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Human attention is often guided by contextual cues that signal where or how to focus in complex environments. Research on object contextual cueing has largely emphasized spatial regularities, but it remains unclear whether socially meaningful information can also provide such guidance. Across three experiments using face stimuli, we examined whether social cues can serve as contextual cues independently of spatial arrangements. In all experiments, participants searched for a target face among distractor faces, with spatial configurations fully randomized on every trial, and contextual information was defined by different types of social mappings. In Experiment 1, the cue was defined by consistent associations between a target identity and a specific set of distractor identities. In Experiment 2, the cue was the overall mood, quantified as the ratio of angry to happy faces. In Experiment 3, the cue was relational information, specifically facing-direction patterns within pairs of profile-view faces. Performance under Consistent Mapping conditions was compared with Variable Mapping conditions, in which these social regularities changed across trials. Bayesian analyses revealed reliable contextual cueing effects across all three experiments, with faster responses under Consistent than Variable Mapping conditions. The effect was strongest in Experiment 2, suggesting that global social cues may be encoded more efficiently than local relational cues. Post-experiment awareness tests indicated minimal explicit knowledge and no reliable association between awareness measures and contextual cueing. Together, these findings suggest that socially meaningful relational structure can provide stable predictive information that supports object-based contextual learning even when spatial regularities are absent.

Autoimmune diseases encompass over 100 distinct diseases where the immune cells betray our body by attacking the tissues they are meant to protect. Even though rare, 15 million Americans are collectively affected by autoimmune diseases, a number that continues to rise every year. Current treatment modalities primarily focus on alleviating symptoms rather than providing prevention or a cure. Tolerogenic dendritic cells (tolDCs) have gained popularity for autoimmune disease treatment as an alternative to traditional systemic immunosuppressive therapies due to their ability to restore immune homeostasis. However, clinical translation of tolDC therapies faces significant hurdles once injected into the body due to suboptimal delivery routes, systemic distribution throughout the body, faster clearance rate, phenotypic instability, and inefficient homing. So, the big question here is: How can we retrain dendritic cells to restore the immune balance while overcoming these challenges? Engineered biomaterials such as nanoparticles, microparticles, hydrogels, and polymer scaffolds offer innovative solutions by enabling targeted delivery of ex vivo-generated tolDCs or in situ reprogramming of endogenous dendritic cells (DCs) by delivering drugs and other bioactive agents at strategic locations. These platforms provide tunable release kinetics, enhanced targeting specificity, improved safety profiles, and high potency, highlighting their importance as a promising alternative to conventional administration methods. Biomaterials can modulate immune responses from inflammatory immune activation to immune tolerance, which is essential for long-term disease management. This review highlights recent advances in biomaterial-based delivery systems for DC delivery and their potential to redefine therapeutic strategies for autoimmune diseases.

Guava (Psidium guajava L.), a tropical fruit known for its immense benefits, has high perishability, leading to significant post-harvest losses. Drying is important preservation method to extend its shelf life and make it more accessible as a food product. This article comprehensively reviews various drying methods, including traditional (solar and osmotic drying) to modern techniques (spray, freeze, cast-tape, foam-mat microwave-assisted drying, and heat pump drying), their impact on nutrients and composition as well as their key advantages and disadvantages. Spray drying is an efficient method for producing guava powders but faces challenges such as stickiness and nutrient degradation. Freeze-drying preserves most of guava's nutritional and sensory qualities but is cost-intensive. Microwave-assisted drying, is gaining popularity for guava processing due to its rapid drying with minimal nutrient loss. Foam blanket drying utilizing low temperatures produces high-quality porous guava products while retaining essential nutrients and volatile compounds. Heat pump drying is low-cost technique and could be used as alternative preservation technique in food industry. Comprehensive understanding of these drying methods helps choose suitable techniques for industrial use as well as improves product shelf life and consumer appeal.

