Hypertension is a leading cause of cardiovascular disease with significant burden experienced in low-and middle-income countries. The Hypertension Treatment in Nigeria (HTN) Program implemented a large-scale hypertension treatment program in the Federal Capital Territory (FCT) of Nigeria. Identification of benefits is important to acknowledge and demonstrate the value of research beyond evaluation of pre-identified scientific outcomes. This manuscript aims to identify the benefits and impact of the HTN Program using the Translational Science Benefits Model (TSBM). The HTN Program was a type II interrupted time series trial conducted from January 2020 to December 2023 to evaluate effectiveness and implementation of a multilevel hypertension control program in 60 primary healthcare centers in Nigeria. TSBM benefits were identified and verified by cataloging events, results, and procedures and aligning using the Translating for Impact Toolkit. The domains include policy, community, clinical, economic, and a new fifth domain, capacity building. The HTN Program enrolled 21,922 patients. Hypertension treatment increased from 86.8% (95%CI: 86.5%, 87.2%) at baseline to 96.2% (95%CI: 96.0%, 96.4%) at the end of the study period. Hypertension control also increased from 22.3% (95%CI: 21.7%, 22.9%) at baseline to 56.4% (95%CI: 55.9%, 56.8%). Thirty-three TSBM benefits were identified across five domains. Most benefits were identified in the policy (9), capacity building (9), and community (7) domains. The HTN Program not only improved hypertension treatment and control in primary care in the FCT of Nigeria but also demonstrated broader impacts beyond its initial effectiveness and implementation objectives supporting program sustainment and scale-up.Trial Registration: NCT04158154.
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The risk of cardiovascular disease is significantly increased by both type 2 diabetes mellitus (T2DM) and obesity through overlapping pathways involving insulin resistance, dyslipidemia, systemic inflammation, and endothelial dysfunction. Tirzepatide, the first dual glucose-dependent insulinotropic polypeptide and glucagon-like peptide-1 receptor agonist, has shown significant glycemic and weight-reducing effects and is increasingly recognized as a cardiometabolic therapy that extends beyond glucose control. This narrative review summarizes clinical and translational evidence about the cardiovascular and metabolic benefits of tirzepatide and the biologic mechanisms that may underpin its effects. Tirzepatide has consistently shown high improvements in key indicators of glycemic control and body weight across the SURPASS program in patients with T2DM and the SURMOUNT program in patients with obesity. Benefits include marked reduction in glycated hemoglobin and cardiovascular risk factors, such as systolic and diastolic blood pressure, atherogenic lipid parameters, visceral adiposity, and several inflammatory biomarkers. Dual incretin signaling seems to increase endothelial function by enhancing the bioavailability of nitric oxide, reducing oxidative stress, inhibiting pro-inflammatory pathways such as nuclear factor kappa B, and favorably modulating adipokine profiles, collectively supporting cardiovascular protection. Promising data suggest symptomatic and functional improvements in obesity-related heart failure with preserved ejection fraction. Reductions in major adverse cardiovascular events are currently under investigation in dedicated outcome trials, including the SURPASS Cardiovascular Outcomes Trial. Overall, tirzepatide provides broad cardiometabolic benefits, making it a promising treatment in the changing landscape of cardiometabolic disease management. More Than Blood Sugar Control: How Tirzepatide Affects Heart Health The risk of developing heart and blood vessel disease, which is a common cause of death worldwide, is very high in obese diabetic patients. Tirzepatide is a new medication that participates in regulation of blood sugar, appetite, and metabolism by causing the same effects of two naturally occurring gastro-intestinal hormones. In addition, Tirzepatide may improve several factors linked to heart health, including blood pressure, lipids, inflammation, blood vessels and heart structure and function. Although its long-term outcomes are still under study, current evidence suggests that Tirzepatide may play an important role in improving cardiometabolic health.
