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A quarter century ago, research-to-practice gaps in addiction care gained national attention and prompted formation of the National Drug Abuse Treatment Clinical Trials Network (CTN) and formalization of the Addiction Technology Transfer Centers (ATTCs). Soon after, the RE-AIM explanatory framework was developed to enable examination of the public health impact of healthcare innovations-with its domain of adoption corresponding most directly to the CTN's mission of transferring research results of its trials to the addiction workforce. A node-level CTN-ATTC collaboration, the Western States CTN Node Training and Dissemination Workgroup, seeks to contribute to this national mission. Our workgroup-currently comprising leadership of the Western States CTN Node, Northwest ATTC, Pacific Southwest ATTC, and CTN Dissemination Library-promotes workforce adoption of scientific advancements in addiction care via two long-running universal technical assistance activities: a semi-annual webinar series, and a monthly column in the ATTC Messenger newsletter. In this commentary, we provide historical context for the salience of bridging research-to-practice gaps, and then describe the origin of this workgroup, detail its pair of long-running universal technical assistance activities intended to increase adoption of healthcare advancements among addiction workforce members, and offer metrics concerning the audiences attracted over a recent five-year period. In celebration of the CTN's 25th anniversary, we also reflect on the value of this multi institutional partnership for the Western States CTN Node and propose a dissemination agenda to prompt future efforts whereby the CTN mission may be more fully and effectively achieved.

Community-led action is essential for building a more effective and equitable health system. Yet Aotearoa New Zealand's history of top-down structural reforms has undermined progress toward "healthy futures for all". We draw on complexity science and system-change principles to explain why genuine devolution and community engagement are not just ideological preferences but practical necessities in a complex health system. Community agency and locally tailored innovation can drive emergent, system-wide improvements, but only if central structures enable and sustain these relationships. A key step is reframing our mental model of the health system from a linear machine to a complex adaptive system. We discuss how the turbulence of current policy changes fits into long-running patterns and why a clearer conceptualisation of complexity can guide policymakers toward tangible actions that reorient the system towards patients and communities. Finally, we outline some essential ingredients for how New Zealand can transition from rhetoric and good intentions to the effective implementation of an equitable, community-centred health system.

As we recognise people we know over many years, their faces can change, sometimes profoundly, and yet we continue to recognise them with ease. How do we update our representations over time? We present four pre-registered experiments to examine this. In Experiment 1, using likeness ratings and speeded name verification, fans of a long-running TV soap opera demonstrated that their representations of the characters' faces were weighted towards their most recent encounters - when the characters were oldest. While we initially hypothesised that this was due to recency, Experiment 2 showed this not to be the case. When new participants were taught these characters either in chronological or reverse-chronological order they all demonstrated representations weighted towards the characters at their oldest ages, regardless of the order in which they had encountered them. We ruled out potentially artefactual explanations using statistical analysis of the images themselves and, in Experiment 3, restricted learning sets. A further, final experiment showed that our results are unlikely to be fully explained by perceived distinctiveness of the stimuli. We conclude that the processes involved in developing representations for familiar people are more sophisticated than previously thought, incorporating real-world constraints, including natural chronology.

Intracellular processes often rely on the timely encounter of mobile reaction partners, including intermittently motor-driven organelles. The underlying cytoskeletal network presents a complex landscape that both directs particle movement and introduces quenched disorder through filament organization. We investigate the mean first encounter times for pairs of intermittently processive and diffusive particles, moving in two dimensions with and without a fixed filament network. In unstructured domains, increasing particle run-length enhances exploration of the domain, but tends to slow down the encounter times compared to equivalent diffusing particles. Encounters for long-running particles occur preferentially near the periphery, contrasting with bulk encounters for the purely diffusive case. When particles are unbiased in their runs along dense filament networks, encounters are shown to be well approximated by a continuum run-and-tumble model. For biased particles, regions of convergent filament orientation serve as traps that slow the overall spatial exploration but can allow for faster encounter rates by funneling particles into regions of reduced dimensionality. These findings provide a framework for estimating intracellular encounter kinetics, highlighting the role of key physical features such as the effective diffusivity, run times, and network architecture.