Skin continually faces stresses that compromise its structure and barrier quality, impacting skin appearance and comfort. By sustaining the main biological process of epithelisation, we could improve skin repair, thus correcting skin appearance or discomfort. A stronger barrier will ultimately lead to improvement of the skin surface smoothness, fine lines and radiance. To bolster barrier function, the cohesion of the stratum corneum involving keratinocyte transglutaminase (TGK) and filaggrin (FLG) and the stratum granulosum via tight junction proteins, is critical. Carboxymethyl beta-glucan (CM-BG), a water-soluble derivative of β-glucan, has shown promise in skin repair and anti-ageing applications. This study investigates its wound repair potential using in vitro assays and a 3D human full-thickness wounded skin model. The effects of CM-BG on various skin biological processes, including inflammation, differentiation and extracellular matrix remodelling, were investigated using a range of in vitro assays. Its potential to promote wound healing, epidermal recovery and barrier function was further assessed in a 3D reconstructed skin model. These comprehensive investigations revealed CM-BG's multifaceted actions in skin biology. Findings showed CM-BG selectively activates Dectin-1 receptors in a concentration-dependent manner. Furthermore, CM-BG exhibited anti-inflammatory properties by inhibiting key pro-inflammatory mediators (PGE2, IL-12/IL-23p40, IL-1β) while promoting the release of anti-inflammatory cytokines IL-10. Additionally, CM-BG significantly enhanced the expression of TGK, tight junction proteins (Claudin-1, Zonula occludens-1 and Occludin) and collagen type I. A 3D skin wound healing model confirmed these findings. CM-BG accelerated wound repair, reduced Transepidermal Water Loss and increased epidermal/dermal thickness in the wounded area. Additionally, post-injury, CM-BG also showed increased expression of key markers on the 3D reconstructed skin model. These results suggest CM-BG is a valuable topical ingredient for promoting wound healing, skin repair and mitigating skin ageing by interacting with Dectin-1 receptors, modulating inflammation, improving skin barrier function and boosting collagen production. Further clinical studies are warranted to confirm these promising findings. La peau est constamment soumise à des agressions qui compromettent sa structure et la qualité de sa fonction barrière, ce qui affecte son aspect et son bien‐être. En soutenant le processus biologique fondamental d'épithélialisation, nous pourrions améliorer la régénération cutanée et, par conséquent, corriger l'aspect de la peau ou atténuer les sensations de désagrément. Une barrière plus solide conduira à terme à une amélioration de la douceur de la surface cutanée, des ridules et de l'éclat de la peau. Pour renforcer la fonction barrière, la cohésion de la couche cornée, impliquant la transglutaminase des kératinocytes (TGK) et la filaggrine (FLG), ainsi que celle de la couche granuleuse via les protéines des jonctions serrées, est. essentielle. Le carboxyméthyl bêta‐glucane (CM‐BG), un dérivé hydrosoluble du bêta‐glucane, s'est. révélé prometteur dans les applications liées à la régénération cutanée et à la lutte contre le vieillissement. Cette étude examine son potentiel en matière de cicatrisation à l'aide de tests in vitro et d'un modèle 3D de peau humaine lésée sur toute l'épaisseur. Les effets du CM‐BG sur divers processus biologiques cutanés, notamment l'inflammation, la différenciation et le remodelage de la matrice extracellulaire, ont été étudiés à l'aide d'une série de tests in vitro. Son potentiel pour favoriser la cicatrisation des plaies, la régénération épidermique et la fonction barrière a ensuite été évalué dans un modèle de peau reconstruite en 3D. Ces études approfondies ont mis en évidence les multiples effets du CM‐BG sur la biologie cutanée. Les résultats ont montré que le CM‐BG active de manière sélective les récepteurs de la dectine‐1 en fonction de la concentration. De plus, le CM‐BG a démontré des propriétés anti‐inflammatoires en inhibant des médiateurs pro‐inflammatoires importants (PGE2, IL‐12/IL‐23p40, IL‐1β) tout en favorisant la libération de la cytokine anti‐inflammatoire IL‐10. De plus, le CM‐BG a considérablement renforcé l'expression de la TGK, des protéines des jonctions serrées (Claudin‐1, Zonula occludens‐1 et Occludin) et du collagène de type I. Un modèle 3D de cicatrisation cutanée a confirmé ces résultats. Le CM‐BG a accéléré la réparation des plaies, réduit la perte d'eau transépidermique et augmenté l'épaisseur de l'épiderme et du derme dans la zone lésée. De plus, le CM‐BG administré après la lésion a également montré une expression accrue de marqueurs importants sur le modèle de peau reconstruit en 3D. Ces résultats suggèrent que le CM‐BG est. un ingrédient topique précieux permettant de favoriser la cicatrisation des plaies, la régénération cutanée et le ralentissement du vieillissement cutané grâce à son interaction avec les récepteurs de la dectine‐1, à sa capacité à moduler l'inflammation, à améliorer la fonction de barrière cutanée et à stimuler la production de collagène. Des études cliniques supplémentaires sont nécessaires pour confirmer ces résultats prometteurs.

