Sixteen percent of the world's population experiences significant disability. This is likely an underestimation, as there is not a uniformly accepted definition of disability and there are limited validated tools to support clinicians in their diagnoses, especially in low- and middle-income nations. Even when a diagnosis is made, access to specialized health care and community resources is limited, with increased travel distances and high cost of services presenting additional challenges for patients and families. The World Health Organization and the United Nations have provided additional frameworks for supporting physical access and social inclusion for people living with disabilities. However, these frameworks remain inequitably applied with individuals living in low- and middle-income countries experiencing both the largest burden of disease and the fewest resources. Pediatricians can take action to ensure adequate access to health care, education, assistive technology, psychosocial support, and policy action for children with disabilities around the world.
Although flexible navigable suction ureteral access sheaths (FANS) combined with head-up positioning has shown promise in retrograde intrarenal surgery, the effects of the head-up position during the stone retrieval phase have yet to be quantified. In this study, we evaluated the effects of a 20° head-up position on stone retrieval time and intrarenal pressure (IRP) using FANS in a kidney phantom model. Using a supramolecular hydrogel kidney phantom, we performed 44 trials (22 paired comparisons). Five artificial stone fragments (2-3 mm) were placed in the renal pelvis and retrieved via suction through an 11/13-Fr FANS under continuous gravity-driven irrigation. Trials alternated between supine (Group A, 0°) and head-up (Group B, + 20°) positions. IRP was measured using a pressure sensor inserted into the upper calyx. The primary outcome was stone retrieval time, whereas mean and peak IRPs were secondary outcomes. All fragments were retrieved by suction alone without the use of a basket. Mean stone retrieval time was significantly shorter in Group B than in Group A (167.4 ± 44.5 vs. 223.0 ± 65.6 s, respectively; mean difference - 55.7 s; 95% confidence interval, - 92.1 to - 19.3; p < 0.01). Mean IRP was significantly lower in Group B (- 1.40 ± 2.34 vs. 0.51 ± 2.70 mmHg; p < 0.01), as was the peak IRP (2.40 ± 2.66 vs. 7.57 ± 3.56 mmHg; p < 0.01). Our findings provide experimental evidence supporting the integration of positional optimization in FANS-assisted retrograde intrarenal surgery.
Advanced practice registered nurses (APRN) who practice as solo hospitalists in critical access hospitals are often underrecognized in their role in providing palliative and end-of-life care. Palliative and hospice care specialty services are often not readily available for consultations in a timely manner, especially in highly remote areas of the country. These hospitalists routinely work without an option for palliative care consultations, ethics committees, or structured advance care planning processes. These hospitalists must simultaneously manage admissions, discharges, inpatient deteriorations, psychosocial situations with patients and families, and then carve out time to have empathic and meaningful end-of-life conversations. As a result, APRNs must independently deliver time-sensitive conversations, including goals of care discussions, health care agents' discussions, and end-of-life planning, in the hospital amid constant interruption, competing clinical priorities, and resource constraints. This article describes the full scope of the solo APRN hospitalist in a critical access hospital setting with close attention to how complex patient demands contribute to the challenges in providing high-quality end-of-life communications. This article examines clinical, educational, and ethical dimensions of this work, and presents a case example that illustrates how these pressures present during a shift. Strategies to strengthen rural palliative care capacity are discussed, including tele-palliative care, remote ethics support, and APRN-centered education. As rural workforce shortages persist and continue to rise, alongside rising patient acuity, naming and addressing these structural gaps is essential in improving quality of care and protecting the well-being of a solo APRN hospitalist.
We report here an efficient radical-promoted dearomative ipso-cyclization of indolyl ynones for the construction of functionalized spirooxindoles under electrochemical conditions. This domino sequence, initiated by the trifluoromethyl (CF3)/selenyl (SePh) radical, involves functionalization, ipso-annulation, and oxidation reactions. The method represents an uncommon example of the construction of spirocyclic oxindoles with good substrate scope. Additionally, the efficacy of this strategy was revealed by synthetic transformations of the product.
