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Low-income US veterans may experience civil legal needs that intersect with financial, housing, and health-related challenges, yet national data describing these patterns remain limited. This study provides national estimates of civil legal needs and receipt of assistance among veterans with household incomes below 300% of the federal poverty level. Data were drawn from the fifth wave (2025) of the National Veterans Homeless and Other Poverty Experiences (NV-HOPE) study, a nationally representative survey of low-income US veterans (N = 1384). Civil legal needs were assessed across seven domains, and receipt of professional assistance was measured among those reporting at least one need. Weighted descriptive statistics and hierarchal logistic regression models examined associations between sociodemographic, clinical, and psychosocial characteristics by reporting a legal need and receiving assistance. Approximately 18% of veterans reported at least one civil legal need, most commonly debt and wills and inheritance. Veterans with legal needs were younger, less likely to be white or married, more likely to have PTSD, and reported higher debt. Among those with a civil legal need, 57% received professional assistance, with notable variation across issue types. Regression analysis showed that factors associated with reporting a legal need differed from those associated with receiving assistance including higher education attainment and naval service. Civil legal needs were reported by a modest proportion of low-income veterans, with distinct characteristics associated with reporting a need and receiving assistance. These findings provide descriptive evidence to inform future research and policy efforts addressing civil legal needs among veterans.
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This study examines the dietary supplement consumption behaviors and ethical attitudes aiming to contribute to a more conscientious and ethical consumption culture within the health industry. A descriptive cross-sectional study was conducted from October to December 2019 with a sample size of 384 individuals aged 20-65 in Turkey. Analysis was performed using the Statistical Package for the Social Sciences 22.0, including exploratory factor analysis and statistical tests. About 55.5% of participants used dietary supplements, with Vitamin D, Vitamin B, Omega-3, and multivitamin complexes being common. Ethical concerns included inadequate label information, price discrepancies, and legal oversight issues. Statistically significant differences were observed in gender regarding the dimensions of meeting needs and promotion, in age regarding the legal dimension, and in the reasons for visiting a dietitian in the other four dimensions, except for the legal dimension (p < 0.05). This study revealed that factors such as gender, age, and dietary preferences influence individuals' supplement choices. Men were found to be more inclined toward the meeting needs and promotion aspects of dietary supplement purchases than women. In addition, age group and dietary preferences were found to affect the sensitivity of individuals in their supplement choices. Examinar los comportamientos de consumo de suplementos dietéticos y las actitudes éticas con el objetivo de contribuir a una cultura de consumo más consciente y ética dentro de la industria de la salud. Se realizó un estudio descriptivo transversal de octubre a diciembre de 2019 con un tamaño de muestra de 384 individuos de entre 20 y 65 años, en Turquía. El análisis se realizó utilizando SPSS 22.0, incluido el análisis factorial exploratorio y las pruebas estadísticas. El 55.5% de los participantes utilizaron suplementos dietéticos, siendo comunes la vitamina D, la vitamina B, los ácidos grasos omega-3 y los complejos multivitamínicos. Las preocupaciones éticas incluían información inadecuada en las etiquetas, discrepancias en los precios y problemas de supervisión legal. Se observaron diferencias estadísticamente significativas en el sexo en relación con las dimensiones de satisfacción de las necesidades y promoción, en la edad en relación con la dimensión legal, y en los motivos para acudir al dietista en las otras cuatro dimensiones, excepto en la dimensión legal (p < 0.05). Este estudio reveló que factores como el sexo, la edad y las preferencias dietéticas influyen en la elección de suplementos por parte de los individuos. Se observó que los hombres se inclinaban más que las mujeres por los aspectos de satisfacción de las necesidades y promoción de la compra de suplementos dietéticos. Además, se encontró que el grupo de edad y las preferencias dietéticas influían en la sensibilidad de los individuos en el momento de elegir suplementos.