Achieving carbon peak and carbon neutrality requires not only reducing emissions but also managing the macroeconomic side effects of the energy transition. This study examines employment reallocation as a carbon transition management problem rather than as a conventional labor market performance issue. We develop an integrated multi-regional input-output (MRIO) and multi-objective optimization model to simulate how China's carbon peak constrained energy transition reshapes formal labor demand across 42 sectors and 31 provinces. The novelty of this study lies in linking a theoretical mechanism of capital biased energy transition with a detailed interregional production network, thereby identifying where the social costs of decarbonization are likely to concentrate. Our results show that although the transition increases aggregate employment, it generates a clear "winner takes all" pattern. Employment gains are captured mainly by economically developed coastal regions and high value added service and power related sectors, while less developed inland and resource dependent regions face severe losses. Shanxi, a typical coal dependent province, could lose nearly 10% of formal employment opportunities, and job growth in renewables is insufficient to fully offset losses in traditional fossil fuel and power industries. These findings provide policy relevant evidence for carbon management by showing that carbon peak pathways must be evaluated not only by emission outcomes but also by their spatial and sectoral employment risks.

Children with life-limiting conditions and their families face profound existential and spiritual challenges throughout the paediatric palliative care (PPC) trajectory. While spiritual care (SC) is a recognised component of PPC, its continuity and quality across care settings remain underexplored. This study examined how SC can be organised and safeguarded across the PPC continuum, from the perspectives of parents, healthcare professionals, and spiritual care providers. An exploratory qualitative study was conducted using multidisciplinary peer consultation groups. Two groups met online in 2022-2023, discussing six PPC cases over seven sessions. Participants included spiritual care professionals, clinicians from hospital and home settings, and parents. Data sources included audio-recorded transcripts, structured case descriptions, and field notes. A modified QUAGOL approach was used for narrative-informed thematic analysis. Coding was supported with team discussions. Continuity of care (relational, informational, and managerial) informed interpretation as a sensitising framework. Two themes were identified: (1) challenges in ensuring continuity of spiritual care, including fragmented referrals, lack of coordination, and cultural disconnects; and (2) defining and delivering quality SC, emphasising relational consistency, cultural and linguistic fit, and interprofessional collaboration. Parents valued providers who "knew their story", while professionals stressed clearer referral pathways and role alignment. Gaps in coordination and information transfer constrained support across transitions.  Continuity of spiritual care in PPC is not merely a logistical task but a relational and interpretive process. Embedding SC into proactive care planning and interprofessional practice may improve coordination, enhance cultural responsiveness, and support families throughout the illness trajectory. • Spiritual care is an essential dimension of paediatric palliative care but is often fragmented across settings. Traditionally, SC has been hospital-centred. • Families frequently lack consistent support during transitions between hospital, home, and community care. • This study suggests that continuity in spiritual care relies on sustained relationships, cultural attunement, and clear coordination. • Embedding spiritual care in proactive planning may support consistency and family-centred support throughout the illness trajectory.

