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IntroductionCervical cancer brachytherapy requires highly conformal dose delivery while minimizing radiation exposure to surrounding organs at risk. However, conventional tandem and ring applicators are limited by fixed geometry that may not optimally accommodate patient-specific anatomy. The purpose of this work was to evaluate the dosimetric performance of a novel tandem and ring applicator (RTA) featuring adjustable tandem translation relative to the ring, intended to improve organ-at-risk (OAR) sparing while preserving target coverage in high-dose-rate (HDR) brachytherapy for cervical cancer.Methods and MaterialsA novel RTA allowing linear tandem translation within the ring plane was developed to enable patient-specific alignment without altering ring position. Two cervical cancer patients treated with external beam radiotherapy (45Gy/25 fractions) followed by HDR brachytherapy (27.5Gy/5 fractions) were analyzed. Conventional and novel RTAs were sequentially applied to acquire CT-based datasets. Plans were optimized for adequate HR-CTV D90 coverage while minimizing D2cm3 doses to bladder, rectum, sigmoid, and bowel. EQD2 values (α/β = 3 for OARs; 10 for HR-CTV) were compared. Five retrospective cases were replanned using the novel RTA. Point A was redefined as 2cm superior along the tandem from the cervical os and 2cm lateral perpendicular to the tandem axis.ResultsFor patient 1, the novel RTA reduced average daily D2cm3 by 0.54Gy (rectum), 0.78Gy (bladder), and 0.18Gy (sigmoid), with cumulative EQD2 reductions of 2.23Gy, 4.88Gy, and 1.05Gy, respectively. Patient 2 showed daily reductions of 0.52Gy (rectum) and 0.44Gy (bladder), with EQD2 decreases of 3.20Gy and 4.55Gy. HR-CTV EQD2 increased by 1.67Gy. Retrospective plans demonstrated consistent reductions in OAR doses.ConclusionThe novel RTA demonstrated favorable dosimetric trends for OAR sparing while maintaining target coverage in cervical HDR brachytherapy. The revised Point A definition provides a preliminary framework for anatomically consistent dose reporting in flexible tandem configurations.

This study aimed to investigate the effects of a 14-week tempo-based strength periodization training program on muscle strength, power, and sport-specific performance in coastal rowers. A single-group pre-post study design was implemented. Twelve well-trained coastal rowers (age 20&#xa0;&#xb1;&#xa0;2.34 years; height 182.42&#xa0;&#xb1;&#xa0;4.83 cm; weight 79.25&#xa0;&#xb1;&#xa0;10.17 kg; training experience 6.33&#xa0;&#xb1;&#xa0;2.81 years) underwent a 14-week periodized training program, which consisted of four phases: hypertrophy, transition, maximal strength, and tapering. Three testing time points were set: baseline (T1), post-hypertrophy (T2), and post-intervention (T3). Assessments included maximal strength (1-repetition maximum squat, bench press, bench pull, deadlift), power (countermovement jump height and peak power), and sport-specific performance tests (50 m sprint, 500 m ergometer, and composite test: 50 m sprint + 750 m ergometer + 50 m sprint). Significant improvements were observed from T1 to T3 in maximal strength (squat: P&#xa0;<&#xa0;0.001, Effect Size (ES) = 1.01; bench press: P&#xa0;<&#xa0;0.001, ES = 0.86; bench pull: P&#xa0;<&#xa0;0.001, ES = 1.06; deadlift: P&#xa0;<&#xa0;0.001, ES = 0.93), countermovement jump (CMJ) height (P&#xa0;<&#xa0;0.001, ES = 0.37), 50-m sprint (P&#xa0;<&#xa0;0.001, ES = -0.42), 500-m ergometer performance (P&#xa0;<&#xa0;0.001, ES = -0.49), and the composite test (P&#xa0;<&#xa0;0.001, ES = -1.1). No significant change was found in CMJ peak power (P&#xa0;>&#xa0;0.05, ES = 0.16). A 14-week tempo-based strength periodization program was associated with significant improvements in muscle strength, countermovement jump (CMJ) height, and sport-specific performance in coastal rowers, suggesting potential utility in integrating structured tempo training into periodized strength plans for power-dependent water sports athletes.

