Generative artificial intelligence [GenAI] is increasingly treated as a primary explanation for students' perceived difficulties with sustained attention in nursing education. The author contends that such a framing risks misdiagnosing a longerstanding educational concern. While GenAI raises legitimate issues related to misinformation, overreliance, academic integrity, privacy, and critical thinking, students' attentional difficulties should also be understood within the broader history of the attention economy, short-form media, and digitally saturated learning environments. Drawing on literature on sustained attention, cognitive effort, attention regulation, digital distraction, short-form media, and GenAI in healthcare education, the author highlights a chronological mismatch between the recent emergence of widely accessible GenAI tools and earlier shifts in digital environments that reward novelty, rapid attentional switching, and low-friction engagement. Rather than reducing the issue to shortened attention span, the author examines how digitally saturated learning environments reshape sustained attention, attention regulation, and tolerance for cognitive effort in nursing education. This reframing matters because nursing education depends on students' capacity to sustain attention during clinical reasoning, patient assessment, communication, documentation, simulation-based learning, and safe decision-making. GenAI may amplify or make visible pre-existing challenges, but restriction alone is unlikely to address the broader attentional conditions shaping students' learning. Thus, the author calls for attention-supportive pedagogy that scaffolds cognitive effort, makes reasoning visible, supports digital and AI literacy, and deliberately cultivates sustained attention, critical evaluation, and clinical judgment in nursing education. Drawing on literature on sustained attention, cognitive effort, attention regulation, digital distraction, short-form media, and GenAI in healthcare education, the author highlights a chronological mismatch between the recent emergence of widely accessible GenAI tools and earlier shifts in digital environments that reward novelty, rapid attentional switching, and lowfriction engagement. Rather than treating declining attention span as a fixed cognitive trait or uniform population-level decline, the paper focuses on difficulties with sustained attention and attention regulation in contemporary nursing education. This reframing matters because nursing education depends on students' capacity to sustain attention during clinical reasoning, patient assessment, communication, documentation, simulation-based learning, and safe decision-making. GenAI may amplify or make visible pre-existing challenges, but restriction alone is unlikely to address the broader attentional conditions shaping students' learning. The paper therefore calls for attention-supportive pedagogy that scaffolds cognitive effort, makes reasoning visible, supports digital and AI literacy, and deliberately cultivates sustained attention, critical evaluation, and clinical judgment in nursing education.
Cancer is not a single disease but a dynamic ecosystem of molecular diversity. Multi-omics profiling provides a panoramic view of tumor biology, yet integrating these heterogeneous modalities into coherent, interpretable representations remains a fundamental challenge. Classical correlation-based methods capture shared variation but fail to model nonlinear, cross-modal dependencies essential for biological discovery. We introduce AttentionCCA, a supervised framework that extends canonical correlation analysis (CCA) with feature- and cross-modal attention to jointly learn discriminative and biologically meaningful projections. AttentionCCA incorporates a weighted multi-class sparse CCA backbone within dual attention modules: feature attention adaptively reweights intra-modality signals, while cross-modal attention enables inter-omics dialogue by aligning latent spaces. The model was tested across four TCGA cancer types (BRCA, LGG, STAD, UCEC) integrating mRNA, DNA methylation, and miRNA data, and externally validated on METABRIC, CGGA, GSE62254, and GSE17025. Across all datasets, AttentionCCA consistently outperformed traditional classifiers (KNN, SVM, Random Forest) and state-of-the-art integration baselines (DIABLO, MOGONET, bPLSDA), achieving accuracies up to 0.93 and Macro-F1 up to 0.92. Ablation studies showed that both attention modules are essential for performance gains, while attention heatmaps identified biologically relevant pathways such as RNA splicing in STAD and MAPK signaling in UCEC. By combining classical correlation analysis and modern attention mechanisms, AttentionCCA transforms multi-omics complexity into interpretable structure, enabling robust cancer subtype stratification and revealing biologically grounded molecular signatures. This work demonstrates how attention-guided representation learning can enhance our understanding of cancer heterogeneity.