Earnings replacement for disabled Canadian servicemembers and Veterans depends primarily on their enrolment component. By reviewing legislation and policies since 1866, this article examines differences in compensation for Regular, Reserve, and Special Force members and Veterans. Since the Regular Force was created in 1883, its members have automatically received unreduced pay and benefits while recovering from injuries. Similarly, disabled Regular Force Veterans received compensation based on lost military salary. Before the First World War, lost civilian earnings and family situations were assessed to determine financial compensation for disabled reservists and Veterans. Subsequently, the government has accepted progressively less liability for disabled reservists, who currently must apply for an allowance based on military salary with no entitlement to benefits. Although the Canadian Forces announced that reservists may be eligible for provincial workers compensation benefits, this is based on a tenuous interpretation of legislation and not supported by policies. For Reserve Veterans, the 1919 Pension Act provided pensions based on rank, severity of injury, and family status. The 1971 change to a common pain-and-suffering benefit left disabled reservists without post-release earnings loss compensation. Changes to legislation between 2005 and 2015 and the 2019 Veterans Well-being Act have improved financial compensation for Reserve Veterans. This article examines the different levels of liability Canada has assumed for disabled serving military members and Veterans from 1866 to 2020. Throughout Canada’s history, the first consideration for financial compensation has been the enrolment component of the casualty, that is, Regular, Reserve, or Special Force. Since 1883, disabled serving Regular Force members have received full pay and benefits while recovering from service-related injuries. Whether through the Militia Act, the Pension Act, long-term disability insurance, or the current Veterans Well-being Act (VWA), disabled Regular Force Veterans received financial compensation based on lost earnings. Before 1914, Canada’s military was a predominantly part-time militia, and if a member was disabled or killed due to a service-related injury or illness, lost civilian earnings and family circumstances were considered in financial compensation. From the First World War until the 1970s, serving reservists were eligible for military pay and benefits while recovering from service-related injuries. Currently, subject to an investigation clearing them of fault or malfeasance, they may apply for an allowance equivalent to military pay with no benefits. Between 1919 and 1999, the government accepted less and less liability for disabled Reserve Force Veterans until recent changes to Veterans benefits legislation incrementally improved this. Le remplacement du revenu des membres et des vétéran(e)s invalides des Forces dépend principalement de la composante où ils et elles servent. Passant en revue les lois, les programmes et les politiques qui ont été ou sont encore en vigueur depuis 1866, cet article examine les différences d’indemnité entre les membres de la Force régulière, de la Réserve et des Forces spéciales et les vétéran(e)s. Depuis la création de la Force régulière en 1883, ses membres qui sont en convalescence ont droit à l’intégrité de leur solde et de leurs avantages sociaux. De même, les vétéran(e)s invalides de la Force régulière reçoivent une indemnité en fonction du salaire militaire perdu. Avant la Première Guerre mondiale, l’indemnisation financière des réservistes et des vétéran(e)s invalides était déterminée par une évaluation de leurs revenus civils perdus et de leur situation familiale. Par la suite, le gouvernement a progressivement réduit sa contribution à la prise en charge des réservistes invalides, qui doivent aujourd’hui déposer une demande pour obtenir une allocation basée sur leur solde et n’ont pas droit aux avantages sociaux. L’information fournie par les Forces armées canadiennes selon laquelle les réservistes handicapé(e)s peuvent être admissibles aux indemnités civiles provinciales pour accident du travail se fonde sur une interprétation fragile de la législation et la démarche n’est pas soutenue par des politiques internes. Pour les vétéran(e)s de la Force de réserve, la Loi sur les pensions de 1919 prévoyait des prestations selon le grade, la gravité de la blessure et la situation familiale. Lorsque cette disposition est devenue, en 1971, une indemnité générale pour douleur et souffrance, les réservistes invalides se sont retrouvé(e)s sans indemnité postlibération pour perte de revenus. Des modifications apportées à la législation entre 2005 et 2015 ainsi que la Loi sur le bienêtre des vétérans de 2019 ont amélioré l’indemnisation financière des vétéran(e)s réservistes handicapé(e)s.
Point-of-care technology (POCT) has expanded rapidly, particularly since the COVID-19 pandemic. However, less is known about which POCT applications and features patients and caregivers prioritize for lung disease management. We refined a patient-facing survey based on feedback from an online focus group recruited through community and advocacy volunteer networks. The survey was then administered via ResearchMatch to uncompensated U.S. volunteers, who indicated interest in lung disease research (April 1 to May 14, 2025; 6,333 invitations). POCT perceptions were measured via a 10-point Likert scale. We received 214 responses (3.4% response rate). Respondents were predominantly patients (79%), female (71%), and older than 60 years (59%). Mean ratings suggested strong perceived benefits across nine POCT benefits and low concern across most drawbacks. The greatest concern was insurance coverage for POCT-associated costs (mean score: 6.7/10). Obstructive lung conditions were most frequently prioritized for future POCT applications. Among a national sample of ResearchMatch volunteers affected by lung disease, interest in POCT was high, and insurance coverage remained the most salient concern. By describing preferences and concerns of patients, this study informs future design, regulatory approval, and clinical integration. These findings provide evidence for POCT developers, clinicians, and policymakers focused on improving patient-centered care.
Atherectomy has become an established tool for lesion preparation in the endovascular treatment of peripheral artery disease (PAD), particularly for complex and heavily calcified lesions. Despite the widespread clinical use of atherectomy, the long-term benefits of this tool remain controversial, and the available evidence is heterogeneous. This review aimed to provide a clinically oriented, expert-driven narrative evaluation of peripheral atherectomy, including the historical evolution, currently available technologies, and the contemporary clinical role of the procedure, while integrating randomized and real-world evidence to support rational patient and lesion selection. A narrative literature review was conducted based on continuous expert monitoring since 2021 and targeted PubMed searches using combinations of the terms "peripheral artery disease", "atherectomy", "critical limb ischemia", and "intermittent claudication". Randomized controlled trials, meta-analyses, major registries, and high-quality observational studies were identified, selected based on clinical relevance and methodological quality, and synthesized accordingly. Randomized trials have consistently shown that atherectomy does not provide superior long-term patency or limb salvage compared with balloon angioplasty, stenting, or drug-coated balloons (DCB). However, atherectomy has demonstrated reproducible procedural advantages across multiple studies, including greater luminal gain, fewer dissections, and less need for bailout stenting. Observational and registry data further suggest potential benefits in selected scenarios, particularly for heavily calcified lesions, long-segment occlusions, in-stent restenosis (ISR), and anatomically challenging mobile segments. Current evidence does not support the routine use of atherectomy in PAD. Nevertheless, when applied selectively in appropriately chosen patients and lesions, atherectomy represents a valuable strategy for vessel preparation. The responsible use of atherectomy requires careful integration of the available evidence with operator expertise, awareness of alternative technologies, and consideration of procedural risks and reimbursement issues.
