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Longitudinal studies linking sedentary behavior (SB) in different contexts to brain structure and white matter hyperintensity (WMH) volume remain limited. We analyzed data from the Atherosclerosis Risk in Communities (ARIC) study (n = 1,712). Self-reported SB was assessed at visit 1 (1987-1989), with neuroimaging (3T magnetic resonance imaging [MRI]) at visit 5 (2011-2013). Participants were non-demented adults (57% women; 53[5.2] years) who reported frequency of TV watching and occupational sitting. Outcomes included cortical, subcortical, and Alzheimer's disease-signature regions (ADSR), and total WMH brain volumes. Frequent TV watching was associated with increased WMH volume and reduced frontal, occipital, and ADSR volumes. Sitting during work, which is more cognitively active, was linked to lower WMH and larger frontal (males only), occipital, and parietal volumes. Results remained consistent when adjusted for physical activity. SB is associated with structural brain and WMH volumes. Cognitively active SB may preserve brain structure and cerebrovascular health.

Despite advancements in the treatment of stroke and dementia, these conditions still contribute significantly to global health and economic burdens, highlighting the need for prevention. Although these diseases are linked to modifiable lifestyle factors such as diet, physical activity, and smoking, previous studies have lacked a systematic and comprehensive framework to fully elucidate these associations. To bridge this gap, this study comprehensively evaluates the causal links between lifestyle factors in "Life's Essential 8" (LE8) and the risks of stroke and dementia, providing evidence for prevention strategies. This study used a two-sample Mendelian randomization approach with genetic variants as instrumental variables to assess the causal effects of lifestyle factors on stroke and dementia risks. Data were sourced from large-scale GWAS and the UK Biobank, including clinical endpoints for stroke and dementia subtypes. The leading analysis utilized the inverse-variance weighted (IVW) method, supplemented by weighted mode, MR-Egger, weighted median and simple mode approaches. Sensitivity analyses included MR-Egger intercept, Cochran's Q test, leave-one-out analysis and MR-PRESSO. Increased grain intake (OR = 0.469; 95% CI: 0.264-0.835; P = 0.010), higher HDL-C levels, and physical activity (OR = 0.927; 95% CI: 0.860-0.999; P = 0.048) reduced stroke risk. Conversely, smoking showed the strongest association with increased stroke risk (OR = 17.375; 95% CI: 1.041-289.999; P = 0.047), followed by genetically predicted high blood pressure for small-vessel stroke (OR = 7.520), prolonged sedentary behavior or TV watching (OR = 1.576), and higher salt intake (OR = 1.229; 95% CI: 1.037-2.291; P = 0.033). Genetically normal blood pressure status was associated with a lower risk of small-vessel stroke (OR = 0.132). For dementia, high salt intake and total cholesterol were associated with increased risk, whereas diastolic blood pressure showed a statistically significant inverse association with dementia risk (OR = 0.765; 95% CI: 0.617-0.949; P = 0.015). This study emphasizes the role of lifestyle interventions, particularly dietary sodium reduction, smoking cessation, blood pressure management, and appropriate physical activity, in mitigating the risks of stroke and dementia. The findings provide strong evidence for prioritizing modifiable behaviors in public health strategies to alleviate the increasing global burden of these conditions.

