The bacterial 16S rRNA gene is widely used to characterize host-associated and environmental microbiomes, most commonly through sequencing short hypervariable regions. Recent improvements in PacBio sequencing chemistry and concatenation approaches can now enable high-throughput, full-length 16S rRNA gene sequencing with high accuracy and depth. However, errors introduced during library preparation remain a major limitation, particularly during PCR amplification of full-length amplicons, where error accumulation may be elevated due to longer sequence lengths. These challenges are amplified when samples vary widely in microbial biomass, making it difficult to select a single optimal number of PCR cycles. Here, we evaluated PCR cycle autonormalization for PacBio Kinnex full-length 16S rRNA gene sequencing across seven agriculturally relevant specimen types. We compared conventional fixed-cycle PCR protocols (20, 24, and 30 cycles) with an autonormalization approach in which individual reactions were terminated during exponential amplification based on real-time fluorescence thresholds. Under the workflow tested here, autonormalized libraries generally retained a high proportion of sequences following denoising and chimera removal, exhibited low residual error rates (<0.005%), and yielded relatively even read distributions across heterogeneous sample inputs. Overamplified reactions (30 cycles) showed elevated residual error rates and greater sequence loss, particularly in samples with higher microbial biodiversity, whereas low-cycle libraries produced more variable read output among specimens. Importantly, the PCR protocol had relatively minor effects on overall community composition compared with specimen type. These results support PCR cycle autonormalization as a useful workflow strategy for heterogeneous full-length 16S library preparation, while also highlighting the importance of library design, pooling strategy, and downstream processing in shaping technical outcomes.IMPORTANCEAmplicon-based sequencing of the 16S rRNA gene is a foundational tool in microbiome research, yet PCR amplification remains a major source of library-preparation error. This challenge is magnified for full-length 16S rRNA sequencing and for workflows that process specimen types with widely varying microbial biomass. Selecting a single PCR cycle number can underamplify low-biomass samples or overamplify high-titer samples, increasing artifacts and sequence loss during downstream processing. Here, we show that PCR cycle autonormalization can be integrated into a PacBio full-length 16S rRNA workflow and, under the conditions tested, provides low residual error rates and relatively even sample representation across heterogeneous inputs. Autonormalization also enables blind pooling of amplicons without post-PCR quantification or equimolar normalization, reducing hands-on time and sample loss. These benefits make cycle autonormalization particularly valuable for high-throughput and production-scale library preparation applications handling diverse specimen types.
The development of rapid, on-site analytical methods and test strips for alkaline phosphatase activity (APA) is crucial for addressing drinking water safety crises, as it enables eutrophication assessment and algal bloom warnings under phosphorus-limited conditions. In this study, we incorporate aggregation-induced emission luminogen (AIEgen) guest TPE-4PA into bimetallic lanthanide-based infinite coordination polymers (Tb/Eu-GMP ICPs). TPE-4PA exhibits unprecedented binding preference for Tb3+ over Eu3+, triggering coordination-induced emission (CIE) at 450 nm and modulating the antenna effect (AE) and the tandem energy transfer (TER) from Tb3+ to Eu3+. Subsequently, acetylacetone (acac) was further introduced to yield TPE-4PA@Tb/Eu-GMP-acac ICPs with an appropriate full-color fluoresce response capability. The addition of alkaline phosphatase (ALP) hydrolyzes GMP and TPE-4PA dual substrates, resulting in reduced characteristic emission of the bimetallic Ln-ICP host at 493, 548, 593, 619 and 703 nm, increased monomer emission of TPE-4PA at 392 nm, as well as the solvent-driven AIE of the enzymatic product TPE-4OH at 430 nm, which constitutes a novel ratiometric ALP sensing mechanism with pale-purple to blue fluorescence color shifts. Featuring high sensitivity, doubly assured selectivity, and operational simplicity, this "all-in-one" probe enables real-time APA monitoring via dual-substrate kinetics and is suitable for on-site ALP test strip development. Moreover, the unique color transition point of the dual-substrate-based TPE-4PA@Tb/Eu-GMP-acac ICPs probe can be designed to signal an APA surge prior to algal bloom onset, which holds significant potential for the development of microalgae pollution early-warning systems, thereby safeguarding drinking water safety.
