their mentors. Mentoring interactions were relatively limited, with 60.4% of residents reporting meeting less than once a month. Among residents with formally assigned mentors, important gaps remained in mentor diversity, feedback quality, and mentoring engagement. Efforts to strengthen mentor training, improve feedback practices, and promote more structured mentoring interactions may help optimize residents' educational and professional development.
Physical therapists are considered movement experts, yet many physical therapists lack the knowledge, training, and confidence to incorporate bioenergetic considerations when prescribing aerobic exercise and resistance training interventions. Additionally, clinical practice guidelines omit bioenergetic considerations reflecting a fundamental gap in how the profession conceptualizes rehabilitation, one that individual clinicians cannot be expected to bridge when clinical practice guidelines themselves exclude the bioenergetic dimensions of health conditions. As this perspective outlines, bioenergetics are essential for propelling human movement and should inform physical therapist interventions. A bioenergetically informed approach to physical therapist interventions empowers physical therapists to design interventions that integrate physiologic systems critical to bioenergetic capacities more fully, optimizing both the mechanical components and fuel systems that power movement. This perspective uses recovery as a model framework to emphasize the benefits of a bioenergetically informed approach, and importantly, it serves as a component of rehabilitation that can be immediately acted on by clinicians, recognizing that optimal therapeutic outcomes require adequate bioenergetic capacity to support the intended applications. While physical therapists have traditionally excelled as biomechanical practitioners who address the structural and mechanical aspects of human movement, the integration of comprehensive bioenergetic principles represents a transformative opportunity to elevate clinical practice by understanding not only the machinery, but also the metabolic systems that fuel optimal performance.
Hormones regulate many essential biological processes by interacting with specific receptors that control gene expression, metabolism, growth, and immune function. Because numerous therapeutic compounds can influence or disrupt hormone signaling pathways, understanding drug-hormone receptor interactions (DHRI) is crucial for ensuring both therapeutic efficacy and endocrine safety. However, computational approaches for predicting DHRI remain limited, and most existing models do not explicitly incorporate hormone receptor-specific information. In this study, we propose a receptor-aware deep learning framework for DHRI prediction that integrates structural drug features with contextually embedded hormone receptor information. Drug molecules are represented using a hybrid encoding strategy that combines Morgan fingerprints and graph transformer-based molecular features to capture both global chemical properties and local structural information, while hormone receptor sequences are encoded using the pretrained ESM2 protein language model to obtain biologically meaningful sequence representations. The fused drug-hormone receptor features are then processed through a multilayer neural network to predict interaction probabilities. Model performance was evaluated using three splitting strategies, including random split, cold-drug split, and scaffold-based split, to assess both predictive accuracy and generalization ability. Under the random split setting, the model achieved an accuracy of 0.93, sensitivity of 0.94, specificity and precision of 0.92, F1-score of 0.93, and MCC of 0.86 on an independent data set, while also maintaining comparable performance under the more stringent cold-drug and scaffold-based settings. Feature importance analysis showed that atomic identity, hybridization, atom degree, and bond type were key shared determinants, while receptor-stratified results revealed receptor-dependent contributions from secondary features such as aromaticity, chirality, etc. In addition, t-SNE visualization showed clear class separation after training, and molecular docking across estrogen, androgen, and glucocorticoid receptors further supported the biological relevance of the predictions. Together, these findings demonstrate that incorporating hormone receptor-specific sequence information enables more reliable and biologically meaningful prediction of drug-hormone receptor interactions.
This article considers the main approaches to assessing the sustainability of the health care system in the development of emergencies of different nature. Based on the analysis and synthesis of data from foreign publications, the most significant factors affecting the efficiency of functioning of national health care systems, as well as the characteristics of their resilience to crisis phenomena are systematised. Experts consider flexible resource management, training of qualified and motivated medical personnel, the possibility of redistribution of powers within the system, both horizontally and vertically, as well as intersectoral cooperation in overcoming crisis situations as the most obvious solutions to improve the viability of the health care system. В статье рассмотрены основные подходы к оценке устойчивости системы здравоохранения в условиях развития чрезвычайных ситуаций различной природы. На основании анализа и обобщения данных зарубежных публикаций систематизированы наиболее значимые факторы, влияющие на эффективность функционирования национальных систем здравоохранения, а также характеристики их устойчивости к кризисным явлениям. Наиболее очевидными решениями по повышению жизнеспособности системы здравоохранения эксперты считают гибкое управление ресурсами, подготовку квалифицированных и мотивированных медицинских кадров, возможность перераспределения полномочий внутри системы как по горизонтали, так и по вертикали, а также межсекторальное взаимодействие в преодолении кризисных ситуаций.
