"DO EVERYTHING!!" How many times have you heard that phrase from a distressed family member? We routinely receive this desperate plea, and our knee-jerk reaction is to press on, push harder, be more aggressive. We, as acute care surgeons, have spent our lives learning a craft geared towards "doing everything" to heal patients so this response comes naturally. However, how do we respond to "do everything" when the probability of a meaningful recovery is extremely low or non-existent? These situations create moral tension for surgeons who must reconcile the desire to preserve life with the obligation to avoid harm, respect patient values, and provide care that is medically appropriate. We will explore three components of this challenging topic: (1) the utility and limitations of risk calculators and prognostic tools in trauma, (2) the best case/worst case model as a structured communication strategy and (3) approaches to counseling families when expectations for recovery are not realistic. Together, these elements provide a framework for decision-making that is compassionate, ethically grounded, and anchored in clinical reality.
This study investigated queer therapists' perceptions of police bias and attitudes toward police. We used a mixed-methods explanatory approach by administering the Perceptions of Police Scale (POPS) to mental health professionals and conducted follow-up qualitative interviews with participants who identify with a queer sexuality to explore the factors influencing their perceptions of police and the ways in which they view and utilize reliance on police when a client is experiencing a mental health crisis. Quantitative data were analyzed with SPSS using correlations and t-tests to assess the relationship between sexuality and perceptions of police scores. Sexuality significantly correlated with perceptions of the police, meaning queer therapists viewed the police less favorably compared to heterosexual participants. A qualitative analysis using reflexive thematic analysis revealed seven themes that address how queer therapists perceive police and strategies utilized to decide if calling 911 for a client in crisis would be lifesaving or life-threatening.
Alcohol-related cirrhosis is an important indication for liver transplantation (LTX) in Germany and worldwide. In Europe, the USA, and Canada patients with alcohol-related cirrhosis often have to maintain at least six months of abstinence and demonstrate treatment adherence before being listed for transplantation. Nevertheless, country-specific exception policies may allow earlier liver transplantation in selected cases. These requirements, combined with the severity of the disease, create challenges for patients, their relatives and the healthcare system. This study aimed to examine the roles and functions of family members in supporting adherence to therapy and maintaining abstinence in patients with alcohol-related cirrhosis prior to LTX listing. A total of 35 interviews were conducted, including narrative interviews with 10 relatives, 11 patients, and 3 former patients, as well as semi-structured interviews with 11 healthcare professionals from different LTX centers across Germany. Interviews were audio-recorded, transcribed, and analyzed using qualitative content analysis. Relatives played a central role in supporting therapy adherence and abstinence, particularly by actively assisting with the implementation of treatment recommendations. They also assumed significant responsibility for acquiring and applying health literacy. Additionally, family members provided critical emotional support, yet their own psychosocial needs were often overlooked, leaving them without sufficient resources to cope with the associated burdens. Building on our findings, we propose a family-centered integrated model for patient-centered care in advanced liver disease and LTX. This model emphasizes the recognition and support of family members in clinical practice, aiming to improve both patient outcomes and the well-being of relatives involved in the care process.
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Vision impairment disproportionately affects individuals from low-income and African American communities, yet underutilization of preventive eye care persists. We conducted a community-based participatory research (CBPR) study to explore perceptions, values, and barriers related to vision care in an underserved urban neighborhood. In partnership with University Settlement, a trusted community center in Cleveland, Ohio, and a study-specific Community Advisory Board (CAB), we conducted semi-structured interviews with 60 adult residents of the Broadway-Slavic Village neighborhood. Thematic analysis identified key facilitators and barriers to accessing vision care. Participants across racial groups described vision as highly important and often endorsed more frequent preventive eye care than they reported receiving. Barriers to eye care utilization included cost, inadequate insurance coverage, transportation challenges, fear of diagnosis, and limited awareness of preventive benefits. Distinct differences emerged in insurance type and visit frequency between African American and White participants despite comparable socioeconomic status. Participants identified community-specific solutions such as free or low-cost exams, mobile clinics, transportation support, and increased education. Our findings demonstrate that underutilization of eye care reflects structural and systemic barriers rather than lack of motivation. System-level interventions that integrate screenings into clinical and community settings, streamline referral pathways, and reduce logistical burdens are needed to facilitate equitable access to vision care. Embedding data collection in a trusted community setting surfaced perspectives from individuals who may be absent from clinic-based or online research and provides a model for translational research addressing health disparities.