Inter-brain synchrony (IBS) is increasingly used as a neural marker of social coordination. Yet standard hyperscanning pipelines rarely distinguish partner-specific coupling from parallel task engagement, and scarcely account for aperiodic (1/f) contributions to phase-based metrics. Here, in 10 dyads (n&#x202f;=&#x202f;20) of close friends from Latin America recorded with dual mobile EEG during cooperative Jenga puzzle-solving, video co-watching, and eyes-closed resting, we combined cluster-permutation statistics, dyad-shuffled surrogate controls, spectral parameterization, and edge-level mixed-effects modeling to dissociate task-enhanced from partner-specific inter-brain synchrony, and oscillatory from aperiodic contributions. Puzzle-solving elicited robust theta band IBS enhancement (p < 0.002), yet surrogate analyses revealed negligible partner-specific theta effects. Alpha IBS showed the opposite pattern, with no interactive condition modulation but exceeding surrogates during cooperation in a right centroparietal cluster (p&#x202f;=&#x202f;0.024, d&#x202f;=&#x202f;0.65) revealing partner-specific coupling. Critically, detectable oscillatory theta peaks were rare (<6%); alpha peaks sparse during cooperation (10%) but ubiquitous at rest (98%). Exploratory edge-level mixed-effects modeling identified aperiodic (and not oscillatory) predictors of IBS: theta tracked dyad-averaged slope (&#x3b2;&#x202f;=&#x202f;+0.053, p&#x202f;=&#x202f;0.003), alpha tracked slope similarity between partners (&#x3b2;&#x202f;=&#x202f;-0.039, p&#x202f;=&#x202f;0.005). These results dissociate two IBS signatures: task-enhanced theta associated with shared aperiodic features, and partner-specific alpha consistent with aperiodic alignment rather than oscillatory coordination. Our findings underscore the necessity of incorporating spectral parameterization and surrogate controls in EEG hyperscanning.

Differences in social perception, a hallmark of autism spectrum disorder (ASD), are also evident at subclinical levels in the general population. However, it remains unclear how such variation in autistic traits relate to neural processing of different types of social information. Here, we investigated whether autistic traits in neurotypical individuals are associated with neural responses to a broad array of social perceptual features during watching naturalistic stimuli using functional magnetic resonance imaging (fMRI). We also tested the generalizability of these effects across two experiments. Ninety-seven participants completed the Autism Spectrum Quotient (AQ) and watched a set of 96 movie clips and a full movie during an fMRI scan. Intensity of 126 social features in the movie stimuli was continuously annotated by independent observers, and 44 most reliably rated features were used to model neural responses. We examined how consistently the responses to each social feature were dependent on the participants' AQ scores. Replicable AQ-dependent neural responses to social features were found in both datasets. The temporal cortex and especially the superior temporal gyrus (STG), served as a central "hub" where autistic traits were consistently associated with neural responses to social features across datasets. Different AQ subscales also revealed distinct association patterns in other brain regions. These findings indicate how autism-related traits broadly relate to neural processing of naturalistic social signals, providing neurobiological evidence for the heterogeneous nature of autism-related traits.

This study examined leisure activity engagement among (near-)centenarians and its association with two aspects of well-being: life satisfaction and purpose in life. We analyzed specific activity types and their combinations, as well as three activity parameters: the total number of activities, the variety of different higher-order activity types, and the distribution of activities across these types (i.e., activity diversity). We pooled data from two comparable studies conducted in the U.S. and Germany, yielding a final sample of N = 134 participants aged 96 to 107. Activity engagement was assessed using open-ended questions, with responses coded into 12 activity types further used to compute the activity parameters. Common activities included watching TV, social activities, and experiential activities (e.g., reading). General activity parameters-number, variety, and diversity of activities-were not related to well-being. Life satisfaction correlated positively with physical and experiential activities and negatively with developmental activities (e.g., visiting a museum). Purpose in life was positively linked to experiential activities. Specific engagement patterns of these activity types, rather than overall activity levels, best predicted well-being outcomes. Our results contrast prior findings from younger-old samples, suggesting that the relevance of activity types for well-being may shift in very late life. This supports theories emphasizing emotionally meaningful and less demanding activities as more beneficial with increasing age. Findings underline the need for interventions that enable personally relevant forms of engagement to support life satisfaction and purpose in the oldest old.