Fatty acid amide hydrolase (FAAH) is a key enzyme in the endocannabinoid system and a promising therapeutic target for pain and depression. However, traditional FAAH inhibitors have faced clinical setbacks due to their limited efficacy and off-target effects. Here, we present the rational design and molecular characterization of C13p, a novel PROTAC molecule targeting hFAAH, composed of a 13-carbon linker connecting the FAAH ligand Carb4d and the CRBN ligand pomalidomide. Our results demonstrate that C13p significantly enhances the protein-protein interactions between hFAAH and CRBN, with a binding free energy of -42.2 kcal mol-1 in the ternary complex compared with -30.5 kcal mol-1 in the binary system. Notably, C13p exhibits stronger binding to CRBN (-13.7 kcal mol-1) than to hFAAH (-7.9 kcal mol-1), suggesting a stepwise assembly mechanism where C13p first binds to CRBN and subsequently recruits hFAAH. Dissociation studies reveal that hFAAH dissociates independently from the ternary complex in 81% of trajectories, with an average residence time of 0.58 s, highlighting a cyclic recruitment mechanism. We further identified K508, K505, and K501 as the potential ubiquitination sites on hFAAH, with significantly enhanced solvent exposure upon C13p binding. This work provides the first detailed mechanistic insight into PROTAC-mediated FAAH degradation, offering a novel strategy for developing next-generation therapeutics for depression-pain comorbidity.

Adolescent pregnancy remains a persistent and inequitable in Latin America. Chile has achieved one of the fastest declines in adolescent fertility in the region, offering insights into how policy and health system responses may accelerate progress.MethodsWe conducted a national descriptive-analytical case study using a mixed-methods approach to examine policies, programs, and health system transformations implemented in Chile between 2010 and 2023. Data sources included administrative data, repeated cross-sectional surveys, policy documents, and scientific literature. The analysis was guided by frameworks on political prioritization and health system building blocks.ResultsAdolescent fertility among girls aged 15-19 declined from 51.6 births per 1,000 in 2010 to 10.6 in 2023 (- 79%). This reduction coincided with sustained political commitment, rights-based health system reforms, and expansion of adolescent-responsive primary care services. Access to contraception-including long-acting methods-increased substantially, alongside improvements in service delivery and health system capacity. Declines occurred alongside persisting and, in some cases, widening socioeconomic inequalities. As a result, marked socioeconomic and territorial inequities in contraceptive uptake persist.ConclusionsChile's experience suggests that rapid declines in adolescent fertility can occur alongside coordinated, rights-based policies and strengthened health systems, particularly with expanded access to contraception. However, causal attribution cannot be established. Adolescent pregnancy is still a major challenge in Latin America and is closely linked to inequality, gender norms, and limited access to education and health services. This study looks at how Chile achieved one of the fastest declines in adolescent pregnancy in the region between 2010 and 2023.We analyzed national data, policies, and health programs to understand what contributed to this change. During this period, adolescent birth rates dropped by about 79%, from 51.6 to 10.6 births per 1,000 girls aged 15–19. This decline happened alongside strong government commitment, expansion of adolescent-friendly health services, and improved access to contraception, including long-acting methods.However, not all adolescents benefited equally. Pregnancy rates remain much higher among those living in poverty and in certain regions. Access to services, including abortion, is still unequal, and some adolescents face barriers such as stigma, lack of confidentiality, and limited education about sexual and reproductive health.The findings show that reducing adolescent pregnancy requires more than health services alone. It also depends on education, social conditions, and policies that support young people’s rights and choices. Chile’s experience suggests that progress is possible, but continued efforts are needed to reduce inequalities and ensure that all adolescents can access the information and services they need.

This paper proposes an integrated model of cognitive, emotional, and community-related predictors of vaccine hesitancy. A multiple mediation model was run using Structural Equation Modeling to test the role of perceived job and economic insecurities, pandemic-related emotions, and Sense of Community (SoC) as to respondents' vaccine hesitancy, through the mediation of safeguarding one's own and others' health and re-accessing pre-pandemic public and social life as motivations toward vaccination. Data was gathered from 432 Italian citizens through an online questionnaire. Results suggest that while emotional and community-related dimensions were effective in motivating individuals to protect their and others' health up to reducing their vaccine hesitancy, the perception of material hardships and re-accessing pre-pandemic public and social life were not. The theoretical and practical implications of these results are discussed, paying also attention to the contextual constraints stemming from the specific policies and approaches adopted in Italy to face COVID-19 outbreak.