Use of digital communication tools (e.g., telehealth, patient portals) is increasing in outpatient palliative care (OPC). Assess patient/caregiver experiences with digital communication tools. Qualitative. Inclusion criteria were age ≥18 years, English/Spanish/Cantonese-speaking, and ≥1 telehealth OPC visit in the prior year. If patients could not converse by phone, we interviewed their caregivers. We developed an interview guide using the Capability-Opportunity-Motivation-Behavior framework. We analyzed semi-structured interviews using thematic analysis. Among 32 participants, 10 were caregivers, 11 Spanish-speaking, 9 Cantonese-speaking. Theme 1: Video and in-person visits have important and distinct roles. Theme 2: Establishing a trusting rapport over video is possible. Theme 3: Engagement can be high with the patient portal despite poor usability. A flexible approach offering both video and in-person visits is ideal. Usability is a key factor in patient portal engagement. Our findings underscore the need to advocate for a permanent Medicare telehealth extension.
This chapter considers biased signaling as a natural function of GPCRs in the form of probe dependence. Thus, any ligand that changes the conformation of the receptor (agonist, antagonist, allosteric modulator) has the potential to change the natural signaling of the receptor through diverse conformational alterations in the receptor structure. Given this, selectivity is discussed in terms of varying intrinsic efficacy and selective stabilization of receptor states with methods to detect and measure these effects. Lastly, the translation of in vitro to complex in vivo systems will be considered.
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Phenolic compounds are a versatile class of bioactive molecules with growing applications in different areas, including the food and health sectors. This comprehensive review deals with many aspects related to the study of phenolic compounds, starting with advances in extraction, detection, and quantification methods, going through bioavailability, bioactivity, and beneficial health properties, and discussing antioxidant and antimicrobial uses and mechanisms. The work also discusses strategies related to sustainable use and production with opportunities related to the bioeconomy. Industrial applications include food conservation, active packaging systems, functional foods, nutraceuticals, cosmetics, and pharmaceuticals. Relevant mechanisms of action include destabilization of cellular membranes, enzymatic inhibition, oxidative stress induction, and interference on quorum sensing communication systems, with the potential to be used in anti-virulence approaches. The potential use of phenolic compounds against planktonic and sessile bacterial cells (biofilms) is discussed, as well as their synergistic interactions with antibiotics and bacteriocins, aligned with hurdle technology in the food industry. Phenolic compounds are promising sustainable and innovative alternatives in the food, health, and industrial realms.
Gene regulation has emerged as an important determinant of phage infection outcomes. Host susceptibility and immunity are often governed by conditional gene expression, which allows reversible shifts in receptor availability and defence system activity that balance phage resistance with fitness costs. Phages likewise rely on tightly regulated gene expression, precisely timing counter-defence deployment and manipulating host transcriptional programmes as well as immune signalling pathways. These dynamics position gene regulation as a major determinant of bacteria-phage co-evolution, acting alongside the gain and loss of defence and counter-defence genes. Viewing phage-host interactions through gene regulation provides insight into variability in infection dynamics and helps explain why genomic information alone cannot accurately predict phage activity.
