Close friend support is a key emotional and coping resource during adolescence, yet less is known about the psychological variables that may statistically account for its association with students' perceived school climate. We conducted a cross-sectional survey among 1,380 Chinese high school students aged 15-18 years from five senior high schools in Shihezi, Xinjiang, China. Perceived school climate was measured using the 12-item school climate component of the Abbreviated Dual School Climate and School Identification Measure-Student; basic psychological needs satisfaction in exercise, self-esteem, and close friend support were assessed with self-report scales. Covariate-adjusted specific and sequential statistical indirect effects were estimated using PROCESS Model 6 with 5,000 bootstrap resamples while controlling for sex and grade level. Perceived school climate was positively associated with close friend support (total effect B = 0.507, 95% CI [0.463, 0.550]). A direct association remained statistically significant after accounting for both intervening variables (B = 0.263, 95% CI [0.217, 0.310]), and the total indirect effect was B = 0.243 (95% CI [0.209, 0.279]). Statistically significant indirect effects were observed via basic psychological needs satisfaction in exercise (B = 0.084, 95% CI [0.062, 0.107]), via self-esteem (B = 0.113, 95% CI [0.088, 0.138]), and sequentially via basic psychological needs satisfaction in exercise and self-esteem (B = 0.046, 95% CI [0.035, 0.058]). A more positive perceived school climate was associated with greater close friend support, with statistical indirect effects via exercise-related basic psychological needs satisfaction and self-esteem. The findings point to practice-relevant considerations for supportive school climates and need-supportive exercise contexts; however, because the data were cross-sectional and adjusted only for sex and grade level, these indirect effects should not be interpreted as evidence of temporal ordering or causal mediation.
Despite increased integration of digital technologies in higher education, nursing students face major barriers in resource-limited settings. The study investigated the utilisation of digital educational technologies amongst undergraduate nursing students in the Western Cape. The study was conducted at the school of nursing at a higher education institution in the Western Cape. A descriptive cross-sectional survey design with a self-administered questionnaire was used to collect data from a sample of 253 participants. Descriptive analysis was conducted to determine the frequencies and percentages; the mean score and Chi-square test were conducted to determine the association between the variables. Nearly 90% of participants had experience in the use of digital educational technology, 94.5%, learning management system and Facebook, and 93.7% used PowerPoint, communication and collaboration tools. The gender differences in technology use are consistent with the literature. The results suggest female respondents' frequent use of social networks. Male respondents reported more frequent use of bibliographic and web conferencing technologies. Although overall use was very low, gender remains an important factor in understanding technology use. In contrast, blogs, discussion forums and immersive technologies were amongst the least utilised educational technologies. Most nursing students use basic digital tools like learning management systems, Facebook and PowerPoint, but advanced tools such as blogs, forums and immersive technologies are underused, revealing a gap in digital competence that limits collaborative learning and clinical simulation. This study provides evidence on digital technology use amongst undergraduate nursing students, showing frequent use of basic tools but limited engagement with advanced, interactive technologies.
Malnutrition is a common problem during the treatment of pediatric cancer. Therapy-induced taste alterations (dysgeusia) can further exacerbate this and may reduce the acceptance of oral nutritional supplements (ONS). There are no available data on the acceptability of commercially available ONS among children and adolescents in Germany. In a prospective, double-blind tasting trial, 36 pediatric oncology patients (6-20 years) evaluated commercially available ONS and a cocoa-based reference beverage. The primary outcome was overall liking (taste rating) on a 1-6 ordinal scale (1 = excellent; 6 = unacceptable). Additional assessments included ratings of appearance and temperature, perceived basic taste qualities, and free-text flavour descriptions. Using linear mixed models, beverage taste ratings were compared globally and pairwise (adjusted for multiple comparisons), and sensory characteristics associated with higher acceptance were explored. Cocoa was rated best overall (mean taste rating 1.42 ± 0.7) and significantly outperformed all tested ONS in taste (Bonferroni-corrected p = 0.025 compared to next-best), appearance, and temperature. The best-rated supplements were predominantly sweet or sweet-sour (red fruits: 2.42 ± 1.3; summer fruit smoothie: 2.64 ± 1.5); the other products were rated rather poorly (all ≥3.47) and most were not accepted (4.0). For salty/savoury beverages, patients' qualitative taste descriptions frequently diverged from manufacturer-declared flavours. Ratings of appearance and temperature, along with perceived sweetness, and in many cases sourness, emerged as the most robust predictors of overall taste evaluations. However, a model comparison indicated that these characteristics did not fully explain between-beverage differences (likelihood-ratio test p < 0.001), suggesting additional unmeasured determinants of acceptance. Among patients in pediatric oncology, receiving chemotherapy, cocoa was consistently preferred over commercially available high-energy ONS. While cocoa served as a highly accepted reference beverage, the findings highlight the importance of flavour characteristics for acceptance. Strategies focusing on flavour optimization of nutritionally complete supplements may help improve oral intake during therapy. In addition to fruit-based beverages, cocoa-based formulations - particularly when combined with energy enrichment approaches - may represent a practical and cost-efficient strategy to support oral nutritional intake when acceptance of standard ONS is limited.