In this preregistered analysis of a large-scale data set, we examined the dimensionalities of home science environment and family science capital and their relationship to science achievement in a sample of 45,720 Chinese Grade 8 students (ages 13-14, 45.1% female). A series of exploratory and confirmatory factor analyses revealed that home science environment has a three-dimensional structure, consisting of formal and informal science activities, as well as access to science resources. Access to science resources was weakly but consistently associated with students' science achievement after controlling for parents' education, expectations, and family science capital (family scientific interest, willingness to support, and scientific network). By contrast, informal science activities were negatively associated with science achievement. Access to science resources also mediated the indirect associations between family science interest, parents' education, expectations, and adolescents' science achievement. These findings suggest that access to science resources may play a small but consistent role in students' science achievement. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Lithium metal anodes are promising for high-energy-density batteries, but their reversibility is limited by nonuniform lithium (Li) deposition and continuous interfacial degradation during repeated plating and stripping. Three-dimensional conductive hosts can reduce local current density and buffer volume changes, yet internal pore volume alone does not ensure effective Li storage. Preferential Li nucleation at the electrolyte-facing outer region blocks Li+ access to internal pores, leading to surface-biased growth and poor pore utilization. Here, we report a metal-organic framework (MOF)-derived core-shell porous carbon framework, denoted ZC-PCF, designed to coordinate Li+ accessibility and outer-region Li nucleation behavior. The host is prepared from a ZIF-8-derived core and a Zn/Co mixed-metal MOF shell, enabling selective outer-region modification. During carbonization, Co-containing species promote local carbon restructuring and mesopore-enriched pore evolution, increasing the total pore volume from 0.15 to 0.29 cm3 g-1 while reducing the micropore contribution from 28.7 to 15.0%. The optimized ZC-PCF-12 enables improved LiFePO4 full-cell cycling, retaining 93.4% of its initial capacity after 100 cycles at 1.0 mA cm-2. This work suggests the importance of coordinating pore accessibility and Li nucleation behavior for reversible Li metal storage.
Spontaneous portosystemic shunts are defined as venous conduits that occur in response to elevated portal venous pressure, resulting in alternative outflows from the portal circulation. We present a case of atypical portosystemic shunt formation between the inferior mesenteric vein branches and the left testicular vein resulting in hepatic encephalopathy in a patient with a history of cirrhosis, describing the access technique we used for successful portosystemic shunt embolization via a combined right common femoral vein and trans-scrotal approach. A 57-year-old male with a history of cirrhosis presented with a 1-month history of progressive cognitive decline despite adherence to a medical regimen of lactulose, rifaximin, and a low-sodium diet. Abdominal computerized tomography and scrotal ultrasound revealed shunt formation from the mesenteric venous system to the systemic circulation, with intermediate connections through the scrotal venous plexus and left gonadal vein. Following an outpatient consultation with interventional radiology for worsening hepatic encephalopathy, the inflow and outflow tracts of the shunt were visualized using digital-subtraction venography. Embolization with Penumbra Ruby XL coil packs and Sotradecol infusion was achieved using an ultrasound-guided trans-scrotal approach for the inflow tract and a femoral approach for the outflow tract. The patient's hepatic encephalopathy resolved shortly after the procedure. Mesogonadal shunts can be a sequela to portal hypertension and leave patients susceptible to hepatic encephalopathy due to direct entry of metabolic toxins such as ammonia into the systemic circulation. Although systemic access is the standard approach for existing coil embolization and balloon-occluded retrograde transvenous obliteration (BRTO) procedures used for the treatment of mesogonadal shunts, further consideration should be given for unconventional vascular access in difficult portosystemic shunt presentations to better address shunt inflow and prevent recurrence. Future avenues for research can include comparing shunt recurrences in patients with layered sclerosant and coil embolization to patients with BRTO or coil embolization alone.
