This study explored the use of Appreciative Inquiry to engage speech-language pathologists in co-designing culturally and contextually responsive diagnostic practices for Developmental Language Disorder in the Northern Territory, Australia. Over 18 months, Appreciative Inquiry was delivered through online sessions with Northern Territory Health speech-language pathologists. Using the 4D cycle (Discovery, Dream, Design, Destiny) and a strategic "Detour" to connect local ideas to organisational priorities, participants engaged in collaborative visioning, resource development, and guided reflection on culturally responsive, linguistically appropriate practices. The process produced a context specific framework, including guiding principles, contextual considerations, diagnostic resources, and scripts to embed child and family voice. Participants reported increased confidence applying developmental language disorder criteria, improved clarity in diagnostic decision-making, and strengthened professional connections across locations and organisations. The approach fostered ownership, flattened hierarchies, and generated practical outputs adaptable to urban, rural, and remote contexts. Appreciative Inquiry is a cost-efficient, inclusive, and flexible methodology for improving rural and remote healthcare services. By aligning locally driven solutions with strategic priorities, Appreciative Inquiry promotes sustainable practice change, collaborative leadership, and culturally and contextually responsive developmental language disorder diagnosis in the Northern Territory.
Personal values shape health behaviors, yet the role of sleep value within broader value systems remains unknown. This study aimed to validate the Values Inventory, a novel measure assessing individual life values, and examine how sleep value fits into broader these value orientations. An online sample of U.S. adults (N = 455) completed the Values Inventory and the Sleep Valuation Item Bank 2.0 (SVIB-2.0), along with demographic and sleep-related surveys. Exploratory factor mixture modeling and confirmatory factor analysis supported a five-factor structure of the Values Inventory: Health/Wellbeing, Fundamental Human Values, Social Status, Personal Accomplishment/Global Advancement, and Community/Belonging. Internal consistency was high across factors (ω ≥ 0.88). Structural equation modeling revealed significant associations between demographic characteristics and value endorsements. Sleep health, along with mental and physical health, formed the core of the Health/Wellbeing factor, supporting the common belief that sleep is a pillar of health. Age was significantly associated with higher valuing of Health/Wellbeing and Fundamental Human Values. Multivariate analysis of variances comparing Values Inventory factors across previously established sleep value profiles (Unconcerned, Appreciative, Devalue, Ambivalent Priority, and Concerned) revealed distinct value patterns. The Appreciative profile showed the highest valuation of Health/Wellbeing. The Ambivalent Priority profile showed the highest valuation of Social Status and Community/Belonging. Findings support the Values Inventory as a psychometrically sound tool for assessing individual value systems and highlight the complex role of sleep. These results suggest the need for future research determining whether aligning sleep health interventions with individuals' broader values may enhance effectiveness and relevance.
Recent advances in long read technologies provide an unprecedented opportunity to study transcript evolution. However, comparative evolutionary studies, even in Drosophila, are limited by inconsistent and incomplete annotation, and the lack of annotated transcript homology. In this study of five species spanning 28 million years ( D. melanogaster , D. simulans , D. yakuba , D. santomea and D. serrata ), we infer transcript homology using reciprocal liftover, and orthology using network analyses, with data validation from long read RNA-seq of male and female head tissue. We build the first genus level annotation, with 15,996 genes and 56,370 transcripts. Expressed transcripts are conserved, 73% of transcript orthologs are detected in all species. Even the improved annotation underestimates the number of genes with alternative transcripts, with 75% of genes expressing multiple structurally diverse transcripts. In a replicated quantitative evaluation of ∼10,000 genes, both male and female-biased transcripts are expressed in 410 ( D. melanogaster ), 608 ( D. simulans ), and 493 ( D. serrata ) genes and in 118 orthologous genes in the D. melanogaster - D. simulans species pair, indicating greater potential for resolution of sexual conflict by alternative transcription than previously appreciated. We identified 605 transcript orthologs conserved for sex bias in the D. melanogaster-D. simulans species pair and of these, 22 male and 19 female-biased transcripts were conserved in sex bias with the outgroup D. serrata, including transcripts of genes involved in brain development, Sxl target Glutamine synthetase 2 and ciboulot . Conserved alternative transcripts suggest that transcriptional diversity is a pervasive driver of the evolution of functional diversity.