In recent years, the prevalence of myopia in children has increased significantly, with increasing screen exposure considered a potential contributing factor. This study aimed to evaluate parents' understanding of the relationship between myopia and screen time, as well as general awareness of myopia in society. In addition, parents' knowledge of protective factors and treatment options was assessed to provide evidence for future preventive strategies and healthcare planning. A structured questionnaire was administered to 2,031 parents to collect data on demographic characteristics, children's daily screen time, types of digital devices and content used, time spent outdoors, parental concerns regarding screen exposure, and knowledge of myopia prevention and control strategies. Associations between parental awareness and children's behavioral patterns were analyzed. The prevalence of myopia among children was 11.8%. A positive family history was the strongest factor associated with myopia, being associated with a 2.3-fold higher likelihood (p < 0.001). Each additional hour of daily screen exposure was associated with a 15% increase in myopia risk, whereas each additional hour spent outdoors was associated with a 28% reduction in likelihood (p = 0.002). Although 87% of parents reported basic awareness of myopia, knowledge of protective measures and treatment options was limited. In addition, 55.5% of children exceeded the recommended daily screen time. Higher parental education level was associated with greater adherence to regular eye examinations and more frequent adoption of protective behaviors. Parental knowledge alone, in the absence of corresponding behavioral changes and supportive structural interventions, was found to be insufficiently associated with reduced risk of childhood myopia. Higher parental education levels were associated with better adherence to regular eye examinations and more frequent adoption of protective behaviors. These findings suggest that strengthening parental education, expanding school-based vision screening programs, and promoting outdoor activity at the community level may be associated with improved awareness and healthier behavioral patterns related to myopia prevention.
Despite the widespread adoption of Nursing Information Systems (NIS), nurses often remain positioned as passive users, which limits the potential for system-driven care transformation. This narrative review synthesizes evidence on nurses' innovative use behaviors in NIS to identify actionable pathways for empowering nurses as co-designers of digital health solutions. A synthesis of peer-reviewed literature was conducted using PubMed, Web of Science, CNKI, Wanfang, and VIP. Studies were selected based on relevance to nurses' roles in NIS innovation following the SANRA principles. Nurses are key drivers in NIS innovation, shifting from passive users to proactive contributors to digital health. Evidence shows nurse-led initiatives improve patient safety, documentation, and care efficiency. Theories explain how nurses adapt NIS to clinical needs, especially in resource-limited settings. However, barriers remain, including inconsistent policies, inadequate digital training, and unequal system access. Advancing NIS innovation may require a policy shift from basic functional training toward structural empowerment. Policymakers and healthcare leaders should consider positioning nurses as system co-designers, providing protected resources and formal incentive mechanisms to foster a sustainable digital nursing ecosystem.