In January 2023, British Columbia (BC) became the first Canadian province to implement a legally sanctioned drug decriminalization policy, removing criminal penalties for adults possessing 2.5 g or less of opioids, cocaine, methamphetamine, and MDMA. Introduced as a three-year pilot, it aimed to reframe substance use as a public health issue, reduce stigma, and improve health and social service engagement. Criminal penalties were reintroduced for drug possession in most public spaces in May 2024, and the pilot ended in January 2026. Its termination has been interpreted as policy failure; this review aimed to examine how the pilot was implemented in practice and to identify factors that shaped its operationalization and early implementation-relevant outcomes. We conducted a systematic review with narrative synthesis of peer-reviewed literature examining implementation-relevant aspects of BC's decriminalization pilot. Six databases were searched (January-February 2026) for studies published May 31, 2022-February 1, 2026. The protocol was registered in PROSPERO (CRD420251271694). Twenty-seven studies were included. Four cross-cutting implementation barriers were identified: pilot design features, public and cross-sector communication gaps, limited frontline training, and insufficient funding and infrastructure. Design features included the 2.5 g possession threshold, misalignment with real-world drug use patterns; the three-year timeframe, which constrained system-level effects; and the May 2024 amendment, which introduced additional instability. The pilot was implemented without commensurate investment in harm reduction, treatment, or housing infrastructure, within already constrained systems. BC's decriminalization pilot suggests the effects of legal reform are shaped by implementation context. Early outcomes may reflect design features, institutional readiness, and system capacity rather than legal change alone; longer-term impacts remain uncertain. Future reforms should align legal change with coordinated implementation, operational guidance, public communication, and adequate service infrastructure.
Cross-national studies provide a valuable framework for examining how assessments of criminal responsibility in forensic psychiatry vary across psychiatric systems and legal contexts. This paper presents a comparative analysis of forensic psychiatric practice in Italy and Switzerland, two neighboring jurisdictions rooted in the Roman legal tradition, yet characterized by distinct trajectories in criminal law and forensic development. Particular attention is devoted to structural differences in psychiatric care, contrasting Italy's community-based model with Switzerland's predominantly hospital-centered system. The analysis further explores divergences in approaches to the assessment of recidivism risk and in expert evaluation methodologies, demonstrating how such variations reflect broader legal, institutional, and epistemological configurations. It also examines disparities in professional training, situating them within their respective cultural and practical contexts. These factors collectively shape the role of the forensic psychiatrist as an independent expert engaged in addressing complex questions concerning criminal behavior, criminal responsibility, and the interplay between psychopathology and free will within judicial proceedings. By identifying both convergences and divergences, this study underscores the value of comparative inquiry in advancing the field and contributes to ongoing efforts toward the development of more standardized international approaches in forensic psychiatry. It concludes by emphasizing the need for further research in this foundational domain, with the aim of enhancing the rigor, coherence, and cross-cultural validity of forensic psychiatric evaluations, particularly in the expertise report and assessment of recidivism risk.
Alcohol consumption is a contributing factor to traffic crashes and road fatalities worldwide. While the effects of blood alcohol concentration (BAC) on driving performance are well documented, less is known about the role of sulphites, used for their antimicrobial and antioxidant properties, on driving performance. Using a triple-blind, randomised, within-subjects design, thirty-two participants completed three driving simulation trials under sober conditions and after consuming a conventional red wine with 'low' (86 mg/l) and 'high' (126 mg/l) sulphite content, while maintaining a BAC at about the Italian legal limit (0.5‰). The driving behaviour was assessed in rural, urban and rural-urban transition environments. In less demanding rural environments, where participants drove in free-flow conditions (i.e., rural and transitional), only BAC affected lateral vehicle control along curves, increasing the standard deviation of lateral position relative to the sober baseline, but no significant differences emerged between the two sulphite levels. However, in the more demanding urban environment, when drivers consumed wine with higher sulphite content, they showed more cautious behaviour during sudden interactions with pedestrians at zebra crossings compared with the sober condition. Conversely, in a car following task, when they drank high-sulphite wine, they behaved more dangerously, maintaining higher speeds and shorter headways with respect to the baseline. Within legal BAC limits, higher sulphite content in wine was associated with context-dependent changes in driving behaviour, promoting greater caution in complex urban scenarios but riskier behaviour in car-following tasks. The small number of significant effects supports the effectiveness of current legal limits, and the findings should be interpreted strictly within regulated conditions, while highlighting the need for further research on sulphite-related effects.