Music appreciation by patients with cochlear implants (CI) is affected by multiple factors. Prelingually deafened CI patients have different expectations and experiences with music that impact their music appreciation. This scoping review aims to describe the factors important for music appreciation and strategies for improved music appreciation in prelingually deafened CI recipients. PubMed, Embase, and Web of Science. PubMed, Embase, and Web of Science were queried for articles related to music appreciation in prelingually deafened CI users. Inclusion criteria were articles describing music appreciation characteristics and strategies for patients with CIs and prelingual hearing loss. The MINORS criteria was utilized to assess the quality of the studies. Of the initial 140 citations screened, 52 articles underwent full-text review, and 32 met inclusion criteria, comprising a total of 599 unilateral and bilateral CI users with prelingual hearing loss. Average age at time of study and implantation were 11.03 and 6.36 years, respectively. Prelingually deafened patients reported increased music appreciation at baseline compared to postlingually deafened patients, but performed worse in melody, instrument, and song identification. Rhythmic music elements are especially important for music appreciation in this population. Additionally, implantation at an earlier age and music training after implantation are associated with improved identification and appreciation of musical elements. Music is experienced and appreciated differently by prelingually deaf CI patients compared to those who have known acoustic listening. Early implantation and music training can significantly help improve identification of complex musical elements and overall music appreciation. Level 3.
To explore students' experiences of taking part in a Death Café and whether they consider the Death Café as being a useful educational tool. Talking about death remains a taboo for both nursing professionals and students. Recognizing the importance of open dialogue, Death Cafés were established to provide safe spaces for individuals to share thoughts and feelings on this topic. A qualitative, exploratory, and descriptive study employing a descriptive analytical approach. This study was conducted between April 2025 and July 2025 at a public university in Catalonia. The Death Café was a mandatory activity within the palliative care course for all third-year bachelor/undergraduate nursing students. After the course, students were invited to participate in a questionnaire containing 12 open-ended questions, and all 39 students agreed to participate. Data were analyzed using Sandelowski's qualitative descriptive approach. Following questionnaire analysis, 24 units of meaning, categorized into 7 subcategories and 2 categories emerged: (1) death without fear: normalizing dialogue and communication. The Death Café fostered speaking about death freely and without prejudices; (2) emotional management and group support in the learning process. Students reported a sense of emotional relief when speaking about death and considered it a tool that can enhance their capacity to support patients and families. Most participants regarded the Death Café as a comfortable and enriching experience that provided a respectful environment for open conversation about death. The activity reduced perceived fears and taboos, promoted emotional reflection, and encouraged the sharing of diverse perspectives. Nursing student’s experiences of taking part in a Death Café: A qualitative study Talking about death can be uncomfortable and is often avoided, even among nursing students who will one day care for dying patients. This study explored how nursing students experienced discussing death in a “Death Café”—a safe and informal setting where people can openly share their thoughts and feelings about death. Between April and July 2025, thirty-nine nursing students participated in a Death Café and later completed an open-ended questionnaire about their experiences. Researchers analyzed their responses to understand what they learned and how the activity affected them. Two main themes were identified. First, students reported feeling more comfortable talking about death and described how the activity helped to normalize this difficult topic. They appreciated the chance to speak openly and without judgment, which improved their confidence in communicating about death. Second, they highlighted how the Death Café supported emotional management and group bonding. Sharing experiences and emotions with classmates helped them feel relief, mutual understanding, and empathy. Overall, students found the Death Café to be a positive, enjoyable, and meaningful experience. They said it created a respectful and trusting environment that encouraged open discussion.