The present pilot study aimed to assess the feasibility of a 'teletriagerheum' service before the first rheumatology visit and identify potential benefits and disadvantages by comparing a regular visit with a first face-to-face visit preceded by the 'teletriagerheum' service. A prospective monocentric pilot study was conducted from October to December 2021. Consecutive patients were contacted to investigate their willingness to receive a phone call ('teletriagerheum' service) from a physician of the Rheumatology Unit before the first rheumatology visit. The number of definite diagnoses at the first visit in the 'teletriagerheum' group was compared with patients receiving a regular first visit, as well as socio-demographic characteristics, the reason for the visit, face-to-face visit duration, and the number of additional exams. Overall, 75 patients performed the 'teletriagerheum' ('teletriagerheum' group), and 74 patients were included in the control group. In the 'teletriagerheum' group, a higher number of conclusive diagnoses was observed (72% vs. 58%, p=0.020) with a higher probability of receiving a conclusive diagnosis compared with the control group, both at univariate [odds ratio (OR) 2.28, p=0.021] and multivariate analyses adjusting for the only differences between the two groups (marital status and information and communication technologies skills; OR 2.95, p=0.007). At the first face-to-face visit, fewer additional tests were prescribed in the 'teletriagerheum' group; however, the overall number of tests (including those prescribed during teletriage) was higher. A telephone-based telerheumatology service could be an effective triage tool for first visits of new outpatients, enabling more definitive diagnoses, thanks in part to the ability to perform the required investigations in a timely manner in most cases.

Dry eye disease (DED) is a prevalent ocular surface disorder driven by a self-perpetuating cycle of oxidative stress and inflammation, for which current therapies face limitations in bioavailability, retention, and multimechanistic action. To address this, we developed a core-shell structured BPNS@Gel platform, integrating a functionalized black phosphorus nanosheet (f-BPNS) core with a thermoresponsive hydrogel shell. The f-BPNS core (3-5 nm thick) was surface-modified with thiol groups and hyaluronic acid for mucoadhesion and corneal targeting, retaining superior multienzyme-mimetic activities (SOD: 5120 U/mg, CAT: 385 U/mg, GPx: 240 U/mg). The shell, composed of Pluronic F127/N-isopropylacrylamide/chitosan, exhibited thermoresponsiveness (sol-gel transition at 37 °C, gelation time: 45 ± 3 s) and smart ROS/pH sensitivity (68.3% BPNS release under 100 μM H2O2). In vitro, BPNS@Gel demonstrated excellent biocompatibility (>90% cell viability at f-BPNS ≤ 50 μg/mL), targeted corneal epithelial uptake, and multimechanistic action: it scavenged reactive oxygen species, reprogrammed macrophages from a pro-inflammatory M1 (CD86+: 69.6% → 28.3%) to an anti-inflammatory M2 phenotype (CD206+: 18.7% → 42.5%), and promoted corneal epithelial repair (89.3% thickness recovery) and goblet cell regeneration (85.6% density restoration). In a benzalkonium chloride-induced DED mouse model, BPNS@Gel significantly improved tear secretion (78.5% increase), tear film stability (tear breakup time: 8.5 s), and corneal integrity (65.2% reduction in fluorescein staining scores), with excellent long-term biocompatibility. This core-shell design exemplifies a paradigm shift in DED therapy, combining smart responsiveness, targeted delivery, and multimechanistic synergy. This work establishes a paradigm for smart, multitarget nanomedicines to restore ocular surface homeostasis, offering a promising clinical strategy for DED and related inflammatory ocular surface diseases.

Clinical trial sites face persistent challenges including inefficiencies in patient recruitment, protocol adherence, and regulatory compliance. To date, standardised benchmarks and supporting tools for site-level evaluation are limited and cumbersome to use. We carried out a three-phase study comprising of: (1) a scoping review of literature to identify key benchmarks; (2) a Delphi exercise to prioritise these benchmarks; and (3) the development of a tool to identify, and operationalise these benchmarks across diverse clinical research sites, spanning different geographic regions, research settings, and specialties. Drawing from over 60 sources, 36 performance benchmarks were identified and organised into eight thematic domains. A two-round Delphi process, completed by experts from 9 countries across 4 continents, with experience spanning academia, the pharmaceutical industry, and all stages of the research lifecycle, led to consensus on the relevance and feasibility of adoption. Initial user feedback on the resulting digital tool, which integrates the benchmarks, indicated perceived utility and acceptability, with features such as automated scoring and real-time performance feedback viewed positively by users. The proposed benchmarking system is intended to support capacity development of trial sites. Designed to be scalable and adaptable, the tool provides a globally translatable framework for assessing and strengthening clinical research capabilities and warrants further real-world evaluation to assess impact on operational and quality outcomes.

