The literature shows inconclusive results from utilizing motivational interviewing (MI) in indigenous populations to address early childhood caries (ECC). Great Beginnings for Healthy Native Smiles (GBHNS) (NIDCR U01DE028508), a community focused oral health (OH) intervention, was utilized alongside adapted MI techniques to promote OH care and education at home. The intervention was conducted by local Community Health Representatives (CHRs) from the two partnered indigenous communities. Reflecting on the years-long MI training and CHRs' concerns, GBHNS conducted post-intervention semi-structured interviews with all MI staff regarding their experiences with MI. This paper uses participant observation, semi-structured interviewing, and inductive and deductive qualitative coding and analysis. Thematic analysis was used to explore lessons learned and future research recommendations for interventions considering the use of MI. Generally considered a person-centered approach, MI reinforces Western psychological frameworks and practices which may disrupt local communicative practices and values. Specifically, interdisciplinary pre-intervention community assessments are recommended to ensure acceptability, relevance and appropriateness through attention to local communicative practices.
North Carolina faces persistent shortages of psychiatric professionals, particularly in rural and underserved regions, resulting in prolonged emergency department (ED) boarding, avoidable psychiatric hospitalizations, and inequitable access to behavioral health services. The North Carolina Statewide Telepsychiatry Program (NC-STeP), launched in 2013, is one of the nation's longest-running statewide telepsychiatry programs. To summarize the development, implementation, outcomes, and lessons learned from NC-STeP across ED, community, maternal, pediatric, and university settings. Data were synthesized from NC-STeP operations, service data, and peer-reviewed publications (2013-2025). NC-STeP completed 67,543 ED psychiatric assessments, prevented 11,802 hospitalizations, and generated $63.7 million in cost savings. Telepsychiatry increased safe discharges, reduced ED boarding, improved access, and revealed persistent equity gaps. NC-STeP demonstrates a scalable statewide telepsychiatry model improving throughput, reducing avoidable admissions, and expanding equitable behavioral health access.
Radiotherapy is an essential component of cancer management, yet access remains limited in many low- and middle-income countries, including Nigeria. Despite a growing cancer burden, radiotherapy infrastructure, workforce capacity, and financing in Nigeria remain grossly inadequate. Nigeria has less than one functional radiotherapy machine per 29 million people, far below International Atomic Energy Agency recommendations. Countries such as Uganda, Zambia, Botswana, Kenya, and South Africa demonstrated that phased infrastructure development, international collaboration, public-private partnerships, equipment leasing, and early workforce investment can significantly improve access to radiotherapy. The expansion of radiotherapy in Nigeria is an urgent need. This review examines the current state of radiotherapy services in Nigeria and draws lessons from these selected African countries that have successfully expanded radiotherapy capacity.
Background Digital HIV prevention interventions (DHIs) are efficacious in increasing prevention behaviors, and delivering them direct-to-consumer (DTC) expands their reach. However, few have successfully moved rigorously-studied DHIs from research to public health practice. Hybrid type 3 effectiveness-implementation studies promise to approximate more naturalistic settings and accelerate translation from research to practice, and few DTC DHIs have been tested this way. This study describes lessons learned from a hybrid type 3 study of a DTC DHI for young men who have sex with men (YMSM) ages 18-29 called Keep It Up! (KIU!) 3.0. Methods KIU! 3.0 was initially designed as a cluster-randomized hybrid type 3 implementation-effectiveness study across 44 United States counties with high HIV incidence among YMSM (22 DTC; 22 implemented in community-based organizations). The DTC strategy relied on online recruitment, at-home HIV/STI testing, and centralized intervention delivery. Over the course of the trial (October 2019-March 2023), we adapted our implementation four times in response to recruitment and retention challenges. Data sources included enrollment logs, advertising expenditures, participant communications, and internal documentation, which are used to characterize recruitment, costs, and recruitment/retention patterns. Results Due to challenges in recruitment and retention, four major changes were made over the course of the trial: 1) streamlining enrollment procedures, including shortening screening and verification steps, 2) modifying eligibility criteria, including expanding age limits, removing sexual risk requirements, and including gender-diverse participants, 3) introducing and increasing financial incentives for intervention completing and follow-up measures, and 4) shifting from county-level to nationwide recruitment. Following this fourth change in March 2021, enrollment increased by 301%, and cost per enrolled participant decreased. Ultimately 1,468 participants were enrolled nationwide. Nevertheless, retention and return of at-home STI test kits remained challenging, and guaranteed incentives increased the prevalence of imposter participants. Conclusion Implementing a DTC DHI within a hybrid type 3 study required balancing pragmatic implementation goals with effectiveness outcomes measurement. Future hybrid studies of DTC digital health interventions should consider eligibility criteria, incentive structures, outcomes measurement strategies, and the distinction between research and service components to better align research with real-world implementation contexts.