The increasing incorporation of engineered nanomaterials into agro-environmental systems requires a balanced evaluation of their biological efficacy and potential environmental implications. Silicon (Si) is a quasi-essential element, which is not only essential for plant survival but also supports their growth under adverse conditions. The large size and tendency to form complexes with inorganic and organic compounds in the growth medium, the bioavailability of Si to plants is limited. These restrictions can be overwhelmed through the application of silicon nanoparticles (SiNPs), which typically range from 1 to 100 nm and exhibit better mobility, solubility, and bioavailability. SiNPs can be synthesized by physical, chemical, and biological methods; however, the biological approach has garnered appreciable response due to multiple ecological benefits, biocompatibility, reduced energy requirements, and cost-effectiveness. Biosynthesized SiNPs are taken up by the plants as silicic acid via transporters viz., Ls1, Ls2, and Ls6, and/or by endocytosis depending upon their size, physicochemical properties, and plant species. Following internalization, SiNPs are predominantly transported to the epidermal cell wall, where it forms silica-cuticle double layer, providing resistance to biotic and abiotic stresses. Accumulation of SiNPs improves plants' water use efficiency, nutrient uptake and assimilation, photosynthetic performance, and antioxidant-based defense system, thereby stimulating plant growth and productivity under normal and stressed conditions such as drought, heat, salinity, and heavy metals stress. At molecular level, SiNPs demonstrated activation of signaling pathways by inducing transient and tightly regulated reactive oxygen species (ROS) burst, which activates phytohormones and MAPK signaling cascade, eventually triggering expression of stress-responsive genes. Biosynthesized SiNPs hold immense potential in field of agriculture, however, their actual deployment is at infancy. A lack of comprehensive understanding of SiNP mediated stress alleviation in plants at molecular level coupled with variability in response, subjected to plant species, and morphological and physicochemical attributes of SiNPs, limits their large-scale application. Thus, elucidating precise molecular mechanism of biosynthesized SiNPs-mediated stress tolerance in plants is crucial. Moreover, integrating advanced biological approaches with emerging technologies can facilitate rational and sustainable implementation of nano-enabled agricultural practices.
Fear of needles is distressing in itself but can also lead to avoidance of vaccinations, blood donation, and medical tests and treatments. Working with adolescents with needle fears, we developed an automated virtual reality (VR) therapy. We set out to evaluate its efficacy. We conducted an initial proof-of-concept cohort study followed by a Phase II randomised controlled trial. Participants were included if they were 12-15 years old and had significant needle fears that they would like treated. The proof-of-concept testing was a pre- to post-cohort study. To proceed to an RCT an effect size of at least 0.6 on the Injection Phobia Scale - Anxiety (child version) (IPS) was required. The Phase II test was a parallel group, single-blind, randomised controlled trial in one centre in England. Participants were randomly assigned (1:1) to either the VR therapy or no treatment, using a permuted blocks algorithm with randomly varying block size. The VR therapy was provided in approximately three sessions over two to three weeks. The trial assessor was masked to group allocation. Outcomes were assessed at 0, 3 (end of treatment) (primary endpoint), and 6 weeks. The primary outcome was needle fear, assessed by the IPS. Outcome analyses were done in the intention-to-treat population. Moderation and mediation tests were also planned. The RCT was prospectively registered with the ISRCTN registry, ISRCTN74002253. From March 26th, 2024, to June 7th, 2024, 12 participants (5 [42%] males; 6 [50%] females, 1 [8%] prefer not to say, mean age 13.4 years [SD = 0.8, range 12-15]; 10 [83%] White, 1 [8%] other, 1 [8%] prefer not to say) were recruited for the cohort study. After the VR therapy, needle fears as assessed by the IPS reduced on average by 15.2 points [95% C.I. 9.2, 21.1, n = 11, Cohen's d = 1.5]. There were no serious adverse events. The RCT could therefore proceed. From October 28th, 2024, to July 15th, 2025, 60 participants (26 [43%] males; 32 [53%] females, 2 other [3%], mean age 13.4 years [SD = 0.9, range 12-15]; 57 [95%] White, 3 [5%] other) were recruited for the RCT. Compared with no treatment, there was strong evidence that VR therapy led to a reduction in needle fears (adjusted mean difference = -14.07, 95% C.I. -17.40, -10.73, p < 0.001, n = 60, Cohen's d = 1.34). The benefits were maintained at follow-up (adjusted mean difference = -14.67, 95% C.I. -18.00, -11.33, p < 0.001, n = 60, Cohen's d = 1.39). There were no serious adverse events. An automated VR therapy, which is potentially scalable, had efficacy in reducing self-reported needle fears in adolescents. Given that this is an age at which people often have a formative experience of medical procedures, it is an important time to reduce needle fears. The intervention requires testing in a Phase III clinical trial. A key focus would be assessing whether the VR therapy increases vaccine uptake in young people who have initially refused due to needle fears. Beryl Alexander Charity and the NIHR Oxford Health Biomedical Research Centre and NIHR Oxford Biomedical Research Centre.