Background:Stenotrophomonas maltophilia is an intrinsically multidrug-resistant, biofilm- forming, non-fermenter increasingly implicated in hospital-acquired infections. Evidence from non-cystic fibrosis populations, especially in the Middle East, remains sparse. Methods: We conducted a retrospective observational cohort study at a tertiary academic center (Al-Khobar, Saudi Arabia) spanning 1 May 2001-30 April 2023. Hospitalized adults (≥18 years) with culture-confirmed, clinically diagnosed S. maltophilia infection and ≥72 h of antibiotic therapy were included. The primary outcome was all-cause mortality (14-day, 30-day, 1-year). Secondary outcomes were clinical response, microbiological eradication, and infection recurrence. Predictors of 30-day mortality were assessed using multivariable logistic regression; 14-day mortality was analyzed by Kaplan-Meier/log-rank according to susceptibility-guided versus alternative therapy. Results: Of 539 patients with positive cultures, 436 met the inclusion criteria. Mean age was 60.5 ± 19.3 years; 62.2% were male. Most infections were hospital-acquired (92.9%); pneumonia composed 64.7% and bloodstream infection 15.4%. Polymicrobial growth occurred in 55.5% (predominantly Gram-negative co-isolation). Susceptibility was 95.1% to trimethoprim-sulfamethoxazole, 76.4% to levofloxacin, and 43.6% to ceftazidime. Mortality at 14 days, 30 days, and 1 year was 22.8%, 37.9%, and 57.2%, respectively. On multivariable modelling, intensive care unit (ICU) admission, leukocytosis, neutrophilia, anemia, and thrombocytopenia independently predicted 30-day mortality. Susceptibility-guided therapy was associated with improved 14-day survival (log-rank p = 0.033). Conclusions: In this large, long-running non-cystic fibrosis cohort, host acuity and early alignment of treatment to susceptibility data were dominant drivers of outcome. High polymicrobial burden and limited reliably active agents underscore the need for meticulous stewardship, robust infection prevention, and cautious interpretation of S. maltophilia antimicrobial susceptibility testing.

I-SPY2 is a long-running phase 2 platform trial that evaluates neoadjuvant treatments for locally advanced breast cancer to identify those with high efficacy that are likely to be successful in phase 3 trials, assigning patients to novel agents using response-adaptive randomization (RAR). Recently, I-SPY2 was reconfigured as a sequential multiple assignment randomized trial (SMART), with up to three stages of therapy. At the first stage, a patient is assigned to a tumor-subtype-specific therapy. If the patient fails to show a satisfactory response, the patient is assigned to a second subtype-specific therapy, and receives a third, rescue therapy if response is still not achieved. The I-SPY2 SMART thus supports identification of highly efficacious entire treatment regimes. The transition of I-SPY2 to a SMART required development of a RAR scheme that updates randomization probabilities at each stage, aligned with the goal of maximizing the number of patients who achieve a pathological complete response (pCR). We present our Bayesian RAR approach, which updates randomization probabilities based on the posterior probability that treatments are part of the optimal regime. Empirical studies demonstrate that it results in more patients having treatment experience consistent with highly efficacious regimes, improves overall within-trial pCR rates, and identifies optimal regimes post trial at rates similar to or exceeding those under simple, uniform, nonadaptive randomization.

This article argues that Alison Bechdel envisioned a new way of looking at lesbians in her long-running comic strip Dykes to Watch Out For (1983-2008). Through simultaneously universalizing lesbian experiences while celebrating the ways in which her characters' sexualities rendered them different from each other and from the so-called 'universal' white male protagonists of much mainstream media, Bechdel created what I term a 'universalizing' gaze. This gaze usurped Laura Mulvey's 'male gaze' through presenting lesbian characters, not as sexual objects drawn for the reader's pleasure, but as aligned with readers: as the sexual subjects of the comic. This technique allowed Bechdel to portray lesbians as sexual people without hyper-sexualizing them, enabling a diverse group of readers to see themselves represented in the strip.

This article outlines some of the key stages in a long-running and groundbreaking campaign for a national strategy on climate and health for Australia. It is hoped this account will be a source of inspiration for others seeking to accelerate climate action in ways that protect and promote health and wellbeing. A multi-pronged approach combining policy development and advocacy, inside track campaigning, movement building, grassroot engagement, and public communications formed the key elements of the campaign.

Failure to account for top-down control on vegetation dynamics can strongly influence restoration trajectories. Abundant (large) herbivores can impede restoration efforts by exerting intense grazing pressure on plant communities. An adaptive management cycle can mitigate initially discounted impacts and alleviate herbivore disturbances. In this study, conducted in an urban and restored tidal freshwater wetland in Washington, D.C., we tested the effects of resident, non-migratory Canada geese (Branta canadensis maxima) in a long-running exclosure study (2009-2025), with vegetation monitoring of paired herbivore exclosure and unprotected control plots both before and after implementation of adaptive management in the form of goose population control. Unprotected plots recovered strongly several years after goose population control measures were initiated. Specifically, total plant cover, cover of annual species, species richness, and Shannon-Wiener Diversity Index increased in response to goose population control. In most regards, unprotected control plots began to resemble herbivore exclosure plots following enactment of goose population control activities. However, community composition was slower to recover and lagged other metrics. Surprisingly, the overall trajectory of recovery continues to be influenced by the initial vegetative state in which the plots occurred when the experiment was begun in 2009, reflecting a long legacy within the plant dynamics. These results highlight the effectiveness of localized population control for non-native or otherwise problematic herbivores in a restoration setting and the value of adaptive management for restoration success.

