Mental health problems among university students predated COVID-19, but pandemic-period conditions coincided with changes in how academic, relational, behavioral, and internalizing difficulties co-occurred. Prior studies often modeled single outcomes or symptom clusters separately. This secondary analysis used a construct-level network to describe conditional associations among contextual stressors, adaptive-functioning indicators, and multidimensional mental health indicators in one archived student dataset. We analyzed cross-sectional survey data from 10,745 students collected January 13-March 26, 2021. Fourteen nodes were included: media time, online adaptation, learning efficiency, family conflict, friendship change, epidemic attitude, epidemic attention, exercise, perceived stress, anxiety, depression, sleep problems, loneliness, and resilience. After correcting exercise-frequency coding and anxiety-score derivation errors, we estimated an EBICglasso-regularized partial-correlation network using Spearman correlations. Expected influence, bridge expected influence, and nodewise R2 were interpreted as descriptive, model-dependent indices. We examined edge accuracy, centrality stability, bridge stability, edge-weight differences, data-quality exclusions, alternative estimators, community definitions, and counterintuitive partial edges. The fitted network retained 53 of 91 possible edges (density = 0.582). In this specification, depression, perceived stress, and anxiety had the highest expected-influence values (1.428, 1.064, and 0.782). The strongest absolute partial-correlation edges linked sleep problems with depression (0.736), depression with anxiety (0.668), anxiety with perceived stress (0.459), and sleep problems with anxiety (-0.423). Under the prespecified two-community partition, bridge expected influence was largest for perceived stress (0.461), loneliness (0.343), family conflict (0.233), epidemic attitude (0.184), and learning efficiency (0.126). Expected influence and bridge expected influence showed high case-dropping stability within this analytic specification (CS = 0.75). Data-quality exclusions and an ordinal/mixed-correlation EBICglasso model yielded estimates very similar to the primary network, whereas an unsigned-weight mixed graphical model yielded different centrality rankings. The findings describe a construct-level snapshot of conditional associations among students from one institutional context during a specific COVID-19 period. Perceived stress showed the highest and most stable bridge expected-influence value across the tested community specifications, while other bridge rankings and centrality values were specification-dependent. The results are hypothesis-generating, not evidence of causal pathways, intervention targets, or population-representative student mental health structure.
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The Hospital for Special Surgery (New York, NY, USA) partnered with Osmania General Hospital (OGH) in Telangana, India, to pilot a novel point-of-care ultrasound (POCUS) training program called Sustainable Point-of-Care Ultrasound Education in Anesthesia in a Resource-Limited Setting (SPEARS). In this study, we sought to teach essential POCUS skills that could be integrated into daily practice, evaluate the program's impact, and establish a reproducible framework for anesthesia providers in resource-limited settings. We conducted a mixed-methods local needs assessment at OGH through direct observations, surveys, and interviews. On the basis of these data, we designed the SPEARS intervention, incorporating online didactics, and training modules followed by a 1-week in-person course. SPEARS was implemented at two time points: in February 2023 (time point 1) and December 2023 (time point 2). Participants were anesthesiology attending physicians and postgraduate residents (N = 26). Data collected at each time point included pre- and post-training knowledge tests, clinical skills assessments, and post-training satisfaction surveys. Participants also maintained logbooks to examine changes in POCUS use over time. The impact of the intervention was analyzed using the Kirkpatrick evaluation model. Repeated measures analysis of variance showed a significant positive within-participant effect on knowledge and clinical skills scores across time points. The mean (standard deviation) 5-point Likert scale satisfaction score was 4.4 (0.8). Logbooks indicated a notable increase in the number of POCUS examinations performed after training. The SPEARS intervention was associated with improved POCUS knowledge, clinical skills, and use among anesthesia providers in a resource-limited setting. These findings suggest that similar blended-learning training initiatives could be adapted and implemented in other resource-limited contexts to build sustainable POCUS capacity. RéSUMé: OBJECTIF: Le Hospital for Special Surgery (New York, NY, États-Unis) s’est associé à l’Osmania General Hospital (OGH), au