A robust strategy was developed to customize the hydrogel's composition, concentration, and crosslink density, thereby providing a method for the screening and optimization of skin repair hydrogels. Specifically, methyltetrazine-modified collagen (Col-T), norbornene-modified RGD peptide, and norbornene-modified hyaluronic acid with varying degrees of modification (HA-Nlow, HA-Nmed, and HA-Nhigh), were synthesized. Upon mixing Col-T, RGD-N, and one of the HA-N derivatives, a bioorthogonal reaction was immediately initiated, thereby forming an in situ crosslinked, shape-adaptable hydrogel. An extracellular matrix-mimetic hydrogel composed of collagen, RGD peptide, and hyaluronic acid was optimized using human epidermal stem cells (hEpdSCs), human dermal fibroblasts (HDFs), and human umbilical vein endothelial cells (HUVECs). The optimized hydrogel effectively promoted the hEpdSCs proliferation, the proliferation and migration of HDFs, and the migration and tubular formation of HUVECs. In comparison, GelMA exhibited significant cytotoxicity against hEpdSCs due to the use of photoinitiator LAP. The hydrogel exhibited anti-hemolytic, pro-coagulant, and tissue-adhesive properties, and significantly accelerated the healing of 15 mm × 15 mm full-thickness wound after a single application without any additives. This hydrogel was associated with enhanced hair follicle-like structure formation and reduced inflammation-related responses in the wound area. Furthermore, its ready-to-use and biodegradable nature made it highly suitable for clinical applications.
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Performing ex situ normothermic machine perfusion (NMP) for ≥24 h represents an opportunity to evaluate and treat livers, but is limited by the lack of support from relevant extrahepatic organs. Incorporation of systems of renal replacement therapy, including hemodiafiltration (HDF), appears useful in this regard during prolonged ex situ liver NMP. This study aimed to demonstrate the impact and benefits associated with incorporation of continuous HDF during 24-h ex situ NMP in a relevant preclinical model, including transplantation and post-transplant follow-up. Porcine livers (n = 28) underwent 24-h ex situ NMP with either partial perfusate exchange at 12 h and no HDF (NHDF, n = 11) or HDF initiated 2 h after NMP start (n = 17). Biochemical, histological, endothelial, and metabolomic parameters were assessed. A subset of grafts undergoing NMP + HDF (n = 8) were transplanted into recipients. Incorporation of HDF during NMP maintained stable pH and electrolyte levels, effectively preventing hypernatremia, hypochloremia, and hypocalcemia developing without HDF. HDF cleared metabolic wastes (e.g. urea) and inflammatory cytokines (IL-1B, IL-2, IL-6, IL-8, and IL-18), resulting in reduced injury and oxidative stress markers after 24 h (Suzuki score 0.8 ± 0.4 HDF vs. 2.7 ± 1.3 NHDF, p <0.001). Vasoprotective endothelial response mechanisms, including KLF2 and eNOS gene and protein expression, were upregulated, whereas stellate cell activation and sinusoidal contraction were reduced among HDF-treated grafts. HDF reduced metabolomic alterations arising in livers during 24-h NMP, and adequate graft maintenance using NMP + HDF was demonstrated by full functional and metabolic recovery during post-transplant follow-up. Continuous HDF promotes a more physiological biochemical and metabolic environment, reduces inflammation and oxidative stress, and preserves homeostatic endothelial response mechanisms in livers undergoing 24-h ex situ NMP, facilitating successful transplantation in a complex preclinical model. In this preclinical study, livers were normothermically perfused for 24 h ex situ, both with and without continuous HDF. Incorporation of HDF offered relevant improvements in numerous on-device measures, including the maintenance of physiological biochemical parameters; removal of injurious metabolic wastes; and improvement of injury and stress responses in parenchymal and nonparenchymal cells. A subset of livers were successfully transplanted and demonstrated full functional and metabolic recovery during follow-up. These findings indicate that advanced renal replacement therapies, such as HDF, are a key aspect of improving and prolonging ex situ normothermic liver perfusion, although there is ongoing need to develop more physiological metabolic support protocols for livers while on such devices.