High levels of sedentary behaviour are an emerging global public health concern, but its impact on cancer risk remains unclear. Within the Global Cancer Update Programme (CUP Global), we systematically searched the literature in PubMed and Embase until September 2024 for observational cohort studies on sedentary behaviour and adult cancer risk. Using dose-response meta-analyses, we investigated sedentary behaviour domains (total, occupational, recreational, transportation, and/or other) and dimensions (duration, frequency), and additionally pooled across domains. The quality of evidence was graded by the CUP Global Expert Panel (protocol registration: https://osf.io/7utbm/ ). We identified 62 publications from 27 cohorts comprising 162,902 incident cancer cases across 19 anatomical sites. There was evidence for a probable causal positive association between sedentary time (mixed definitions) and breast (RR per 2 hours/day =1.03; 95%CI=1.02-1.05; I 2 =10%; n=11 studies) and colon (RR=1.05; 95%CI=1.03-1.07; I 2 =0%; n=9) cancer risk, and between television watching time and colon cancer risk (RR per 2 hours/day =1.08; 95%CI=1.05-1.11; I 2 =0%; n=6). Limited suggestive evidence supported positive associations between sedentary time (mixed definitions) and lung (RR=1.04; 95%CI=1.00-1.09; I 2 =69%; n=7), ovarian (RR=1.06; 95%CI=1.01-1.10; I 2 =0%; n=7), premenopausal (RR=1.03; 95%CI=0.99-1.08; I 2 =20%; n=7) and postmenopausal breast (RR=1.02; 95%CI=1.00-1.04; I 2 =7%; n=11), and colorectal (RR=1.02; 95%CI=1.00-1.04; I 2 =47%; n=11) cancers, and between occupational sitting time and breast (RR per 2 hours/day =1.05; 95%CI=1.01-1.09; I 2 =0%; n=4) and colon (RR=1.08; 95%CI=1.02-1.15; I 2 =28%; n=2) cancers. An interactive evidence platform is available at: https://teacup.cc.ic.ac.uk/sedentary-behaviour-cancer.html . Evidence supports that prolonged sedentary behaviour is probably a cause of breast and colon cancers, while limited suggestive evidence supports positive associations for several other exposure-cancer pairs, including lung and ovarian cancers. This evidence should lead to revised cancer prevention recommendations. Future research should focus on device-based exposure assessments, repeated measurements, exposure substitution models, inclusion of diverse populations and investigation of biological mechanisms. World Cancer Research Fund network of charities (American Institute for Cancer Research; World Cancer Research Fund; Wereld Kanker Onderzoek Fonds).

Lower socioeconomic position (SEP) groups have higher risks of cardiovascular diseases (CVD), with diet quality being a crucial risk factor. However, whether the association between diet quality and incident CVD differs across SEP (education and income) groups is unclear, which was examined in this study. This study included participants aged 30-80&#x202f;years, free of CVD at baseline, from the Dutch Lifelines cohort. The Lifelines Diet Score, a diet quality indicator based on Dutch dietary guidelines, was calculated with data assessed by a 110-item food frequency questionnaire. Cox proportional hazards models were used to assess the association between diet quality and incident CVD (the first non-fatal major cardiovascular event), and whether this association was modified by SEP, adjusted for age, sex, energy intake, alcohol intake, smoking, TV watching time, moderate-to-vigorous physical activity, sleep duration, social/hobby clubs participation, chronic stress, family history of CVD, and BMI. Of 82,360 participants included, 2827 incident CVD cases were identified (median follow-up 7.4&#x202f;years, incidence rate 4.7 per 1000 person-years). Education modified the association between diet quality and incident CVD (P-interaction&#x202f;=&#x202f;0.033). Comparing the poorest to the best diet quality quartiles, hazard ratios (95%CI) were 1.27 (1.06, 1.51) in low, 1.28 (1.06, 1.54) in middle, and 0.98 (0.76, 1.27) in high education group. For low- and middle-education groups, poor diet quality was associated with disproportionately higher risks of incident CVD. Improving diet quality may therefore have the potential to be a core entry point for lowering CVD health inequalities. To address persistent health inequalities, health policies should tackle broader environmental, social, and structural factors of diet and health equity.