Alcohol has been appreciated by civilizations for thousands of years. Nonetheless, alcohol has recently been linked to serious cardiovascular diseases. Therefore, this review summarizes the effects of alcohol on the heart based on the most current literature available. This review covers the effects of alcohol on blood pressure (BP), heart rate (HR), autonomic dysfunction, coronary artery disease (CAD), cardiomyopathy, and cardiac arrhythmias. Evidence supports the harmful effects of both acute (binge) and chronic heavy alcohol consumption on BP, HR, autonomic dysfunction, and the risk of CAD, cardiomyopathy, and various arrhythmias. Some studies suggest that mild to moderate drinking may reduce the risk of CAD and arrhythmias, consistent with a potential J-shaped relationship. However, other evidence contradicts this, thereby indicating that alcohol use may increase the risk of developing hypertension, CAD, and atrial fibrillation. At the time of this review, evidence supports the harmful effects of acute and chronic heavy alcohol consumption on the heart. Findings are mixed for mild to moderate drinking and may be influenced by confounding factors, underscoring the need for further research. Given the inconclusive benefits, the authors recommend that no level of alcohol consumption be promoted as beneficial for cardiac health.
Observed differences in mean phenotypic values across human groups have attracted renewed interest with the rise of large-scale genomic studies and polygenic risk prediction. However, the genetic basis of these differences is far more difficult to establish than is often appreciated. Populations can diverge in allele frequency differences without diverging in mean genetic value. Empirical approaches to infer whether populations differ in mean genetic value fall under two broad categories: top-down approaches, which quantify the proportion of phenotypic variance explained by ancestry and bottom-up approaches, which compare polygenic scores across groups. However, both approaches have limitations that prevent them from reliably distinguishing true differences in genetic apart from statistical artifacts like population structure, ascertainment bias, and poor cross-ancestry portability. Further, observed phenotypic shifts between populations may reflect bias in phenotype measurement and heterogeneity in study design rather than underlying genetic drivers. We argue that claims about group differences in genetic risk should be interpreted with considerable caution.
Chiroptera species (hereafter bats) exhibit extraordinarily long lifespans compared to non-flying mammals of similar body size, yet the underlying ecological drivers and molecular mechanisms remain poorly understood. In this study, we employed phylogenetic regression models to explain maximum longevity (MLg) variation using 24 life-history traits from 101 bat species. In parallel, we conducted comprehensive comparative genomics analyses on 39 high-quality bat genomes to identify candidate genes and biological processes involved in longevity regulation. Our results revealed that female age at sexual maturity and maximum latitude explain the greatest proportion of MLg variation within bats, and genes involved in DNA damage repair, inflammation, immunity and mitochondrial function may play critical roles in various extremely long-lived bat species. We also identified the potential importance of lipid metabolism, specifically the cholesterol metabolism pathway and APO gene family, as a previously under-appreciated mechanism in bat longevity regulation. Given the distinct ecological and physiological features, our family-specific analyses on Vespertilionidae and Pteropodidae uncovered divergent life-history predictors and genetic strategies for extended longevity. In Vespertilionidae, MLg is most strongly associated with latitude and may be regulated primarily through the maintenance of DNA stability, while MLg in Pteropodidae is best predicted by body mass and is linked to tumour suppression and immune response. Overall, our study elucidates the complex interplay between life-history factors and genomic adaptations underlying extended lifespans in bats, providing valuable insights into mammalian longevity evolution and potential targets for improving human healthspan.
In-plane (IP) ultrasound-guided venipuncture is widely used for its recognized advantages, including improved needle tip identification and a shallower puncture angle, which enhances echogenicity, reduces posterior wall injury, and facilitates guidewire insertion. These benefits, however, can create a false sense of security if the inherent limitations of ultrasound imaging are not appreciated. Among these, slice thickness artefact, caused by the finite elevational thickness of the ultrasound beam, is frequently overlooked in clinical practice. This narrative review examines the mechanisms, clinical implications, and strategies to mitigate slice thickness artefact during IP venipuncture, with particular emphasis on factors influencing artefact magnitude and needle tip visualization. Slice thickness artefact projects echoes from structures outside the imaging plane onto the two-dimensional image, making the needle tip appear intraluminal while it actually lies in a parallel, off-plane trajectory. Misinterpretation may increase the risk of injury to adjacent arteries, nerves, or other critical structures and lead to inadvertent extravascular catheter placement. The magnitude of the artefact depends on imaging depth, focal zone alignment, beam divergence, and transducer design, and is particularly relevant for deep, small-caliber veins and low-frequency or handheld devices. Mitigation strategies include awareness of beam limitations, careful probe selection, optimization of depth and focal zone, dynamic probe manipulation, controlled needle advancement, backflow verification, and complementary out-of-plane confirmation. When recognized and managed appropriately, slice thickness artefact can be minimized, preserving the procedural advantages of IP guidance. Understanding ultrasound beam geometry and applying targeted technical strategies are essential to optimize needle tip visualization, procedural safety, and patient outcomes.