Mpox epidemiology has expanded from endemic zoonotic spillover to sustained human-to-human transmission. While behavioral risk factors have been well recognized, how macro-level correlates of mpox burden vary across epidemic phases remains insufficiently quantified, limiting targeted public health responses. Using World Health Organization (WHO) global daily mpox surveillance data from January 1, 2022 to April 30, 2025, we calculated country-period reported mpox incidence and developed a phase-sensitive analytical framework integrating multi-domain macro-level variables across distinct epidemic phases. Five ensemble machine learning models (eXtreme Gradient Boosting, Gradient Boosting Decision Tree, Light Gradient Boosting Machine, Random Forest, Categorical Boosting) were optimized, and their outputs were interpreted using SHapley Additive exPlanations (SHAP) values to identify the changing correlates of mpox burden across phases. Reported mpox incidence exhibited four temporal-epidemiological phases, comprising localized sporadic emergence, accelerated global spread, sustained dissemination, and region-specific resurgence. SHAP-based interpretation revealed a phase-dependent shift in model-associated correlates, from behavioral factors in earlier phases, such as close-contact networks and population mobility, to later structural vulnerability indicators related to socioeconomic disparities and health-system capacity. The LGBT+ (lesbian, gay, bisexual, transgender, and other sexual and gender minorities) Legal Index was the strongest overall predictor, accounting for 13.5% of the overall SHAP importance. Its association with reported mpox incidence was context-dependent, with positive contributions occurring in legally inclusive settings and negative contributions observed in restrictive settings, a pattern consistent with differential case ascertainment and reporting visibility. Our findings highlight a transition from behavioral to structural indicators in global mpox burden, uncovering phase-specific and geographic heterogeneity. These results support phase-tailored interventions that combine early targeted prevention with later health-system strengthening, equitable surveillance, community support, and stigma reduction.
Severe burns continue to impose significant global morbidity and mortality, particularly where surgical and critical-care resources are limited. As survival has improved, attention has shifted toward optimizing reconstruction. Bioprinted and lab-grown skin substitutes-building on advances in tissue engineering, cellular scaffolds, and 3D bioprinting-offer new possibilities for coverage, yet raise ethical, legal, and distributive challenges that remain underexamined in burn care. A narrative review was conducted using PubMed, Embase, Web of Science, and Google Scholar (2010-2025), supplemented by foundational legal and bioethics literature. Sources were selected for conceptual and policy relevance to ownership, consent, commercialization, intellectual property, and equity in regenerative skin technologies. Fifty publications spanning burn surgery, biobanking, organoid governance, IP law, and global health were synthesized inductively. Five major ethical domains emerged: (1) ambiguous ownership and ontological status of hybrid bioprinted tissues; (2) inadequacy of consent processes to address commercialization and downstream uses of patient-derived cells; (3) complex intellectual property environments that may restrict access and clinical innovation; (4) distributive injustice driven by high costs and global resource disparities; and (5) a near absence of empirical ethics research involving burn patients or care teams. Bioprinted and lab-grown skin substitutes could transform burn reconstruction, but current ethical and regulatory frameworks lag behind. Addressing ownership, consent, commercialization, and equity-supported by robust empirical engagement with patients-is essential for responsible integration of these technologies into burn care.
This descriptive retrospective study evaluated the content, completeness and usability of information available in the Human Pluripotent Stem Cell Registry (hPSCreg®), including registered cell lines, research projects, clinical studies, donor characteristics and regulatory information. We analysed data registered in hPSCreg® from January 2008 to December 2021. We analysed the data regarding cell lines, research projects, clinical studies, diseases, countries and legal issues. There were 7538 total cell lines registered in the hPSCreg®. The most common derivation and generation countries were the United Kingdom, the United States, Germany and China. There were 3139 (46.5%) cell lines labelled as readily obtainable for a third party; few (7.2%) were labelled as available for commercial use. The most common diseases of the donor were Parkinson's disease, Alzheimer's disease and diabetes mellitus. Complete characterization data were available for the minority of the cell lines. The most common sponsor of research projects registered in the hPSCreg® was the European Union's Seventh Framework Programme (FP7). There were 97 registered clinical trials in the hPSCreg®. Challenges identified were incomplete user-entered information, entry of non-standardized information about diseases and continuing verification of the evolving legal status of embryonic stem cell (ESC) research per country. The hPSCreg® represents an important international resource for stem cell research; however, this evaluation identified substantial variation in data completeness and standardization across registry fields. Future development should focus on improving the completeness of key metadata, standardization of terminology and systematic monitoring of registry data quality.