The study aims to develop and validate a multi-omics model based on preoperative ultrasound (US) imaging results, intraoperative H&E- stained slides, and clinical features to predict lymph node metastasis (LNM) before lymph node dissection (LND) in ovarian cancer (OC) patients. We analyzed 157 OC patients undergoing LND with definitive pathological confirmation of LNM status, comprising 91 patients in the training cohort, 38 in the internal validation cohort, and 28 in the external test cohort. US images were processed with PyRadiomics to extract radiomics features, while pathological WSIs were processed with deep learning (DL) algorithms and multi-instance learning(MIL) algorithms to extract pathomics features. Then, radiomics and pathomics models were developed using support vector machines (SVMs), logistic regression (LR), and extreme gradient boosting (XGBoost) after dimensionality reduction and feature selection. To create a powerful multi-omics model, clinical features were incorporated into the optimal radiomics and pathomics features. Performance of models was assessed by accuracy, AUC, 95% CI, sensitivity, specificity, PPV and NPV. A total of 11 features were used to build radiomics models out of a selection of 1561 radiomics features. The SVM_rad model demonstrated superior predictive performance (AUC: training=0.816, validation=0.760, test=0.775). In parallel, pathomics models were built using a refined set of 3 features selected from the original 206 pathomics features. Among these, the SVM_path model showed the highest predictive efficiency (AUC: training=0.983, validation=0.817, test=0.813). The multi-omics model showed the greatest discriminative power (AUC: training=0.988; validation=0.923; test cohort=0.862). The quality of the prediction model was demonstrated by the DeLong test, calibration curves, and decision curve analysis, which verified its high discrimination, calibration, and clinical usefulness. The study's findings indicate that the multi-omics model integrating the tumor-level radiological data, cellular-level pathological information, and patient-level clinical features can predict LNM before LND in OC and support rational treatment plans.

This study was undertaken to perform a dosimetric comparison of four distinct radiotherapy planning strategies for pituitary adenomas on the Varian Halcyon platform (Varian Medical Systems, Palo Alto, CA, USA): three-dimensional conformal radiotherapy (3DCRT) using electronically flattened beams, 3DCRT using true flattening filter-free (FFF) beams, intensity-modulated radiotherapy (IMRT), and volumetric modulated arc therapy (VMAT). The study additionally evaluated the feasibility and dosimetric implications of reproducing conventional forward-planned beam characteristics on an inherently FFF platform using dynamic multileaf collimator (MLC)-based electronic fluence shaping. Planning data from 15 patients were utilized. Four plans were generated per patient: 3DCRT with electronically flattened beams, 3DCRT with true FFF beams, IMRT, and VMAT. A prescription dose of 54 Gy in 30 fractions was applied with &#x2265;95% planning target volume (PTV) coverage. Plan evaluation included D2%, D50%, D98%, conformity index (CI), homogeneity index (HI), gradient index (GI), and doses to optic nerves, chiasm, lenses, cochleae, brain, and brainstem. All techniques achieved clinically acceptable coverage (V95% > 99%). IMRT and VMAT showed superior conformity compared with 3DCRT (p < 0.0001), with VMAT achieving the lowest HI. IMRT provided the lowest mean doses to lenses. VMAT achieved the lowest maximum doses to optic nerves, eyes, brain, and brainstem, and the lowest mean doses to the chiasm and brainstem. True 3DCRT FFF required fewer monitor units (MUs) and had sharper gradients, whereas electronically flattened plans were more uniform. Inverse-planned techniques provide superior organ-at-risk (OAR) sparing in pituitary adenomas. VMAT offers superior normal tissue dose constraints. Their complementary strengths suggest that technique selection should be guided by anatomical considerations and proximity of critical structures, emphasizing individualized planning rather than reliance on a single modality. Significant dosimetric differences exist between electronically flattened and true 3DCRT FFF delivery, underscoring the importance of beam model selection in forward-planned radiotherapy for pituitary adenomas.