The landscape of asthma management is undergoing significant transformation. This change is driven by several factors: deeper understanding of asthma pathophysiology, appreciation of the long-term harm of oral corticosteroids, biological treatments that dramatically improve patient outcomes with asthma remission becoming a realistic goal, and a focus on patient-centred care combined with the use of virtual health and artificial intelligence strategies. This Viewpoint provides a perspective on current dilemmas and then emphasises recent innovations that can provide solutions. If applied judiciously, these advances will enable healthcare professionals to improve outcomes for people with asthma.
The mental health of expatriate employees is a growing concern. While occupational health nurses (OHNs) are well-positioned to coordinate multidisciplinary support, their specific role remains underexplored in international literature. This paper describes OHNs' role in coordinating multidisciplinary mental health support for expatriates. Based on 10 years of experience (2010-2020; N = 450) supporting Japanese engineers across eight international plant construction projects, we characterize this framework through three cases, exploring its feasibility and acceptability over effectiveness. We used a descriptive, retrospective design based on routine occupational health work within a Japanese multinational engineering firm. Cases were purposively selected from eight overseas projects in five regional clusters: North Africa (Algeria), Sub-Saharan Africa (South Africa), Southeast Asia (Malaysia), Central Asia and the former Russian bloc (Uzbekistan, Turkmenistan, and Tatarstan), the Caribbean (Trinidad and Tobago), and South America (Chile). Data sources included health records, structured emails, semi-structured manager interviews, and field notes. Outcomes were evaluated using three objective indicators (safe repatriation, absence of significant residual harm, and absence of acute crises), key-informant ratings, and OHN observation notes. Newsletter feedback underwent inductive thematic analysis following Braun and Clarke's framework. The study complied with the Declaration of Helsinki and received ethics approval from Kaito Clinic; individual consent was waived due to the use of de-identified retrospective records. Three illustrative cases are presented. Case 1 demonstrates the successful emergency aeromedical repatriation and return-to-work of an employee with acute psychiatric illness, aided by the OHN's coordination and a pre-established referral pathway. Case 2 documents the reception of a multilingual monthly newsletter; 90 respondents (≈20% response rate) appreciated the culturally resonant content (55.6%), noted increased service awareness (44.4%), and felt connected to the home team (38.9%). Case 3 describes overseas site visits, rated favorably by 100% (22/22) of interviewed project managers. The three objective indicators were met across all cases, demonstrating practical feasibility and acceptability within this context rather than proven clinical effectiveness. Positioning OHNs as coordinators within a multidisciplinary mental health support team is a feasible and well-accepted approach for Japanese technical employees on overseas assignments. Site visits, multilingual communication, and established referral pathways are practically valuable. Given the retrospective, single-organization design, these findings do not prove clinical effectiveness or generalizability. Further prospective, multi-organizational studies with validated outcome measures are needed to evaluate effectiveness and transferability to other contexts.
The existential dimension is a key aspect of palliative care but is often insufficiently integrated in clinical practice. We developed a structured meaning-making conversation for patients living long-term with incurable cancer led by a spiritual counsellor to support patients' meaning-making process. To support the integration of the existential dimension, a synopsis of patient's sources of meaning and existential needs was shared afterwards with the referring health care provider (HCP) via the electronic health record. This study explored HCPs' experiences with this meaning-making synopsis and its impact on patient care. The findings will inform further refinement of the intervention to enhance perceived benefits. Semi-structured interviews were conducted with HCPs who referred patients for a meaning-making conversation. A reflexive thematic analysis was performed. The following themes were constructed from the interviews with HCPs (n = 10): providing potentially useful existential information to HCPs, supporting personalised, value-based care through the synopsis and barriers and facilitators for using the synopsis. HCPs appreciated the synopsis for its insight into patients' sources of meaning and existential needs, for its ability to initiate conversations about meaning and its potential impact on discussing treatment options. For half of them, it helped deliver more personalised care. For some it provided reassurance that the treatment aligned with patients' wishes. The most frequently mentioned barriers to starting a conversation about meaning were lack of contact due to disrupted continuity of care and limited time. HCPs appreciated the meaning-making synopsis and recognised the (potential) impact on enhancing personalised care. The synopsis can assist HCPs in integrating the existential dimension into clinical care.