Telangana (Inde), afin de mettre à l’essai un programme novateur de formation en échographie au point de service (POCUS), intitulé Sustainable Point-of-Care Ultrasound Education in Anesthesia in a Resource-Limited Setting (SPEARS). Cette étude visait à enseigner des compétences essentielles en POCUS pouvant être intégrées à la pratique quotidienne, à évaluer l’impact du programme et à établir un cadre reproductible destiné aux personnes exerçant en anesthésie dans des contextes à ressources limitées. MéTHODE: Nous avons réalisé une évaluation locale des besoins selon une approche mixte à l’OGH, à l’aide d’observations directes, de questionnaires et d’entretiens. À partir de ces données, nous avons conçu l’intervention SPEARS, combinant un enseignement théorique en ligne et des modules de formation, suivis d’un cours en présentiel d’une semaine. Le programme SPEARS a été mis en œuvre à deux moments: en février 2023 (temps 1) et en décembre 2023 (temps 2). Les personnes participantes comprenaient des médecins spécialistes en anesthésiologie et des résidents et résidentes (N = 26). Les données recueillies à chaque moment incluaient des tests de connaissances avant et après la formation, des évaluations des compétences cliniques ainsi que des questionnaires de satisfaction post-formation. Les participantes et participants ont également tenu des carnets de bord afin d’analyser l’évolution de l’utilisation du POCUS au fil du temps. L’impact de l’intervention a été évalué à l’aide du modèle de Kirkpatrick. RéSULTATS: L’analyse de variance à mesures répétées a montré un effet intra-participant significatif et positif sur les scores de connaissances et de compétences cliniques aux différents temps de mesure. Le score moyen (écart type) de satisfaction sur une échelle de Likert à cinq points était de 4,4 (0,8). Les carnets de bord ont révélé une augmentation notable du nombre d’examens POCUS réalisés après la formation. CONCLUSION: L’intervention SPEARS a été associée à une amélioration des connaissances, des compétences cliniques et de l’utilisation du POCUS chez les personnes exerçant en anesthésie dans un contexte à ressources limitées. Ces résultats suggèrent que des initiatives de formation hybrides similaires pourraient être adaptées et mises en œuvre dans d’autres contextes à ressources limitées afin de renforcer durablement les capacités en POCUS.
Safe diagnostic reasoning is a central but challenging competency in general practice training, particularly in frontline settings where information is limited, uncertainty is common, and diagnostic error has direct implications for patient safety. Although Murtagh's diagnostic framework provides a clinically intuitive structure, its educational application and structured assessment in lower-resource, non-English-speaking training environments remain underexplored. The objective of this study was to evaluate a modified Murtagh-style safe diagnostic rubric (MM-SAFE-Dx) and its application within a general practice training context. This study was conducted as a single-centre retrospective real-world implementation study at The First Affiliated Hospital of Harbin Medical University in Northeast China. In 2025, a modified Murtagh-style safe diagnostic training programme was delivered across three voluntary rounds. Eighty-three general practice trainees and residents were included, contributing 145 scored encounters. Baseline and follow-up case-based assessments were analyzed using nonparametric methods. Preliminary real-world validity evidence for the MM-SAFE-Dx rubric was examined in terms of internal consistency, baseline-stratified discrimination, responsiveness, context sensitivity, and practical scoring stability. The overall educational signal was modest but directionally favourable. When separating first-exposure from repeated-use effects, baseline to first exposure showed minimal change, whereas subsequent rounds demonstrated more coherent directional improvements consistent with cumulative learning processes, although not all comparisons reached statistical significance. Sensitivity analyses further indicated that uncorrected baseline stratification yielded counterintuitive patterns dominated by short-term effects among lower-performing learners, whereas longitudinally informed stratification produced more interpretable results. These findings suggest that baseline measurements derived from first-time exposure to a complex diagnostic rubric may not reliably reflect underlying diagnostic competence. In this low-resource, heterogeneous general practice training environment, the MM-SAFE-Dx rubric demonstrated preliminary real-world validity and practical educational utility. Beyond evaluating a specific programme, this study highlights a broader methodological issue: structured diagnostic tools introduced into unfamiliar and resource-variable settings may require both guided implementation and context-sensitive analytical calibration before their educational effect can be meaningfully interpreted.