In many research studies, the handling and procedures performed can generate stress and require the use of anesthesia or sedation. In this sense, plant-based extracts named essential oils have emerged as potentially effective and environmentally safe anesthetic/sedative options. Here, we sought to evaluate the essential oil of Varronia curassavica (VCEO) as an anesthetic/sedative ingredient. Here, the anesthetic and sedative capabilities of the VCEO using adult zebrafish (Danio rerio). The anesthetic induction was performed under four different concentrations (100, 200, 400, and 600 mg L-1), followed by evaluation of recovery time; furthermore, a 3 h long exposure was performed for sedative testing, where fish were exposed for 3 h at three different concentrations (50, 80, and 100 mg L-1) under a superpopulation condition, such as those faced during transport. To assess stress, we collected whole-body cortisol from each individual after each exposure. The concentrations of 400 and 600 mg L-1 induced anesthesia (S4) but promoted excessive recovery times; on the contrary, they reduced the cortisol levels of the fish compared with the positive and negative controls. In the sedative testing (3 h long exposure), the animals exposed to 50 mg L-1 remained in S2 stage from the first 10 min, and those exposed to 80 mg L-1 after 20 min. The 100 mg L-1 induced stage S3a. There were no significant changes in cortisol levels observed at these concentrations. Limitations include measurement of whole-body cortisol at a single endpoint and the consistently slower induction and recovery with VCEO compared with a reference anesthetic MS-222, a property that constrains its practical use and warrants further dose-response, time-course, and recovery-optimization studies. Therefore, VCEO appears to be a promising anesthetic and sedative alternative, effective and plant-based, without increasing the physiological stress of the animals.

Cervical cancer remains a leading cause of mortality among women worldwide, particularly in low- and middle-income countries, yet human papillomavirus (HPV) vaccination-the most effective method of prevention-faces variable uptake and acceptance. This study addresses the problem of suboptimal HPV vaccination by examining the factors associated with parental consent for HPV vaccination of adolescent girls in two distinct Peruvian cities, the capital city of Lima and a large city in the Peruvian Amazon, Iquitos. Cross-sectional survey data were collected in 2017 from 986 women attending public health centers, and the Capability, Opportunity, Motivation, Behavior model was applied to categorize behavioral factors associated with women's willingness to vaccine their daughters for HPV. Overall, 90.1% of women reported willingness to vaccinate their daughters, with higher support in Iquitos (94.2%) than in Lima (84.7%). Women who were willing to vaccinate tended to be younger and were more likely to believe the vaccine was safe (Capability), know that it was free and be willing to pay for it (Opportunity), and know someone who had been vaccinated (Motivation). This study contributes to the literature on parental willingness to vaccinate daughters against HPV in a Latin American context applying a validated behavioral framework. Findings provide insight into psychosocial and contextual factors associated with self-reported parental willingness to vaccinate daughters against HPV. The results have implications for public health research and practice by identifying modifiable barriers and facilitators that can inform targeted vaccine promotion strategies in Peru and similar settings, particularly in informing future vaccine promotion strategies in contexts where vaccine confidence may have shifted following the COVID-19 pandemic.

Artificial intelligence (AI) has the potential to reshape learning processes, especially through tools such as ChatGPT. This study aims to evaluate veterinary students' attitudes towards AI-supported veterinary public health education applications, their anxiety levels and their experiences regarding the education process. The study adopted a mixed method design in which quantitative and qualitative methods were used together. The study was conducted with final-year veterinary students (n = 60) enrolled in the Veterinary Public Health course. This study consisted of four phases: (1) the Artificial Intelligence Anxiety Scale (AIAS) was administered as a pre-test, (2) traditional face-to-face training was given, (3) the same topic was repeated with a ChatGPT-based AI-supported exercise and (4) after the trainings, the AIAS was administered again and post-test was conducted and a questionnaire consisting of closed and open-ended questions was administered to the students. Factor analysis revealed that the scale had high internal consistency (Cronbach's α > 0.90). Analysis of the scale scores revealed that veterinary students exhibited moderate anxiety towards AI and that AI-focused education did not significantly alter this anxiety in the short term. In the content analysis of qualitative data, students stated that they benefited from the aspects of AI such as fast access to information, practicality and time-saving; the same time, they expressed concerns about ethical concerns, information reliability and professional role change. Overall, the findings indicate a duality in students' potential attitudes towards AI. These findings indicate the applicability of AI-based educational practices in the context of veterinary public health education and point to the need for multidimensional evaluation of student attitudes.