Worldwide, new technologies appeared to be inevitable for human being. Man is the creator of all these technologies but the core question is whether these innovations are dangerous and threatening for creativity, especially in arts. Technology significantly influences art creativity by providing new tools and mediums, such as digital painting and virtual reality, which expand the artistic possibilities. It also enhances the accessibility, allowing artists to reach wider audiences and fostering inclusivity within the art community. This relationship between art and technology isn't new, but the digital revolution has accelerated changes at an unprecedented pace, creating exciting new possibilities while challenging the traditional notions of creativity, ownership, and what we even consider "art" in the first place. While AI can enhance efficiency, it lacks the instinct, emotion, and nuance that human-driven storytelling provides. Emerging technologies such as Artificial Intelligence (AI), Virtual Reality (VR), and blockchain are re-shaping the creative industries by enabling new forms of expression, expanding access to global audiences, and redefining how art is produced, distributed, and experienced. However, if an AI creates a piece, should the credit go to the machine, the programmer, or the artist who directed it? There is a completely understandable and reasonable concern that AI-generated art may lead to homogenization, where artworks start to look similar due to reliance on the same algorithms and datasets. While the nature of the creative process is under debate, many believe that creativity relies on real-time combinations of known neural and cognitive processes. Every original work, whether it is a music or a painting, contains within it that invisible sign of inimitableness, which Benjamin called 'the aura'. A convinced suspicion of the original work, whether it be a music, novel or a painting, saves within itself that invisible sign of irreversibility dictated to the aura.
Mental health conditions, including depression, anxiety, and psychological distress, are prevalent among the aging population and affect their health, functioning, and quality of life. Access to proper and high-quality mental health treatment is necessary; however, mental health treatment and care remain underused due to stigma, workforce shortages, cost, and mobility limitations. Digital mental health interventions (DMHIs) are emerging as a promising strategy to improve the accessibility and effectiveness of mental health services for older adults, but older adults have historically been underrepresented in DMHI development and evaluation. Additionally, the effectiveness of different types of DMHIs and how age-centered design approaches influence outcomes remain underexplored. This scoping review mapped and synthesized evidence on DMHIs focused on adults aged 50 years and older and identified gaps in the evidence base related to study design, age-related adaptations, and clinical outcomes. Specifically, we examined (1) the technologies and therapeutic approaches used, (2) the outcomes and effectiveness of DMHIs, and (3) age-centered adaptations and their outcomes. This scoping review searched for studies focusing on DMHIs for older adults across PubMed, PsycINFO, Scopus, Ageline, and Web of Science that were published from 2000 to February 2025. Eligible studies evaluated or described the design of DMHIs targeting mental health conditions among adults aged 50 years or older. Two rounds of independent screening and data extraction were conducted by multiple reviewers. Extracted data included study design, sample characteristics, intervention features, technologies used, age-related adaptations, and clinical outcomes. Seventy-two studies met the inclusion criteria, of which 36 were randomized controlled trials and 54 reported clinical outcomes. Web-based cognitive behavioral therapy was the most commonly used approach, followed by games, virtual reality, mobile apps, chatbots, and robots. Fifty-four studies reported positive clinical outcomes, most commonly reductions in depression, anxiety, or psychological distress. However, only one-third of the studies incorporated age-centered design adaptations or co-design approaches, such as simplified interfaces, larger fonts, age-relevant content, or participatory development with older adults. Among studies reporting positive clinical outcomes, DMHIs can reduce depression, anxiety, and psychological distress. However, with only half of the included studies using randomized controlled trial designs, the overall evidence base remains moderate. In addition, age-adaptive design remains underdeveloped. Future research should strengthen trial designs and systematically examine how usability and age-centered adaptations influence DMHI effectiveness.