Paramedics in South Africa frequently respond to psychiatric emergencies in complex, high-risk pre-hospital environments. Their care is shaped by limited formal training, workplace cultures and varying mental health literacy, alongside legal, ethical and contextual constraints specific to emergency medical services. Despite these demands, little research has examined paramedics' perceptions, attitudes and experiences of psychiatric emergencies in South Africa. To explore paramedics' perceptions, attitudes and experiences of psychiatric emergencies and how they influence assessment, communication and decision-making in the pre-hospital setting. Paramedics working in private and public emergency medical services in Gauteng, South Africa. An exploratory qualitative design was employed. Semi-structured interviews were conducted with eight paramedics across Basic, Intermediate and Advanced Life Support levels. Data were analysed using inductive thematic analysis to identify patterns across participants' accounts. Five themes were identified. Participants described limited formal training in psychiatric emergency care, resulting in reliance on experiential learning and peer modelling. Communication and de-escalation were viewed as essential but inconsistently supported by training and resources. Workplace humour, stigma and emotional distancing were commonly described as coping responses, with divergent views regarding their impact on patient care. Ethical and legal uncertainty shaped conservative or coercive decision-making around consent, restraint and sedation. Cultural, linguistic and environmental factors complicated assessment and engagement. Despite commitment to supporting psychiatric patients, significant educational and structural gaps constrained effective care. Enhanced training, reflective supervision and context-sensitive guidance may improve patient experiences and paramedic decision-making. This study contributes to understanding how South African paramedics perceive and manage psychiatric emergencies in pre-hospital settings, highlighting educational, ethical, and contextual challenges influencing care.
Neural mass models (NMMs) are often used to help understand the circuitry that underpins observed brain dynamics in basic and clinical research. A key step is to fuse models with data so that model parameter values can be inferred for a given data set-a process called model fitting or model calibration. This can shed light on putative physiological mechanisms underlying the observed signals. Calibration is notoriously challenging in biology since models are often non-identifiable, high-dimensional, and nonlinear. Established methods such as dynamic causal modelling (DCM) circumvent some of these issues, for example, by incorporating prior information and employing fast local search methods in the space of feasible parameter values ("parameter space"). However, it is pertinent to better understand the potential limitations of these methods so that we can increase our confidence in the use of models to interpret brain activity, and to develop new approaches as required. Here, we use tools from dynamical systems theory to illustrate some of the complexities of model calibration in an archetypal NMM. We use this information to motivate the use of calibration methods that work across large regions of parameter space, rather than focusing on informative priors or localised search methods. We subsequently evaluate the performance of approximate Bayesian computation (ABC) and evolutionary search metaheuristics (ESMs) for mapping feasible sets of parameters for which an NMM can recreate electroencephalographic recordings during an eyes-closed resting state. Our results demonstrate the superiority of ESMs in terms of computational efficiency and accuracy. Furthermore, we elucidate potential reasons why ESMs are able to perform better than ABC, that is, that they are less susceptible to biases induced by the complexity of underlying cost landscapes. These results highlight the importance of incorporating ESMs in future efforts to model brain dynamics.
Eosinophilic inflammation is involved in approximately 20% of patients with chronic obstructive pulmonary disease (COPD). Research examining the role of eosinophils in the initiation and progression of COPD has yielded varying conclusions, potentially attributable to the different subtypes of eosinophils. In this prospective observational study from Jan 2025 and Jun 2025, we included 27 patients with stable COPD and 10 controls. Blood samples were collected for eosinophil isolation, and flow-cytometry analysis was used to determine the subtype of eosinophil: resident eosinophils (rEos: Siglec-8+CD62L+IL-3Rlow) or inflammatory eosinophils (iEos: Siglec-8+CD62LlowIL-3Rhi). We also recorded and analyzed baseline characteristics, pulmonary function test results, and several cytokines. The absolute number and proportion of rEos was significantly lower in patients with stable COPD compared to healthy controls. The absolute number of rEos (cell/uL) serves as a biomarker for predicting COPD (AUC 0.856; 95% CI 0.736-0.975). A ratio below 1.955 (odds ratio 0.231; 95% CI 0.063-0.841; p = 0.026) may be linked to COPD pathophysiology. rEos levels were notably lower in stable COPD patients compared to healthy individuals and were associated with COPD presence. Future research should include larger, diverse groups in multicenter studies to confirm the role of rEos in COPD and conduct basic experiments to investigate the molecular and cellular pathways of eosinophilic phenotypes in COPD patients.