Heterotopic transcatheter caval valve implantation (CAVI) has emerged as a palliative yet promising therapeutic strategy for treating severe tricuspid regurgitation (TR), which aims to reduce systemic venous congestion by implanting bioprosthetic valves in the venae cavae rather than in the native tricuspid annulus. However, despite encouraging procedural success, clinical improvement and survival remain highly variable. A systematic review of published registries and case series was performed, focusing on the outcomes, procedural success, mortality, and safety of CAVI. Data were extracted from multicenter registries and observational series describing the use of transcatheter stented bioprosthesis or bioprosthesis alone. Across published cohorts and registries, procedural success rates ranged from 90% to 100%, with 30-day mortality ranging from 5% to 25%. The TRICUS EURO study, which included 35 patients across 12 European centers, demonstrated significant improvements in New York Heart Association (NYHA) functional class and Kansas City Cardiomyopathy Questionnaire (KCCQ) scores at 6 months, with minimal device-related complications and adverse events. The ongoing TRICAV-II pivotal trial (NCT06458907) and EuroTR registry (NCT06307262) are expected to provide larger real-world datasets. Smaller case series and individual reports, typically involving ≤10 patients, confirmed feasibility and symptomatic benefits, particularly reductions in peripheral edema and ascites. However, long-term outcome data remain limited. This study highlights right ventricle (RV) dysfunction, severe pulmonary hypertension, advanced end-organ failure, and clinical frailty as major determinants of unfavorable outcomes. Heterotopic CAVI represents a viable alternative for high-risk patients with severe TR, offering symptomatic improvement and reduced venous congestion when conventional surgery or orthotopic repair is not feasible. However, current evidence is derived primarily from non-randomized studies and limited registries. Ongoing prospective registries and pivotal trials are crucial for defining patient selection, procedural optimization, and long-term survival benefit. Early intervention and multidisciplinary patient selection appear crucial for avoiding futile procedures and identifying patients who may derive true symptomatic and prognostic benefit from CAVI.
Continuous doula support during labor and delivery in the hospital setting is associated with improved maternal and newborn outcomes, such as reduced labor duration and higher infant Apgar scores. ACURE4Moms, a 4-arm cluster randomized controlled trial of 39 prenatal clinic groups across North Carolina, is evaluating whether community-based doula support can reduce low birthweight. This short report outlines hospital doula policy insights gleaned from implementation of the doula support intervention. Identify the most common models for doula support in the hospital setting and discuss their potential impact on patient access to doula support. We worked with study clinics and their health systems to obtain their hospital doula policies so that we could prepare study doulas to support patients at the participating hospitals. We conducted thematic analysis to categorize the policies by their various approaches. Four commonly observed approaches to hospital access policies for doulas were identified among study sites: (1) the Visitor Model, (2) the Credentialing Model, (3) the Vendor Compliance Model, and (4) the Hospital Workforce Model. We noted that the wide variability in policies and their enforcement and restrictiveness could create confusion and unnecessary barriers for doulas who support patients in labor. There is a need for equitable, standardized, and clearly communicated hospital doula policies to ensure that more patients, especially those from underserved populations, can access the benefits of continuous doula support in hospital-based births.
Exposure to traumatic experiences during military service can result in different psychological and social consequences for individuals and their close social networks. This study aims to contribute to a psychosocial understanding of these phenomena by examining whether the relationship between perceived socio-economic status and the health of Veterans is moderated by participation in Veterans' associations, as well as whether this moderation effect is moderated by the level of identification with the military group. A total of 480 male Portuguese Veterans (Mage = 73.24; SD = 3.74) completed validated measures of perceived socio-economic status, physical and mental health, identification with the military, and participation in Veterans' associations. The results show that Veterans facing greater economic vulnerability report poorer health outcomes. However, those who are members of Veterans' associations, particularly those with a strong identification with the military, report better health despite their socio-economic vulnerability. Overall, this study highlights the importance of Veterans' associations as identity-based support networks that can promote the health and well-being of military Veterans. Exposure to traumatic experiences during military service can lead to various psychological and social effects for Veterans and their close social networks. This study aims to better understand how Veterans’ health is related to their economic situation and whether participating in Veterans’ associations can make a difference for their health status. We also examine whether the benefits of these associations are stronger for those with a strong identification with the military. The results show that male Portuguese Colonial War Veterans facing greater economic vulnerability tended to report poorer health outcomes. However, members of Veterans’ associations, particularly those with a strong identification with the military, tended to report better health despite their socio-economic vulnerability. Overall, the findings highlight the important role of Veterans’ associations as supportive communities that can help improve the health and well-being of military Veterans. L’exposition à des expériences traumatiques pendant le service militaire peut avoir des conséquences psychologiques et sociales différentes selon les diverses personnes et leurs réseaux sociaux proches. Cette étude vise à mieux comprendre ces phénomènes sur le plan psychologique par l’examen des relations entre la perception de la situation socioéconomique et la santé des vétéran·e·s, qui est modérée par la fréquentation des associations de vétéran·e·s. Elle évalue aussi si cet effet de modération est relativisé par le degré d’identification au groupe militaire. Au total, 480 vétérans portugais. (Mâge = 73,24; ÉT = 3,74) ont fourni des mesures validées de la perception de leur situation socioéconomique, de leur santé physique et mentale, de leur identification aux Forces armées et de leur fréquentation des associations de vétéran·e·s. Les résultats révèlent que les vétérans plus vulnérables sur le plan économique déclarent de moins bons résultats cliniques. Cependant, ceux qui sont membres d’associations de vétéran·e·s, notamment lorsqu’ils s’identifient fortement aux Forces armées, déclarent être en meilleure santé malgré leur vulnérabilité socioéconomique. Dans l’ensemble, cette étude fait ressortir l’importance des associations de vétéran·e·s pour renforcer l’identité et promouvoir la santé et le bien-être des militaires vétéran·e·s. L’exposition à des expériences traumatiques pendant le service militaire peut avoir divers effets psychologiques et sociaux sur les vétéran·e·s et leurs réseaux sociaux rapprochés. Cette étude vise à mieux comprendre la relation entre la santé des vétéran·e·s et leur situation économique et à déterminer si la participation à des associations de vétéran·e·s peut faire une différence pour leur état de santé. On examine également si les bienfaits de ces associations sont plus marqués pour les personnes qui ressentent un plus fort sentiment d’appartenance envers les Forces armées. Les résultats démontrent que les vétérans des guerres coloniales portugaises dans une grande vulnérabilité économique avaient tendance à signaler une moins bonne santé physique. Cependant, les membres d’associations de vétéran·e·s, notamment s’ils et elles ressentaient un fort sentiment d’appartenance envers les Forces armées, avaient tendance à se déclarer en meilleure santé malgré leur vulnérabilité socioéconomique. Dans l’ensemble, les résultats démontrent le rôle important des associations de vétéran·e·s pour former des communautés solidaires qui peuvent contribuer à améliorer la santé et le bien-être des vétéran·e·s.