Fortification of wheat-based products with high-nutritional-value ingredients is becoming of great interest as a strategy for producing high-quality sustainable food products. Therefore, pumpkin products such as pulp (PPU), peel (PPE), and seed (PS) were blended into wheat pasta at different proportions and combinations using D-optimal mixture design (DMD), resulting in 12 mixtures between PPU, PPE, and PS flours. Fifteen responses were analyzed and predicted models with high accuracy (p < 0.02) and a satisfactory coefficient of determination (R2 > 0.92). The optimum composition was 85% semolina, 11.85% PPU, 0% PPE, and 3.15% PS, achieving a desirability of 86.04%. It corresponded with the following properties: moisture of 9.66%, ash of 1.49%, protein of 11.89%, fat of 1.63%, carbohydrates of 75.06%, total phenolics of 107.22 mg/100 g dry weight (DW), total flavonoids of 19.27 mg/100 g DW, carotenoids of 10.17 mg/100 g dry powder (DP), and antioxidant activity of 15.34%. The cooking loss, optimal cooking time, and water absorption capacity reached values of 5.04%, 8.5 min, and 211.86%, respectively. The color parameters L*, a*, and b* values were 84.38, 2.76, and 27.3, respectively. The sensory analysis scores of the DMD mixtures disclosed that the mixture with 12% PPU and 3% PS was the most appreciated, and these proportions were quite similar to the optimized formula, which could be a major asset in combining nutritional and sensory profiles. This new formulation advocated that pasta fortified with pumpkin products could confer improved nutritional, cooking, and sensorial profiles. PRACTICAL APPLICATIONS: For the production of products with appealing consumer attributes, adding additives to pasta formulas is a suitable replacement. The amount of ingredients added can affect the pasta's quality and produce properties that could impact the final result. It is possible to identify the ingredients that support pasta quality using the D-optimal combination design, which provides pertinent information for the food sectors. The findings defined the proportions of pumpkin products, including pulp, peel, and seed, in pasta. They also disclosed their remarkable potential in enhancing the quality parameters, nutritional value, and cooking profile of pasta while maintaining a satisfactory sensorial profile, thereby promoting the industrial development of high-value alimentary paste.
We evaluated a Collaborative Online International Learning (COIL) programme in enhancing nursing students' intercultural sensitivity and understanding of cultural safety. From April to May 2024, nursing students in Japan, the United Kingdom, and New Zealand completed a COIL module integrating Virtual Empathy Museum exploration, Padlet discussions, and live debriefings. A convergent mixed-methods design was adopted. Multi-source qualitative data were thematically analysed and integrated with pre/post Intercultural Sensitivity Scale (ISS) scores compared using Wilcoxon signed-rank tests. Students reported a deeper understanding of cultural safety, appreciated diverse perspectives in nursing care, and valued the opportunity for cross-cultural learning. ISS scores showed no significant change, although Intercultural Attentiveness significantly improved among Japanese students. This programme has the potential to develop intercultural sensitivity, cultural safety awareness, and support culturally congruent learning across continents. Further studies with larger samples and longer follow-up are needed to assess scalability and longer-term outcomes.