Immune-mediated necrotizing myopathy (IMNM) is a rapidly progressing autoimmune muscle disease that severely affects the proximal, respiratory, and cardiac muscles. There is no globally unified consensus on treatment. Here, we compare the effects of cyclophosphamide (CTX) and methotrexate (MTX) in IMNM to provide evidence for treatment strategies. This is a retrospective single-center study. Patients were assigned into a CTX group or an MTX group based on the type of immunosuppressant. Statistical analyses were compared using SPSS 23.0. A total of 35 patients were included-19 in the CTX group, and 16 in the MTX group. Before treatment, the aspartic transaminase (AST) levels were significantly higher in the CTX group than in the MTX group (P < 0.05). All patients received high-dose glucocorticoids as basic therapy. After inductive treatments, the proportion of patients whose creatine kinase (CK) decreased by more than 50% was higher in the CTX group (18 cases, 94.7%) than in the MTX group (10 cases, 62.5%; P < 0.05). The descent degree of laboratory indicators were analyzed further. Reductions in CK (6919.1 U/L vs. 3245.3 U/L), lactate dehydrogenase (LDH, 964.0 U/L vs. 318.5 U/L), and AST (225 U/L vs. 52.5 U/L) were also greater in the CTX group than in the MTX group (P < 0.05). In this cohort of IMNM patients, CTX achieved greater improvements in CK, LDH, and AST levels compared to MTX. CTX may be more beneficial than MTX for disease inductive treatment in IMNM patients. This finding provides evidence for selecting clinical treatment schemes.
Amines are important atmospheric basic gases that contribute to secondary particle formation via acid-base reactions, affecting air quality and human health. In urban atmospheres, their clustering with sulfuric acid is the key pathway driving new particle formation and growth into cloud condensation nuclei, with consequences for climate. Elevated amine levels have been observed in traffic environments, yet direct tailpipe evidence remains scarce. Here, we provide unambiguous identification and quantification of amines and their derivatives in the exhaust of heavy-duty diesel vehicles (HDDVs). Our results show that these compounds originate predominantly from transformations of ammonia (NH3) released during overdosing of diesel exhaust fluid (DEF, an aqueous urea solution) in selective catalytic reduction (SCR) systems. Instantaneous patterns further demonstrate that amine formation requires the coexistence of NH3 and oxygenated volatile organic compounds. The tested China VI fleet exhibited lower NOx emissions than China V vehicles, but more pronounced NH3 overdosing, likely leading to higher amine-related emission factors (EFs). Furthermore, both amine and NH3 EFs increased with vehicle mileage, indicating emission deterioration associated with aging SCR-related aftertreatment components. Our findings highlight that the environmental implications of SCR-based NOx control extend beyond NOx reduction, as excessive NH3 dosing enhances amine emissions and also stimulates secondary particle formation, with broader impacts on air quality and climate.
This study investigated the association of serum fetuin-B with large-artery atherosclerotic acute ischemic stroke (LAA-AIS) and poor functional outcome after stroke. We retrospectively enrolled 216 consecutive LAA-AIS patients from September 2023 to December 2024 and 194 age- and sex-matched healthy controls. Serum fetuin-B was measured via ELISA. Multivariable logistic regression and restricted cubic spline (RCS) analyses were used to assess the relationships between fetuin-B and the presence of LAA-AIS or poor functional outcome (modified Rankin Scale > 2). Predictive performance was evaluated using C-index, net reclassification index (NRI), integrated discrimination improvement (IDI), calibration plots, and decision curve analysis (DCA). Internal validation was performed via 1000 bootstrap resamples. Serum fetuin-B was significantly higher in patients with LAA-AIS than in controls (2.68 vs 1.79 µg/mL, P < 0.001) and correlated positively with total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), glycated hemoglobin (HbA1c), and C-reactive protein (CRP). Multivariable regression showed higher fetuin-B independently associated with the presence of LAA-AIS (OR = 2.433, P < 0.001) and poor functional outcome (OR = 1.903, P < 0.001). Fetuin-B tertiles showed a graded increase in both risks (all P for trend <0.05). Incorporating fetuin-B to the basic model significantly improved the C-index for LAA-AIS risk (from 0.827 to 0.871) and poor functional outcome (from 0.749 to 0.806), supported by significant NRI and IDI (all P < 0.01). Calibration curves and DCA indicated good consistency and clinical net benefit. RCS analysis further revealed a non-linear association between fetuin-B and the presence of LAA-AIS, as well as an approximately linear association with poor functional outcome. Elevated serum fetuin-B measured after stroke onset was independently associated with LAA-AIS status and poor functional outcome.