Postgraduate medical education increasingly requires learners to develop clinical reasoning, manage uncertainty, integrate heterogeneous clinical information and collaborate across disciplines. Multidisciplinary team (MDT) teaching may provide a clinically situated learning environment in which trainees can observe and participate in complex decision-making. However, evidence on the use of remote MDT teaching in urology postgraduate education remains limited. This randomized controlled study included 76 professional master's students rotating through a surgical standardized residency training base. Students were assigned to a remote MDT teaching group or a conventional teaching group, with 38 students in each group. The remote MDT intervention was delivered as a structured teaching package that included pre-session case preparation, remote multidisciplinary case discussion, expert-guided case analysis, post-session reflection and iterative feedback. Outcomes included theoretical knowledge, clinical decision-making, practical skills, questionnaire-based evaluation of the teaching model and overall competency. Students in the remote MDT group achieved higher scores than those in the conventional teaching group in theoretical knowledge, clinical decision-making, questionnaire-based evaluation and overall competency. No significant between-group difference was observed in practical skills. The pattern of findings suggested that the remote MDT model had a stronger effect on outcomes requiring information integration, clinical reasoning and collaborative decision-making than on procedural performance. Remote MDT teaching may be a useful component of urology postgraduate education, particularly for learning outcomes related to clinical reasoning and knowledge integration. Its value appears to derive not only from remote delivery, but also from the structured organization of preparation, multidisciplinary discussion, reflection and feedback. Procedural skill development remains dependent on supervised hands-on practice. Future multicentre studies are needed to confirm these findings and to examine which components of the intervention contribute most to learning. Not applicable.
Prior biological knowledge and phenotype information can help identify disease genes from whole genome/exome sequencing studies, but how best to incorporate external knowledge with variant data remains challenging. We developed a machine learning algorithm called RankVar to prioritize causative variants for rare diseases, based on clinical notes and genome/exome sequencing profiles. RankVar uses a random forest classifier trained on ~ 1 million variants from the 1000 Genomes Project with spiked-in pathogenic variants. For testing, we compiled sequencing data and phenotype information from several independent datasets: 260 subjects from the Children's Hospital of Philadelphia (CHOP) with positive genetic diagnosis of various Mendelian diseases, 135 subjects from Birth Defects Biorepository (BDB), as well as 356 and 97 subjects with candidate causal variants for autism spectrum disorders from the Simons Simplex Collection (SSC) and the Simons Foundation Powering Autism Research for Knowledge (SPARK), respectively. RankVar achieves a top 10 variant accuracy of 90.0%, 81.5%, 46.1%, and 76.3% for CHOP, BDB, SSC, and SPARK, respectively, with improved performance over existing approaches. Notably, RankVar successfully identified X-linked and Y-linked disease-causal variants, such as KDM6A (p.N915Kfs5*) and SRY (p.W98X), as the top candidate variants. Moreover, we evaluated RankVar for genomic reinterpretation of 130 unsolved CHOP cases with hearing loss and successfully identified 61 candidate causal variants after manual review. In summary, RankVar performed favorably relative to existing methods in our evaluation, accommodated different genetic models and X/Y chromosome variants, and may provide a useful framework for prioritizing variants in monogenic or oligogenic diseases. We anticipate that RankVar may aid in primary genetic diagnosis, genome reinterpretation of previously unsolved cases, and the discovery of novel disease genes.
In recent years, increasing aesthetic expectations have led to a growing demand for porcelain laminate veneer treatments. This study aims to address a gap in the literature by evaluating the knowledge, attitudes, and practices of undergraduate dental students regarding porcelain laminate veneers, within the context of updated dental curricula, thereby providing insight into their current level of theoretical understanding and clinical preparedness. This study employed a descriptive cross-sectional design. The sample consisted of final-year students from the Faculty of Dentistry at Atatürk University. A total of 150 students were invited to participate; those who agreed and completed the questionnaire in full were administered a KAP-based survey adapted for porcelain laminate veneer applications. A total of 134 dental interns participated in the study, of whom 61.9% were female and 38.1% were male. Based on objective assessments, the level of theoretical knowledge was found to be high, with correct response rates ranging between 85% and 94% for many items; however, lower success rates were observed in technically demanding aspects, such as cement thickness effects on shade selection (28.4%) and preparation classifications (45.5%). Subjective evaluations revealed limited clinical experience and self-confidence; notably, only 32.1% of participants had encountered a laminate veneer case in clinical practice. While no significant difference was found in theoretical knowledge levels by gender (p = 0.083), male participants demonstrated significantly higher self-perceived clinical confidence scores compared to females (p = 0.024). A weak negative correlation was observed between objective knowledge scores and self-perceived clinical confidence scores (r = -0.201, p = 0.020). Despite a high level of theoretical knowledge among dental interns, this theoretical knowledge was not reflected in students' self-perceived clinical preparedness and confidence. Furthermore, a weak negative correlation was identified between objective knowledge and self-perceived clinical confidence scores, suggesting these constructs are related but distinct. These findings highlight the need to strengthen simulation-based training, clinical case exposure, and complication management within undergraduate prosthodontic education.