While border screening measures were widely adopted by countries during the COVID-19 pandemic, a lack of consensus on the utility of border screening created a gap in best practice for its implementation. As such, countries adopted a diversity of approaches, providing an opportunity to evaluate the configuration and evolution of border screening systems. The article addresses three questions: (i) how did countries configure their border screening systems for COVID-19? (ii) In what contexts did countries rely on public or private providers of these services? (iii) what do policies and narratives reveal about the perceived role of border screening in global public health? The article contributes to long-standing debates over the private sector's role in public health and the perceived value of border screening measures. This article presents results from an international comparative study based on tracking the organisation of border screening in eight countries. Secondary data was collected between July 2021 - June 2022 from official government websites and policy publications, private sector sources where relevant, and trusted media sources in each study country. The countries included are Australia, Canada, Germany, Ireland, South Africa, South Korea, Spain, and the United Kingdom. All study countries used private provision for pre-departure diagnostic testing for international travellers. In contrast, screening of arriving travellers was more diverse. Countries that opted for private sector post-arrival screening saw governance challenges around accreditation and monitoring of providers, while public service provision saw challenges in capacity and high resource costs. Travel was often framed as a 'luxury,' allowing states to shift responsibility for obtaining tests onto individuals; especially in the context of individuals travelling from low income to high income countries. The different approaches countries followed for screening of departing and incoming travellers suggests wealthy countries were more oriented towards defending their populations against disease importation, rather protecting the international community from disease exportation. These findings provide an opportunity to reflect on the purpose and implementation of border screening. We emphasise a need for further discussion on the efficacy of border screening from both perspectives, given the tendency for countries to rely on these measures.
Microglia, the resident innate immune cells of the central nervous system, play a pivotal role in the pathogenesis of Alzheimer's disease (AD). Microglia are now recognized as a highly dynamic and heterogeneous population whose molecular and functional states vary with spatial context, disease stage, and genetic background. Recent discoveries across multiple scales from genetics, molecular and cellular biology, to systems-level imaging and epidemiology have underscored the complex and context-dependent contributions of microglia to the AD cascade. Together, these findings highlight the need for integrative, multiscale approaches that bridge molecular, cellular, and systemic perspectives to elucidate the diverse roles of microglia and their impact on disease progression. This mini-review discusses recent advances in understanding microglial biology across these dimensions and outlines current challenges toward achieving a more unified and therapeutically oriented framework for studying microglia in AD.
Pediatric exanthematous diseases pose diagnostic challenges because clinical presentations overlap. To determine whether current artificial intelligence (AI) models achieve diagnostic accuracy within or above the performance distribution of pediatric residents and specialists for common rash-associated diseases. Participants and AI models were evaluated against definitive diagnoses confirmed by clinical features, laboratory findings, and consensus of two pediatric infectious disease specialists. A volunteer sample of 263 pediatric clinicians: 107 residents (years 1 through 4) and 156 specialists. Each clinician completed a blinded multiple-choice questionnaire with a clinical photograph and accompanying clinical data per case. The same cases were presented to three AI models: ChatGPT, Gemini, and Copilot. Among 263 clinicians (107 residents, 156 specialists), specialists scored higher than residents (median, 46 [IQR, 42-50] vs 41 [IQR, 36-46]; P < .001; r = 0.32). ChatGPT correctly diagnosed 53 of 61 cases (86.9%), Gemini 50 (82.0%), and Copilot 44 (72.1%). Both ChatGPT and Gemini exceeded the upper bound of the specialist population median 95% CI (47.17). All three AI models scored above the resident 95% CI upper bound (42.76). Disease-level accuracy ranged from 0% (insect bites, all models) to 100% (9 conditions, all models). Fourth-year residents scored higher than first- and second-year residents (P = .001; ε2 = 0.13).Conclusions: AI models given clinical data alongside images matched or exceeded specialist-level performance for pediatric exanthems. Accuracy varied by disease; failures clustered in conditions that require contextual reasoning. Physician oversight remains necessary where AI accuracy is lowest. What is Known • Childhood exanthematous diseases pose significant diagnostic challenges due to their overlapping clinical presentations. • Artificial intelligence models are becoming increasingly proficient in accurately diagnosing these conditions. What is New • In this diagnostic accuracy study of 61 cases evaluated by 263 clinicians and 3 artificial intelligence models, ChatGPT (86.9%) and Gemini (82.0%) exceeded the 95% CI upper bound of the specialist population median. Disease-level accuracy ranged from 0 to 100% across models • Artificial intelligence models given clinical data alongside images can match or exceed specialist-level accuracy for common pediatric exanthems, but failures in context-dependent diagnoses require physician oversight.