Understanding disease activity and therapy goals of patients with rheumatoid arthritis (RA) is important to provide patient-centered specialty pharmacy care and achieve positive therapy outcomes. The Routine Assessment of Patient Index Data 3 (RAPID3) is a validated metric to track patient-reported RA disease activity. Consistent and frequent monitoring of RAPID3 scores may provide clinically meaningful insights. To describe the trajectory of RAPID3 scores over time and factors related to changes in RAPID3 scores among patients new to specialty medications. Adult patients with RA who initiated specialty medications were included if they filled medications at least 3 times and had at least 2 RAPID3 scores documented in 6 months. Linear mixed effects regression models estimated trends in RAPID3 scores over time with respect to patient identifiers. Logistic regression models adjusted for baseline RAPID3 severity and estimated adjusted odds ratios (aOR) and associated 95% CIs of achieving a minimal clinically important improvement (≥3.8 points) or low severity/near remission (LS/NR) RAPID3 severity score at 6 months, by patient characteristics. Of 312 patients with RA, 195 (63%) had baseline high severity RAPID3 scores. Patients with baseline high severity achieved significant RAPID3 decreases over 6 months (5.9 points; P < 0.0001). Nearly half of patients (N = 147, 47%) had a clinically important improvement and 105 (34%) were LS/NR at follow-up; 67 patients (21%) met both criteria. After adjusting for baseline RAPID3 severity category, medication change (aOR, 0.39; 95% CI, 0.21-0.71) and opting out of full therapy management (aOR, 0.36; 95% CI, 0.19-0.65) were inversely associated with achieving a clinically important improvement. Being LS/NR at follow-up was also inversely associated with medication change (aOR, 0.19; 95% CI, 0.075-0.48) and opting out of full therapy management (aOR, 0.27; 95% CI, 0.12-0.63). Low medication adherence (aOR, 0.28; 95% CI, 0.11-0.72) and Medicaid insurance (aOR, 0.52; 95% CI, 0.29-0.93) were also inversely associated with being LS/NR at follow-up. RAPID3 is a valuable tool in the specialty pharmacy setting, helping assess patient outcomes beyond traditional metrics. Specialty pharmacies should support their patients in striving to reach clinically important improvement and/or achieving LS/NR as measures of quality pharmacy care during the crucial months after therapy initiation and throughout care. Active collaboration between patients and pharmacists is crucial in reaching positive RA disease activity outcomes. To support this, implementing programs that foster patient engagement with pharmacists may be important for optimizing care delivery.
This study describes the heterologous expression and stability profiling of a manganese superoxide dismutase from Thermus aquaticus (TaqMn-SOD). Codon-optimized TaqMn-SOD fused with a C-terminal 6His tag was expressed in Escherichia coli. The apoenzyme (ApoTaqMn-SOD) was successfully recovered and purified under optimized induction conditions followed by post-lysis thermal treatment (85 °C for 90 min), affording a yield of >100 mg of purified protein per liter of culture. The purified TaqMn-SOD exhibits a specific activity of about 3,000 U/mg and exceptional stability profiles: retaining full activity at 85 °C for 4 h; maintaining > 56% activity across a broad pH range of 3.0-12.0; tolerating ethanol concentrations up to 40%, preserving > 80% activity after 48 h and 50-80% activity after 90 d in 5-20% ethanol. Moreover, its activity was not significantly affected by various divalent metal ions (excepting Fe2+), organic solvents, detergents, denaturants, or the chelating agent EDTA, with n-hexane enhancing activity by 47%. The enzyme was partially inactivated (47%) in simulated gastric fluid for 10 min, but remained stable in simulated intestinal fluid and water. These results suggest that TaqMn-SOD holds potential for applications in high-temperature food processing, thermally-stable cosmetic manufacturing, agricultural protection, and pharmaceutical formulations requiring stability under extreme conditions.
A 32-year-old woman with panhypopituitarism following surgical resection, chemotherapy, and radiotherapy for a pituitary germinoma underwent assisted reproductive treatment. Management involved comprehensive hormone replacement therapy, ovulation induction with exogenous gonadotropins, in vitro fertilization (IVF), and thromboprophylaxis with low molecular weight heparin due to a diagnosed thrombophilia. A fresh embryo transfer resulted in a successful singleton pregnancy. The pregnancy progressed uneventfully and reached full term and a healthy neonate was delivered. This case highlights the feasibility of pregnancy in women with complex endocrine and thrombotic conditions and adds to the limited literature supporting IVF in women with significant hypothalamic-pituitary axis compromise.