Time-restricted eating (TRE), a form of intermittent fasting, limits daily food intake to a specific window. This randomized-controlled pilot study examined the potential of a 4-week 16:8 TRE regimen (16 h fasting, 8 h eating) as a behavioural intervention on cognitive performance, well-being, and body weight among healthy women. Participants were assigned to either a Fasting group (N = 23) or a Control group (N = 20) maintaining their usual diet. Cognitive performance was assessed weekly using the Symmetry Span task (working memory) and the Stroop Squared, Simon Squared, and Flanker Squared tasks (attentional control), along with well-being and bodyweight. Working memory and attentional control improved across time, but no significant differences were observed between groups. The Fasting group showed a statistically significant reduction in BMI compared with controls, with no group differences in reported adverse events. These findings suggest that short-term 16:8 TRE was feasible and well tolerated in this pilot sample and was associated with reduced BMI, with no evidence of TRE-specific improvement or impairment in the tested cognitive functions.
Post-match institutional communication has become a visible component of elite football events, yet comparable official messages can receive very different levels of public attention. This study examines UEFA Champions League post-match communication as a configurational problem rather than as a linear consequence of response speed or message strategy. Using 25 theoretically selected focal club-event observations from the 2017-2018-2022-2023 seasons, it calibrates one outcome set, High_News, from a Raw_Mentions-derived media-visibility proxy and four causal-condition sets: High_Delay, High_Shock, High_Stakes, and High_TemplateDeviation. The analysis uses conservative coding of template deviation, separating response latency from communication form. The intermediate solution identifies one stable high-stakes legacy pathway and one sensitivity-dependent crisis-minimalism pathway. The stable pathway combines non-delayed response, low outcome shock, high match stakes, and trophy/legacy-oriented template deviation. The crisis-minimalism pathway is retained in the baseline solution but is interpreted cautiously because it depends on medium-confidence coding and changes under strict recoding. The analysis of ~High_News confirms causal asymmetry: non-membership in the high-attention set is not simply the inverse of the pathway(s) associated with High_News. The findings contribute to sport communication research by showing how event structure and institutional discourse combine to produce bounded media visibility, while avoiding population-level claims about all football matches or internal platform algorithms.
While runoff forecasting models based on neural networks demonstrate the superior performance over traditional methods in the hydrological field, they also face challenges such as insufficient depth, rapid decay in accuracy with increasing lead times, and poor interpretability. To address these problems, we innovatively propose an interpretable hourly deep runoff forecasting framework capable of robust multi-lead-time forecasting: Spatio-Temporal Residual Bidirectional Gated Recurrent Unit (STResBiGRU). This framework fundamentally relies on a significantly enhanced BiGRU network, which not only captures the rich hidden relationships in long sequences through bidirectional traversal of the input sequence but also innovatively introduces unique temporal shortcut connections between cells. In the overall network architecture, the novel design of dual residual block pathways and dense spatial shortcut connections considerably deepens the recurrent architecture-based neural network. The integration of spatiotemporal shortcut connections effectively improves the mode of information transmission in different dimensions, mitigates the vanishing gradient problem caused by deep networks and long sequences, and enhances feature reuse. Furthermore, during the fusion of bidirectional information flows in BiGRU, we also propose a lightweight dual-path attention (DPA) mechanism module to explicitly model the interdependencies between features in both temporal and spatial dimensions of the forward and reverse GRU output feature maps, respectively, selectively amplifying key features to enhance the model's temporal robustness in processing long sequences. The training phase of the model employs the snapshot ensemble method, which is able to achieve excellent generalization performance of integrating multiple models through a single training process. Additionally, we use interpretable machine learning (IML) method to visualize the model's forecasting process, thereby enhancing algorithmic transparency. Ablation and comparative experiments on a real-world dataset from the Columbia River in the United States demonstrate that the proposed STResBiGRU framework significantly enhances accuracy and temporal robustness over mainstream models, providing reliable decision support for stakeholders.