Against the dual backdrop of population aging and China's Rural Revitalization Strategy, investigating the mechanisms through which the built environment in traditional settlements is associated with older adults' health is of substantial significance. Taking traditional Dong ethnic settlements in Western Hunan as a case study, a theoretical model encompassing "objective environment-subjective perception-behavioral mediation-health outcomes" was constructed to examine the associations and pathways linking the built environment to older adults' health, with leisure activities and social participation considered both as independent and sequential mediators. The findings revealed that: (1) objective built environment shows no direct association with older adults' health; rather, its health-related benefits appear to be entirely mediated by leisure activities and social participation; (2) perceived built environment is not only directly associated with older adults' health but also demonstrates indirect positive associations through leisure activities, social participation, and their sequential mediation pathways; (3) within the context of traditional "acquaintance societies," social participation holds a central position, with leisure activities further associated with health through their relationship with social participation, thereby creating a hierarchical mechanism of association. The findings suggest that the health benefits of traditional settlements may not originate from the physical space per se, but appear to be deeply embedded in residents' subjective environmental perceptions and sociocultural practices. This research expands the contextual scope of built environment and health research and deepens understanding of health-related behavioral mechanisms among older adults in traditional communities. The findings provide theoretical reference and empirical evidence for the development of age-friendly rural environments and the advancement of healthy aging practices.
Tumor-associated high endothelial venules (TA-HEVs) mediate lymphocyte trafficking into tumors and modulate the tumor microenvironment, with reported effects on clinical outcomes. However, reports have described discordant associations across cancers and microenvironmental contexts. Studies on state-specific, pan-cancer analyses of TA-HEV function remain limited. We integrated publicly available single-cell RNA sequencing datasets from 11 cancer types. Functional features of TA-HEVs were inferred by pathway enrichment and single-cell gene-set scoring for pathway gene sets. State-specific programs were applied to The Cancer Genome Atlas dataset to assess their clinical impact. We constructed a comprehensive atlas of tumor-associated endothelial cells and identified TA-HEV subclusters. Five TA-HEV subclusters were grouped into two functional states: inflammatory and stress-metabolic. The inflammatory TA-HEVs were enriched for innate immune stimulation, cytokine/chemokine signaling, and MHC class II antigen presentation, whereas the stress-metabolic TA-HEVs were characterized by the unfolded protein response, heat shock pathways, oxidative phosphorylation, and ATP biosynthesis. Across cancers, the stress-metabolic TA-HEV state was generally associated with worse prognosis, while the inflammatory TA-HEV state showed context-dependent associations. Together, these findings define TA-HEVs as a heterogeneous endothelial population comprising distinct functional states with divergent clinical associations, providing a pan-cancer framework for interpreting TA-HEV signals in tumor biology.
Parents of autistic children report more depression, anxiety, and caregiver strain, and poorer well-being than parents of non-autistic children. Though more research has begun to investigate how parent-specific factors may influence these outcomes, few consider cognitive factors like emotion regulation or self-inhibition. These skills may be particularly relevant given their documented benefits and associations with mental health and well-being in the general population. An important consideration when investigating the needs of parents is the interconnectedness of the family unit. Thus, methodologies that consider this shared context are essential to appropriately support resilience of parents of autistic children. Our sample consisted of 263 different-sex parent dyads with at least one child formally diagnosed with autism spectrum disorder. Using the Actor-Partner Interdependence Model, we assessed the links between parents' emotion regulation and self-inhibition and their own and their partner's depression and anxiety symptoms, caregiver strain, and well-being. Interdependence was established using correlations given the distinguishable nature of our dyads. Both mothers' and fathers' emotion regulation were associated with their own depression and anxiety symptoms, caregiver strain, and well-being. Stronger emotion regulation was associated with fewer mental health symptoms, less caregiver strain, and better well-being. There was only one significant association for self-inhibition: stronger self-inhibition scores in fathers were linked to better well-being. We did not observe any associations between parents' emotion regulation or self-inhibition and partner outcomes after false discovery rate correction. Emotion regulation, and not self-inhibition, emerged as an important source of resilience for mental health and well-being of parents of autistic children. Previous work has looked to reduce caregiver strain in this population through interventions that directly and indirectly target emotion regulation. Our findings highlight the need for further research on interventions that both directly target parents' emotion regulation skills and modify environmental contexts (e.g., social support, respite care) to enhance regulatory capacity and support parental resilience. As our work was cross-sectional, future work should investigate the causal relationship between emotion regulation, mental health, and well-being in parents of autistic children.