Adherence to maintenance asthma inhaled therapy remains suboptimal globally. An asthma patient decision aid (PDA) can facilitate shared decision-making between patients and physicians when selecting asthma treatment options. This study aimed to explore the perspectives of the clinicians and patients in the implementation of this PDA in the primary care practice and to identify optimal delivery approaches for its sustainability. Thirty primary care doctors, nurses, pharmacists, and 20 patients who were prescribed inhaled corticosteroids were interviewed through focus group discussions and individually to gather their perspectives on using a locally designed asthma PDA. The transcribed qualitative data were analysed and presented using the Normalisation Process Theory framework. Platform preferences differed among the patients, with older patients favouring print formats whilst younger patients preferred digital versions. Nonetheless all participants agreed that the PDA should be written in layman's language, have large font sizes, and good visual design. Most of the clinicians highlighted time constraints as a barrier to PDA use and emphasised the need for easy access to the materials during consultations. Clinicians suggested mutual sharing of experiences with the PDA to address implementation hurdles and facilitate integration into clinical practice and workflow, alongside conducting regular content updates. Successful asthma PDA implementation requires multi-format delivery to accommodate diverse patient preferences and streamlined access to address clinician time constraints. Peer sharing and regular content updates are essential for sustained adoption. This study's findings provide practical guidance for integrating the asthma PDA into primary care.
IntroductionChronic wounds which do not heal as expected, are common in residential aged care homes (RACHs). While specialised wound care is essential for improving outcomes, access is challenging in RACHs. Emerging virtual interventions are known to improve access to wound care, but little is known about use in this setting. This scoping review identifies and maps virtual wound care use in RACHs.MethodsAn electronic search of Medline, CINAHL, Embase, AgeLine, IEEE Xplore, ACM digital library and clinical trial registries was conducted from database inception to March 2026. Studies were screened and data extracted by two independent reviewers using a reviewer-developed tool.ResultsOf the 17 included studies, a combined model of telehealth and store and forward was most frequently used (n = 9). Virtual wound care was used for both diagnosis and management (n = 15) and commonly delivered by teams of clinicians (n = 8). Included studies demonstrated wound care could be delivered safely and facilitated clinical decision-making. Acceptability of virtual wound care by residents, families, staff and other care providers was high. Reliable internet, stable workforce and adjunct in-person care were enablers to virtual interventions. Lack of training participation, workforce shortages and technology limitations were perceived barriers to virtual wound care.ConclusionsCurrent evidence indicates that virtual wound care is being used in RACHs though it remains under investigated. Addressing workforce, training, and technology barriers can support broader implementation of virtual wound care and improve chronic wound outcomes for aged care residents.Review registrationOpen Science Framework https://osf.io/j97bt.
Transvaginal pelvic imaging is an integral and sensitive aspect of gynecologic care that individuals find both invasive and burdensome. At-home transvaginal imaging provides an opportunity to navigate these barriers to care. To evaluate the use of at-home transvaginal ultrasonography for gynecologic assessment, as measured by diagnostic imaging quality and participant satisfaction, in a broad sampling of women aged 22 to 50 years. Prospective, interventional, single group nonrandomized clinical trial with blinded review of collected images from premenopausal women aged 22 to 50 from Florida, Massachusetts, Maryland, Maine, Minnesota, New Hampshire, Texas, Utah, Virginia, Vermont, and Washington, DC. Images were gathered between July 2022 and July 2023, and data were analyzed from April to September 2025. At-home pelvic ultrasonography guided by verbal communication with a fully trained remote sonographer who had real-time access to study images. Cine clips were used to capture standard views of the uterus, ovaries, cervix, and posterior cul-de-sac. Primary outcomes were image quality and participant net promoter score (NPS), reflecting participants' likelihood of recommending the procedure, with higher scores indicating greater likelihood. Secondary outcomes included minor pain or discomfort, sonographer reported experience and/or pain, and all other adverse events. A total of 265 participants (mean [SD] age, 32 [6.7] years; mean [SD] body mass index, 27.0 [5.6]) enrolled in the trial, and 263 ultrasonographic scans were completed. Image quality showed that 253 at-home ultrasonographic scans (96.2%) met diagnostic quality while 10 (3.8%) did not. NPS was significantly higher with use of the at-home ultrasonography (59) compared with in-clinic scans (24), with an adjusted difference of 33.7 (95% CI, 23.3-44.0; z = 6.35; P < .001). No adverse events were reported. This nonrandomized clinical trial of at-home pelvic ultrasonography in premenopausal women demonstrated that broad use of at-home gynecologic ultrasonography technology is feasible, safe, and preferred by participants and sonographers compared with in-clinic ultrasonography. At-home ultrasonographic imaging presented an innovative and clinically acceptable alternative to in-clinic care, providing opportunities for improved access to and decreased burden of gynecologic and reproductive care. ClinicalTrials.gov NCT05443698.