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Clinically robust molecular biomarkers for depression have remained elusive, despite extensive transcriptomic research. This gap is consequential: depression is prevalent and heterogeneous, yet objective measures to quantify burden, stratify patients, and track recovery remain limited. Here, we review evidence that intron retention (IR) can serve as a homeostatic state variable-and therefore a sensitive biomarker-reporting stress adaptation and recovery at an upstream regulatory layer, often preceding or outperforming differential gene expression (DEG) readouts. Mechanistically, IR enables bidirectional fine-tuning of effective gene output: increased IR (IncIR) can throttle output under overload, whereas decreased IR (DecIR) releases this brake to restore gene output. Because these shifts are reversible and treatment-responsive, IR signatures can function not only as disease markers but also as pharmacodynamic metrics for blood-based monitoring of drug response and recovery. To evaluate the clinical utility of IR, we use depression as a proof of concept and focus on two interventions: (i) the Kampo formula hangekobokuto (HKT), which is associated with IR normalization consistent with reduced peripheral inflammatory load; and (ii) ketamine, where IR patterns measured before ketamine treatment in non-responders are linked to stronger innate-immune/antiviral activity, suggesting a higher inflammatory load that may limit treatment benefit. Finally, we discuss transdiagnostic extensions beyond depression, using early cognitive decline (mild cognitive impairment, MCI) as a stringent, biologically distal test case for blood-based IR/DI readouts and motivating independent cohort replication and longitudinal validation.
This Viewpoint examines regulatory frameworks, limitations and exemptions, and policy implications of corporate practice of medicine doctrines.
Double-J (DJ) stents find extensive use in Endourology. Nevertheless, occurrence of forgotten stents is not uncommon. This retrospective study details our encounters in handling forgotten stents and outlines the measures we have implemented to mitigate morbidity associated with DJ stents. We conducted a retrospective analysis of hospital records of cases with Forgotten DJ stents from Jan 2021 to Jan 2025. The details reviewed included age, sex, indication for stenting, duration of the indwelling stent, presenting complaints, management, and complications. Of the total of 35 patients, the mean patient age was 46.8 years (14-70 years). The male-to-female ratio was 4:3 (20 males and 15 females). The mean indwelling time was 35.8 months. Flank pain was the commonest symptom (72.7%), followed by storage lower urinary tract symptoms (54.5%) and dysuria (50%). Complicated stents were noted in 17 patients (48.5%), whereas uncomplicated stents were noted in 18 patients (51.5%). All 18 "uncomplicated" stents could be removed cystoscopically, while complicated stents were removed by the combination of endourological techniques mainly, while two patients underwent laparoscopic nephrectomy in which one of them needed open cystolithotomy also. The issue of forgotten DJ stents remains a prevalent problem in developing countries, causing significant morbidity and financial burdens for patients. Stent registers and electronic stent extraction reminders helps us to minimize the incidence of forgotten stents.
Background: Infections caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have generated major public health concerns worldwide. Young adults represent a critical group for viral transmission due to their high proportion of asymptomatic infections. Objective: To characterize the dynamics of SARS-CoV-2-specific antibodies in individuals aged 20-29 years from Bogotá, Colombia, across two longitudinal phases. Methods: Phase I assessed seroprevalence, seroconversion, spatial clustering, symptoms associated with seropositivity and antibody kinetics following natural infection. Phase II evaluated vaccine-induced antibodies, immune memory, and neutralizing capacity. Analyses included Functional Principal Component Analysis, survival analysis, clustering, and predictive modeling. Results: In Phase I, a seroprevalence of 15.59% (17/109 participants enrolled) was observed, while seroconversion among those who completed all six sampling points was 30.18% (16/53), with clusters of positive cases in different areas of Bogotá. The symptoms most associated with seropositivity included mucus hypersecretion, fever, and respiratory difficulty. Antibody responses were heterogeneous: naturally infected individuals generally showed high titers during the first 1-2 months, remaining detectable up to 4 months. The reduction in dimensionality suggested dominant humoral patterns, and clustering revealed two immune profiles differing in the risk of seroconversion. Predictive modeling indicated diverse antibody trajectories over 12 months. In Phase II (2024), three long-term immune memory clusters (low, medium, high) were observed; post-vaccination IgG titers were observed, although in most cases they lacked neutralizing activity. Conclusions: This longitudinal exploratory observational study provides an initial characterization of antibody dynamics in young adults, suggesting their potential epidemiological relevance and offering preliminary insights into post-infection and post-vaccination immunity.