Falls are a major tipping point in older adults, heralding functional decline and increased healthcare utilisation. Falls-risk-increasing drugs (FRIDs) are a key risk factor for falls, but their influence on outcomes when prescribed after a fall is under-examined. This study examined the association between an index fall requiring medical attention and subsequent 2-year risk of falls and fractures, evaluating how FRID use modifies this relationship. We analysed data from Waves 5 and 6 of The Irish Longitudinal Study on Ageing, including participants ≥ 70 years with 2-year follow-up. FRIDs were identified from medication lists using STOPPFall. Regression models were used to assess the association between index falls and falls/fracture outcomes during follow-up: Falls, falls requiring medical attention, emergency department visits due to falls, and fractures. Two-way interactions were used to assess how FRID use modified this association. Of 1717 participants, 14% reported a fall requiring medical attention at baseline; 38% were prescribed ≥ 1 FRID. Index falls were associated with increased future falls (OR 2.65), falls requiring medical attention (OR 3.82), ED attendance due to a fall (OR 2.93), and fractures (OR 2.46) over 2 years (all p < 0.01). Combined exposure to both a fall and FRIDs further amplified risk, with odds ratios ranging from 3.77 to 4.36 across outcomes. A fall requiring medical attention is a strong predictor of future falls burden, and FRID use significantly amplifies this risk. These findings highlight the need for targeted medication review within comprehensive geriatric assessment for older people with falls.
Accurate, nondestructive, and high-throughput identification of sorghum varieties is essential for intelligent agriculture and industrial quality control. However, single-modality approaches based on either RGB imaging or near-infrared spectroscopy (NIRS) often suffer from limited robustness when inter-variety differences are subtle. In this study, a synchronized NIRS-RGB multimodal dataset was established for six representative sorghum varieties, including 14,400 paired kernel samples (2400 samples per variety). Each sample contained a NIR spectrum covering 901.467-1706.76 nm with 256 variables and a high-resolution RGB image. An end-to-end Multi-modal Attention Network (MAN) was proposed to perform deep feature fusion through bi-directional cross-attention, enabling adaptive interactions between spectral physicochemical signatures and visual appearance cues. Under an 8:2 split with five-fold cross-validation on the training set, MAN with a Swin Transformer visual branch achieved an accuracy of 0.9888 and an F1-score of 0.9889, outperforming the best NIRS-only baseline by 8.40 percentage points in accuracy and the best RGB-only baseline by 6.09 percentage points. Ablation results showed that cross-attention was the major contributor to performance improvement, while bi-directional interaction and spectral SE attention further enhanced discriminability. Furthermore, independent three-day replicate validation achieved a pooled accuracy of 0.9758 and an F1-score of 0.9755, indicating good generalizability across acquisition days. The results demonstrate that the proposed MAN effectively exploits complementary NIRS and RGB information, providing a robust and nondestructive solution for fine-grained sorghum variety identification in high-throughput inspection scenarios.
Complex gastroschisis (cGS) is associated with substantial neonatal morbidity, but long-term outcome data remain limited. To evaluate long-term outcomes of patients with cGS. We performed a retrospective single-center cohort study of patients with cGS treated between 2008 and 2016. Clinical data were obtained from the electronic health record. Long-term parent-reported outcomes were assessed by telephone survey using the PedsQL™ Quality of Life, Cognitive Functioning, and Gastrointestinal Symptoms Scales. Scores were compared with published reference data from patients with simple gastroschisis and healthy children. Fifty-seven patients with cGS were included, with no mortality and a median follow-up of 9.7 years. After discharge, nine patients (15.8%) were hospitalized for nonoperative small bowel obstruction, and 16 (28.1%) underwent at least one abdominal operation. For most patients growth improved over time. Twenty-three parents completed the survey, reporting overall quality-of-life to be similar to literature-based simple gastroschisis and healthy reference populations, whereas cognitive functioning and selected gastrointestinal symptom domains were worse, particularly diarrhea, constipation, and reflux-related symptoms. Attention-deficit/hyperactivity disorder was the most commonly reported psychiatric diagnosis, present in 8 of 23 surveyed patients (34.8%). Children with cGS have excellent long-term survival but substantial ongoing morbidity. Despite frequent catch-up growth and preserved overall parent-reported quality of life, many patients require abdominal reoperations, have persistent gastrointestinal symptoms, and have worse parent-reported cognitive functioning compared to controls. These findings support the need for longitudinal multidisciplinary follow-up with attention to bowel function and neurodevelopment.