Lethal means safety counseling involves limiting access to lethal means of suicide in times of crisis. The National Institute of Mental Health Emergency Department (ED) Suicide Risk Screening Pathway recommends lethal means safety counseling for patients with suicidal thoughts being discharged from the ED. We sought to understand ideal characteristics of a lethal means safety counseling tool for the ED from the perspective of teens and caregivers with lived experience. This qualitative study was conducted at a tertiary care children's hospital ED from September 2024 to June 2025. Patients ≥10 years are screened for suicide risk using the Ask Suicide-Screening Questions; those with a nonacute positive Ask Suicide-Screening Questions screen and reported firearm access were eligible. We conducted semistructured interviews with teens (13 to17 years) and/or their caregiver participants spoke English. Teens and caregivers were interviewed separately. Interviews were recorded and transcribed. Inductive coding was performed by 2 team members. Themes were identified using content analysis. We completed 33 interviews (19 caregivers, 14 teens, 14 dyads). Participants were mostly women, heterosexual, White, and non-Hispanic. Themes included the following: (1) lethal means safety counseling is beneficial and helps families feel cared for; (2) specific lethal means safety counseling tool elements should utilize technology, consider equity, and include straightforward language and supportive messaging, as well as an actionable plan; and 3) differing family dynamics and balancing teen autonomy and safety remain barriers to lethal means safety counseling. Lethal means safety counseling is an essential, high-yield component of suicide prevention. Our findings will directly inform the development of a brief family-centered lethal means safety counseling intervention for the ED.
This article examines challenges in delivering psychological services in the Philippines, a lower-middle-income country facing workforce shortages, geographic barriers, and unequal access to care. Using a holistic perspective, it examines how mental, physical, social, and cultural factors interact to shape health outcomes and service utilization. Insights from mental health initiatives across low- and middle-income countries inform a community-oriented service delivery approach, consisting of (a) integration of mental health into primary care to promote early detection, continuity of care, and cost efficiency; (b) task-sharing strategies that engage trained nonspecialists to address workforce gaps; (c) strengthening community- and school-based platforms that build on existing social networks and cultural values; and (d) the use of low-cost communication channels, such as mobile phones, television, and radio, to expand reach in underserved areas. Evidence from a number of countries, including India, Pakistan, Nepal, Kenya, Zimbabwe, and Tanzania, indicates improvements in service utilization, symptom reduction, and community engagement. These approaches are also cost-effective, reducing reliance on specialist and emergency services while maximizing limited resources. Overall, this article offers practical directions for expanding access, improving outcomes, and supporting more equitable and sustainable mental health systems in underserved Filipino communities and similar contexts. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Surgery is the most frequent treatment for breast cancer and requires postoperative follow-up to detect complications and monitor patient recovery. Postoperative telemonitoring has demonstrated benefits in improving rehabilitation and psychological well-being. However, patient expectations of and barriers to telehealth follow-up after oncologic breast surgery remain insufficiently explored. A prospective survey was conducted among adult patients attending pre- or postoperative follow-up appointments for breast cancer in the Department of Breast and Reconstructive Surgery at the Civil Hospitals of Colmar between March and August 2025. The questionnaire comprised four sections: demographic data, treatments received, telemedicine accessibility and acceptability, and patient expectations of and barriers to telemonitoring. A total of 124 questionnaires were analyzed. Results demonstrated high accessibility to digital tools among participants. Although patients recognized several advantages of telemonitoring, most expressed a strong preference for in-person follow-up visits. The most expected features included the ability to report postoperative complications and to monitor recovery and pain. The main barrier was the fear of reduced human contact. Retired status was associated with lower acceptance of postoperative telemonitoring. These findings support the implementation of a hybrid follow-up model combining early postoperative telemonitoring with later in-person consultations, which could help reassure patients and shorten hospital stays while maintaining personalized care. The monocentric design may limit the external validity of the findings. Future studies should explore patients' perceptions following repeated use of telemonitoring tools and incorporate healthcare professionals' perspectives on their integration into clinical practice.