Many approved oral paediatric medicines continue to have poor taste acceptance, suggesting that the ingredient blends employed in these medicines are not adequately effective in taste-masking drugs with strongly aversive tastes. To address this inadequacy, this narrative review provides a comparative evaluation of taste-masking ingredients used by the pharmaceutical industry with those employed in the food industry, as well as food items used by caregivers to mask the unpalatable taste of medicines for young children. Information was sourced from academic databases, industry publications, and caregiver forums on informal social platforms. Ingredients were classified into sweeteners, salts, acids, fats, peptides/amino acids, flavourants, cyclodextrins and polymers, with their taste-masking mechanisms delineated into receptor-level interactions and the creation of physical barriers and alternative dominant taste. Their applications are compared across the regulated medicinal and consumer food products, and in home remedies. Sweeteners show the highest cross-domain convergence as they are used in medicinal and food products and are recommended by caregivers. Peptides, amino acids, salt and texture modifiers applied in food and home remedies may have translational potential in medicines. Challenges, including drug-food interactions, regulatory constraints, and the need for combination approaches, are addressed. A decision framework is also designed to guide the development of simple, acceptable, and effective ingredient-based taste-masking systems for drugs with aversive tastes.
Radiation-induced ureteral stricture (RIUS) is a rare but refractory late complication of pelvic radiotherapy, driven by severe fibrosis and microvascular injury that undermines the effectiveness of conventional interventions such as balloon dilation, ureteral stenting, and reconstructive surgery. This review summarizes the pathophysiological basis of treatment resistance in RIUS and critically appraises current management strategies. Beyond its clinical relevance, RIUS is discussed as a paradigmatic model of advanced fibrotic ureteral disease, offering broader insights into the limitations of purely mechanical approaches. We further examine emerging biologically oriented strategies, including mesenchymal stem cell-derived extracellular vesicle-based regenerative therapies, next-generation ureteral stents incorporating advanced biomaterials, and drug-eluting stent platforms for localized antifibrotic and antimicrobial delivery. Although largely investigational, these approaches collectively signal a conceptual shift from palliative drainage toward biologically informed, restorative management of RIUS and related refractory ureteral strictures. New ways to treat radiation-induced ureteral stricture 1. Why was this study done? Radiation therapy for cancers in the pelvis can sometimes cause a blockage in the ureter (the tube that carries urine from the kidney to the bladder). This condition, called radiation-induced ureteral stricture (RIUS), is rare but very difficult to treat. Standard treatments, such as balloon dilation, stents, or surgery, often do not work well because the radiation damage continues to cause scarring and poor blood supply. 2. What did the researchers do? This review looked at why current treatments fail and explored new ideas that scientists are testing in the laboratory and in early studies. 3. What did the researchers find? Three main areas of innovation were identified: Using tiny particles from stem cells (called extracellular vesicles) to reduce scarring and help healing. Developing new types of stents made from advanced materials, including metals or biodegradable plastics. Designing drug-coated stents that can release medicines directly into the ureter to fight scarring or infection. 4. What do the findings mean? These new approaches are still at the experimental stage, but they represent a shift in thinking—from simply relieving symptoms to trying to repair the ureter and restore its function.