Background: The dissociative subtype of posttraumatic stress disorder (D-PTSD) was recognized in DSM-5, and a dissociative subtype of complex posttraumatic stress disorder (D-CPTSD) in ICD-11 was recently proposed. It was documented that the DSM-5 PTSD criteria encompass all symptoms of the ICD-11 CPTSD. Exploring the relationship between D-PTSD and D-CPTSD may help to clarify whether the knowledge on D-PTSD could be extended to D-CPTSD.Objective: The current study aimed to compare the symptomatic characteristics of DSM-5 D-PTSD and ICD-11 D-CPTSD.Methods: The current study re-analyzed a database consisting of 57,984 trauma-exposed adolescents. Posttraumatic stress disorder (PTSD), complex PTSD (CPTSD), trauma-related dissociation, and functional impairment were assessed using the Global Psychotrauma Screen for Teenagers (GPS-T). Generalized anxiety disorder (GAD) and major depressive disorder (MDD) were measured with the Generalized Anxiety Disorder-7 and the Patient Health Questionnaire-9, respectively. Prevalence, functional impairment, and comorbidities with GAD/MDD were compared between DSM-5 D-PTSD and ICD-11 D-CPTSD. Agreement between the D-CPTSD and D-PTSD was also examined.Results: The agreement between D-PTSD and D-CPTSD was extremely high (Kappa = 0.90). All individuals with D-CPTSD met the criteria for D-PTSD and accounted for the majority of the D-PTSD group (82.4%). The D-CPTSD group exhibited higher levels of functional impairment and comorbidity with GAD/MDD compared to the D-PTSD group (All ps < 0.001).Conclusions: These findings indicated that ICD-11 D-CPTSD might be a part of DSM-5 D-PTSD, informing that the previous basic, clinical, and practical knowledge on DSM-5 D-PTSD might be applicable to the ICD-11 D-CPTSD. The current study is the first to compare dissociative subtypes of PTSD and CPTSD in a large sample of trauma-exposed adolescents.The prevalence of D-CPTSD was lower than D-PTSD. The agreement between DSM-5 D-PTSD and ICD-11 D-CPTSD was extremely high. Specifically, all individuals with D-CPTSD met the criteria for D-PTSD, and individuals with D-CPTSD represent the majority of the D-PTSD population. Individuals with D-CPTSD exhibited higher levels of functional impairment and comorbidity with GAD/MDD.These findings indicated that ICD-11 D-CPTSD might be a part of DSM-5 D-PTSD, indicating that the knowledge on DSM-5 D-PTSD might be extended to the ICD-11 D-CPTSD.
Spontaneous pupil fluctuations (SPFs) during rest provide a non-invasive, low-cost index of central arousal dynamics, independent of cognitive task demands. These features position SPFs as promising markers for baseline neurophysiological activity in both basic and translational research. This review synthesizes current evidence on the resting-state pupil-brain system, focusing on its core components: central neuromodulatory circuits and large-scale cortical networks. We first examine the relationship between SPFs and distributed elements of the ascending arousal system, including noradrenergic, cholinergic, serotonergic, and dopaminergic nuclei. We then detail SPF coupling with intrinsic functional networks-default mode, salience, and sensorimotor systems-highlighting their role in mediating transitions between internally- and externally-oriented brain states. Finally, we discuss the spectral and directional properties of pupil-brain interactions, emphasizing analytical approaches suited for assessing directionality and outlining implications for clinical and translational applications. Converging evidence from animal and human neuroimaging studies reveals robust spatiotemporal and spectral coupling between SPFs and neural activity across micro- and macro-scales. These findings support a systems-level framework in which SPFs serve as integrative markers linking subcortical neuromodulation with large-scale cortical dynamics. We conclude that SPFs offer a sensitive window into arousal regulation and body-brain integration, with potential utility as biomarkers for neuropsychiatric conditions and altered states of consciousness.