BackgroundWorkplace violence (WV) is unfortunately common in healthcare environments and leads to difficult ethical choices for nurses who must decide how to provide for patients' care needs while also navigating a risk of being harmed. When safety takes priority over care, nursing values such as non-abandonment and duty to care cannot be fulfilled, and moral distress results.Research questionThis study examined how moral distress is experienced when nurses encounter WV, to better understand the implications of these ethically fraught situations.Design, Participants & ContextWe conducted a secondary qualitative analysis using conventional inductive content analysis of interview transcripts related to nurses' experiences of WV from 36 nurses working in a range of settings across Canada.Ethical considerationsThe study was approved by the University of Manitoba Fort Garry Campus Research Ethics Board (HE2023-0102).FindingsViolence from patients is a significant moral event, creating moral distress for nurses. We identified three themes: Moral Compromise: angst related to the inability to meet patient needs, the impact of causing trauma to the patient, and being part of dignity-compromising care; Disengagement: decreased tolerance, restrictive boundaries, and leaving the situation; and Structural Influences: watching colleagues suffer, lack of options for violence prevention, and the impact of supervisor support.ConclusionThis study provides critical insights into the ways that nurses experience WV-related moral distress, including the contextuality of the duty to care, opportunities to reframe the concept of abandonment to allow for withdrawal when needed to mitigate risk and moral distress, and the key role of institutions in the production of moral distress. The impact of moral distress experienced by nurses when facing WV and the profound ethical and professional consequences of violent interactions for nurses are a clear call for measures to address both the antecedent behaviors and the resulting distress.

Human relationships form a complex web of affiliative and antagonistic ties. Yet how the brain represents their affective structures remains unclear. Here, using a television drama depicting intertwined friendships and rivalries, we examined how the brain encodes the valence of interpersonal relationships. Participants underwent fMRI scanning before and after watching the drama while viewing the faces of its central characters. They then rated each character pair for relationship strength and valence, and whole-brain representational similarity analysis (RSA) identified brain regions representing these relational structures. Relationship valence effects were most prominent for antagonistic (negative) relationships in the left anterior supramarginal gyrus and right medial prefrontal cortex. Univariate analyses revealed increased activation in the precuneus after drama viewing, suggesting enhanced retrieval of narrative-related person knowledge, though this region did not show statistically significant representational similarity patterns reflecting interpersonal relationships. These findings indicate that the human brain constructs a multidimensional social map from narrative experience, with antagonistic ties playing important role in shaping social relationship representations.

The primate visual system is a hierarchical network of brain areas that transform retinal inputs into rich percepts. According to efficient neural coding principles, basic visual features such as orientation, which are already represented in early visual areas, should not be redundantly encoded in higher areas like V4 and inferotemporal (IT) cortex. We tested this hypothesis by quantifying orientation representation throughout the entire visual stream using functional Magnetic Resonance Imaging (fMRI) and multivoxel pattern analysis (MVPA) in macaque monkeys watching full-field gratings. Contrary to predictions from efficient coding, we found robust orientation information along the entire visual ventral stream from V1 to IT cortex. Orientation information was distributed in cortical and representational space, especially in IT. Voxels with multivariate responsiveness to faces, objects, and bodies carried more orientation information than highly category-selective voxels. They also displayed stronger connectivity within IT and with upstream areas V1-V4. These finding suggests the existence of functional "hubs" that integrate low- and high-level features through enhanced connectivity. This phenomenon generalized to deep convolutional neural network models with high brain similarity, underscoring the importance of hub-like units in hierarchical processing of complex inputs. Together, our results show that orientation re-emerges in IT cortex not through redundancy but as a computational byproduct of functional diversity and connectivity, propounding the existence of "hub" neurons that may support flexible, integrative visual processing beyond object recognition.