Accurate decoding of motor intent from biosignals is an important step toward intuitive upper-limb prosthetic-control interfaces. We propose a novel high-dimensional multimodal deep learning framework that fuses surface electromyography (sEMG) and B-mode ultrasound (US) images to estimate metacarpophalangeal and proximal interphalangeal joint angles continuously. The framework employs a shared Encoder-Decoder-Regression architecture integrating convolutional neural networks (CNNs), transposed convolutions, an action-conditioned multi-head cross-attention module (ATT) that uses the commanded action as a query, and long short-term memory (LSTM) layers to jointly capture spatiotemporal features from both modalities. To improve cross-subject generalization and reduce data requirements for new users, we introduce a transfer learning strategy with parameter freezing. Experiments on data from seven able-bodied subjects show that, compared with sEMG-only and US-only baselines, the fusion model reduces test local root mean square error (RMSE) by 2.187° (23.385%) and 0.890° (11.054%), and increases test local correlation (Pearson's r) by 0.069 (10.02%) and 0.039 (5.48%) (p < 0.05), supporting the potential of multimodal fusion for future prosthetic-control interfaces. A preliminary validation on one amputee participant further supports the feasibility of applying the framework under a residual-limb sensing condition. Ablation studies further confirm that the full CNN+LSTM+ATT model achieves the best performance, reducing test local RMSE by 0.933° (11.524%) and increasing test local correlation by 0.033 (4.56%) (p < 0.05). Furthermore, fine-tuning the pretrained model with only 25% of a new subject's data yields performance comparable to full retraining, highlighting the framework's data efficiency.
Deployment complexity and specialized hardware requirements hinder the adoption of deep learning models in neuroimaging. We present MindGrab, a lightweight, fully convolutional model for volumetric skull stripping across the evaluated imaging modalities. MindGrab's architecture is designed from first principles using a spectral interpretation of dilated convolutions, and demonstrates state-of-the-art performance on the tested benchmarks (mean Dice score across datasets and modalities: 95.9 ± 1.6), with up to 40-fold speedups and substantially lower memory demands compared to established methods. Its minimal footprint allows for fast, full-volume processing in resource-constrained environments, including direct in-browser execution. MindGrab is delivered via the BrainChop platform as both a simple command-line tool (pip install brainchop) and a zero-installation web application (brainchop.org). By removing traditional deployment barriers without sacrificing accuracy, MindGrab makes state-of-the-art neuroimaging analysis broadly accessible.
Trained immunity, an emerging treatment strategy, confers long-term anti-tumour memory by modulating epigenetic and metabolic reprogramming of innate immune cells, offering a novel pathway for immunotherapy of haematological malignancies. This article systematically outlines the mechanisms by which inducers such as β-glucan, Bacille Calmette-Guérin (BCG) and cytokines train key effector cells including macrophages and natural killer (NK) cells. It further analyses how ageing-encompassing both organismal ageing and cellular senescence-specifically undermines the efficacy of relevant pathways at multiple levels, from haematopoietic stem cell function and intracellular signalling to the tumour microenvironment, thereby systematically impairing the induction efficiency, durability of effect, and safety of trained immunity. Building on this, the article evaluates the clinical translation prospects and associated risks, including graft-versus-host diseases (GVHDs), of strategies such as cytokine-induced memory-like (CIML) NK cells, and proposes concrete, testable translational ideas aimed at overcoming ageing-related defects. We argue that to realise the full potential of this therapy in elderly patients with haematological malignancies, future work must focus on developing individualised training protocols capable of circumventing or reversing immunosenescence.
Recent advances in machine learning (ML) have accelerated automated analysis of phonocardiogram (PCG) signals, yet prior surveys often narrow their scope (e.g. omitting segmentation, focusing only on classical ML or overlooking recent deep learning [DL] trends) and provide limited methodological transparency. We present a comprehensive, Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA)-guided synthesis of PCG classification research published predominantly between 2021 and 2025, resulting in 151 studies included in the final synthesis. The systematic search was conducted across IEEE Xplore, PubMed/MEDLINE, Scopus, SpringerLink, ScienceDirect and Google Scholar, using Boolean combinations of heart sound/PCG-related terms and ML keywords. The review maps the full pipeline - acquisition, preprocessing, segmentation, feature extraction and classification - and distinguishes feature representations as single-independent-variable (SIV) and double-independent-variable (DIV). We compare classical classifiers with modern DL and hybrid architectures, and summarize public/proprietary datasets and evaluation practices. Our analysis shows that DL - especially convolutional neural network (CNN)-based approaches-dominates recent work, with growing interest in hybrid CNN-recurrent neural networks (RNNs) models and attention/transformer architectures. Segmentation is handled either explicitly (standalone or embedded) or bypassed in end-to-end designs. Despite high benchmark performance, comparability is hindered by heterogeneous datasets, non-uniform splits and metric choices; generalization under noise, device variability and pediatric vs. adult domain shift remains a key challenge. Bridging technical progress to clinical utility requires robustness, interpretability, efficient on-device inference and privacy-preserving training. We conclude with practical recommendations for standardized evaluation protocols, interpretable modeling, multimodal fusion, edge deployment and federated/multi-center learning. By integrating methodological and clinical perspectives, this review connects state-of-the-art results with the requirements of scalable, clinically viable PCG-based screening systems.