Persuasive narratives have been shown to be effective in influencing health behaviors. However, their impact on at-risk populations, such as justice-involved juveniles who use cannabis, has received limited attention. This study analyzes the response of 93 juveniles with judicial measures in detention centers to persuasive video-based narratives. These narratives were developed in accordance with the Health Action Process Approach (HAPA) and were gender-adapted. Additionally, variables influencing resistance to the persuasive message, assessed in terms of favorability, were examined. Prior to exposure to the narrative, motivational variables such as risk perception, outcome expectancies (both positive and negative) of cannabis non-use, and self-efficacy for action were measured. Following the viewing, generated thoughts (cognitive responses) and engagement with the narrative, focusing on identification with the protagonist and narrative transportation, were assessed. The results revealed that the thoughts generated focused on the message content of the message and personal experiences, with favorable thoughts predominating. No significant differences were found between males and females. Furthermore, narrative transportation acted as a significant mediator between risk perception and message favorability. This study provides empirical evidence on the effect of persuasive narratives in this population, indicating that their design, based on health behavior change theories, enhances receptivity. The findings support their integration into prevention programs within the context of juvenile justice. Las narrativas persuasivas han demostrado ser efectivas para influir en los comportamientos de salud. Sin embargo, su impacto en poblaciones en riesgo, como menores en conflicto con la ley que consumen cannabis, ha sido poco explorado. Este estudio analiza la respuesta de 93 menores que cumplen medidas judiciales en centros de internamiento ante narrativas persuasivas en formato video. Estas narrativas se elaboraron conforme al modelo del Proceso de Acción en Salud (Health Action Process Approach, HAPA) y adaptadas por género. Asimismo, se investigaron las variables que influyen en la resistencia al mensaje persuasivo, evaluada en términos de favorabilidad. Antes de la exposición a la narrativa, se midieron variables motivacionales como percepción del riesgo, expectativas (positivas y negativas) de resultados del no consumo de cannabis y autoeficacia para la acción. Tras la visualización, se analizaron los pensamientos generados (respuestas cognitivas) y el engagement con la narración, a través de la identificación con el/la protagonista y el transporte narrativo. Los resultados revelaron que los pensamientos se centraron en contenido del mensaje y en experiencias personales, predominando aquellos de carácter de favorable. No se encontraron diferencias significativas entre hombres y mujeres. Además, el transporte narrativo actuó como mediador significativo entre la percepción del riesgo y la favorabilidad. Este estudio aporta evidencia empírica sobre el efecto de las narrativas persuasivas en esta población, demostrando que su diseño, basado teorías de cambio de conducta de salud, favorece la receptividad. Los hallazgos respaldan su integración en programas de prevención en el contexto de la justicia juvenil.
This work proposes a general framework for the optimal design of radiofrequency pulses in MRI. Based on optimal control theory, it proposes a Python-based numerical implementation using state-of-the-art nonlinear optimization solver (IPOPT). This study proposes three main contributions. It allows the incorporation of hard constraints to the problem and their consistent integration into the optimization process. It proposes to express the pulse as wavelet coefficients which proves to be highly effective in an applicative context. Finally, an innovative approach to minimize the pulse peak amplitude is presented by taking advantage of the efficient constraint management. The proposed framework is made available through a Python package, along with Jupyter Notebooks to reproduce the paper results. It also allows external users to solve their own design problem, benefiting from the generality and flexibility of the proposed implementation. The efficacy of the proposed method is validated in the context of short- T 2 $$ {T}_2 $$ selective excitation and B 1 $$ {B}_1 $$ -robust problems, with a primary focus on power and energy minimization. The optimized pulses provide a substantial enhancement regarding the compromise between energy/peak power and overall pulse performances, when compared to state-of-the-art solutions.