Despite increasing attention to ketogenic dietary therapy (KDT) for drug-resistant epilepsy (DRE) in children, research examining its impact on non-seizure outcomes in children and their mothers remains limited. This study examined effects of KDT on sleep quality, children's psychosocial functioning, and maternal mental health. This prospective study followed 40 children with DRE and their mothers from baseline to 4 and 12 weeks after KDT initiation. Children's sleep and psychosocial functioning were assessed using the Children's Sleep Habits Questionnaire and the Strengths and Difficulties Questionnaire. Maternal sleep and mental health were evaluated using the Pittsburgh Sleep Quality Index and the Depression Anxiety and Stress Scale. Significant improvements in children's sleep and psychosocial functioning, as well as maternal sleep and mental health symptoms, were observed at 4 weeks, with the greatest improvements at 12 weeks. Regression analyses showed changes in seizure severity were associated with improvements in children's sleep and psychosocial functioning. Improved children's sleep was associated with better psychosocial outcomes. Maternal sleep quality and stress demonstrated a reciprocal relationship. A 12-week KDT was associated with improvements in children's sleep quality and psychosocial functioning, as well as maternal sleep quality and mental health, suggesting benefits beyond seizure control. KD has recently gained attention in pediatric drug resistant epilepsy (DRE) management, and further potential assets for patients and families should be emphasized. KD is a tolerable, safe, and effective line of therapy in pediatric DRE without significant negative impacts on the patients. The positive effect of KD on sleep and psychological function of pediatric patients, as well as mothers' mental health, are promising findings, and wider scale studies and longer KD usage can prove additional achievements in treated patients.
Accurate forecasting of effluent total nitrogen (TN) is essential for stable operation and compliance-risk management in wastewater treatment plants (WWTPs). However, nonlinear biochemical reactions, multiscale temporal dependencies, and weak physical coherence in purely data-driven models still limit prediction reliability. This study proposes a physics-informed dual-attention BiLSTM-Kolmogorov-Arnold network framework, termed PI-DABiLSTM-KAN, for accurate and interpretable effluent TN prediction. LightGBM-SHAP was used to screen process-relevant variables from high-dimensional monitoring data, and ASM1/ASM3-informed descriptors were constructed to represent nitrogen-transformation potential. Feature and temporal attention were introduced to capture key variables and long-range temporal dependencies, while a KAN decoder enhanced nonlinear mapping. Soft constraints derived from mass conservation and Monod kinetics were embedded into a two-stage adaptive training strategy to improve physical plausibility. The framework was evaluated using long-term online monitoring data from a full-scale WWTP in China and an independent external WWTP validation dataset. On the main test set, PI-DABiLSTM-KAN achieved R² = 0.9796, RMSE = 0.3580 mg/L, and MAE = 0.0968 mg/L, with less than 0.8% R² degradation under noise perturbation. It maintained R² > 0.95 for 1-60 h forecasts and achieved R² = 0.9610 on the external validation dataset, with stable seasonal performance across spring, summer, autumn, and winter. Physical-consistency analysis showed that the adaptive physics strategy reduced Any violation from 4.21% to 1.87%. SHAP-CCM analysis further distinguished model-sensitive proxy variables from dynamically coupled candidate drivers, identifying Coarse_Screen_Pump_Flow as a controllable variable with dynamic-coupling support. Counterfactual regulation analysis indicated that coordinated adjustment of hydraulic loading, influent pH, and aerobic pH could reduce high-risk TN predictions within the 0-15 mg/L compliance-risk screening interval. These results suggest that PI-DABiLSTM-KAN provides a process-plausible decision-support framework for effluent TN prediction and operational screening in WWTPs.