Clinical pharmacology and pharmacometrics are central to understanding patient response to new and existing therapies, yet access to training in Africa remains limited, particularly in francophone countries where language is a barrier. We report the design and implementation of a 12-week French-language online course combining asynchronous lessons with live interactive sessions. The inaugural cohort enrolled 72 students from Senegal (n = 37), Tunisia (n = 24), and the Democratic Republic of the Congo (n = 11). While only one-third completed the full program, all survey respondents judged the course useful, highlighting clear objectives and adequate preparation time. Challenges related to perceived workload, time-zone difference in scheduling, and internet connectivity were reported by participants. A second iteration of the course hosted by the Tunisia Chapter of Pharmacometrics Africa has just completed and will gather further feedback and attempt to address lessons learnt. This proof-of-concept hands-on educational program demonstrates that delivering training in French through an online format can effectively expand access to pharmacometrics education in Africa. Strengthening local institutional partnerships to take on technical support will be critical to improving participant retention and ensuring program sustainability. Moreover, this model could be adapted to other languages and extended to additional regions, thereby promoting more inclusive global capacity building.
Tofersen is a disease-modifying antisense oligonucleotide therapeutic for people living with SOD1-amyotrophic lateral sclerosis (SOD1-ALS). Autopsy tissue donors have provided the first opportunity to study the distribution of intrathecally administered tofersen in human central nervous system tissues. To determine the tissue distribution of tofersen and to provide the first estimates of SOD1 reduction in human somatic motor systems tissues. This was a cross-sectional autopsy tissue case series conducted between 2018 and 2026. Autopsies were performed at 3 US academic medical institutions. Tissue samples from 8 deceased patients who lived with SOD1-ALS, participated in tofersen clinical trials (ClinicalTrials.gov Identifiers NCT02623699 [An Efficacy, Safety, Tolerability, Pharmacokinetics and Pharmacodynamics Study of BIIB067 (Tofersen) in Adults With Inherited Amyotrophic Lateral Sclerosis (ALS)] and NCT03070119 [Long-Term Evaluation of BIIB067 (Tofersen)]) or the Expanded Access Program, and whose families authorized autopsies were eligible for this study. All autopsy tissue donors known at the time of this study were included (none were excluded). Analyses were conducted between August 2020 and January 2026. Participants received multiple intrathecal 20- to 100-mg tofersen doses. Tofersen tissue concentrations were measured using hybridization enzyme-linked immunosorbent assay (ELISA). SOD1 messenger RNA (mRNA) and protein reduction estimates, defined as percentage SOD1 levels in this study's recently treated autopsy tissue donors compared to a cohort of samples from tofersen-naive SOD1-ALS autopsy tissue donors, were measured using quantitative reverse transcription polymerase chain reaction (PCR) and ELISA. Histological localization of tofersen and SOD1 transcripts were studied using immunohistochemistry and in situ hybridization assays. In 8 tofersen-treated autopsy tissue donors (5 male and 3 female donors; age range, 42-66 years), spinal cord and motor cortical tissue tofersen concentrations strongly correlated with predictions based on individual dosing histories and a preclinical pharmacokinetic model. For 3 recently treated autopsy tissue donors, reductions in lumbar spinal cord tissue SOD1 mRNA and protein levels ranged from 45% to 84% despite not having been administered 1 to 2 scheduled doses before autopsy. Residual somatic motor neurons demonstrated tofersen transduction and low SOD1 mRNA probe hybridization. Misfolded SOD1 protein inclusions were detected in residual motor neurons of tofersen-naive SOD1-ALS tissue donor controls and tofersen-treated tissue donors. Meningeal and perivascular lymphocytic immune responses were observed in 5 recently treated tissue donors but were not apparent in tissue donors with remote final tofersen doses. This case series presents the first emerging autopsy tissue data confirming the predicted distribution of tofersen and robust SOD1 protein reduction in human somatic motor systems tissues.