Here, we present a protocol to acquire high resolution, extended depth of field images of insect specimens by photographic focus stacking using a modular digital imaging system. The method provides a standardized workflow linking equipment assembly, calibration, image acquisition, and post processing. Using a full frame mirrorless camera (61 MP) coupled to microscope objectives and synchronized strobe illumination, the protocol achieves pixel scales from 0.76 m-0.19 m and produces artifact free composites through sub-micron focus increments (0.2 m). The procedure can capture and process approximately 20 final images per week under routine laboratory conditions. Compared with existing stacking solutions, this low-cost hybrid setup (< 30% of the cost of commercial systems) maximizes accessibility while maintaining diffraction limited image quality. Representative applications include the production of color calibrated identification plates for taxonomy, biodiversity digitization, and outreach. The protocol's standardized structure facilitates reproducibility across laboratories and field stations, supporting large scale insect imaging campaigns in both resource limited and institutional environments.
Available thought disorder (TD) scales used in schizophrenia research are limited to positive and negative TD dimensions and do not adequately assess the full spectrum of TD. Moreover, TD evaluation scales are often time-consuming, relying on diverse visuals, forms, or lengthy structured interviews. Therefore, a new TD scale that can be administered during routine psychiatric interviews and that evaluates TD more comprehensively is needed. This study aimed to develop a more complete TD scale for assessing TD in patients with schizophrenia during psychiatric interviews. This study examines the reliability and validity of the new Dokuz Eylül Thought Disorder Scale (DEU-TDS). The study included 130 schizophrenia patients and 35 controls. Reliability was assessed via Cronbach's α, test-retest, and inter-rater reliability. Validity was evaluated through exploratory factor analysis - which tested a theoretically hypothesised three-factor structure comprising Positive TD, Negative TD, and Pragmatic Comprehension Disorder - and correlations with established scales. Inter-rater reliability was excellent (Pearson r = 0.987 across two raters in 34 patients; ICC = 0.985 in a five-rater concordance analysis). Three factors (positive, negative, pragmatic TD) accounted for 73.2% variance. Strong correlations with PANSS, SAPS, and TLI were found. The DEU-TDS demonstrates promising psychometric properties as a multidimensional tool for evaluating TD in patients with schizophrenia, though replication in larger and more diverse samples is needed before definitive conclusions about its clinical utility can be drawn.
Nitrous oxide (N2O) is a potent greenhouse gas emitted from wastewater treatment plants (WWTPs). However, the origins of emitted N2O remain insufficiently understood, and emissions from primary treatment processes are often overlooked due to methodological limitations. In this study, N2O emissions were monitored at seven WWTPs across China using zonal odor control systems to obtain spatially resolved measurements. The average N2O emission factors ranged from 0.014% to 0.122%, with either primary or biological treatment process serving as the dominant contributor depending on plant conditions. To further characterize emissions from different emission zones, intensive monitoring covering both diurnal and seasonal variations was conducted at two representative WWTPs. In the biological-dominant plant, influent NH4+-N loads exhibited a strong positive correlation with N2O emission rates in aerobic treatment (ρ=0.866, p < 0.01). In the primary-dominant plant, N2O transported from the sewer system accounted for 104-168% of total full-scale emissions, which was likely due to N2O consumption via denitrification in the anaerobic and anoxic treatment. Meanwhile, on-site batch experiments revealed that primary treatment also generated N2O, with microbial production contributing 43.6% of total gaseous emissions from the primary treatment. Elevated emissions were observed during winter months at this plant. Overall, this study highlights the substantial and previously underestimated contribution of primary treatment to N2O emissions and provides new insight into identifying emission hotspots and understanding N2O formation mechanisms in WWTPs.