Scabies represents a significant infection control challenge in geriatric care facilities. Traditional reactive strategies, such as isolating identified cases, have frequently proven inadequate in preventing recurrent outbreaks, underscoring the need for proactive, systematic approaches. This study aimed to evaluate the effectiveness of a comprehensive, proactive intervention strategy in controlling nosocomial scabies transmission in a large specialized geriatric hospital. A before and after study was conducted, comparing a pre-intervention period (January 2021-December 2024) with an intervention period (January-December 2025). The multimodal strategy included mandatory admission screening and transfer isolation for all new inpatients, weekly active symptom surveillance of caregivers, and strict implementation of a "one patient, one caregiver" model coupled with infection prevention training. Pre-intervention, 114 scabies cases were recorded, including 62 definite nosocomial transmissions and 18 infected caregivers. Post-intervention, 13 imported cases were intercepted at admission. Only one nosocomial transmission event (involving a nurse) was recorded, and no caregiver infections occurred. The reduction in nosocomial transmission was statistically significant (P < 0.001). A proactive, multimodal intervention bundle effectively interrupted nosocomial scabies transmission in a high-risk geriatric setting. This strategy should be considered for integration into standard infection control protocols in long-term care facilities.
Background: Sexual health research with migrant and refugee communities presents unique challenges, shaped by cultural sensitivities, stigma, and the under-representation of these populations in health research. However, lived experiences insights are essential for the development of appropriate and useful research and health initiatives. It is important to learn from researchers' experiences to expand the representation of migrant and refugee community voices. Method: This paper draws on two qualitative studies conducted in South Australia: one exploring the sexual and reproductive health perspectives of refugee and migrant women, and the other of men. We reflect upon the methodological and ethical considerations in conducting research in this sensitive field and provide recommendations for future researchers and healthcare providers when working with migrant and refugee communities. Results: Both studies encountered difficulties in relation to participant recruitment, cross-cultural communication, and addressing taboos surrounding sexual health. At the same time, they highlighted opportunities for generating meaningful insights through culturally safe, gender-sensitive approaches and collaboration with community stakeholders. Conclusions: By synthesising experiences from both projects, we identify practical strategies for building trust, overcoming linguistic and cultural barriers, and creating supportive environments for discussing sensitive topics. These reflections offer guidance for researchers and clinicians aiming to advance culturally responsive sexual health research and strengthen healthcare provision for migrant and refugee populations.
Carrier screening identifies individuals at risk of transmitting autosomal recessive or X-linked recessive conditions, supporting informed reproductive decisions. Despite international recommendations for universal carrier screening, integration into public healthcare systems remains limited. This study evaluated the feasibility of implementing a carrier screening program in Spain's public health system. Non-pregnant women aged 18 to 38 with reproductive intent were recruited through text messages sent from a primary care center, along with their partners. A sequential screening approach was used: women underwent a 351-gene massively parallel sequencing panel and complementary tests, while male partners were tested only if their partner carried autosomal recessive variants. Specific genetic counselling was provided, and emotional responses were assessed through pre- and post-test questionnaires. Of 518 candidates contacted, 400 (77%) responded positively and 152 couples (50.8% of those eligible) enrolled. Among 218 individuals screened, 62% (135) carried at least one pathogenic variant. Six carrier couples (4%) were identified as being at reproductive risk of non-syndromic hearing loss (GJB2, 2 couples), cystic fibrosis (CFTR), Stargardt disease and retinitis pigmentosa (ABCA4), Smith-Lemli-Opitz syndrome (DHCR7), and Fabry disease (GLA). Of four couples followed post-disclosure, 75% opted for in vitro fertilization with preimplantation genetic testing or prenatal diagnosis. Prevention of severe genetic conditions was the most frequently reported motivation for participation. This study proves the feasibility and clinical utility of carrier screening within a public healthcare system. Our findings demonstrate high participation rates, clinical relevance through the identification of 4% of carrier couples, and strong motivation among participants to prevent the transmission of severe genetic conditions.
Tumor budding (TB), defined as isolated single cells or small clusters of up to four tumor cells at the invasive front of colorectal carcinoma (CRC), is recognized as an important histopathologic marker associated with adverse tumor behavior. This review summarizes current knowledge on the morphologic assessment, biological significance, and clinical relevance of TB, emphasizing emerging artificial intelligence (AI) methods that aim to automate and standardize its quantification. Standardized reporting by the International Tumor Budding Consensus Conference (ITBCC) has improved reproducibility, while novel deep-learning algorithms demonstrate potential for objective and prognostically relevant TB assessment. Integration of AI-based TB evaluation with molecular and stromal biomarkers may refine patient stratification and facilitate personalized treatment strategies.