Patients who survive critical illness and intensive care unit (ICU) admission often experience long-lasting physical, psychological, and cognitive impairments. Cognitive impairments are common and may persist well beyond ICU discharge. Few structured interventions address these impairments across the care continuum, from the ICU to post-discharge recovery. This gap informed the development of a stakeholder-driven cognitive rehabilitation intervention. The aim was to develop a cognitive rehabilitation intervention for critically ill patients that bridges the period from ICU admission to post-discharge recovery. The intervention was developed using a multiphase process guided by the 2021 Medical Research Council (MRC) framework for complex interventions and reported in line with the GUIDED and TIDieR checklists. Stakeholder input was gathered through: (1) a workshop (n = 11) to identify end-user needs; (2) a three-round Delphi process (n = 39) to prioritise interventions using a seven-point Likert scale; and (3) expert consultations to refine selected components. Qualitative data from the workshop and open-ended Delphi responses were analysed thematically, while quantitative analysis identified consensus, defined a priori as ≥80% agreement on importance. The process generated a range of proposed interventions, including both novel and established elements. Interventions reaching stakeholder consensus were further reviewed by experts for clinical relevance and feasibility. Two prototype interventions were selected: (1) a Mindfulness-based intervention and (2) a Brain Training intervention. This study outlines a stakeholder-informed process for developing a cognitive rehabilitation intervention tailored to ICU patients across the care continuum. The co-design approach improved contextual fit and clinical applicability. These findings support the planned feasibility evaluation of the proposed interventions. The overall research study received ethics approval, while formal ethics committee approval was not required for the workshop and Delphi activities under Danish legislation (osf.io/5a4xq).
Monitoring wildlife in remote areas is a key challenge in conservation, with traditional methods proving increasingly inadequate in the face of accelerating biodiversity loss. Uncrewed Aerial Vehicles (UAVs) or drones help bridge data gaps, but methods require careful development and validation to ensure protocols are appropriate, accessible, reproducible, and generate reliable data. Herein, we develop detailed UAV-based protocols for surveying the endangered marine iguana (Amblyrhynchus cristatus), a lizard that is endemic to the coastlines of the Galápagos Islands, Ecuador. We outline steps from image collection and processing, through locating and counting animals, before validating results against traditional methods. We find that UAV-based surveys outperform traditional ground-based surveys in terms of count reliability and effort in the field in different types of terrain and various population densities. Moreover, we show that consumer-level drones can be used effectively - even by newly trained pilots - and describe a standardised manual flying protocol that mimics automated flying whilst maintaining flexibility in the field. Finally, we recommend the use of orthomosaics (geometrically corrected, high-resolution aerial image maps) for surveys on flat terrains and 3D models (digital representations of the surface in three dimensions) for cliffs and compare several common image-processing platforms in terms of success to reconstruct marine iguanas. Our protocols advance the effective monitoring of Galápagos marine iguanas. Whilst they were specifically developed for this species, we postulate that these could be applicable for other species across the archipelago, or in coastal and open landscapes worldwide.
The transition from undergraduate education to medical school demands increasing learner autonomy and self-regulation. Guided by Zimmerman's Self-Regulated Learning (SRL) theory and Grow's Staged Self-Directed Learning Model, this study examined how self-directed learning readiness (SDL-R), encompassing learning motivation, planning and implementation, self-monitoring, and interpersonal communication varies across the preclinical curriculum and how these domains relate to academic performance. A mixed longitudinal and repeated cross-sectional study (2022-2024) was conducted among preclinical medical students (N = 807 responses; 434 unique students from three cohorts, Classes of 2025-2027) at an LCME-accredited US medical school. All enrolled first- and second-year students were eligible; recruitment was voluntary via web-based REDCap surveys administered once per semester. Linear mixed-effects models evaluated within-student change in total SDL-R and its four domains across semesters. Ordinary least-squares regression with cluster-robust standard errors assessed the contribution of standardized subscale scores to cumulative grade point averages. Bonferroni correction was applied within each family of comparisons, with effect sizes and 95% confidence intervals reported. SDL-R scores varied across preclinical semesters in a pattern consistent with developmental progression, with a modest decline in first-year Spring followed by recovery through year two. Planning and implementation was the strongest positive predictor of GPA in Year 1 (β = 0.142, p = .004) and in the combined model (β = 0.154, p < .001). The SDL-R domains collectively explained 22.2% of GPA variance in Year 1 (R² = 0.222) and 9.0% in Year 2 (R² = 0.090); the combined model explained 15.0% (R² = 0.150). Interpersonal communication showed a significant negative partial association with GPA, consistent with a statistical suppressor effect. Second-year students, older learners, males, and higher-achieving students showed higher SDL-R levels. SDL-R is a dynamic, context-sensitive competency during preclinical training, with planning and implementation as its strongest academic predictor. Targeted curricular interventions that scaffold metacognitive planning, self-monitoring, and adaptive strategy use may enhance both academic performance and lifelong learning capacity.