In healthcare settings, it is crucial to understand the identities of patients receiving services, both for cultural considerations and to identify and prevent disparities in care. Our retrospective observational study analyzed 763 adult bioethics consultations from 2016-2024 at a large urban academic health system and compared the demographics of patients receiving bioethics consultation to the general patient population. We also evaluated demographic differences between patients receiving consults for different categories of ethics issues. We found that Hispanic and Asian patients were underrepresented among those receiving ethics consults, while Black and White patients were overrepresented. Additionally, patients receiving consults were more likely to be male and older. Consults for refusal of medically indicated care were significantly associated with younger age, HIV/AIDS diagnosis, and having diabetes with complications. Initial bivariable associations of consults for refusal of medically indicated care with race and language did not remain significant after adjustment for confounders. The finding that Hispanic and Asian patients were less likely to receive ethics consults may reflect language-related communication barriers or underrecognition of ethics-related concerns. Findings highlight racial and linguistic disparities in ethics service utilization, which may mirror broader structural inequities in care delivery and provider communication. Addressing these gaps is essential for advancing ethical, culturally responsive care. Future efforts should focus on improving access to ethics resources for marginalized groups and investigating how structural racism and communication dynamics influence ethics consult initiation.
In Aotearoa New Zealand (NZ), families face persistent barriers to accessing evidence-based early support for Autistic children. This randomized controlled trial (RCT) evaluated the effectiveness of Let's Play; a bespoke, caregiver-mediated early support program for Autistic children and their caregivers. This single-blind (rater) RCT included 91 parent-child dyads, randomly assigned to the Let's Play program (active support; AS [n = 45]) or a waitlist control (WLC; n = 46). Participants were caregivers of children aged 0 to 5 years with a formal diagnosis or characteristics of autism. Let's Play was delivered over 9 weeks via group workshops and in-home coaching. Primary child and caregiver outcomes, assessed at baseline, post-support, and 6-month follow-up, included parent-child engagement and parental stress, respectively. Children showed descriptive evidence of improvement in caregiver-child engagement, health-related quality of life and behaviour from baseline to post-support. Improvement in parental stress, depression and anxiety symptoms, and self-perceived parenting competence were also evident, across timepoints. However, there were no significant Group x Ttime effects for caregiver-child engagement, number of utterances or number of different words. A Group x Time effect was evident for all other child and caregiver outcome variables, underscoring the benefits of Let's Play. This research provides preliminary evidence of the effectiveness of a low-intensity, community-based, caregiver-mediated early support program for Autistic children's health-related quality of life and behavior and caregiver well-being. However, more targeted or sustained approaches to supporting caregiver-child engagement and vocal communication may be needed for improvement to be observed. The research protocol was prospectively registered on the Australian New Zealand Clinical Trials Registry (ACTRN12622001139763).
Electron microscopy provides direct real-space access to the structural heterogeneity of catalysts across multiple length scales. However, its application to practical catalytic systems is often constrained by imaging artifacts, low signal-to-noise ratios, narrow fields of view, and the difficulty of extracting statistically representative information from large and complex data sets. Recent advances in artificial intelligence (AI), particularly deep learning, are transforming electron microscopy into a quantitative, high-throughput, and increasingly standardized analytical platform. This review highlights how AI enables large-scale, statistically grounded analysis of electron microscopy data, making it possible to extract structurally meaningful descriptors from catalytic materials across atomic, nanoscale, and dynamic regimes and to connect these descriptors more rigorously with structure-performance relationships. Current challenges, including data scarcity, model transferability, interpretability, and integration with spectroscopy, theory, and autonomous microscopy, are also discussed.