Second primary invasive cutaneous melanomas (SPICMs) are common and pose an increased risk of death compared with single invasive melanoma only. Using data from the Queensland Oncology Repository, we investigated changes in the cumulative incidence of SPICMs for people diagnosed with a first primary invasive cutaneous melanoma between 1982 and 2022, with follow-up until December 31, 2023. Death due to any cause was treated as a competing risk. Among the 101,035 people in the study cohort, 9% (n = 9224) were diagnosed with a metachronous SPICM. Estimated 40-year cumulative incidence of SPICMs was 16.3% (95% confidence interval = 15.8-16.8%). Ten-year cumulative incidence was 4.9% between 1982 and 1991, 7.0% for 1992-2001, 7.9% for 2002-2011, and 7.3% between 2012 and 2022. After multivariable analysis, people first diagnosed between 2012 and 2022 were 23% more likely to subsequently be diagnosed with a SPICM within 10 years than those first diagnosed in 1982-1991 (subhazard ratio = 1.23, 95% confidence interval = 1.11-1.35), whereas the subhazard ratio was 1.38 (95% confidence interval = 1.26-1.52) for 2002-2011. These results provide evidence that the cumulative incidence of SPICM may have plateaued within a population having the highest rates of melanoma in the world, possibly owing to the impact of long-running sun safety campaigns in Australia combined with increased surveillance.

Non-communicable diseases, particularly cardiovascular diseases (CVDs), have become major contributors to morbidity and mortality in sub-Saharan Africa (SSA) and are projected to surpass infectious diseases as the leading cause of death among adults by 2030. Although CVDs have traditionally been associated with older age and obesity, adverse cardiovascular phenotypes are increasingly being observed in younger and leaner individuals in SSA. This pattern suggests that pathways to CVD risk in SSA may differ from those described in high-income countries. Early-life infectious exposures, undernutrition and socio-demographic conditions common in many SSA settings have been proposed as potential risk factors. Still, empirical evidence linking these exposures to cardiovascular risk in early adulthood remains limited due to a scarcity of long-running birth cohorts in the region. This protocol describes a new round of data collection nested within the Entebbe Mother and Baby Study (EMaBS), a population-based Ugandan birth cohort established originally as a clinical trial (ISRCTN32849447) between 2003 and 2006 with prospective follow-up from pregnancy through adolescence. All participants currently under follow-up will be invited to participate at approximately 21 years of age. Primary outcomes are physiological determinants of CVD measured in early adulthood, including blood pressure, blood lipid levels, body mass index, body composition and markers of glucose metabolism. Secondary outcomes include behavioural CVD risk factors (diet, physical inactivity, alcohol use and tobacco use) and qualitative measures of CVD knowledge and risk perception. Key exposures of interest include prospectively collected early-life and childhood infectious exposures (malaria and helminth infections), markers of growth and undernutrition, micronutrient status, inflammatory markers, socio-demographic factors and selected genetic variants. Quantitative analyses will use multivariable regression and causal modelling approaches and will be complemented by qualitative interviews and focus group discussions. The study protocol has been reviewed and approved by the Uganda Virus Research Institute Research and Ethics Committee (UVRI REC Ref: GC/127/35), the Uganda National Council for Science and Technology (UNCST Ref: MV625), and the London School of Hygiene & Tropical Medicine Research Ethics Committee (LSHTM Ethics Ref: 8811). Written informed consent will be obtained from all participants before study activities. Study findings will be shared and discussed with participants and community stakeholders through established engagement platforms. Results will be disseminated to the scientific community through peer-reviewed publications and conference presentations, and data will be made available to other researchers via established data-sharing platforms. We will engage policymakers at the district, national and international levels to facilitate the translation of findings into policy-relevant outputs.

How a scholarly community organizes knowledge about the deaths of marginalized populations is itself a question for death studies. This bibliometric review maps the global literature on end-of-life and palliative care for adults with intellectual and developmental disabilities, drawing on 919 English-language articles from 1990 to 2025. Only 5.5% of papers appeared in palliative care journals; the evidence base has accumulated in disability-specialist venues largely invisible to scholars and clinicians of dying. Topic modeling on 423 core documents shows staff training has dominated this scholarship for three decades, while the perspectives of dying people themselves remain peripheral, a pattern that speaks to long-running concerns about awareness contexts and the social organization of dying. Citation analysis reveals a field whose intellectual architecture rests on a single author. The literature mirrors the marginalization of the population it studies; this review offers death scholarship a structural map and an agenda for diversification.