Globally, as many as 1 in 8 children experience severe and persistent language difficulties. These children are at heightened risk for mental health difficulties, however, both the ways in which mental health concerns manifest in the context of language difficulties, and the experiences of children with language difficulties and their caregivers in accessing and engaging with formal mental health supports remain under researched. The aim of the current study was to explore lived experience perspectives (child and caregiver) on mental health concerns and, mental health support, for children (≤ 18 years) with language difficulties. A 2-phased sequential explanatory design was employed, which combined findings from an online international survey of caregivers (n = 120) of children with language difficulties with data from semi-structured interviews with both children (n = 4) and caregivers (n = 12). Combined data from the survey and interviews highlighted a high level of caregiver concern about the mental health of children with language difficulties but low levels of access to formal mental health support. Interviews highlighted several reasons for not accessing formal mental health supports including limited availability of mental health care providers; funding and time constraints (i.e., not wanting to over-schedule their child); mental health providers lacking knowledge about DLD, and perceived or actual barriers of traditional methods of therapy (e.g., one-on-one talk therapy) for children with language difficulties. The findings of our study support the view that children with language difficulties are at risk of mental health concerns and yet are also under-served by mental health services. These findings highlight the need for targeted interprofessional training and integrated models of collaborative care between mental health and language specialists to more adequately meet these children's needs. Future research to engage a wider range of child perspectives and the perspectives of clinicians on the facilitators and barriers to engaging children with language difficulties in formal mental health support is needed. Children and adolescents with language difficulties experience high rates of anxiety, low self-esteem, and social difficulties, often in response to academic and peer-related challenges. Despite significant mental health concerns, most families report limited access to formal mental health support, citing barriers such as service unavailability, lack of professional understanding of language difficulties, and the unsuitability of traditional talk-based therapies. There is a critical need for interprofessional collaboration between speech-language pathologists and mental health professionals, alongside targeted training and inclusive therapeutic approaches, to ensure accessible and effective support for this population. What is already known on this subject Globally, as many as 1 in 8 children experience severe and persistent language difficulties. These children are at heightened risk for mental health difficulties. What this study adds to existing knowledge Our study provides lived experience perspectives on mental health concerns and mental health support in the context of language difficulties. The findings highlight caregiver concerns about self-esteem, anxiety, peer difficulties and the inaccessibility of formal mental health support. What are the potential or actual clinical implication of this study? Children with language difficulties are at risk of mental health concerns and yet are also under-served by mental health services. Findings highlight the need for targeted interprofessional training and integrated models of collaborative care between mental health and language specialists to more adequately meet these children's needs.
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Oregon's vast and complex terrain creates potential barriers for patients needing daily radiotherapy. The large geographic area and the lack of a standardized database to guide referrals make navigating regional radiation oncology (RO) resources and understanding treatment access across the state challenging. This is a cross-sectional statewide analysis of RO centers and physicians in Oregon using geospatial information software to estimate resident-level access, RO center-specific capability, and facility-level population coverage by distance and drive-time in 2025. Additionally, regional all-cancer outcomes are summarized by mortality-to-incidence ratios (MIRs) based on proximity to RO access. Oregon has 27 active RO centers, with a recent closure in Pendleton that previously served approximately 110,000 residents. Although 71% of the population lives within 10 miles of an RO facility, 54.5% of the state's land area lacks proximal access, leaving 434,855 residents (10.3%) more than 60 minutes from care. For many counties, the nearest center is located out-of-state at distances up to 137 miles. One-way drive-times vary widely but can exceed 2.5 hours. Despite statewide resource levels exceeding national averages (one linear accelerator per approximately 83,000 residents and one radiation oncologist per approximately 49,000 residents), there is limited access to brachytherapy and no proton therapy centers. Additionally, increasing geographic isolation from RO access is ecologically associated with worse all-cancer MIRs. This study provides a comprehensive characterization of RO resources across Oregon. Results reveal substantial regional disparities in proximity, treatment capability, and outcomes, particularly in rural/remote counties that lack in-state RO options. By integrating geospatial, population, and outcome data, this work establishes a statewide baseline to identify persistent access gaps and serves as both a referral resource and a framework for future access studies.