Effective transition from pediatric to adult care is essential in Duchenne muscular dystrophy (DMD), but evidence on how transition is delivered in everyday practice remains limited. In Turkey, no clinical framework specifies how transition should occur, although national regulation requires completion of transfer by age 23. This study aimed to describe current practice, identify barriers and facilitators from physician and patient perspectives, and compare findings with international frameworks to inform a national guideline. As part of the AIM-DMD (National plan of action to raise Awareness and Improve Medical care of Duchenne Muscular Dystrophy) initiative, we conducted a national cross-sectional survey between June and December 2025, comprising parallel sub-studies of physicians and patients with DMD and their caregivers. Two structured online questionnaires were developed, guided by the Got Transition Six Core Elements framework and international Delphi consensus statements. The physician survey was distributed through professional networks; the patient and caregiver survey through the DMD Families Association and neuromuscular reference centers. Sixty-two physicians (43 pediatric and 19 adult neurologists) from 28 cities and 48 patients and caregivers from 24 of these cities responded. Only 17.7% of physicians reported a systematic institutional transition program, 38.7% prepared individualized transition plans, and 9.7% described true readiness assessment. Joint pretransition consultations were held regularly by only 6.5% of physicians. Among transitioned patients, 72.4% first heard about transition at age 17 or later, and 62.1% considered their preparation inadequate. All physicians reported transferring medical data at transition, most commonly through institutional electronic health records (80.6%); however, 41.4% of patients and caregivers were unaware that any information had been conveyed to the adult team. Physicians, patients, and caregivers all identified the lack of a formal transition protocol, joint pediatric and adult consultations, multidisciplinary integration, and a designated coordinator role as priority areas for improvement. DMD transition care across Turkey lacks consistent structure. Key gaps include limited readiness assessment, delayed discussions, poor patient and caregiver awareness of the transition process, and lack of coordinated multidisciplinary structures. Our study identified common priorities raised by physicians, patients, and caregivers that need to be improved and could inform the development of standardized protocols.

Returning home after international study can involve complex readjustment, especially when personal life plans, family expectations, workplace experiences, and broader social norms do not fully align. In contemporary China, never-married female returnees may encounter distinctive expectations concerning marriage timing, family responsibility, career development, and future life planning. Drawing on Bronfenbrenner's Ecological Systems Theory and Patriarchal Bargaining, this study adopts a qualitative design based on in-depth semi-structured interviews with 22 never-married Chinese female returnees who had studied in Western countries and returned to China. The findings suggest that participants' post-return experiences were shaped by multiple, interconnected layers of social life. At the family level, they encountered expectations related to marriage timing, filial responsibility, and socially approved life-course choices. At the workplace level, they described gendered assumptions, unequal professional opportunities, and concerns about career mobility. At the broader societal level, participants perceived public discussion around unmarried women and women with overseas experience as an additional source of pressure. These experiences shaped how participants evaluated marriage, with many approaching it cautiously while weighing family expectations, institutional conditions, reproductive concerns, and future quality of life. The study suggests that continued singlehood among female returnees should not be understood simply as individual preference or delayed transition. Rather, it can reflect an ongoing negotiation of gendered expectations during reacculturation. The study contributes to scholarship on return migration, singlehood, and gender by showing how family, workplace, and wider sociocultural contexts intersect in shaping women's post-return lives in contemporary China.

The availability of digital technologies such as virtual patient simulation has nurtured innovation in higher healthcare education. However, the quality of validated questionnaires related to virtual patient simulation in higher healthcare education remains limited. In particular, there is a need for validated questionnaires for virtual patient simulations focusing on intimate partner violence. Thus, the aim was to cognitively validate questions in the Questionnaire Virtual Patient (QVP) among undergraduate nursing students. A think-aloud design was employed. Eleven undergraduate nursing students from a single school of nursing in western Sweden participated in an individual digital cognitive interview. Collected data were analyzed using a qualitative conventional analysis. The QVP consists of eleven background questions and additional eighteen questions, structured into two themes: (1) User friendliness virtual patient and (2) Virtual patient as an integrated part of educational module. The QVP was perceived as clear, well-constructed, and easy to understand. At the same time, some areas for refinement were emphasized. Thus, original questions and revised versions of the questions in QVP are presented in the alignment with the structure of the QVP. The cognitive validation of the QVP highlights the need for methodological rigor and thoughtful planning in survey design. Ongoing refinement of questionnaires can contribute to the development of evidence-based learning didactics in an increasingly digital healthcare educational context.