Syphilis, a sexually transmitted infection caused by Treponema pallidum, continues to represent an important public health challenge worldwide, especially in underserved and resource-limited settings. We report a 65-year-old man from a rural area who presented with progressive weight loss, malaise, generalized lymphadenopathy, and a trunk rash, features that can mimic HIV, tuberculosis, viral infections, or lymphoma. A rapid HIV/Syphilis Duo test (SD BIOLINE, Standard Diagnostics Inc., South Korea) was reactive for syphilis and negative for HIV, but no nontreponemal or confirmatory assays were available. According to international guidelines, accurate diagnosis requires both treponemal and nontreponemal testing, yet in rural settings, clinicians often must act on incomplete data. Based on the clinical findings and reactive treponemal test, a presumptive diagnosis of secondary syphilis was made, and benzathine penicillin G 2.4 million units intramuscularly was administered. This case highlights the diagnostic and management challenges faced in resource-limited environments, where overlapping clinical features, incomplete diagnostic algorithms, and restricted access to treatment and follow-up increase the risk of persistent infection and continued transmission.

Adolescents and young adults (AYAs; aged 15-39 years) with cancer face significant threats to future fertility. Despite fertility preservation (FP) guidelines, disparities in access persist, particularly among female AYAs. This systematic review aims to describe FP access and explore disparities by sociodemographic and clinical factors among female AYAs with cancer in the United States. This systematic review was registered in PROSPERO (CRD420251077846) and conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. PubMed, the Cumulative Index to Nursing and Allied Health Literature, and Embase were searched from May 1, 2006, through July 17, 2025. Eligible studies were US-based, peer-reviewed observational or interventional studies examining FP access among female AYAs with cancer. Two reviewers independently screened articles, extracted data, and appraised methodological quality with Joanna Briggs Institute tools. Among 10,151 records, 25 studies met the inclusion criteria. All included studies demonstrated high methodological quality and low risk of bias. Reported rates of FP discussions ranged from 9% to 75%, referrals or consultations with fertility specialists ranged from 0.9% to 57%, and completion of FP procedures ranged from 0.56% to 70.3%. Facilitators of access included younger age, private insurance, nulliparity, higher socioeconomic status, certain cancer types, and more recent diagnosis year. Barriers included non-Hispanic Black or Hispanic race/ethnicity, lower income, public insurance, and residence in rural or low-resource areas. Institutional interventions improved access but did not eliminate the underlying disparities. Substantial inequities in FP access persist for female AYAs with cancer in the United States, which underscores the need for routine integration of FP into oncology care and for interventions that address structural and geographic barriers.

Uterine fibroids (UF) affect up to 80% of women of reproductive age, with Black women experiencing disproportionate rates and symptom severity. Despite significant UF prevalence, Black women face delayed diagnosis and treatment due to lack of awareness, menstrual stigma, and healthcare distrust. This two-phase, mixed-methods study developed and evaluated a patient-centered, community-based UF education intervention to address these challenges. In Phase 1, focus groups with Black women identified gaps in UF knowledge, preferences for educational delivery, and trust-related communication barriers with healthcare providers. Findings informed the design of educational sessions implemented in Phase 2 across community venues in a large midwestern city, engaging 110 participants. Post-session evaluations revealed significant improvements in participants' confidence in UF knowledge, with satisfaction rates exceeding 90%. This study underscores the value of community-based education facilitated by trusted Black female healthcare providers. This model demonstrates feasibility and potential for addressing other health issues that disproportionately impact Black women by integrating patient perspectives and leveraging community-based settings for health education.