Overweight and obesity in adolescents have become significant public health issues, with traditional interventions showing limited effectiveness. Cognitive behavioral therapy (CBT) offers a novel approach to adolescent health promotion by altering individuals' cognitive and behavioral patterns. This study was designed to construct a health behavior promotion model for overweight adolescents integrating CBT theory and to empirically validate it based on multidimensional behavioral scoring. A cross-sectional study was conducted among 294 adolescents aged 13-16 from three secondary schools. Participants were classified into overweight/obese (n = 86) and normal weight (n = 208) groups based on BMI criteria. Data were collected using the Body Appreciation Scale-2, Weight Control Practices Questionnaire, and Comprehensive Lifestyle Assessment Scale. Statistical analyses included independent t-tests, Pearson correlation, structural equation modeling (SEM), and multiple regression. Overweight adolescents scored significantly lower in body appreciation cognition (t = 4.32, p < 0.001) and healthy weight control behaviors (t = 3.87, p < 0.001), and higher in unhealthy weight control behaviors (t = 4.96, p < 0.001). SEM revealed that body appreciation cognition had a direct negative effect on BMI (β = -0.18, p < 0.01) and an indirect effect through healthy weight control behaviors (β = -0.12, p < 0.05). The model demonstrated good fit (χ2/df = 2.36, CFI = 0.94, RMSEA = 0.06). The findings support the applicability of a CBT-based health behavior promotion model for overweight adolescents. The model, encompassing cognitive restructuring, behavioral activation, self-monitoring, and relapse prevention, provides a theoretical foundation for school- and community-based interventions.
To explore the acceptability of the Community Outpatient Psychotherapy Engagement Service for Self-harm (COPESS) intervention and trial procedures for participants. A mixed-method approach and a single-blind randomised controlled trial design with 1:1 allocation to either COPESS plus treatment as usual or treatment as usual alone. Primary care. Fifteen semistructured interviews were conducted with participants in the COPESS trial; eight were randomised to the intervention arm, and seven were randomised to the treatment-as-usual arm. Interviews lasted 30-60 min. COPESS is a brief, relational psychotherapy delivered over 4 weekly sessions plus a follow-up, focusing on understanding difficult emotional states and their links to self-harm through here-and-now relational and emotional processes. Thematic analysis allowed exploration of themes important to participants in their experiences in the COPESS trial and their experiences of care for self-harm more generally. Five themes were identified as associated with the acceptability of the COPESS intervention and trial: self-harm as a primary problem, what I needed when I needed it, being heard and understood, online delivery of the intervention and lasting impacts. Participants generally expressed positive views about the intervention, citing a need for services that specifically target self-harm and an appreciation of the rapid access to help. Strong relationships with the therapist were highly valued and not diminished by online delivery of the intervention. Positive impacts continued post therapy sessions. These results support the acceptability of the COPESS intervention, the need for self-harm specific services and support moving forward to a full trial. Pre-registered on clinicaltrials.gov (NCT04191122) on 9 December 2019.
Spinal angiolipomas are rare benign epidural tumors accounting for 0.14-1.2% of all spinal neoplasms. Pathologically, these lesions are composed of mature adipose tissue and contain proliferative vascular elements. Here, a 44-year-old female presented with a thoracic epidural angiolipoma causing progressive myelopathy, which was diagnosed and effectively managed, resulting in a good clinical outcome. A 44-year-old female presented with a 7-month history of progressive thoracolumbar pain radiating into the lower extremities, accompanied by bilateral paraparesis (Medical Research Council scale [MRC] 4/5), symmetric hyperreflexia, and a T8-T9 sensory level to pin appreciation, along with impaired vibration/proprioception (Nurick Grade 3; Modified Japanese Orthopaedic Association scale [mJOA] score 11/18). The magnetic resonance imaging demonstrated a T7-T8 epidural mass with heterogeneous T1 signal and T2 hyperintensity that homogeneously enhanced with contrast, causing significant spinal cord compression and intramedullary high signal. Through a T7-T8 decompressive laminectomy, gross total tumor resection from T6 to T9 was accomplished; additionally, a T6-T9 posterior instrumented fusion was performed. Histopathology confirmed a non-infiltrating epidural angiolipoma. Three months postoperatively, the patient's ability to ambulate continued to improve. Spinal angiolipomas should be considered amongst the differential diagnoses of spinal epidural masses, particularly in middle-aged women presenting with progressive myelopathy. Notably, early surgical decompression with gross total tumor resection offers an excellent prognosis.