Bystander cardiopulmonary resuscitation (CPR) and early use of automated external defibrillators (AEDs) are key measures to improve neurologically intact survival after out-of-hospital cardiac arrest (OHCA). In Germany, however, heterogeneous emergency medical service structures, insufficient legal frameworks for public-access defibrillation, and only partially implemented CPR training in schools limit the full realization of this potential. This review summarizes the available evidence on school-based CPR training, national and international programs (including "Kids Save Lives"), and innovative mobile AED strategies. As an example, a regional project in the city and district of Osnabrück is presented, in which a non-profit organization has been implementing CPR training in schools since 2020, training both teachers and students. Building on this, regional initiatives have been launched to systematically record and improve the availability of AED locations. Based on these findings, key fields of action for policymakers, emergency medical service providers, and civil society stakeholders are identified. Nationwide, legally mandated CPR training in schools, a structured public-access defibrillation concept including AED registries, and the consistent involvement of local non-profit organizations appear crucial to strengthening the early links in the chain of survival and to sustainably improving outcomes after OHCA. Laienreanimation und der frühzeitige Einsatz automatisierter externer Defibrillatoren (AED) sind zentrale Maßnahmen zur Verbesserung des neurologisch intakten Überlebens nach außerklinischem Herz-Kreislauf-Stillstand (OHCA). In Deutschland verhindern jedoch heterogene rettungsdienstliche Strukturen, unzureichende gesetzliche Rahmenbedingungen für Public-Access-Defibrillation (PAD) und ein bislang nur teilweise implementierter Reanimationsunterricht an Schulen eine optimale Ausschöpfung dieses Potenzials. Diese Übersichtsarbeit bündelt die verfügbare Evidenz zu schulbasiertem Reanimationstraining, zu nationalen und internationalen Programmen (u. a. „Kids Save Lives“) sowie zu innovativen mobilen AED-Strategien. Exemplarisch wird ein regionales Projekt in Stadt und Landkreis Osnabrück vorgestellt, in dem eine gemeinnützige Organisation seit dem Jahr 2020 Reanimationsunterricht an Schulen implementiert und Lehrkräfte sowie Schüler schult. Darauf aufbauend wurden regionale Initiativen zur systematischen Erfassung und verbesserten Verfügbarkeit von AED-Standorten angestoßen. Aus den dargestellten Befunden werden Handlungsfelder für Politik, Rettungsdienstträger und zivilgesellschaftliche Akteure abgeleitet. Flächendeckender, gesetzlich verankerter Reanimationsunterricht, ein strukturiertes PAD-Konzept einschließlich AED-Register sowie die konsequente Einbindung lokaler Non-Profit-Organisationen erscheinen entscheidend, um die ersten Glieder der Rettungskette zu stärken und das Outcome nach OHCA nachhaltig zu verbessern.
Early marriage remains a significant public health and social issue in Lesotho, with profound implications for women's health, education, and economic empowerment. Despite legal frameworks aimed at curbing the practice, a substantial proportion of women continue to marry before the age of 18, driven by sociocultural norms, economic constraints, and limited access to opportunities. This study investigates the timing and factors associated with first marriage among women in Lesotho using advanced multilevel survival analysis to inform targeted interventions. We analyzed retrospective time-to-event data from the nationally representative, cross-sectional 2023-24 Lesotho Demographic and Health Survey (LDHS), employing a log-logistic accelerated failure time (AFT) model within a multilevel framework to account for individual, household, and community-level factors. The analysis included 6,413 women aged 15-49, with 48.76% having experienced first marriage (events) and 51.24% right-censored. Statistical computations were performed using R statistical software (version 4.4.3), incorporating survey weights to ensure representativeness. The median age at first marriage was 24 years (95% CI: 24-25), with significant variation across socioeconomic and contextual factors. Employment (TR = 1.072, 95% CI: 1.043-1.103), middle wealth quintile (TR = 1.060, 95% CI: 1.012-1.110), low community poverty (TR = 1.094, 95% CI: 1.045-1.145), and urban residence (TR = 1.079, 95% CI: 1.033-1.126) were statistically associated with later age at first marriage (p < 0.05). In contrast, primary education (TR = 0.856, 95% CI: 0.749-0.979), younger birth cohorts (1979-2003: TR range 0.774-0.907), richest wealth quintile (TR = 0.927, 95% CI: 0.875-0.981), and rural residence (TR = 0.927, 95% CI: 0.888-0.967) were associated with earlier age at first marriage. The intraclass correlation coefficient (ICC = 0.0029) indicated that only 0.3% of the variation in age at first marriage was attributable to community-level differences. Although statistically significant, the magnitude of these associations is modest. The findings show that employment, middle wealth status, low community poverty, and urban residence are associated with a later age at first marriage, while primary education, younger birth cohorts, richest wealth quintile, and rural residence are associated with earlier marriage. The minimal community-level variation suggests that individual and household-level factors are more important determinants of marriage timing. Policymakers could consider prioritizing multisectoral interventions, including expanded educational access, economic empowerment programs, and poverty reduction strategies, with particular attention to rural-urban disparities. Addressing these structural factors may be relevant to achieving sustainable development goals related to gender equality and women's empowerment in Lesotho.