Access to safe drinking water remains a global challenge due to increasing contamination by heavy metals, organic pollutants, dyes, pharmaceuticals, oils, and pathogenic microorganisms. In this context, sustainable and low-impact materials for water purification are gaining increasing attention. This review focuses on bio-based materials, specifically cellulose, lignin, and melanin, as well as their functionalized derivatives and hybrid systems, for water purification applications. These materials are integrated within a common framework, allowing direct comparison of their structure-property-performance relationships and highlighting potential complementary functionalities. Emphasis is placed on adsorption-filtration processes, membrane technologies, and electrospun fibrous systems. Nanocellulose-based materials, including cellulose nanocrystals, nanofibers, and bacterial cellulose, are discussed in terms of extraction methods, surface functionalization, adsorption behavior, and performance toward a wide range of contaminants. Lignin-based systems, such as sorbents, hydrogels, foams, aerogels, and hybrid membranes, are examined with attention to the effects of chemical modification on adsorption capacity, selectivity, and reusability. Emerging melanin and melanin-like materials, particularly polydopamine-based systems, are also considered, highlighting their ability to bind metal ions and organic pollutants and their integration into multifunctional composites and membranes. Across all material classes, the role of surface chemistry, porosity, and structural organization in determining adsorption performance is discussed, together with adsorption models, regeneration behavior, practical constraints, and the current level of technological maturity of the different material systems. After an overview of biodegradability and sustainability aspects, the review critically examines key limitations, including long-term stability, regeneration efficiency, validation under realistic wastewater conditions, and scalability, which currently hinder large-scale implementation. These aspects are discussed to outline future research directions toward the development of effective and sustainable water purification technologies based on renewable bio-based materials.
Suicide is a leading cause of death among young people worldwide and remains a significant cause of mortality across all age groups, especially in older adults. The underlying causes of suicide span various disciplines and are deeply influenced by societal attitudes, which fluctuate between glorification and severe condemnation of suicide. This study aims to evaluate the role of court rulings on suicidal behavior, with particular attention to implications for healthcare policy in Israel. We searched the national court rulings databases for alleged psychiatry malpractice in suicide-related cases and of pre-trial settlements from 1985 to 2023. For court decisions, we collected patients' socio-demographic and clinical characteristics, lawsuit characteristics, and the quality of medical documentation and decision-making processes. For pre-trial settlements, we collected data about lawsuit characteristics. Two researchers reviewed the qualitative data, while the quantitative data was analyzed with descriptive statistics. Over the 38-year period, there were 20 psychiatry malpractice court lawsuits related to patient suicides, including 17 deaths and 3 life threatening attempts. Of these, 12 (60%) of cases were won by the plaintiff, and eight (40%) by the defendant. In 14 cases, the suicides occurred in inpatient units and in six cases in community settings. The number of lawsuits notably increased over time for suicide events, with 17 pre-court settlements between 1985 and 1997, and 56 cases in each of the subsequent periods (1998-2010 and 2011-2023). The number of malpractice lawsuits related to suicide in Israel is increasing over time. Our findings, which show a rise in both litigation and pre-trial settlements, may put pressure on psychiatrists to avoid certain kinds of work, especially in the public sector. Such a shift could have broader effects on the quality of suicide prevention efforts and overall mental health care. The study highlights the structural tension between retrospective legal accountability and prospective clinical and public-health approaches to suicide prevention. Addressing this challenge requires balanced policy responses, including strengthening patient-safety and risk-management systems, improving clinical documentation and decision transparency, fostering constructive collaboration between legal and mental health systems, and considering alternative compensation mechanisms that reduce adversarial pressures while supporting affected families.