Almost half of the world's population is at risk of acquiring dengue virus (DENV) each year. However, no specific licensed prophylactic or antiviral treatment for dengue currently exists. Mosnodenvir, a novel DENV inhibitor, has been shown to inhibit DENV replication in vitro and in animal studies. Here, we provide new insights into the in vivo prophylactic inhibitory effect of mosnodenvir exposure on primary DENV-2 infection by fitting mechanistic within-host models of DENV infection to virological and serological data observed from pre-clinical challenge studies in AG129 mice and rhesus macaques. We estimated a median mosnodenvir concentration achieving 50% of maximal inhibitory effect (IC50) on viral replication of 8.35 (6.82, 9.22) ng ml-1 and 7.61 (5.67, 8.92) ng ml-1 for AG129 mice and rhesus macaques, respectively. A higher concentration is typically required to suppress viral replication in AG129 mice compared with rhesus macaques owing to a higher estimated within-host basic reproduction number (R0) in mice. By integrating multiple data types in a single framework, this study enhances our understanding of the within-host dynamics of primary DENV infection in non-human host species. Furthermore, the methods developed here could possibly assist in quantifying the prophylactic inhibitory effect of mosnodenvir on DENV infections in humans.
Surgical education in colorectal surgery is a multifaceted process that requires the acquisition of theoretical knowledge of basic sciences, disease recognition, and the command of evidence-based treatments. Technical skill building through simulation and supervised operative responsibility is also essential. The rise of minimally invasive techniques poses further challenges, requiring specialized training in new, advanced, and costly technologies. This paper aims to dissect the current state of colorectal surgery education globally, elaborating on quality indicators of the delivery of training. Significant disparities are noted internationally, with high-income countries offering structured training programs, specialized fellowships, and formal certification, while many low- and middle-income countries face challenges in accessing advanced training resources. Furthermore, cultural and societal factors significantly impact training outcomes across different health systems, including hierarchical structures, gender disparities, and limited diversity in surgical leadership. By acknowledging these inequalities and the factors that foster them, solutions can be explored, aiming to ensure equitable access to high-quality colorectal surgery education worldwide, ultimately improving patient outcomes.
Technologies for editing epigenetic modifications and controlling transcription in mammalian cells have revolutionized targeted gene perturbation, functional genomics, and basic research. By avoiding the generation of DNA breaks, epigenome editing serves as a safe and precise approach for altering gene expression and has emerged as a promising platform for therapeutic applications. The advent of CRISPR has contributed significantly to the expansion of the existing toolkit for programmable modulation of epigenetic and transcriptional states. This review highlights recent discoveries in engineering novel tools for epigenome editing and transcriptional modulation through rational design, high throughput screening methods, and mutational scans, which leverage the endogenous reservoir of chromatin and transcriptional effectors for targeted gene repression and activation. We also discuss the therapeutic potential of epigenome modulators and highlight the key challenges that need to be addressed to improve their safety and efficacy. Advancing our understanding of the complex mechanisms driving gene expression and overcoming current limitations will pave the way for the development of novel technologies that advance fundamental research and translational applications.