Sepsis remains a leading cause of mortality worldwide, in part because it represents a biologically heterogeneous syndrome rather than a single disease entity. Numerous clinical trials targeting inflammation, coagulation, or immune pathways have failed to improve outcomes, largely due to indiscriminate enrollment of biologically diverse patient populations. Precision medicine has therefore emerged as a necessary paradigm shift in sepsis research and care. Endotoxin is a key driver of sepsis pathobiology through Toll-like receptor 4-mediated inflammatory signaling, endothelial dysfunction, and thromboinflammation. The development of the endotoxin activity assay (EAA) enabled real-time functional assessment of circulating endotoxin activity, revealing marked interindividual variability and dynamic changes during illness. These insights provided a rationale for biologically guided endotoxin-targeted therapy. Polymyxin B hemoperfusion, despite its strong mechanistic plausibility and early clinical promise, yielded inconsistent results in trials that relied on syndromic enrollment criteria. The TIGRIS trial was designed to address this limitation by refining patient selection through the integration of EAA-defined endotoxemia and organ dysfunction severity, assessed by the Sequential Organ Failure Assessment score. By defining a therapeutic window in which endotoxin was both biologically relevant and potentially modifiable, TIGRIS provides preliminary evidence suggesting that polymyxin B hemoperfusion may be effective when applied in an appropriate biological context. Beyond endotoxin removal, TIGRIS may offer insights into broader implications for precision medicine in sepsis, including biomarker-guided trial design, rational combination therapy, and reinterpretation of prior "negative" studies. Embracing biological heterogeneity may offer a credible path toward effective, individualized sepsis treatment.
IgE-mediated food allergy (FA) represents an increasing global health burden, with rising prevalence and limited therapeutic options beyond allergen avoidance and emergency management. The approval of omalizumab as the first biologic to reduce reactions after accidental food exposure marks a turning point in FA care. While randomized controlled trials (RCTs) have demonstrated its efficacy in raising reaction thresholds and reducing allergic responses, real-world studies provide complementary evidence capturing outcomes relevant to everyday life. This review integrates evidence from sources of observational studies, including cohort, case series, and case reports evaluating omalizumab in patients with FA, including complex phenotypes and populations typically excluded from RCTs. Real-world data demonstrate that omalizumab can prevent severe reactions in atypical and non-ingestive FA phenotypes, increase reaction thresholds as monotherapy, and enable dietary liberalization in a substantial proportion of patients. Observational cohorts consistently report improvements in food allergy-related quality of life, reduced anxiety, and enhanced confidence in food management. Omalizumab appears effective and well tolerated across complex populations, including patients with multiple comorbidities and very high total IgE levels, even beyond currently approved dosing limits. Emerging evidence also suggests that FA may require disease-specific dosing paradigms distinct from those used in asthma. Real-world evidence complements RCTs findings by highlighting the multidimensional benefits of omalizumab in FA, encompassing clinical protection, dietary freedom, and psychosocial well-being as well as dose fine-tuning and off-label scenarios. These data support its broader clinical value and inform future research, dosing strategies, and personalized application in routine care.
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Robotic colorectal surgery has revolutionized minimally invasive techniques worldwide, offering a more stable operative platform, superior 3D visualization, and wristed instrumentation for challenging pelvic dissections. This narrative review describes the global evolution of robotic colorectal surgery, from the use of multi-port to single-port systems, modular platforms and endoluminal robotic devices. Using Hong Kong's role as an innovation and research hub, this review demonstrates how integrated innovation, structured training, workflow efficiencies and digital policy frameworks can overcome barriers and inform international implementation of robotic colorectal surgery. Since 2005, The Chinese University of Hong Kong has been pioneering the use of robotic platforms in colorectal surgery, performing first-in-human trials of the da Vinci SP system, the locally developed Sentire C1000 and the EndoMaster EASE for robotic ESD. There is increasing evidence supporting the use of the robotic platform over laparoscopic colorectal surgery, with benefits including reduced open conversions, fewer intraoperative complications, shorter hospital stay, better long-term functional outcomes and improved oncologic outcomes. However, several challenges remain before robotics can be implemented widely on a global scale, such as higher initial capital costs, limited training access, surgeon credentialing and governance for AI-driven data analytics.