Cardiac magnetic resonance (CMR) imaging has become one of the most comprehensive noninvasive tools for evaluating cardiac structure, function, and myocardial tissue characteristics. Moreover, the role of CMR imaging in cardiovascular tomography has become increasingly central, providing unparalleled insights across a wide range of cardiac diseases. Over the past decade, several technical advances have expanded the clinical applications of CMR imaging and strengthened the role of this modality in diagnosis and management. Therefore, this review synthesizes these rapid advances and the associated growing influence on contemporary cardiovascular imaging practice. This literature review examines recent advances in CMR imaging, including improved contrast agents, refined mapping techniques, integration of artificial intelligence (AI), and accelerated imaging protocols, and highlights how these innovations are enhancing CMR imaging performance and delivering meaningful benefits in clinical practice. Recent advances in CMR imaging include higher-resolution imaging, novel gadolinium-enhanced and parametric mapping sequences, strain imaging, and four-dimensional (4D) flow magnetic resonance imaging (MRI), enabling more comprehensive assessment of myocardial structure, function, and hemodynamics. Improvements in contrast agents, the development of gadolinium alternatives, and increasing integration of AI have further enhanced the diagnostic accuracy and workflow efficiency. Advances in CMR imaging have strengthened the role of this technique as a highly accurate and increasingly accessible tool for cardiovascular evaluation, despite ongoing challenges related to cost, patient tolerance, and contrast use. Future directions should include enhanced tissue characterization, integration with complementary imaging modalities, and continued technological innovation to expand clinical applications, improve patient outcomes, and reduce reliance on radiation-based techniques.
Salvage biomass harvesting is increasingly recognized as a strategic approach to reduce emissions associated with spruce budworm (SBW) damage in eastern Canada by diverting biomass that would otherwise decompose in forests toward bioenergy and harvested wood products (HWP). However, its effects on overall system carbon dynamics remain poorly understood. We assessed how SBW-related salvage harvesting influences long-term (2010-2110) forest-sector carbon dynamics in the Côte-Nord region of Québec, Canada, considering net sector production (NSP), which is the sum of net carbon sequestration by ecosystem and HWP less operational emissions (harvesting, forwarding, transport, sawing, chipping, pelletization). This study evaluates the biophysical carbon balance and sector-level carbon dynamics of salvage harvesting, without accounting for substitution. We used the LANDIS-II model, its Forest Carbon Succession extension, and additional modules to simulate wind, fire, and SBW disturbances under multiple climate pathways. A no-additional-salvage reference (S0) was compared to increasing salvage areas (S1-S3) of dead snag stems. All additional salvaged biomass was directed to one of three pathways: bioenergy, sawnwood with a 35-year half-life, or sawnwood with a 60 year half-life. Salvage harvesting had minimal impact on ecosystem carbon pools but slightly reduced heterotrophic respiration by removing decomposing deadwood. The net carbon outcome depended strongly on product pathway: directing salvaged biomass to bioenergy resulted in immediate emissions and negative balance relative to the reference scenario; short-lived sawnwood (35-year half-life) increased HWP storage but accumulated decomposition emissions over time, also resulting in negative carbon balance; only long-lived sawnwood (60-year half-life) reduced total emissions sufficiently to approach/exceed carbon neutrality-and only under warmer climate scenarios (RCP4.5-RCP8.5) by late century. Operational emissions from harvesting, transport, and processing remained small relative to ecosystem and HWP carbon fluxes. Within the modeled system boundary (excluding substitution effects), the forest-sector carbon outcome of salvage harvesting depended strongly on target area, product type and their longevity; however, any benefits for reduced carbon emissions are likely to come from substitution effects unless warming dramatically increases decomposition and HWP have above-expected half-lives. The online version contains supplementary material available at 10.1007/s10980-026-02376-1.