Exposure to environmental pollutants can disrupt the gut microbiota, but how pollutants impact natural, seasonal changes in wildlife gut microbiota remains unknown. We quantified how exposure to radionuclides affected temporal changes in the gut microbiota of bank voles (Clethrionomys glareolus) inhabiting the Chornobyl Exclusion Zone (CEZ), Ukraine. Wild-caught bank voles from contaminated and uncontaminated areas within the CEZ were released into field enclosures that differed in their levels of environmental radionuclides so that the gut microbiota could be longitudinally sampled from animals experiencing a known difference in contamination. Using 16S rRNA amplicon sequencing, we uncovered pronounced seasonal changes in alpha and beta diversity. Underlying this seasonal variation, exposure to radionuclides had a significant influence on beta diversity. Notably, the Bacillota (formerly Firmicutes) to Bacteroidota (formerly Bacteroidetes) (F:B) ratio and the number and composition of differentially abundant bacterial genera differed with time. Exposure to environmental radionuclides did not increase the dispersion in gut microbiota beta diversity. This contrasts with expectations of the Anna Karenina principle for microbiota, which predicts that exposure to a stressor leads to more stochastic, individualised changes in community composition, resulting in increased variation among individuals. Our data demonstrate how a cross-sectional study can fail to capture the wider effects of pollutants on the gut microbiota of wild animals because of natural, seasonal dynamics in the microbial communities. Also, we highlight the importance of temporal monitoring of wildlife to uncover context-dependent effects of pollutants on microbiota. Exposure to radionuclides is associated with changes in the gut microbiota of wild bank voles, but in a seasonally contingent manner that is likely shaped by interactions between host diet, physiology and the level of environmental stress. Полютанти навколишнього середовища можуть порушувати мікробіоту кишечника, водночас наразі невідомо, як вони впливають на природні сезонні зміни мікробіоти кишечника диких тварин. Ми кількісно визначили вплив радіонуклідів на часові зміни мікробіоти кишечника рудої нориці (Clethrionomys glareolus), що мешкала у зоні відчуження навколо Чорнобильської АЕС, Україна. Вловлених на забруднених та незабруднених територіях зони відчуження рудих нориць випускали у польові вольєри, які відрізнялися за рівнем радіонуклідів навколишнього середовища для подальшого логітудинального відбору зразків мікробіоти кишечника у тварин з визначеною різницею в забрудненні. Із використанням секвенування 16S рРНК амплікону ми виявили виразні сезонні зміни альфа‐ та бета‐різноманіття. Опромінення, що було в основі цих сезонних коливань, мало значний вплив на бета‐різноманіття. Зокрема, співвідношення Bacillota (= Firmicutes) до Bacteroidota (= Bacteroidetes) (F:B), а також кількість і склад диференційно поширених бактеріальних родин відрізнялися з часом. Вплив радіонуклідів навколишнього середовища не збільшував дисперсію бета‐різноманіття мікробіоти кишечника, всупереч очікуванням принципу Анни Кареніної для мікробіоти. Наші дані демонструють, як короткочасне дослідження може не охопити ширші наслідки впливу полютантів на мікробіоту кишечника диких тварин через природні сезонні зміни в мікробіомі. Також ми підкреслюємо значення довготривалого моніторингу диких тварин для виявлення контекстно‐залежного впливу полютантів на мікробіоту. Вплив радіонуклідів був асоційований зі змінами мікробіоти кишечника дикої рудої нориці, але сезонно обумовленим чином, який, ймовірно, формується взаємодією між рівнем стресу навколишнього середовища, дієтою та фізіологією тварин.
Previous work highlights issues surrounding stigma related to participation in physical activity, defined as a personal characteristic that is "deeply discrediting". Through the lens of stigmatization, let us assess a new Federal initiative - placing pullup bars in airports. On the surface, 1 may conclude this is a positive step for the promotion of population health through increased opportunities for physical activity. Below the surface, this initiative may create a situation for stigmatization and deter individuals from considering a more physically active lifestyle, as the few with power and able to do pullups discredit the many who are unable.