There is a body of literature regarding the high levels of psychological distress routinely experienced by medical students. There is less known about their mental health during times of war and political conflict. This study examined the impact of the 2023 October 7th war on Israeli medical students' mental health, well-being, lifestyle behaviors, academic function and coping strategies. A cross-sectional survey with retrospective pre-war self-report of health and academic capability was administered to Bar-Ilan University (BIU) medical students between June and September 2024. Data were collected via an online questionnaire assessing mental health (Depression, Anxiety, and Stress, DASS-21), Kimhi Well-being Scale, Connor-Davidson Resilience Scale, lifestyle behaviors, and coping strategies. Descriptive statistics were conducted; Wilcoxon signed-ranks test was used for pre-post comparisons. Spearman's rank correlation was used to assess associations between war-related exposure variables and health outcomes. 118 medical students completed the survey. Comparison of health status showed that 96 (81.4%) recalled excellent/very good health pre-war compared to only 45 (38.2%) currently. Mental health distress was substantial: 38 (33.9%) met criteria (above the normal range) for depression, 36 (32.1%) for anxiety and 24 (21.4%) for stress. Sleep quality had declined in 88 (75%) of students, physical activity in 58 (50%) and healthy eating in 71 (61%). Well-being scores fell below adequacy threshold for 69 (59%) of students. In sub-group analysis, male students showed significantly higher resilience scores (p&#x202f;=&#x202f;0.037) than females (Male: M&#x202f;=&#x202f;39.38, SD&#x202f;=&#x202f;6.90; Female: M&#x202f;=&#x202f;36.09, SD&#x202f;=&#x202f;7.65). Reserve service was significantly associated with poorer mental health status (Spearman's rank correlation coefficient, r&#x202f;=&#x202f;-0.2248, p&#x202f;=&#x202f;0.01). 94 (80%) reported a reduction in ability to study and 72 (61%) poorer academic progress. Primary coping strategies included watching television 67 (58%), spending time with family 65 (57%), and physical activity 54 (47%). The October 7 war was associated with substantial deterioration in self-reported mental well-being among Israeli medical students. The findings support the need for targeted mental health and resilience-support strategies within medical schools, ideally introduced early. Future research is needed to examine long-term effects and evaluate any interventions.

Circumduction gait is a common compensatory movement pattern used by stroke patients, which significantly affects mobility and quality of life. Action observation therapy (AOT), an emerging rehabilitation approach based on the mirror neuron system, has shown promise in motor recovery. This study explores the impact of AOT on circumduction gait in poststroke individuals. This study aims to evaluate the effectiveness of AOT in reducing circumduction gait and improving overall gait kinematics in stroke survivors. A pre-post experimental study was conducted involving 30 stroke patients exhibiting circumduction gait. Participants were divided into an intervention group (n = 15) receiving AOT alongside conventional physiotherapy and a control group(n = 15) undergoing physiotherapy alone. The AOT group watched videos of normal gait patterns and actively attempted to imitate them. Gait parameters, including hip circumduction angle, stride length, and step width, were assessed pre- and postintervention using the footprint method and motion analysis (by Kinovea software; developed by Joan Charmant and Contributors, Kinovea Open Source Project, Bordeaux, France). Patients in the AOT group demonstrated significant improvements in gait symmetry, reduced circumduction angle, increased stride length, and reduced step width compared to the control group (p < 0.05). The findings suggest that AOT facilitates motor relearning and reduces compensatory gait deviations. AOT is an effective adjunct to conventional stroke rehabilitation, aiding in correcting circumduction gait. Its implementation may enhance functional recovery and mobility in stroke patients, ultimately improving independence and quality of life. Further studies with larger sample sizes are recommended to validate these findings.