Population ageing has led to a rise in neurodegenerative disorders, driven by metabolic, inflammatory, and nutritional factors. The Mediterranean diet and adequate protein intake may help protect cognitive function and support muscle health. Sarcopenia is strongly associated with cognitive decline through the muscle-brain axis. This study evaluates the combined effects of a Mediterranean-type diet and whey proteins on cognition, body composition, and muscle strength in sarcopenic older adults. A total of sixty-eight older adults with sarcopenia and cognitive impairment were retrospectively enrolled and divided according to adherence to the nutritional intervention. Group A (n = 38) followed both a Mediterranean-type diet and whey protein supplementation, while Group B (n = 30) followed the diet alone and served as controls. Clinical, anthropometric, and body composition parameters were assessed at baseline, 3 and 6 months. At 6 months, Group A was associated with significant improvements in body composition and functional outcomes compared with baseline. In particular, Body Cell Mass (BCM) increased, together with an improvement in right-hand grip strength, indicating enhanced muscle quality and strength. Muscle mass also increased, supporting better physical performance, as reflected by a reduction in perceived frailty (SARC-F score). Cognitive outcomes improved in both groups, with significant increases in MMSE scores, while executive function also improved in the intervention group, as shown by better TMT-A and TMT-B performance. A Mediterranean-type diet combined with whey protein supplementation was associated with improvements in both muscle and cognitive function in sarcopenic older adults; however, due to the observational nature of the study, causal relationships cannot be established. These findings align with evidence on the benefits of protein intake for musculoskeletal health. Potential mechanisms include reduced inflammation and muscle-brain communication via myokines. The lack of resistance training may have limited long-term effects. Overall, results support combined nutritional strategies to improve ageing outcomes.
To determine the optimal weekly frequency of 4 × 4 min high-intensity interval training (HIIT) in male university students and thus provide evidence for prescribing efficient endurance training in this population. Forty-five physically active male university students were randomly assigned to three groups performing 4 × 4 min HIIT once, twice, or three sessions per week (n = 15 per group) for 6 weeks. Maximal oxygen uptake (VO2max), time to exhaustion, heart rate (HR), oxygen uptake (VO2), ventilatory threshold (VT), respiratory exchange ratio (RER), and blood lactate concentration were assessed via treadmill testing and breath-by-breath gas analysis. Repeated-measures ANOVA was used for statistical analysis. After 6 weeks of intervention, all groups showed prolonged time to exhaustion and reduced submaximal HR and blood lactate, with the 2- and 3-session groups exhibiting larger improvement magnitudes. VO2max increased markedly in both the 2- and 3-session groups, while the 1-session group showed only a small increase. Submaximal VO2, VT, and RER changed minimally across groups. Post-intervention blood lactate was notably lower in the 2- and 3-session groups than in the 1-session group (p < 0.001), whereas physiological improvements were generally comparable between the 2- and 3-session groups. Training completion rates were 100%, 93%, and 80% in the 1-, 2-, and 3-session groups, respectively. Within the present study conditions, twice-weekly 4 × 4 min HIIT yielded substantial improvements in aerobic capacity and submaximal metabolic economy while maintaining relatively high adherence, showing a favorable balance between training benefits and tolerability. The twice-weekly frequency appears relatively optimal for physically active male university students. These findings are limited by the homogeneous sample and short intervention period, and further validation in larger, diverse cohorts is warranted.
Seafood is widely consumed for its nutritional benefits. However, its perishability promotes the formation of biogenic amines (BAs), posing a risk of food poisoning. This study quantified concentrations of 8 BAs in 22 seafood species (including fish and shrimp) from Korea and evaluated the effects of various cooking methods. Results indicated that BA profiles varied by habitat, with elevated histamine in Mugil cephalus (239.66 mg/kg) and 2‑phenylethylamine in Oncorhynchus keta (90.53 mg/kg) and Pleuronectidae (59.42 mg/kg). While estimated daily intake analysis indicated that raw Mu. cephalus (0.273 mg/kg bw/day for histamine), O. keta (0.075 mg/kg bw/day for 2-phenylethylamine), and Pleuronectidae (0.033 mg/kg bw/day for 2-phenylethylamine) may pose health risks to Korean consumers, these risks are mitigated at the consumption stage as cooking reduces BA levels by over 45%. These findings suggest that although raw seafood may contain elevated levels of BAs, cooking is an effective strategy for enhancing seafood safety. The online version contains supplementary material available at 10.1007/s10068-026-02218-5.
Substance use disorder (SUD) is a significant cause of morbidity and mortality among perinatal people. Integrated perinatal SUD treatment programs (SUD, obstetrics, mental health, and other services) show promising improvements in SUD and perinatal outcomes. This study describes the redesign of an integrated perinatal SUD treatment program that partnered with a community-based recovery housing facility to integrate clinical and social services and evaluated the impact of this redesign on several indices of treatment retention. This retrospective cohort study used health record data from 164 perinatal people aged 18+ years admitted to an integrated intensive outpatient SUD treatment program in Baltimore, Maryland, between March 8, 2021, and June 11, 2025. Negative binomial regression was used to examine the association between the program redesign and length of treatment, and logistic regression was used to examine associations between program redesign and retention (until delivery and at 30-, 60-, and 90-days postpartum). Perinatal people admitted post-redesign had a 108% increase in length of treatment compared to people admitted pre-redesign (adjusted incidence rate ratios [aIRR] 2.08, 95% CI: 1.40, 3.10). People admitted post-redesign had greater odds of treatment retention until delivery (aOR 3.53, 95% CI: 1.39, 8.95); and greater odds of treatment retention at 30-, 60-, and 90-day postpartum compared to people admitted pre-redesign (adjusted odds ratio [aOR] 6.58, 95% CI: 2.52, 17.16; aOR 9.87, 95% CI: 3.47, 28.07; and aOR 5.50, 95% CI: 1.98, 15.27, respectively). The study illustrates the benefits of creating community partnerships to deliver integrated clinical and social services to perinatal people with severe forms of SUD.