BackgroundAs global populations age, understanding how older adults access and receive workplace accommodations is essential for promoting equity, productivity, and well-being.ObjectiveThis scoping review explores the intersection of aging, disability, and workplace accommodations among older workers.MethodsGuided by PRISMA-ScR standards, four databases-AgeLine, ScienceDirect, Scopus, and Social Science Premium Collection-were searched for empirical studies published from 1990 to 2023. Studies examining accommodations for employees aged 55 or older were included. Of 2293 records screened and 231 full texts reviewed, eight met the inclusion criteria.ResultsOlder workers most frequently requested accommodations included flexible scheduling, ergonomic adaptations, and job modifications (5 out of 8 studies); however, these supports were also the most frequently provided (4 out of 8 studies). Key influences on accommodation access included awareness of rights, stigma around disclosure, employer attitudes, and workplace culture. Most research was qualitative and focused on North America, underscoring the need for broader demographic, geographic, and methodological diversity. Thus, caution should be taken when interpreting the results.ConclusionsSignificant gaps persist between accommodation needs and implementation, driven by limited awareness, stigma, and uneven organizational support. To enhance outcomes, workplaces should foster inclusive cultures, train supervisors, and enforce accommodation policies. Future research should adopt mixed-methods and international perspectives to guide equitable employment practices for aging workforces under different cultures and legal frameworks.
This study aimed to present the status of on-farm conservation, considering its relevance for the preservation of agrobiodiversity on a global scale and its impacts in Brazil. Through bibliometric analyses, the most frequent institutions, countries, and researchers publishing on the topic were identified, and the main topics studied in each four-year publication period were discussed, covering the period from 1996 to 2023. A timeline of significant events in the establishment and legal recognition of landrace conservation was created. Since 1996, 315 original and 15 review articles have been indexed. Italy, Brazil, and the USA lead in publication numbers, with Italy standing out due to its focus on Fabaceae varieties and high researcher output. Brazil, like the USA and Italy, also has a significant support from global funding agencies for on-farm conservation research. The four-year analysis revealed the decentralization of research from Europe to the Global South and the improvements in research over time. The bibliometric review and organization of a timeline demonstrated that the development of incentive programs for the conservation of landrace varieties, coupled with support for scientific research, enhances the value of plant genetic resources and contributes to food security, sustainable agriculture, and genetic conservation.
The June 2023 Supreme Court decision against affirmative action and the November 2024 US election impacted American universities and companies nationwide, many of which have ended their diversity, equity, inclusion (DEI) programs. This review was undertaken to assess the impact of these events, if any, on DEI publications in plastic surgery. It also examines the core issues-barriers to minorities, equity, a leaky pipeline, and racial concordance. Six plastic surgery journals were queried from January 2024 to December 2025 using the search term "diversity." The recommendations and keywords were evaluated. Sixty articles were identified. Publications commonly evaluated racial and gender compositions of plastic surgery trainees, academic surgeons, websites, presentations, and publications. Frequent keywords included: diversity, inclusion, mentorship, equity, underrepresented, disparity, barriers, and a leaky pipeline. The publications uniformly made recommendations in favor of DEI initiatives. The recruitment and sponsorship of underrepresented applicants was a common theme. The plastic surgery literature almost exclusively supports DEI initiatives. However, recent federal lawsuits underscore the risk of continuing racial preferences, which have been ruled unconstitutional by the US Supreme Court. Many keywords and recommendations contrast sharply with the US Supreme Court decision. Moreover, an unrecognized shift in demographics has taken place over the last 4 decades. Whites are now underrepresented in medical schools compared with the US population. It has not been demonstrated that Blacks or Hispanics are underrepresented because of barriers. The evidence shows that there are simply fewer Black and Hispanic applicants entering the pipeline, as opposed to a "leaky pipeline." Racial concordance - aligning providers and patients by race - cannot be condoned. The need for continued pro-DEI publications that overlook the constitutionality and legality of their recommendations warrants reconsideration.