Closed reduction of distal radius fractures is painful, and current analgesic strategies may be inadequate. Ultrasound-guided lateral infraclavicular brachial plexus block may offer complete analgesia and muscle relaxation, potentially improving patient comfort and reduction quality. However, benefits and challenges regarding anesthetic agents for this procedure remain unclear. In this randomized, controlled, blinded, noninferiority trial, 63 adults with distal radius fractures requiring closed reduction received a lateral infraclavicular block with either 30 mL of ropivacaine 0.5%, lidocaine 1% with epinephrine, or ropivacaine 0.2%. The primary outcome was block success at 45 min, defined as complete sensory and extensive motor block of the radial, musculocutaneous, ulnar, and median nerves. Noninferiority was assessed using a margin of 20%. Exploratory outcomes included sensory and motor block assessments, time to pain relief, block duration, pain during reduction, patient satisfaction, quality of closed reduction, fracture treatments, and safety. Ropivacaine 0.2% was statistically inferior to ropivacaine 0.5% in achieving block success at 45 min (risk ratio (RR) 0.63, 97.5% CI 0.40-0.99). Lidocaine 1% with epinephrine did not meet the predefined noninferiority criteria for block success (RR 0.95, 97.5% CI 0.73-1.22) but did provide comparable analgesia with a shorter block duration. Pain scores during reduction were low across all groups, with a significant decrease in pain from baseline. Patient satisfaction was high in all groups. No significant differences were found in the quality of closed reduction, safety, or fracture treatments. Lateral infraclavicular block with ropivacaine 0.2% failed to demonstrate noninferiority for block success and was statistically inferior to ropivacaine 0.5%. Inferiority testing should be interpreted cautiously within the context of a noninferiority design, although the results suggest reduced effectiveness for distal radius fracture reduction. Lidocaine 1% with epinephrine yielded inconclusive results for noninferiority on block success, but provided a shorter block duration without compromising analgesia, patient satisfaction, or quality of reduction. ClinicalTrials.gov Identifier NCT06379490 (released April 23, 2024); https://clinicaltrials.gov/study/NCT06379490; EUCT Identifier 2024-510,572-20-00; https://euclinicaltrials.eu/ctis-public/view/2024-510572-20-00.
While normothermic machine perfusion (NMP) has benefits over static cold storage (SCS), its efficacy in high-acuity recipients with high Model for End-Stage Liver Disease (MELD) scores, particularly using a back-to-base application model, is not well established. We aimed to compare short-term outcomes between NMP and SCS in this cohort. This retrospective cohort study analyzed 215 adult recipients with a laboratory MELD score ≥ 25 who underwent isolated liver transplantation from donation after brain death (DBD) donors between July 2022 and June 2024. Patients were divided into SCS (n = 137; median MELD, 35) and NMP (n = 78; median MELD, 36) groups. Outcomes were compared using multivariable regression analyses. NMP was associated with higher daytime surgery rates (88.5% vs. 23.4%) and lower peak alanine aminotransferase levels (median 298 vs. 653 IU/L). However, no significant differences were found in blood loss, early allograft dysfunction, acute kidney injury, comprehensive complication index, hospital stay, or 90-day graft survival. In high-MELD recipients of DBD grafts, a predominantly back-to-base NMP approach did not improve major short-term clinical outcomes compared to SCS. Benefits of NMP appear to be highly context-dependent across three axes-graft type, application model (upfront vs. back-to-base), and recipient acuity.
The building sector is a major contributor to global energy consumption and greenhouse gas emissions, positioning zero-energy home (ZEH) strategies as a critical pathway toward sustainable development. While the technical feasibility of zero-energy buildings has been widely studied, their successful implementation depends largely on residents' awareness, acceptance, and willingness to adopt such strategies. However, empirical evidence examining residents' perceptions of ZEH in the Middle East, particularly in Saudi Arabia, remains limited. This study investigates Saudi residents' perceptions of zero-energy homes, their awareness of passive and active ZEH strategies, and the key barriers hindering their adoption. A structured three-part survey was distributed across Saudi Arabia, yielding 411 valid responses. Descriptive statistical analysis was used to examine awareness levels, behavioral intentions, and current practices, while thematic analysis was applied to identify perceived obstacles. The findings reveal a substantial knowledge gap, with 45% of respondents unfamiliar with the concept of zero-energy homes. Despite this limited awareness, most participants recognized the environmental benefits of ZEH and expressed a willingness to invest in such homes. Passive strategies, including insulation and natural ventilation, were more widely recognized and adopted than active strategies such as photovoltaic systems and advanced HVAC technologies. Four primary barriers to adoption were identified: high initial costs, lack of technical expertise, insufficient public awareness, and inadequate infrastructure for retrofitting existing homes. This study contributes user-centric empirical evidence to the body of knowledge on zero-energy homes in a hot-climate, oil-dependent context and highlights the need for targeted policy interventions, public awareness programs, and industry capacity building.