Children and families from priority populations (e.g. culturally and linguistically diverse and regional/rural communities) often experience significant psychosocial challenges and barriers to accessing health and social care. These inequities were further exacerbated during the COVID-19 pandemic. Integrating social care with health services has been proposed as an approach to improve service access and address unmet needs. A two-site parallel randomised controlled trial was conducted in Australia between August 2021 and 2023. Parents/carers of children from priority populations were recruited through Child and Family Health services (n = 288) and randomised to the Watch Me Grow-Electronic (WMG-E) intervention (n = 145) or care as usual (n = 143). The WMG-E program comprised digital developmental screening and community navigation to relevant health and social services via a service navigator. The primary outcome was change in unmet social needs measured using the WE CARE instrument. Intention-to-treat generalised linear mixed-effects models adjusted for child developmental concerns, parental mental health, and sociodemographic factors. Unmet social needs decreased over time across both groups (&#x3b2; = -0.23, SE = 0.11, p = 0.036). At 12 months, the intervention group showed greater reductions in unmet needs than the control group (&#x3b2; = -0.35, SE = 0.17, p = 0.046), although the time &#xd7; group interaction was not significant. The WMG-E platform demonstrated feasibility as a digital developmental screening and navigation tool supporting families from priority populations. WMG-E shows promise in improving access to health and social care and reducing unmet social needs; however, further research is needed to assess sustained impacts across diverse settings. The study (Protocol No. 1.0, Version 3.1) was registered with ANZCTR (registration number: ACTRN12621000766819) on July 21st 2021, and the trial results are being reported according to recommendations in the CONSORT Statement. What is already known on this topic Significant inequities exist in the access to healthcare for priority population families with preschool children and this results in children missing opportunities for early identification and intervention for health and developmental problems.While addressing heath care inequities is critical for providing children a healthy start to life, there are no effective and systematic ways to reach such families as they do not engage with services early, and often experience significant barriers due to social care needs.Addressing health inequities by tackling social determinants of health alongside healthcare is critical to supporting families in priority population groups, aligning with the Sustainable Development Goals (SDGs) of the World Health Organization (WHO). What this study adds This study is one of the first Australian randomised controlled trials evaluating the effectiveness of a digital developmental screening program coupled with service navigation for improving unmet social care needs in multicultural and rural/regional communities.Significant reductions in unmet need scores were observed over time in both intervention and control groups, with a greater reduction in the intervention group, though no significant interaction between time and group was found.The Watch Me Grow Electronic (WMG-E) platform was shown to be a feasible and effective tool for developmental screening and navigation to address unmet social needs in diverse, priority population families.

Neurofeedback Training (NFT) employs real-time feedback on brain activity to empower participants to self-regulate cognitive functions within specific brain regions. Understanding the neurophysiological correlates of NFT is critically important, as these remain largely unclear, especially regard to their neural underpinnings. This study aims to investigate whether and to what extent NFT enhances attentional orientation and executive control in healthy adults, and to explore the potential electrophysiological features associated with these behavioral changes. Participants were divided into two groups: the neurofeedback group (NF, n&#x2009;=&#x2009;19), who received real-time EEG signal feedback from the F3 electrode with training in the beta1 band (15-18&#xa0;Hz); and the sham group (sham, n&#x2009;=&#x2009;18), who watched pre-recorded videos unrelated to brain activity. Both groups underwent pre- and post-intervention assessments, which encompassed attention tasks and EEG data collection. Behavioral results demonstrated that the NF group achieved improvements in attention performance compared to the sham group. These findings were corroborated by event-related potential (ERP) data: post-intervention, the NF group exhibited enhanced N1 amplitudes during attention-orienting tasks and increased N2 amplitudes during executive control tasks. Furthermore, the NF group showed a phased increase in beta1 power during training, reaching statistical significance by the third session, whereas the sham group remained stable. These findings suggest that NFT may, to some extent, modulate attention-related neural activity, thereby potentially contributing to the enhancement of attentional task performance in healthy adults.