Despite increasing interest in complementary and integrative health (CIH) interventions for treating Veterans with posttraumatic stress disorder (PTSD), comprehensive evidence is lacking. This review aims to synthesize evidence regarding benefits of CIH interventions for improving mental health and quality of life among Veterans with PTSD in Canada, the United States, the United Kingdom, Australia, and New Zealand. We searched MEDLINE, PsycINFO, and AMED for studies that enrolled Veterans with PTSD and their families from Five Eyes countries from 2013 to December 2023, evaluated CIH interventions, and assessed changes in mental health outcomes using validated scales. We pooled estimates of effectiveness when reported by more than one study and assessed certainty of evidence using GRADE. Twenty-six randomized controlled trials and 14 observational studies with 3,321 participants (84.4% male, median age 51.4 y) were included. Moderate-quality evidence suggests meditation (weighted mean difference: -10.66, 95% CI, -15.00 to -6.32) reduces PTSD symptoms, depression, and anxiety greater than the minimal important difference (MID). Moderate-quality evidence suggests Sudarshan Kriya Yoga and emotional freedom techniques result in clinically meaningful improvements in PTSD and other mental health outcomes, but the evidence base is very limited. High- to moderate-quality evidence for mantram repetition and moderate-quality evidence for mindfulness-based stress reduction suggest reduced PTSD and depression symptoms by less than one MID and improved quality of life. Meditation may result in clinically meaningful reductions in PTSD, depression, and anxiety for Veterans. Further rigorous research is warranted to better understand effectiveness of CIH interventions for Veterans with PTSD. Posttraumatic stress disorder (PTSD) is more prevalent among Veterans than civilians, with key differences such as trauma types and military context. There is growing interest in complementary and integrative health (CIH) ­interventions to support Veterans with PTSD, but comprehensive evidence on their effectiveness is lacking. To address this, we gathered and reviewed evidence from studies assessing CIH interventions for improving mental health in Veterans with PTSD in Canada, the United States, the United Kingdom, Australia, and New Zealand. We identified 40 studies, involving 3,321 Veterans, of whom 16% were women. Our findings suggest meditation probably results in clinically significant reductions in PTSD symptoms, as well as in depression and anxiety symptoms. Sudarshan Kriya Yoga and emotional freedom techniques may also improve PTSD and other mental health outcomes, but the evidence base is currently limited. Mantram repetition and mindfulness-based stress reduction show reduced PTSD symptoms and depression with smaller effects and improved quality of life. Overall, meditation is promising for improving mental health in Veterans, but more research is needed to better understand the effectiveness of CIH interventions in Veterans. Malgré l’intérêt croissant envers les interventions en santé complémentaire et intégrée (SCI) pour traiter les vétéran.e.s ayant un trouble de stress post-traumatique (TSPT), on ne possède pas de données probantes détaillées sur le sujet. Cette analyse vise à synthétiser les données probantes sur les bienfaits des interventions de SCI pour améliorer la santé mentale et la qualité de vie des vétéran.e.s atteint.e.s d’un TSPT au Canada, aux États-Unis, au Royaume-Uni, en Australie et en Nouvelle-Zélande. Les auteur.e.s ont fouillé les bases de données MEDLINE, PsycINFO et AMED pour en extraire les études qui avaient recruté des vétéran.e.s atteint.e.s d’un TSPT et leur famille dans les pays du groupe des cinq entre 2013 et décembre 2023, et ils et elles ont évalué les interventions de SCI ainsi que les changements aux résultats cliniques en santé mentale à l’aide d’échelles validées. Ils et elles ont regroupé les estimations d’efficacité qui étaient déclarées par plus d’une étude et ont évalué le degré de certitude des données probantes au moyen de l’échelle GRADE. Au total, 26 études randomisées et contrôlées et 14 études observationnelles regroupant 3 321 participant.e.s (84,4 % hommes, âge médian de 51,4 ans) en ont fait partie. Selon des données probantes de qualité modérée, la méditation (moyenne pondérée des différences : −10,66, IC à 95 %, −15,00 à −6,32) réduit les symptômes de TSPT, de dépression et d’anxiété davantage que la différence importante minimale (DIM). D’après des données probantes de qualité modérée, la technique yogique Sudarshan kriya et la technique de libération émotionnelle entraînent des atténuations des symptômes de TSPT et d’autres troubles de santé mentale importants sur le plan clinique, mais la base de données probantes est très limitée. D’après des données probantes de qualité élevée à modérée à l’égard de la répétition de mantras et des données probantes de qualité modérée à l’égard de la réduction du stress par la pleine conscience, les symptômes de TSPT et de dépression diminueraient de moins d’une DIM et la qualité de vie s’améliorerait. La médication pourrait réduire les symptômes cliniques de TSPT, de dépression et d’anxiété de manière importante sur le plan clinique chez les vétéran.e.s. De nouvelles recherches rigoureuses devront être réalisées pour mieux comprendre l’efficacité des interventions en SCI chez les vétéran.e.s ayant un TSPT. Le trouble de stress post-traumatique (TSPT) est plus fréquent chez les vétéran.e.s que chez les civil.e.s et comporte des différences clés comme les types de traumatisme et le contexte militaire. L’intérêt envers les interventions de santé complémentaire et intégrée (SCI) augmente pour