With the escalating popularity of marathon running, Achilles tendon injuries, particularly gradual-onset Achilles tendon injury, have become common, often causing substantial training disruptions. However, the influence of running experience on the Achilles tendon structure in amateur runners remains largely unclear. This study aimed to investigate the association between running experience and asymptomatic Achilles tendon pathology as well as its structural changes. This was a cross-sectional observational study. Forty-eight amateur marathon runners were categorized into four groups based on running experience (1, 3, 5, and > 5 years), with 12 healthy nonrunners as controls. Inclusion and exclusion criteria were strictly applied. All participants underwent MRI scanning using a 3.0 T GE scanner. Two radiologists evaluated MRI scans for pathology and measured tendon length, thickness, volume, and cross-sectional area (CSA). Statistical analyses, including Shapiro-Wilk, ANOVA, Kruskal-Wallis H, and chi-squared tests, were conducted using SPSS 23.0. Baseline characteristics showed no significant group differences. Qualitative analysis revealed that the prevalence of midportion tendinopathy, insertional tendinopathy, and retrocalcaneal bursitis increased significantly with longer running experience. Quantitative measurements indicated that tendon thickness, volume, and CSA were significantly greater in long-running groups compared to short-running and control groups, whereas tendon length remained unchanged. Interobserver reliability was excellent. In amateur marathon runners, running experience is associated with increased asymptomatic Achilles tendon pathology and morphological remodeling. Prolonged running may induce both adaptive and degenerative changes, highlighting the importance of MRI-based monitoring for early intervention in high-risk populations.

Ethnic minority groups experience higher stroke risk than majority groups. While overall stroke incidence has declined, it is unclear whether recent prevention strategies have narrowed ethnic inequalities. We systematically reviewed last decade trends on ethnic inequalities in stroke incidence. We systematically reviewed observational studies (2015-2025) reporting first-ever stroke incidence by ethnicity in adults globally. We searched MEDLINE, Embase, and Scopus; assessed bias using ROBINS-E; reported narratively using PRISMA-2020 and conducted random-effects meta-analysis for Black versus White populations in North America. Twenty-six publications from 22 studies across high-income countries were included. Five studies had low risk of bias; six had some concerns, twelve were high or very high risk of bias. Black populations in the US experienced higher stroke incidence versus White populations (pooled incidence rate ratio=1.62; 95% CI 1.18-2.22), with persistent and, in some repeated-wave registries, widening inequalities in the US and UK. Aboriginal and Torres Strait Islander peoples in Australia and Māori in New Zealand showed two- to threefold excess incidence with widening gaps observed across successive survey waves. Asian and Middle Eastern populations and Hispanic/Latino populations showed heterogeneous patterns. Adjustment for socioeconomic status and cardiovascular risk factors only partially reduced inequalities. Ethnic inequalities in stroke incidence persist and and show widening in some long-running registry populations, particularly among Black, Aboriginal and Torres Strait Islander, and Māori populations. Cardiovascular risk factors only partly explain these inequalities, indicating that additional unmeasured drivers are also at play. While improved detection and treatment of hypertension and diabetes remains necessary, it is insufficient on its own; reducing inequalities will also require investigation of these upstream determinants and population-based prevention strategies that address structural barriers to equitable care. Evidence from low- and middle-income countries is urgently needed.

Xanthomonas spp. are devastating plant pathogens that cause significant agricultural losses worldwide. Their virulence relies on type III secretion system (T3SS) effectors that manipulate host cells, but the functions of many effectors remain unknown. A recent report demonstrated that the AvrBs2 effector from the rice pathogen Xanthomonas oryzae pv. oryzicola manipulates host metabolism to synthesize a unique metabolite, xanthosan, from host sugars. The bacteria then import and utilize this metabolite via specific transporters. Notably, transgenic rice plants engineered to degrade this metabolite exhibited strong resistance to the pathogen. Another recent study revealed that the PthA4 effector from the citrus pathogen Xanthomonas citri pv. citri activates the host gene CsLOB1, inducing cell wall degradation. The released sugars, particularly xylose, activate bacterial nutrient uptake systems, creating a feed-forward loop that promotes infection. Specifically, AvrBs2 generates monosaccharide building blocks for the cell wall, whereas PthA4 depolymerizes existing cell walls, likely by activating a fruit-ripening program, highlighting that virulence emerges from the interplay between host manipulation and bacterial physiology. These discoveries establish nutrient hijacking as a conserved virulence mechanism in Xanthomonas and provide new targets for sustainable crop protection. © 2026 Society of Chemical Industry.