Stiers (2026) presented a case example of differential diagnosis in clinical neuropsychology wherein standardized testing was not possible, and discussed a structure and process for using history, behavioral observations, and disease base rates to develop a preliminary diagnosis. In response, Basso et al. (2026) state that these alone are not sufficient, and they emphasize the importance of standardized testing. This article describes a clinical encounter where standardized norm-referenced testing was not possible because appropriate standardized tests or norms did not exist, as can occur with, for example, a patient from a rural country who speaks a local dialect and has not had any formal education, a patient with locked-in syndrome, a patient with receptive and expressive aphasia, or a patient who is poorly cooperative. When standardized testing is not possible because of the lack of appropriate tests and norms, what is a neuropsychologist to do? Is it best to say that we can offer no opinion as to the condition of the patient, or is it best to say that we can offer limited opinions pending further data? My contention is that when testing data are not available, a competent neuropsychologist can still conduct a partial, not full, assessment of brain-behavior relationships and make contributions to patient care based on history, behavioral observations, and disease base rates. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Research is needed to establish optimal cutoffs to determine cocaine use via oral fluid testing while considering the possibility of unintentional exposure. We compared detection of cocaine and its metabolites to self-reported use while considering other drug use to determine optimal cutoffs to determine intentional use. In this study, 1819 adults entering randomly selected nightclubs were surveyed about cocaine and other drug use and had their oral fluid analyzed using liquid chromatography quadrupole time-of-flight mass spectrometry. We compared self-reported use to detected exposure. 13.6% of participants reported past 24-hour cocaine use, 43.7% tested positive for cocaine exposure (≥1 ng/mL), and 11.8% tested positive for at least one metabolite. 28.6% either tested positive for or reported past 24-hour use of other drugs, primarily ketamine. Among those testing positive for cocaine exposure (n = 794), only 29.1% reported past 24-hour use. Among positive cases, the optimal cocaine concentration cut-point for predicting self-report was ≥ 26 ng/mL. When focusing on the full sample and a subsample with data on past 48-hour reported use, optimal cut-points were ≥ 6 ng/mL and ≥ 5 ng/mL, respectively. However, detection of metabolites was the strongest predictor of self-reported use. Using self-report as the gold standard, metabolite detection most accurately classified reported use, over and above detection of cocaine or other drugs; however, relying solely on detection of metabolites or higher cocaine concentration thresholds often led to under-detection. In conclusion, relying on detection of metabolites or higher concentrations most accurately detects intentional use, but these lack sensitivity to detect a portion of use.
Self-Help Plus (SH+) and Problem Management Plus (PM+) are two scalable psychological interventions developed by the World Health Organization to reduce stress, improve emotional regulation, and strengthen coping skills among adults experiencing adversity. SH+ is a low‑intensity, group‑based stress‑management course, while PM+ is a brief, individual intervention focused on problem‑solving and behavioural activation. This study explores the acceptability of SH+ and PM+, among staff providing psychosocial support and clients of the opioid agonist treatment (OAT) programs in Ukraine during wartime. A qualitative study was conducted using semi-structured interviews with 12 clients, alongside an analysis of meeting notes from monthly staff management discussions. Data were collected from April to October 2023 (during the second year of the full-scale Russian invasion of Ukraine) at OAT centers in Lviv, Sumy, and Vinnytsia. The SH+ group format created a supportive atmosphere, which contributed to the outcomes despite initial challenges with client engagement. Participants noted that even passive attendance in program sessions was associated with positive impacts, reflecting the intervention's suitability for clients who struggle with active participation. The key advantage of PM+ was its flexibility in scheduling, which was beneficial given many clients' unpredictable and chaotic life situations. The personalized nature of PM+ facilitated open dialogue and a deeper exploration of clients' needs. Clients responded positively to the individual format of PM+, finding it familiar and comfortable. They appreciated the opportunity to be heard in a relaxed and confidential setting. Overall, the study indicates that SH+ and PM+ are acceptable, feasible, and valued by both clients and staff, supporting their potential integration into routine OAT services to help address unmet mental health needs during wartime.
Simulation and tabletop exercises are widely used in disaster preparedness education, yet comparative evidence remains limited. Pilot findings informed the refinement of this study. To evaluate and compare prelicensure baccalaureate nursing students' perceived knowledge acquisition, confidence, and satisfaction following participation in either a full-scale (FS) simulation or a tabletop (TT) disaster preparedness exercise using standardized facilitation and structured debriefing. A quasi-experimental design included 316 students assigned by clinical practicum to FS or TT across 3 semesters. Validated survey tools measured perceived knowledge, simulation effectiveness, satisfaction, confidence, and debriefing quality. Both modalities demonstrated significant pre-post increases in perceived knowledge with comparable baseline scores. TT exercises showed greater increases in confidence and learning, whereas the FS simulation more strongly supported communication and decision-making. FS and TT modalities are complementary approaches for disaster education when aligned with best practices.