The "physical activity health paradox" posits that physical activity done during work (occupational physical activity [OPA]) may not yield the health benefits consistently observed for leisure-time physical activity (LTPA) and, in some cases, may be harmful. Given the broad implications for such a paradox, which contradicts current public health guidelines for physical activity, we conducted a narrative, non-systematic review to discuss the current epidemiological and mechanistic evidence on the topic to inform opportunities for research and practice moving forward. Epidemiological evidence shows that LTPA is reliably protective against mortality and cardiovascular disease, whereas OPA has mixed or adverse associations. Several recent meta-analyses found higher all-cause mortality risk among men with high vs low OPA and found LTPA to potentially mitigate this OPA risk. Studies with device-measured OPA further highlight potential heterogeneity by OPA task and context. These conclusions remain limited by low quality evidence due to heterogeneous OPA exposure measurements, referent group selection, challenges in study design, and varied confounder adjustments. Mechanistically, four interrelated pathways that may explain the observed presence of a paradox have been proposed and preliminarily tested: (1) acute cardiovascular strain catalyzed by long-duration OPA with little recovery; (2) downstream vascular changes such as greater arterial stiffness, blunted baroreflex sensitivity, and maladaptive cardiac remodeling from chronic OPA exposure; (3) systemic inflammation associated with high OPA levels; and (4) modifiers such as low cardiorespiratory fitness and high psychosocial stress amplifying strain, inflammation, and risk. Current evidence is limited by reliance on cross-sectional or between-subject designs, crude OPA classification, and limited mechanistic interventions. Unlike the clear benefits from LTPA, research findings examining the health effects of OPA remain mixed. While uncertainty remains, the balance of evidence suggests that OPA is less beneficial to health than LTPA which should be considered in public health messaging. Advancing the field will require multidimensional OPA exposure assessment, rigorous study designs, and evaluation of mechanism-driven outcomes to clarify causal pathways and identify feasible intervention targets to promote health in workers with physically demanding jobs.
Decades of conflict, epidemics, and climatic shocks have severely weakened Somalia's health system. The failure of five consecutive rainy seasons in 2022-2023 led to the longest and most severe drought in recent history, resulting in an unprecedented nutrition and food security crisis. These conditions have heightened the risk of disease epidemics, particularly cholera and measles. To assess the effect of interventions on disease transmission in real time, make short-term projections of disease incidence, and inform response efforts, the World Health Organization Somalia Country Office developed the Somalia infectious disease explorer (WHO-SIDE). To describe the development and application of WHO-SIDE and demonstrate its potential to identify high-risk areas for targeted public health interventions. WHO-SIDE is an interactive web-based application designed using the Shiny framework in R. It estimates the time-varying reproduction number (Rt), projects case incidence, and evaluates the impact of interventions on transmission. The application uses routine disease surveillance data, offering features such as data visualization, geographic analysis, and customizable epidemic projections. Since its deployment, WHO-SIDE has been used to monitor infectious disease trends, guide targeted interventions, and evaluate public health response efforts in Somalia. Outputs were reviewed jointly by WHO and Ministry of Health staff and formed part of the evidence base used to prioritise response activities. Challenges including limited access to technology, incomplete surveillance data, and a lack of trained personnel have hindered its full potential. WHO-SIDE highlights the feasibility and utility of analytical tools for disease monitoring and response in resource-limited, crisis-affected settings. Realising this potential will require sustained investment in three areas: building analytical capacity among local health staff; improving the completeness and timeliness of surveillance data; and developing processes for integrating modelled outputs with field intelligence. Without progress in these areas, tools such as WHO-SIDE risk producing outputs that are difficult to interpret and act upon in operational contexts.