Most gastric cancer cases are attributable to chronic Helicobacter pylori (H. pylori) infection and can theoretically be prevented. The objectives of the EUROHELICAN project were to assess the feasibility, acceptability, effectiveness, and adverse events of the H. pylori screen-and-treat program in younger adults aged 30 to 34 years, for the first time in Europe; to evaluate long-term effects of H. pylori eradication in middle-aged adults (starting from 45 years of age) previously enrolled for at least 5 years in the GISTAR study in Latvia, and to prepare the IARC expert Working Group Report on population-based H. pylori screen-and-treat strategies for gastric cancer prevention. The study of H. pylori screen-and-treat in younger adults was conducted in the Community Healthcare Center Dr. Adolf Drolc Maribor following methodology prepared by the National Institute of Public Health of Slovenia. Assessment of possible effects of H. pylori screen-and-treat in the long term was conducted by following up on the long-running GISTAR study conducted by the Institute of Clinical and Preventive Medicine at the University of Latvia. A team of experts led by the Nantes University Hospital evaluated the study protocols and their progress at different stages. The IARC convened a Working Group of international experts to develop globally applicable guidance on best practices for implementing population-based H. pylori screen-and-treat strategies in adult populations to prevent gastric cancer. Both studies received a positive evaluation at different stages of completion and were deemed appropriate for testing the feasibility of H. pylori screen-and-treat in a community health care setting and investigating possible adverse effects of the strategy in the long-term. The IARC expert group guidance report on the implementation of population-based H. pylori screen-and-treat strategies to prevent gastric cancer in adults will guide future primary gastric cancer prevention programs in Europe and beyond.

Defined by DSM-5-TR as a neurodevelopmental disorder Attention-Deficit/Hyperactivity Disorder (ADHD) has attracted ever-mounting attention from the public, coupled with a growing interest from clinicians, researchers, and patients. This is reflected in significantly higher demand for clinical assessments and frequent media reports of a surge in ADHD cases across the lifespan. These trends are puzzling as it is unknown what they truly reflect: an improvement in clinical detection or a concerning degree of overdiagnosis? A key reason for this uncertainty is our limited understanding of the disorder and imprecision of the diagnosis - a long-running subject of criticism. To better understand these issues, in this article we deconstruct ADHD through the lens of its DSM-5-TR diagnostic criteria - the basis upon which the diagnosis is routinely made. Our in-depth analysis reveals major problems associated with the diagnostic criteria with respect to their arbitrariness, vagueness, redundancy, and context-dependent normality, which together substantially undermine the validity and reliability of the diagnosis, and the ADHD construct itself, blunting the precision of ADHD research, clinical decisions and the effectiveness of treatment - all of which are contingent on having a robust diagnosis in the first place. Hence, our detailed deconstruction of the diagnosis of ADHD is critical as it provides the necessary groundwork for its accurate reconstruction - an essential step towards developing a valid, reliable, and clinically meaningful diagnostic foundation that will inform research and improve clinical care for patients with attentional and hyperactivity-impulsivity problems.

Solid organ transplant (SOT) recipients face elevated tuberculosis risk, yet optimal prevention strategies in low- to medium-incidence regions remain unclear. We conducted a multicenter retrospective cohort study of adult SOT recipients transplanted between 2007 and 2012 at 15 European centers, with follow-up through 2018. The primary outcome was microbiologically confirmed post-transplant tuberculosis. Incidence rates were calculated per 100,000 person-years; standardized incidence ratios (SIRs) used World Health Organization country-specific background rates. Cox models assessed risk factors. Among 5805 patients (median age 51; 62.7% male; 73.9% renal transplants), 33.8% were tested for tuberculosis infection and 10.3% received tuberculosis preventive therapy (TPT). Over 33,785 person-years, 23 patients (0.4%) developed tuberculosis (68.0/100,000 person-years). Highest incidence occurred in patients with positive screening but no TPT (233.8/100,000). Incidence was higher in Southern vs. Central Europe (251.9 vs. 28.7/100,000), with pooled SIRs of 12.8 and 3.1, respectively. Tuberculosis risk was elevated among Southern European recipients (HR 22.9) and those with migration history (HR 2.7). Tuberculosis risk is increased in European SOT recipients. Regionally adapted prevention strategies, including targeted screening in low-incidence areas and universal screening in higher-incidence regions, are warranted.