The associations between the herpesviral infections and neurodevelopmental disorders, including autism and attention deficit hyperactivity disorder (ADHD), remained unclear. Using the Taiwan National Health Insurance Research Database, the present study included 27,922 children < 6 years who were exposed to herpesviral infections between 1997 and 2011, as well as 111,688 age- and sex-matched children who were not exposed. All participants who developed autism and ADHD, as well as started to use ADHD medications during the follow-up (from enrollment to the end of 2013) were identified. Human herpesvirus (HHV) subtypes were further assessed for the neurodevelopmental disorder risk. After adjusting for demographic characteristics, perinatal conditions, Charlson Comorbidity Index scores, and all-cause clinical visits, we found that any herpesvirus infection was associated with increased risks of developing autism (hazard risk [HR]: 2.23), ADHD (1.53), and ADHD medication use (HR: 1.42). We further observed such increased risks in HHV-1/2, HHV-3, HHV-4, and other HHVs, but not in HHV-5. Finally, a herpesviral infection involving the central nervous system was markedly related to higher risks of developing autism (HR: 6.16) and ADHD medication use (1.77). Preschool children exposed to herpesvirus infection had higher subsequent risks of autism and ADHD, as well as a greater likelihood of ADHD medication use than unexposed peers. Elucidating the immunoneuro developmental mechanisms underlying herpesviral infection and neurodevelopmental disorders will require additional investigation.
In April 2024, two severe flooding events in southwestern Pennsylvania caused regional disruptions. How smaller-scale, rapidly unfolding disasters affect opioid use disorder (OUD) treatment and recovery services remains underexamined in disaster and public health research. This study explores how these localized floods influenced OUD service provision. We conducted 18 semi-structured interviews with treatment program directors, clinicians, counselors, and emergency service providers in Allegheny and Washington counties. Interviews focused on general operational challenges, disruptions in patients' OUD treatment, and adaptations made to the provision of OUD services during and after the flooding events. Participants described the April floods as disruptive but not catastrophic, noting that the impacts on service provision were substantially mitigated by telehealth infrastructure that had been established during the COVID-19 pandemic. Virtual service delivery was critical in sustaining continuity of care when transportation systems and in-person appointments were interrupted. Telehealth, however, was uneven in its effectiveness: it supported stable patients, caregivers, and those with transportation barriers, while presenting challenges for individuals in early recovery, those lacking private or safe home environments, and those with limited digital literacy. Across interviews, providers emphasized flexibility and patient-centered care as essential to adapting service delivery during the floods. Findings demonstrate that smaller, fast-onset disasters warrant greater attention in disaster preparedness planning for behavioral health systems. Strengthening telehealth access and embedding flexibility into OUD treatment models may enhance resilience for both patients and providers as climate change increases the frequency of localized hazard events.
Ants dominate terrestrial ecosystems yet are often overlooked in temperate annual cropping systems. These social insects provide valuable ecosystem services in tropical and subtropical agriculture, but their potential roles in temperate row crops have received less attention. This review examines how no-till farming practices create opportunities for ants to establish and contribute to pest suppression, weed-seed removal, and soil improvement in temperate row crops. Unlike conventional tillage that may destroy ant colonies, no-till systems preserve nest architecture and foraging networks, allowing ant populations to persist across growing seasons. Evidence from multiple regions demonstrates that no-till fields support greater ant abundance, species richness, and predation activity than tilled systems. Cover crops further enhance ant communities by providing habitat complexity and alternative prey, while integrated pest management preserves beneficial populations through judicious insecticide use. Ants offer multiple mechanisms for pest control, including direct predation, non-consumptive deterrence, and season-long activity when other natural enemies are scarce. Their soil engineering activities create biopores that improve water infiltration and nutrient transport. Despite these potential benefits, critical knowledge gaps persist regarding ant community composition, seasonal activity patterns, and quantitative impacts on economically important pests in temperate systems. Future research should apply molecular gut content analysis and stable isotope techniques to reveal cryptic trophic interactions, develop economic valuations of ant-mediated services, and create practical decision-support tools for farmers. As agriculture faces pressure to reduce environmental impacts while maintaining productivity, conservation practices that support ant communities represent an underutilized strategy for sustainable intensification in temperate cropping systems. © 2026 The Author(s). Pest Management Science published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.