Atopic dermatitis (AD) is a complex chronic inflammatory skin disease whose pathogenesis involves a vicious cycle of epidermal barrier defects, immune dysregulation, and microbial imbalance. Despite advances in targeted biologics and small-molecule drugs, there remains an unmet clinical need for safe, effective treatments that can simultaneously intervene in multiple pathological processes. Extracellular vesicles (EVs), as key mediators of intercellular communication, play an increasingly prominent dual role in the pathophysiology and treatment of AD. This review systematically elaborates on this dialectical unity of EVs in AD. In terms of pathological mechanisms, EVs derived from pathogens such as Staphylococcus aureus and Malassezia spp., as well as from host mast cells, act as active "nanoscale pathological messengers" that deeply participate in disease initiation and progression by delivering virulence factors, disrupting the skin barrier, driving Th2/Th17 immune polarization, and sustaining chronic inflammation. Regarding therapeutic applications, therapeutic EVs derived from mesenchymal stem cells (e.g., adipose-, umbilical cord-derived), plants, probiotics, and marine organisms serve as efficient "cell-free therapeutic platforms, " demonstrating great potential for intervening in AD through multipathway immunomodulation, active restoration of barrier function, and systemic regulation of the gut-skin axis. Moreover, strategies such as preconditioning parental cells (e.g., hypoxia, cytokine stimulation), genetic engineering, or constructing hybrid EVs can further enhance the therapeutic efficacy of EVs; combining them with advanced delivery systems (e.g., hydrogels, microneedles) can effectively overcome transdermal delivery bottlenecks. Although promising, the field still faces challenges including uneven source selection, lack of standardization in preparation and characterization, insufficient mechanistic elucidation, limitations of preclinical models, and inadequate pharmacokinetic and long-term safety data. Future research should focus on establishing standardized protocols, deepening mechanistic understanding, developing more accurate disease models, and exploring translational avenues to assess the potential for next-generation precision diagnostic and therapeutic strategies for AD based on EVs.
The pronounced mismatch between polymeric electrodes and metallic components hinders the formation of robust electrical contacts. While most approaches rely on chemical design to strengthen interfacial interactions, we present a double-sided mechanical interlocking strategy that provides both stability and adaptability. A conductive fabric scaffold bridges polymers and metals, with adhesives sequentially applied to both sides. The adhesive infiltrates and encapsulates scaffold fibers, forming a thread-hole adhesion that can only be disrupted by bulk failure. This mechanism achieves a record high interfacial toughness of 730 J m- 2 between conductive elastomer and copper using commercial silver pastes. Peeling tests show delamination occurs between silver paste and copper, indicating even higher toughness could be obtained with better-performing products of conductive adhesive. Notably, the interface stability surpasses that of the electrode itself, remaining intact even when the electrode fails. The design is broadly compatible with elastomeric or hydrogel matrices and with diverse commercial adhesives. It enables the construction of reliable epidermal electronics and hydrogel-based devices. Overall, this interlocking strategy provides a versatile platform for integrating soft and rigid conductors in hybrid electronic systems.
The Convention on the Rights of Persons with Disabilities emphasizes individual rights and autonomy. However, certain restrictive practices in support services for people with intellectual and developmental disabilities (IDD) may limit these rights and undermine autonomy. Structural practices are a type of restrictive practice usually defined as blanket rules or prohibitions that affect all users equally. They are considered restrictive because constrain the freedom of individuals with disabilities. Since these practices are so deeply ingrained in the organizational culture, they often become normalized and invisible. Despite the implications of structural practices for the rights of people with IDD, empirical evidence on their prevalence is limited, particularly in Spain. In this context, this article aims to analyze the presence of structural practices in different support services for people with IDD in Spain. A cross-sectional study was conducted with 45 disability support organizations, which participated by assessing the occurrence of restrictive practices, including structural practices, in their daily contexts using the LibRe scale. Among the structural practices, aspects related to the organization of time and activities, information management and decision-making, money management and established organizational norms were evaluated. The organizations conducted the assessments in teams, involving 194 professionals, 6 family members and 25 individuals with disabilities in the process. The assessment was part of an organizational transformation process. Frequency analyses and ANOVA tests were conducted to identify the most common restrictive practices. Although organizations generally report a low frequency of restrictive practices, structural practices are significantly more common than others, such as physical or mechanical restraints. Within the structural practices, those referring to limitations in the organization of time and activities of daily living of people with disabilities stood out as frequent practices. Among the most frequent practices were limitations on recreational activities and inflexible meal schedules. Implications of the restrictive practices most frequently reported by organizations on users' quality of life are discussed, as well as the need to reduce structural practices through organizational transformation approaches. Future lines of research are also highlighted.