Guideline-recommended non-targeted systemic therapies for previously treated metastatic colorectal cancer (mCRC) include regorafenib, trifluridine/tipiracil, and fruquintinib, but no consensus exists on the definition of clinically meaningful improvements for later-line mCRC treatments. Trials were identified from systematic searches in MEDLINE, Embase, and the Cochrane Library. Meta-analyses were performed to characterize overall survival (OS) and progression-free survival (PFS) improvements with systemic therapy versus placebo in previously treated mCRC. Meta-analyses were conducted using fixed effect and random effects (RE) frequentist models of difference in medians, hazard ratios (HRs), and 12-month restricted mean survival time (RMST). Six randomized, placebo-controlled, phase III trials of 3277 patients comparing oral systemic monotherapies with placebo were analyzed. Using the RE model, the meta-analyzed OS estimate for oral systemic monotherapy versus placebo was 1.86 months (95% confidence interval [CI], 1.30-2.42) for difference in medians, 0.69 (95% CI, 0.64-0.76) for HRs, and 1.25 months (95% CI, 0.69-1.82) for difference in 12-month RMST. For PFS, meta-analyzed median improvement was 0.97 months (95% CI, 0.28-1.66), HR was 0.38 (95% CI, 0.30-0.47), and 12-month RMST difference was 1.90 months (95% CI, 1.41-2.39). Sensitivity analyses, excluding the FRESCO-2 trial due to prior treatment differences, confirmed the primary meta-analysis results. When assessing clinical benefit of later-line mCRC treatments, the broad clinical picture including individualized treatment goals should be evaluated. Considering multiple survival measures in the later-line mCRC context, an incremental survival improvement with oral systemic monotherapy versus no active therapy is clinically meaningful.
This study examines the role of gender stereotypes in shaping the perceptions and specialisation choices of medical students in Italy. Although women are increasingly entering the medical profession, strong gender segregation persists across medical specialities, with surgical and technological fields remaining male-dominated and people-oriented specialities female-dominated. Using a survey of 502 senior medical students, the analysis explores whether students perceive certain specialities as more suitable for men or women, and how gendered dispositions influence these perceptions and career orientations. The results show that gendered patterns in both perceptions and intended specialisation choices cannot be fully accounted for by gender alone. Rather, they are mediated by communal and agentic traits, understood as socially produced dispositions aligned with the organisation of medical work. Students with stronger communal orientations are less likely to endorse gender-stereotypical views, whereas agentic traits are associated with perceiving certain fields-both male- and female-dominated-as more suitable for one gender. Family background also plays a role, with students from medical families more likely to perceive specialities as gendered. Overall, the findings suggest that implicit biases continue to shape medical career trajectories through indirect and less visible pathways, even in contexts of increasing gender parity in education.
Calciphylaxis is a rare syndrome of microvascular calcification and skin infarction, occurring most commonly in patients with kidney failure. Calciphylaxis carries a poor prognosis, and current treatment involves mitigating risk factors, wound care, and medical therapies such as intravenous sodium thiosulfate for calcium chelation. We present an innovative treatment approach of topical sodium thiosulfate soaked gauze successfully used to treat calciphylaxis of a 58-year-old female with renal transplant. She presented with a tender bruise over the posterior right calf, in the context of good graft function (serum creatinine 88 μmol/L), warfarin use for metallic mitral valve, and total parathyroidectomy. Ultrasound imaging highlighted extensive subcutaneous tissue calcification. A punch biopsy of the lesion confirmed calciphylaxis and revealed acute deep ulceration within necrotic debris and calcium deposits along dermal blood vessels. She was managed with cessation of calcitriol and warfarin (switch to enoxaparin with anti-factor Xa level monitoring), replacement of vitamin K2, analgesia, and diligent wound care and debridement. She had twice-weekly intravenous sodium thiosulfate without any improvement and was suspended at 16 weeks after developing central line bacteraemia. On routine deep tissue debridement, small hard calcium deposits resembling calcinosis were noted to superficialise. The decision was made to commence thrice-weekly applications of topical sodium thiosulfate, prepared as gauze soaked in sodium thiosulfate 25% 15 mL applied for approximately 15 min. The ulcer completely healed, pain resolved, and topical treatment was suspended after a total of 20 weeks. This case demonstrates successful treatment of calciphylaxis using topical gauze soaked in sodium thiosulfate without concurrent intravenous sodium thiosulfate.