Perioperative risk assessment still relies largely on models that estimate outcomes from variables measured at a single time point. These tools remain useful for cohort stratification, communication of baseline risk, and perioperative planning, but they often underrepresent the temporal dynamics that shape individual postoperative trajectories. That mismatch may reflect more than ordinary clinical variability. At least in part, it may point to a limitation in how perioperative risk itself is conceptualized. This paper offers a conceptual analysis drawing on physiology, critical care medicine, and dynamic systems theory. Its central claim is simple: perioperative risk may be better understood as a trajectory through physiological state space than as a fixed probability assigned before surgery. Surgical interventions can then be viewed as structured perturbations imposed on already reconfigured biological systems, with responses shaped by prior states, adaptive capacity, and physiological resilience. From this perspective, postoperative complications are not merely isolated adverse events. They may instead mark transitions between physiological regimes. Processes such as sterile inflammation, microcirculatory dysfunction, organ crosstalk, and loss of physiological complexity may help explain why postoperative trajectories diverge so sharply. Cardiac surgery provides a particularly clear setting in which these dynamics become visible, although the broader argument likely extends beyond it. The analysis has practical implications for clinical reasoning in high-risk settings. Rather than displacing static prediction, it highlights dimensions of perioperative risk, such as state dependence, irreversibility, and loss of resilience, that static models represent only incompletely. That shift does not solve the problem of perioperative uncertainty. It does, however, describe it more faithfully.

Trait-based ecology has become central for understanding plant form, function and ecosystem processes, but progress has been hampered by biased representation in trait databases. As such, global trait syntheses remain strongly biased towards temperate forest biomes. Tropical savannas are the most extensive, biodiverse and disturbance-driven ecosystems worldwide, yet are poorly represented in functional trait databases, limiting ecological inference and applied decision-making. Here, we introduce the Cerrado Plant Traits (CPT), an open-access initiative compiling and standardising plant functional trait data for the Brazilian Cerrado, the world's most biodiverse tropical savanna. CPT integrates trait information for all major plant organs (whole-plant, root, shoot, leaf, flower, fruit and seed) across vegetation types in the Cerrado, drawing on a collaborative and inclusive research network. The current version of CPT compiles data from 148 datasets, totalling 113,859 curated trait records for 2,134 taxonomically verified species across 150 families. Trait records span pristine, degraded and restored environments and capture both interspecific and intraspecific variation. Whole-plant and leaf traits dominate the current dataset, while belowground and reproductive traits remain comparatively underrepresented, highlighting key priorities for future research. By substantially increasing the representation of savanna species in global trait repositories, CPT enables tests of ecological hypotheses across multiple levels of organization, analyses of trait-environment relationships across fire, soil and climatic gradients, and robust comparisons across forest-savanna transitions. Beyond its scientific value, CPT provides a practical, standardised resource to support conservation planning, restoration programs and evidence-based policy in a biodiversity hotspot facing accelerating land-use and climate pressures.

Sacral epidural cavernous hemangioma involving the intervertebral foramen is exceptionally rare and may closely mimic more common benign nerve sheath tumors on magnetic resonance imaging. We report the case of a woman in her mid-50s who presented with a 1-month history of nocturnal left lower-extremity pain and mild weakness. Contrast-enhanced lumbar magnetic resonance imaging revealed a strongly enhancing nodular lesion in the left S2 foraminal region, and schwannoma was considered preoperatively. The patient underwent microsurgical resection through a posterior midline approach. Intraoperatively, the lesion was dark red, soft, and hypervascular, raising suspicion for a vascular malformation rather than schwannoma. Frozen-section analysis suggested hemangioma, and postoperative histopathology confirmed cavernous hemangioma. The patient experienced marked postoperative relief of radicular pain, and follow-up analysis indicated complete symptom resolution without radiological evidence of residual lesion. This case emphasizes that cavernous hemangioma should be included in the differential diagnosis of sacral foraminal masses. Purely epidural cavernous hemangiomas centered in the sacral foramen are particularly rare and frequently misdiagnosed preoperatively as schwannoma; thus, careful preoperative planning, anticipation of intraoperative hypervascularity, and frozen-section histology may help guide safe resection.