Asymptomatic tuberculosis (TB) is emerging as a disease state warranting attention because it is presumed infectious, yet affected individuals lack symptoms. The World Health Organization recommends screening for cough, fever, weight loss and night sweats and recently defined asymptomatic TB. However, the place of these symptoms in the definition has not yet been standardised. We determined the proportion of patients with bacteriologically confirmed asymptomatic TB without four symptom definitions: persistent cough (> 2 weeks), cough of any duration, W4SS of any duration or W4SS for > 2 weeks. Secondary analysis of the Namibia TB prevalence survey data was performed; a representative sample had been interviewed for symptoms, underwent chest radiography and was offered bacteriological testing. The proportion of asymptomatic TB was computed for each definition. Logistic regression was used to determine factors associated with asymptomatic TB across four definitions. Among 29,495 participants in the nationally representative sample (86.8% of the target sample size), 123 TB cases met the case definition. Mean age was 45 years, and 74 (60%) were male. Of TB cases, 60/123 (48.8%) reported a cough of any duration, 20/123 (16.3%) a fever of any duration, 25/123 (20.3%) weight loss and 26/123 (21.1%) night sweats. Asymptomatic TB ranged from 39.8% to 63.0% by definition, with screening based on prolonged cough missing 63.0% of bacteriologically confirmed TB patients, while screening based on W4SS any duration missed 39.8% of TB cases. Even when using an inclusive symptom screening system that includes any duration of the W4SS, asymptomatic TB occurred in 39.8%, highlighting a public health concern for asymptomatic TB. There is a need to standardise the symptoms being used when defining asymptomatic TB and we recommend the W4SS of any duration.
This narrative review examines post-traumatic stress disorder (PTSD) and other trauma- and stressor-related mental health disorders in elite athletes. Elite athletes may experience these disorders at higher rates than the general population owing to disproportionate exposure to traumas and stressors, which can be experienced at individual and collective levels. These disorders can be difficult to detect due to complex symptom presentations and coping strategies that may mask symptoms. They can have both psychological and somatic components, and this dual nature has significant relevance for elite athletes given sport demands. Early identification of elite athletes suffering from trauma- and stressor-related symptoms may prevent progression to PTSD and other chronic mental health disorders. Cultural considerations specific to trauma require attention, as athletes' diverse cultural backgrounds shape help-seeking behaviours, symptom expression, stigma and access to care. Within a framework of trauma-informed care, first-line psychotherapies are generally cognitive-behavioural therapy-based, and first-line pharmacological treatments are generally serotonergic antidepressants. Team-based interventions may be necessary if there is a vicarious aspect to traumas or stressors. Future needs for the field include study and implementation of coordinated approaches to trauma screening and trauma- and stressor-related symptom screening for elite athletes. Healthcare providers and other entourage members for elite athletes should receive education on trauma-informed approaches. Organisational supports should facilitate implementation of trauma-informed care. Further research is needed on all types of traumas and stressors and particularly on institutional and systemic maltreatment as well as on established and emerging therapies as uniquely applied to elite athletes.