Digital remote monitoring technologies, including smartphones and wearables, offer promising avenues for early detection of psychosis relapse. However, selecting devices that are acceptable to participants and produce high-quality data remains challenging. The aim of this nested pilot study was to assess the acceptability and data quality of 3 commercially available wearable devices in people with psychosis recruited to the CONNECT cohort study. Participants recruited to the CONNECT study before July 31, 2024, were included in the pilot study and selected 1 of 3 wearable devices: a Fitbit Charge 5, Samsung Galaxy Watch 5, or Apple Watch SE. Baseline demographics were compared between device groups. Acceptability of devices to participants was assessed through a Wearable Device Satisfaction Questionnaire after 3 months of use, with the proportion of positive responses to each question calculated and compared. Data completeness was also assessed by calculating the number (and percentage) of valid days of step count, heart rate, and sleep data, and comparing between groups. Data quality was assessed through summarizing the amount of troubleshooting required, additional metrics available from the wearables, and continuity of data completeness by calculating the proportion of participants with at least 3 days of heart rate data per week for the first 20 weeks of follow-up. Predefined criteria were used to determine the next steps for the wider CONNECT study: if one device was superior, this would be selected; if none were found to be superior and the Fitbit was found to be noninferior, then Fitbit would be retained. Of the first 107 participants recruited to CONNECT, 105 were included in the pilot study evaluation. The Samsung Galaxy Watch was selected most frequently by participants (46/105, 43.8%), followed by the Apple Watch (27/105, 25.7%), and Fitbit Charge (23/105, 21.9%). Differences in participant demographics were observed across device groups. Self-reported acceptability after use did not differ substantially between devices. However, in terms of data completeness, the median proportion of valid heart rate data days was significantly lower for Samsung Galaxy (median 31.2%, IQR 8.5%-46.0%) compared to Fitbit (median 80.1%, IQR 26.7%-95.0%; P=.003) and Apple Watch (median 49.3%, IQR 21.5%-86.0%; P=.02). There was no significant difference between Fitbit and Apple Watch. Similar patterns were observed for step count and sleep data. The Samsung Galaxy Watch required more frequent troubleshooting for data flow issues and lacked additional physiological metrics, available from the other devices. Due to comparatively lower data quality and technical performance, the Samsung Galaxy Watch was discontinued for use in the subsequent phase of the CONNECT study. The study highlights the importance of incorporating nested evaluations of devices in long-term research.

Exercise intolerance (EI) predicts hospitalization for symptomatic heart failure (HF) in patients with type 2 diabetes mellitus (T2DM); however, cardiopulmonary exercise testing (CPET) is not always feasible in routine practice. The prognostic value of the 30-s chair stand test (CS30), a simple functional assessment correlated with peak oxygen uptake (peakVO2), remains unclear. We investigated whether the CS30 reflects exercise capacity and predicts hospitalization for symptomatic HF in patients with T2DM and stage B HF. A total of 502 outpatients with T2DM and stage B HF were prospectively enrolled. Exercise capacity was assessed using peakVO2 from CPET and functional performance using CS30. EI was defined as peakVO2&#x202f;&#x2264;&#x202f;80% predicted, and abnormal-CS30 as <18 repetitions for males and&#x202f;<&#x202f;16 for females. Participants were followed for the first hospitalization for symptomatic HF. Associations were assessed using multivariable Cox models, and discrimination using the 5-year time-dependent area under the receiver operating characteristic curve (AUC). The CS30 performance was significantly associated with peakVO2. Over a median follow-up of 5.1&#x202f;years, 91 patients were hospitalized for symptomatic HF. Abnormal-CS30 independently predicted hospitalization for symptomatic HF after adjustment for the WATCH-DM score, B-type natriuretic peptide, left ventricular hypertrophy, and atrial fibrillation. Adding the CS30 to resting risk models significantly improved the 5-year AUC, with performance comparable to that of EI. In patients with T2DM and stage B HF, the CS30 reflected reduced exercise capacity and independently predicted hospitalization for symptomatic HF. Given its simplicity and feasibility, the CS30 may serve as a practical functional marker to complement resting risk models when CPET is unavailable.