soutenir les vétéran.e.s atteint.e.s d’un TSPT, mais on ne possède pas de données détaillées sur leur efficacité. Pour corriger cette lacune, les auteur.e.s ont examiné et rassemblé des données probantes tirées d’études qui évaluaient les interventions de SCI en vue d’améliorer la santé mentale des vétéran.e.s ayant un TSPT au Canada, aux États-Unis, au Royaume-Uni, en Australie et en Nouvelle-Zélande. Ils et elles ont retenu 40 études auprès de 3 321 vétéran.e.s, dont 16 % étaient des femmes. Selon les résultats, la méditation réduit probablement les symptômes de TSPT, de dépression et d’anxiété de manière importante sur le plan clinique. La technique yogique Sudarshan kriya et les techniques de libération émotionnelle pourraient également atténuer les symptômes de TSPT et d’autres troubles de santé mentale, mais la base de données probantes est limitée. La répétition de mantras et la réduction du stress par la pleine conscience réduisent les symptômes de TSPT et la dépression dans une moindre mesure et améliorent la qualité de vie. Dans l’ensemble, la méditation est prometteuse pour améliorer la santé mentale des vétéran.e.s, mais de nouvelles recherches devront être réalisées pour mieux comprendre l’efficacité des interventions de SCI auprès de cette population.
Generative AI tools such as ChatGPT now perform core cognitive operations-reasoning, synthesis, evaluation, and creative generation-on users' behalf, raising urgent questions for educational psychology about how AI use relates to cognitive development. Yet research on cognitive offloading has largely treated AI use as a unidimensional phenomenon, obscuring a theoretically consequential distinction: whether AI substitutes for the user's own thinking or scaffolds it. Drawing on the autonomous-dependent help typology and self-determination theory, the present study introduces and examines a distinction between dependent cognitive offloading (delegating core thinking to AI) and autonomous cognitive offloading (using AI as a scaffold while retaining cognitive agency). In a three-wave time-lagged survey study (N = 589 university students and early-career knowledge workers), we tested a dual-pathway model linking the two offloading modes to four perceived downstream cognitive outcomes-autonomous capability, creativity, deep processing, and independent judgment-through cognitive agency transfer and intrinsic motivation. Dependent offloading was positively associated with cognitive agency transfer and negatively associated with intrinsic motivation, which in turn were linked to poorer perceived outcomes. Autonomous offloading was positively associated with intrinsic motivation and more favorable perceived outcomes. Metacognitive monitoring attenuated the link between dependent offloading and cognitive agency transfer but did not buffer the negative motivational association. Notably, both offloading modes yielded comparable immediate benefits despite divergent downstream correlates, suggesting that potentially maladaptive AI engagement may be difficult for users to detect from immediate experience. These findings highlight the manner of AI engagement-not merely its frequency-as a key factor in understanding its associations with perceived cognitive functioning, and point to practical strategies for educators, learners, and AI tool designers seeking to harness AI without undermining cognitive autonomy.
Optimizing tyrosine kinase inhibitor (TKI) therapy in chronic myeloid leukemia (CML) requires careful consideration of patient quality of life (QoL), which significantly influences treatment adherence and long-term outcomes. Long-term treatment can be associated with persistent symptoms that may negatively impact QoL, adherence, and patient satisfaction. This nationwide Italian survey explored patient experiences, treatment patterns, and factors influencing clinical decision-making in CML, with the aim of better understanding unmet needs and potential barriers to optimal care. We conducted a cross-sectional survey involving 146 adult patients with CML. A structured questionnaire, developed collaboratively by hematologists and patient association representatives, assessed patient-reported outcomes (PROs), treatment-related burden, and care satisfaction. Analyses were descriptive and exploratory. Despite the availability of effective therapies, a substantial proportion of patients reported impaired QoL due to both disease and treatment-related factors. While most patients reported overall satisfactory QoL, 26% described low or very low QoL. The burden was particularly evident in specific patient subgroups and in later lines of therapy, reflecting a significant physical and psychological impact of CML and its management. Fatigue, weakness, and muscle pain were the most frequently reported symptoms, often persistent and affecting daily functioning. Female patients reported a higher symptom burden and greater psychological distress compared to males. Despite high overall satisfaction with healthcare professionals, relevant unmet needs were identified, particularly regarding information on supportive services, long-term disease management, and fertility-related issues. Treatment-related adverse events were common and frequently chronic, suggesting a substantial cumulative burden over time. Despite the effectiveness of TKIs, patients with CML continue to experience a meaningful and multidimensional burden, particularly in later treatment lines and specific subgroups. These findings highlight the importance of greater attention to patient-centered management in CML, with treatment decisions carefully balancing the benefits and limitations of available therapeutic options to optimize both clinical outcomes and quality of life.