Remote sensing has rapidly advanced with the integration of deep learning, enabling more accurate and scalable detection of land use and land cover (LULC) changes, particularly with the increasing availability of Sentinel-1 and Sentinel-2 multispectral imagery. This review traces the evolution of classical machine learning approaches toward modern deep learning architectures, including Convolutional Neural Networks (CNNs), encoder-decoder models, Siamese and dual-stream networks, attention-based frameworks, and, more recently, Transformer-based models. Recent developments in Earth observation foundation models, trained on large-scale, multimodal datasets, have introduced new capabilities, including zero-shot inference, cross-sensor transferability, and improved generalization across diverse geographic regions. Despite these advances, significant challenges remain. The fusion of multimodal data, including optical, SAR, and ancillary sources, is complicated by differences in spatial, spectral, and temporal characteristics. Furthermore, domain adaptation, label noise, and limited geographic transferability continue to constrain the robustness of change detection pipelines. The quantification of uncertainty and model interpretability has also become increasingly important for operational applications in urban planning, agriculture, ecosystem monitoring, and disaster response. In addition, the growing computational and environmental costs of large-scale model pretraining underscore the need for more sustainable AI practices. Future research should therefore focus on advancing the Earth observation foundation and generative models, developing temporal AI methods for long-term sequence analysis, and promoting responsible, energy-efficient geospatial artificial intelligence. Integrating advances in remote sensing, machine learning, and environmental science will be essential for building practical, scalable, and reliable planetary monitoring systems.

To systematically review patient activation interventions in adult populations with cancer, identify their key components, and synthesize evidence on the effectiveness of behavioral change-based strategies in enhancing patient activation. This systematic review and meta-analysis were conducted in accordance with the PRISMA guidelines. A comprehensive systematic review was conducted across ten databases (PubMed, CINAHL, Embase, ISI Web of Science, Cochrane Library, Medline, CNKI, Wanfang, VIP, and CBM) to identify randomized controlled trials (RCTs) published between January 2005 and June 5, 2025. The Cochrane Risk of Bias tool was used to evaluate study quality. Meta-analyses were performed using Review Manager 5.3 and Stata 14.0, and sensitivity and subgroup analyses were conducted to examine heterogeneity and assess robustness.` RESULTS: Of 8329 records initially retrieved, 18 RCTs involving 2768 participants met the inclusion criteria. Behavior change interventions produced a statistically significant small-to-moderate effect on patient activation (SMD&#xa0;=&#xa0;0.32, 95% CI: 0.10-0.53), although with considerable heterogeneity (I2&#xa0;=&#xa0;86%). Subgroup analyses based on pre-specified variables did not identify the source of heterogeneity. Behavioral change-based interventions appear effective in enhancing patient activation among adults with cancer. Strategies emphasizing active patient engagement, such as knowledge shaping, goal setting and planning, and feedback and monitoring, were the most frequently employed and showed consistent benefits. Heterogeneity in intervention design limits generalizability. Further rigorous trials are needed to define the optimal components, duration, and intensity for sustained activation outcomes.

The COVID-19 pandemic disrupted dental services worldwide, requiring rapid adaptation of biosafety measures. In Brazil, emergency protocols were widely implemented across public and private dental care. This nationwide cross-sectional study investigated which biosafety practices adopted during the COVID-19 pandemic were maintained by Brazilian dentists and analysed factors associated with continued respirator use in the post-emergency period. Data were collected between March and October 2023 using non-probabilistic snowball sampling through an online questionnaire based on Brazilian biosafety guidelines and international recommendations. Descriptive statistics, chi-square and Fisher's exact tests, and simple and multiple logistic regression models were used (&#x3b1;=0.05). Among 1,136 dentists, most were female (71.2%), aged 41-50 years (33.6%), and had &#x2265;12 years of professional experience (76.1%). Difficulties obtaining personal protective equipment during the pandemic were reported by 80.2% of participants, mainly involving masks and gloves, with significant associations according to work setting (p<0.05). Respirator use became widespread during the pandemic, with 45.6% reporting use only during the emergency phase and 39.6% continuing its use in the post-emergency period. In the adjusted model, sex and work setting remained associated with maintenance of respirator use (p<0.05). Fatigue (47.7%) and respiratory discomfort (27.3%) were the most frequently reported adverse effects. The pandemic changed dental biosafety practices in Brazil: traditional infection-control measures remained routine, whereas enhanced measures were partly sustained. These findings may inform preparedness planning for future public health emergencies.