Dental age estimation (DAE) by means of direct visualisation remains a fundamental tool in forensic odontology, particularly for Disaster Victim Identification (DVI) in resource-limited settings. This systematic review and meta-analysis aimed to calculate the pooled correlation coefficient between chronological age (CA) and six Gustafson-derived dental variables in modern adults. Following PRISMA guidelines, five databases were searched until June 2025, resulting in 27 included studies, with 19 utilized in a three-level random-effects meta-analysis. The overall weighted correlation between CA and Gustafson-derived variables was moderate (r = 0.67, [Formula: see text] = 0.93), though significant heterogeneity was observed with low certainty due to method variability. Subgroup analyses indicated that the six variables do not contribute equally to age prediction; transparency of the root gives the highest correlation (r = 0.75), while root resorption showed the lowest correlation (r = 0.28). Additionally, sectioned teeth showed a higher correlation than intact teeth, although this difference was not statistically significant. In conclusion, while direct visualisation of Gustafson-derived variables shows utility for DAE, high between-study heterogeneity and low certainty of evidence dictate cautious application and interpretation of the current results. Furthermore, although tooth sectioning may improve correlation, using destructive methods requires balancing potential analytical benefits against ethical and legal constraints.
The increasing digitalization of everyday life means that digital artifacts persist after death, presenting unique and complex challenges in palliative care. Lacking clear conceptualization, digital legacy raises clinical, ethical, and legal uncertainties. Conceptual clarity is crucial to support palliative care teams in addressing digital legacy issues at the end of life. To examine and clarify the concept of digital legacy in palliative care. A concept analysis was conducted using Walker and Avant's eight-step method. Seven electronic databases (CINAHL, Embase, Medline, PsycInfo, Scopus, Web of Science, CareLit) were searched in May 2025, with no time restrictions and relevant English- and German-language publications were reviewed. Given the conceptual focus, no formal study quality appraisal was conducted. From 373 records, 46 articles were included. Digital legacy comprises the totality of digitally encoded artifacts that endure after an individual's death, manifesting as multidimensional, dynamically reconfigurable formations shaped by varying degrees of purposefulness, curation, meaning, media dependency, and access. Consequences include a broad range of emotional responses, ongoing support needs, transgenerational transmission, and potential risks of misuse. The concept of digital legacy in palliative care offers insights into its attributes, antecedents, and consequences. It clearly demonstrates that digital legacy is a complex, multidimensional phenomenon that extends far beyond technical data storage as an integral component of palliative care. Further research is needed to investigate the dynamics of digital legacy in palliative care.
Weight stigma (WS) negatively impacts the health and well-being of people living with obesity (PwO). However, it remains understudied in Latin America and the Caribbean. This review synthesizes findings from 128 studies across the region, revealing widespread WS in society, healthcare, education, workplaces, and media. Evidence highlights explicit and implicit biases among healthcare professionals and students, frequent bullying of children and adolescents, and social exclusion of PwO. Cultural beliefs often associate obesity with personal failure, reinforcing the stigma and undermining access to care. This review highlights the need for reforms in healthcare systems, professional education, and public communication to address WS. It also highlights the absence of legal safeguards against weight-based discrimination in most countries. Together with the Brazilian Association for the Study of Obesity and Metabolic Syndrome (ABESO), this review issues a Call to Action urging the adoption of person-first, non-stigmatizing language, evidence-based care, and policies to reduce WS. Addressing WS is critical to ensuring equitable, ethical, and effective treatment for PwO in Latin America and the Caribbean.