Targeting the ubiquitin-proteasome system has emerged as a powerful therapeutic strategy in oncology, particularly through modulation of deubiquitinating enzymes that regulate the stability of oncogenic proteins. Among these, ubiquitin-specific protease 7 (USP7) has garnered considerable attention due to its ability to deubiquitinate and stabilize multiple cancer-relevant substrates, including MDM2, FOXP3, N-Myc, and PTEN. By controlling protein turnover and subcellular localization of substrates, USP7 contributes to tumor progression across diverse types of cancer, positioning it as an attractive therapeutic target. Here, we report the identification of novel small-molecule USP7 inhibitors from a high-throughput screening campaign employing the fluorogenic ubiquitin-rhodamine enzymatic assay. Screening of 2446 compounds led to the identification of five hit compounds with measurable inhibitory activity against recombinant USP7 in vitro. These hits were further evaluated for antiproliferative activity across a panel of human and murine cancer cell lines with distinct molecular backgrounds. Among the identified hits, YM155 displayed the highest activity across all cancer types tested, exhibiting nanomolar IC50 values in the proliferation assays. Importantly, YM155 demonstrated significant tumor growth inhibition in lung and breast cancer mouse models, supporting its in vivo activity and pharmacological tractability in clinically relevant settings. Together, these findings expand the chemical space of USP7 inhibitors and identify YM155 as a hit for further optimization and mechanistic investigation toward USP7-targeted anticancer therapeutics.
Subjective cognitive decline (SCD) is under-addressed in survivorship care despite associations with other adverse patient-reported outcomes and poor long-term cognitive health. Research on SCD and social determinants of health (SDOH) is limited among cancer survivors. This study examined associations of SCD, and its impacts, with cancer-related characteristics and SDOH among survivors. The study analyzed cross-sectional data from survivors ages ≥ 45 years in the nationally representative 2023/2024 Behavioral Risk Factor Surveillance System. Survey-weighted modified Poisson regression modeling with robust standard errors was employed. Exposures were cancer-related characteristics (cancer type, age at diagnosis, multiple cancer diagnoses) and SDOH (employment instability, food insecurity, low social connection, financial strain, limited transportation, number of SDOH). Outcomes were SCD and four SCD-related impacts (worrying, discussing with a healthcare provider, interference with day-to-day activities, interference with work/volunteer activities). Prevalence ratios (PRs) with 95% confidence intervals (CIs) are reported. Among 11,713 survivors, the weighted prevalence of SCD was 19.6%. Being diagnosed before age 40 and with multiple cancers were associated with greater prevalence of SCD in bivariate analyses, however, no cancer-related characteristics were associated with SCD measures in multivariable analyses. Each SDOH measure except employment instability was associated with SCD (aPRs = 1.37 to 2.25; all p ≤ 0.0039), versus no SDOH. Compared to no SDOH, number of SDOH was associated with each SCD-related impact (aPRs = 1.35 to 3.36; all p ≤ 0.0007) except provider discussion. Findings highlight the role SDOH plays in influencing SCD among survivors. Greater attention to SCD may improve long-term outcomes among survivors.
As extracorporeal membrane oxygenation (ECMO) utilization has increased and evolved over decades, much literature has focused on the technical and clinical aspects, with substantially less attention paid to the impact of ECMO support on patients, families, and clinicians. As part of the ECMO Ethics Workgroup project, this paper explores the experiential aspects and impacts of ECMO on clinicians, patients, and families. Review of available literature identifies substantial physical and psychological burdens associated with ECMO survivorship as well as psychosocial challenges for family members and medical decision makers. We also examine the impact of ECMO support on clinicians providing care. Though many challenging experiences associated with ECMO are potentially unavoidable consequences of care, we recognize an ethical imperative to improve our understanding of such challenging experiences and develop strategies to reduce or resolve them. As such, we review the current literature and provide recommendations based on our current understanding to improve the experiences of those impacted by ECMO. Our recommendations include guidance on clear and consistent decision-making frameworks, interdisciplinary communication, incorporation of patient values, and early ethics and palliative care consultation. Given the limited evidence, we also call for further research to support best practices in ECMO care, particularly regarding interdisciplinary communication, expert consultation, educational interventions for families, and systematic follow-up of survivors.