The quantity of ultrasound-guided procedures performed by physician assistants and other advanced practice providers has increased substantially in recent years. Simulation models that balance anatomical realism, cost, and accessibility are needed to allow physician assistant (PA) students to develop the critical tactile skills necessary to perform procedures under ultrasound guidance in a safe and stress-free learning environment. Twenty-four PA student participants watched a brief orientation training video and then received 20 minutes of one-on-one instruction on performing ultrasound-guided knee arthrocentesis using a formalin-embalmed cadaver. Participants were given pretraining and post-training self-confidence surveys and were objectively evaluated with a procedural skills assessment following cadaveric simulation training. Twenty-one of the 24 participants passed the skills assessment by successfully using ultrasound guidance to aspirate 1 mL of fluid from an artificial effusion in a cadaveric knee within the 5-minute time limit. Successful participants needed an average of 2.25 attempts (needle sticks) and 121.8 seconds to successfully complete the procedure. Participant self-confidence increased significantly following training across all surveyed items. Artificial knee effusions can be easily created in formalin-embalmed cadavers. These make excellent simulation training models to teach PA students to perform ultrasound-guided knee arthrocentesis. Following brief simulation training with formalin-embalmed cadaver knees, PA students can significantly increase their self-confidence in their procedure-related abilities, and they can objectively perform the procedure quickly and accurately.

Conflicts of interest (CoI) can undermine trust in scientific publishing, yet empirical evidence on how often CoI lead to editorial action and how journals respond remains limited. This study aimed to characterise the frequency, patterns, and editorial handling of CoI&#x2011;related notices in the scholarly literature using an openly available, multidisciplinary dataset. We conducted a descriptive cross&#x2011;sectional analysis of publicly available records from the Retraction Watch (RW) database, accessed via Crossref, from inception to 23 April 2026. All editorial notices in which CoI was explicitly mentioned as the sole or one of several stated reasons were included, encompassing retractions, corrections, expressions of concern, and reinstatements. For each record, we extracted article and notice dates, article type, scientific field, country of the corresponding author, number of authors and institutions, publisher, and all stated reasons for the notice. Data were analysed using descriptive statistics and bootstrap&#x2011;based confidence intervals. We identified 886 CoI&#x2011;related records (748 retractions, 39 corrections, 97 expressions of concern, and 2 reinstatements). CoI was the sole stated reason in 95 cases (10.7%), including 32 retractions, 11 corrections, and 52 expressions of concern; in the remaining notices, CoI most commonly co&#x2011;occurred with concerns such as compromised peer review, authorship or affiliation problems, journal or institutional investigations, and broader ethical violations. The median time from publication to editorial action was longest for expressions of concern and shortest for corrections, with wide variability across records and notice types. CoI&#x2011;related notices were concentrated in basic life, biomedical, and health sciences, and were unevenly distributed across high&#x2011;output countries and a small number of large publishers, particularly open&#x2011;access outlets. Most affected articles were original research papers with multi&#x2011;author, multi&#x2011;institution teams. Among articles with determinable author gender, both first and last authors were more often male than female, although these patterns were exploratory and lacked a baseline comparator. Editorial actions explicitly linked to CoI remain relatively uncommon compared with the broader volume of retractions and corrections, and CoI are rarely cited in isolation. The frequent co&#x2011;occurrence of CoI with other forms of misconduct or procedural problems suggests that undisclosed or poorly managed CoI often signal deeper weaknesses in disclosure practices, editorial oversight, and research governance rather than isolated administrative lapses. Strengthening CoI policies, transparency, verification mechanisms, and linked metadata systems may help detect problems earlier and support more consistent, graduated editorial responses.