Reducing opioid overdose death rates across the United States demands novel community partnerships and information sharing to implement and sustain evidence-based opioid overdose prevention strategies. During the NIH-funded HEALing Communities Study, a multisite intervention to reduce opioid overdose deaths, researchers from 4 states (MA, NY, OH, KY) used Learning Collaboratives as part of training and technical assistance. Learning Collaboratives are forums for gathering people with intersecting goals intended to promote peer-based learning and build professional networks. We described the design, implementation, and lessons learned from Learning Collaboratives, and collected and synthesized data to identify strengths, challenges, and limitations. State research teams developed variable Learning Collaborative delivery and evaluation approaches. Site research staff evaluated similarities and differences between state-specific processes, including: session structure, cadence, topics, attendance, and lessons learned. From January 2020 to December 2023, 383 Learning Collaborative sessions were completed (MA n = 236; NY n = 96; OH n = 25; KY n = 24; Cross-Site n = 2), each 1 to 2 hours in duration. Learning Collaboratives had a mean attendance of 30 and a median attendance of 17 participants/session, and included frontline workers and clinicians (eg, harm reductionists, community members/leaders, people with lived/living experience, social workers, physicians, advanced practice providers, nurses, pharmacists, criminal legal professionals, and policy and regulatory experts). Attendance was voluntary and unpaid. Learning Collaboratives were designed as individual sessions or series, content- or community-specific, and involved diverse speakers, community cases, and active discussion. Learning Collaboratives supported strategy implementation for 3 evidence-based practices (overdose education and naloxone distribution, medication for opioid use disorder, safer opioid prescribing) and communications campaigns. HEALing Communities Study Learning Collaboratives successfully convened interprofessional partners for opioid overdose prevention learning, leveraging local expertise and engagement; responded to community needs, including unexpected current events; and encouraged multidirectional knowledge sharing to foster networks and resource sharing within/across communities to enhance collaboration and improve service delivery.
Artificial intelligence (AI) has emerged as a potential enabling technology for lower-dose paediatric PET/CT, but its value depends on whether dose reduction can be achieved without compromising diagnostic accuracy, lesion detectability, quantitative reliability or clinical confidence. This review examines AI-enabled pathways for paediatric PET/CT dose optimisation, including low-count PET denoising, image enhancement, full-count synthesis, reconstruction-integrated AI, low-dose CT reconstruction, synthetic CT, CT-free attenuation/scatter correction, motion correction, automated quality control, patient-specific protocol selection and reduction of unnecessary or repeat imaging. The strongest direct opportunities are low-count PET enhancement and AI-supported CT dose reduction, while synthetic CT and CT-free correction may reduce or eliminate attenuation-correction CT in selected settings where diagnostic CT is not required. Indirect AI approaches, including motion-risk reduction, quality-control systems and agentic workflow support, may reduce dose by improving first-time-right imaging, avoiding repeat acquisition and matching protocols to the clinical question. It is important to differentiate between visually aesthetic images and diagnostic images, in other words, visual image improvement is an inadequate endpoint. AI-enhanced lower-dose PET/CT must be validated for small-lesion detection, quantitative accuracy, response-classification stability, scanner and tracer generalisability, failure modes and prospective clinical safety. Social, ethical and legal considerations are also central, because AI tools have the potential to widen disparities. AI may make paediatric PET/CT lower dose, but only when it preserves clinical value within a governed, paediatric-specific optimisation framework.
Chinese transgender individuals seeking gender-affirming surgery (GAS) face legal, familial, and healthcare barriers, yet data on their psychological characteristics and surgical motivations remain limited. This exploratory study examined personality traits, defense styles, and self-reported motivations in a Chinese clinical sample. In this cross-sectional study, 37 transgender individuals (transmasculine participants, n = 25; transfeminine participants, n = 12) completed the Eysenck Personality Questionnaire (EPQ), Defense Style Questionnaire (DSQ), and a self-developed GAS-related questionnaire. EPQ scores were compared with Chinese national normative values in an exploratory manner using Wilcoxon signed-rank tests. Associations between EPQ and DSQ dimensions were examined using Spearman correlations with false discovery rate correction. Findings from the self-developed questionnaire were analyzed descriptively. In exploratory comparisons with Chinese national norms, participants showed lower Extraversion (p < 0.001), higher Neuroticism (p = 0.012), and higher Lie scores (p < 0.001), while Psychoticism did not differ significantly (p = 0.976). After FDR correction, Neuroticism remained positively associated with immature defenses (ρ = 0.646, FDR-adjusted p < 0.001), middle defenses (ρ = 0.468, FDR-adjusted p = 0.032), and hidden defenses (ρ = 0.428, FDR-adjusted p = 0.043). Descriptive questionnaire findings indicated that common motivations included enhancing self-confidence, changing the gender marker on official identification documents, and increasing social acceptance. Cronbach's α was 0.82 for the Likert-type domains, with subscale values ranging from 0.78 to 0.85. This exploratory study provides preliminary insights into personality traits, defense styles, and self-reported motivations among Chinese transgender individuals seeking GAS. The findings contribute context-specific descriptive data to the existing literature and may inform future research using larger, multicenter samples, appropriately matched comparison groups, and validated assessment instruments.