Practitioners worldwide have become interested in fascia and how it relates to human appearance and movement. Our study describes an anatomic layer containing connective tissue attachments between the dermis and threconstructive surgery and physical therapye underlying deep investing fascia. Classically labeled as the retinacula cutis (RCs) or fatty septa within the hypodermis, we sometimes refer to these connective tissue attachments as the subcutaneous endoskeleton or Cinderella Layer for their overlooked importance. The significance of these structural attachments as functional tethers has, to a large degree, been neglected. We are adding a descriptive classification system to various types of RCs, while further exploring the important clinical implications of the anatomy through a lens of reconstructive surgery and physical therapy. Dissection of 25 fresh, lightly embalmed, and hypertonic saline embalmed cadavers complemented years of clinical observation to identify and describe consistent relationships between the skin, hypodermis, fascia, and, in some cases, periosteum. We qualitatively noted whether the connective tissue attachments within the hypodermis were long or short, dense or filmy, elastic or rigid, and further subdivided the collagen and elastin bands into functional categories. Identification of the RCs was also attempted on sections from the Visible Human Project (National Library of Medicine). Our dissections revealed numerous and consistent attachments between the fascia and dermis. These RCs are found to have distributed fascial-dermal attachments with directional organization. The origin is typically a continuous fascial covering of muscle or bone, and the insertion is the dermal layer of the skin. The gross morphology of these attachments reinforces their aesthetic and functional purpose as a boundary, anchor, animator, accordion or elastic framework. In most areas of the body, the RCs serve more than one of these purposes. A few of these complex areas are highlighted separately. Gaining an appreciation for the concept of fascial-dermal attachments that define the human body as an organized network of compartments, contours, and creases is relevant to the surgeon, therapist, artist, and student of anatomy alike. Once recognized, their function can often be appreciated. Cataloging and categorizing the RCs with respect to their morphological and functional variability is a crucial addition to modern clinical anatomy.
Since establishment in 2020 of the global consensus-2 diagnostic criteria for mast cell activation syndrome (MCAS), recognition of this prevalent disease, existing alongside rare cutaneous or systemic mastocytosis, has grown significantly. Despite this progress, some have continued using more restrictive criteria, significantly underdiagnosing this complex but treatable disorder. Consensus-2 has brought diagnosis and effective treatment in many MCAS patients previously labeled with unexplained (mostly inflammatory) syndromes or misdiagnosed as somatization or other primary psychiatric disorders. Fears that consensus-2 diagnostic criteria might bring overdiagnosis have not been realized. Appropriate therapy for MCAS can dramatically improve quality of life, sometimes after decades of morbidity and disability despite extensive past unhelpful workups and treatment. Appreciating the breadth and heterogeneity of MCAS, and achieving good management outcomes, requires understanding the complexity of mast cell biology and pathophysiology as well as the range of comorbidities the disease can drive and which can aggravate the disease. The spectrum of diseases thought possibly rooted in variants of MCAS (or to which MCAS is significantly contributing) continues expanding, calling for more research. New therapeutic options have emerged, and clinicians have gained better appreciation for use of existing treatments and mitigation of impediments to treatment. MCAS research remains in early stages, hampered by many factors including limited awareness of the disease and challenges in objective assessment of treatment response. This review examines developments in awareness, education, clinical care, and research since consensus-2 emerged, while discussing challenges and opportunities for accelerating progress.
Pregnancy involves profound physical and psychological changes that may increase the risk of lumbopelvic pain and affect body image. Body surveillance and functionality appreciation are key constructs in this context, yet little is known about interventions targeting them in pregnant women experiencing pregnancy-related pain. This study examined whether standard prenatal education alone or combined with pain neuroscience education could improve functionality appreciation and reduce body surveillance in women with pregnancy-related lumbopelvic pain. A total of 211 third-trimester pregnant women with pregnancy-related lumbopelvic pain were randomly assigned to standard prenatal education or a combined program with pain neuroscience education. Both programs included twelve online lessons delivered over four weeks. Functionality appreciation and body surveillance were measured at baseline and post-intervention using validated questionnaires. Linear mixed models were used for analysis under an intention-to-treat approach. Functionality appreciation improved significantly over time in both groups (p = .018), but no between-group differences were observed (Cohen's d = 0.056). Body surveillance scores remained unchanged in both groups (Cohen's d = 0.00). Adherence was higher in the SPE group (88%) compared to SPE+PNE (77.5%, p = .011). Brief online educational programs, especially standard prenatal education, can enhance functionality appreciation during pregnancy, shifting focus from appearance to bodily capacities.