Tethered cord syndrome (TCS) is an important consideration in pediatric scoliosis because it can present with curve progression, pain, and evolving neurologic or urologic dysfunction that may affect deformity evaluation and surgical planning. This state-of-the-art review summarizes the current literature on TCS in pediatric spinal deformity, with emphasis on diagnostic workup, scoliosis natural history, and surgical timing relative to deformity correction. A literature review was performed focusing on pediatric TCS in the setting of spinal deformity, including dysraphism-associated tethering, filum-based tethering, retethering, and occult tethered cord syndrome. Studies addressing diagnosis, neurologic and urologic evaluation, scoliosis progression, outcomes after detethering, and timing relative to deformity correction were synthesized narratively. Current evidence supports a clinically driven approach in which imaging findings alone are not sufficient to define clinically active tethering. Decision-making should focus on interval neurologic or urologic change and scoliosis behavior over time. Detethering may improve or stabilize cord-related symptoms, but it does not reliably prevent scoliosis progression, especially in larger curves and skeletally immature patients. Evidence supporting routine prophylactic detethering before deformity correction in asymptomatic patients remains limited. Variation in diagnostic criteria and outcome reporting continues to limit clear treatment recommendations. In pediatric deformity care, TCS management should be driven by objective clinical progression rather than imaging findings alone. Detethering should be viewed as treatment for active cord-related dysfunction, while scoliosis treatment should be guided by curve progression and skeletal maturity. Standardized definitions and prospective multicenter studies are needed to improve treatment algorithms and reduce practice variation.

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

Membrane-based direct air capture (m-DAC) offers an energy- efficient route to mitigate rising atmospheric CO2, but its practical deployment is hindered by low CO2 concentration and high humidity. Herein, we propose a "Sailing-with-Water" strategy that turns humidity from an obstacle into a mass-transfer driving force. The bifluorinated motifs are engineered by integrating fluorinated ionic liquid@UiO66 (IL@UiO) as porous fillers and a novel polymer, PIM-1DFBP, as the second fluorine source.&#xa0;The abundant fluorine sites within the membrane facilitate CO2 capture and enrichment from dilute streams via Lewis acid-base interactions. Notably, under high humidity conditions, the fluorine sites in the membrane form a hydrogen-bond network with water molecules, creating a polar microenvironment that further enhances CO2 affinity and builds ultrafast channels for CO2 permeation. The optimized membrane achieves a CO2 permeability of 12697.08 Barrer and CO2/N2 selectivity of 44.06 under 65% relative humidity, surpassing the 2019 Robeson upper bound.&#xa0;The membrane also exhibits 180-days stability, large-area defect-free fabrication, and process simulation shows that only 612.37&#xa0;m2 is needed to reach 40% CO2 outlet concentration. This work provides a humidity-resistant paradigm for high-performance m-DAC.

Inguinal bladder herniation is a rare condition and is frequently underdiagnosed because of its nonspecific presentation. We report the case of a 68-year-old man who presented with progressively worsening lower urinary tract symptoms, including frequency, nocturia, weak urinary stream, elevated post-void residual volume, and a slowly enlarging right inguinoscrotal swelling. The coexistence of severe voiding symptoms and obstructive urinary parameters initially suggested benign prostatic obstruction. However, the presence of two-stage micturition requiring manual compression of the scrotal mass to complete bladder emptying (Mery's sign) raised suspicion of bladder involvement. Contrast-enhanced computed tomography with delayed excretory-phase acquisition revealed a giant right inguinoscrotal bladder hernia with marked distortion of the bladder contour, while three-dimensional reconstruction provided precise anatomical characterization and facilitated surgical planning. The patient underwent successful surgical repair with complete resolution of urinary symptoms. This case highlights the diagnostic challenge posed by giant inguinoscrotal bladder hernias, particularly when they mimic common causes of bladder outlet obstruction, and emphasizes the importance of recognizing Mery's sign and performing preoperative cross-sectional imaging to establish the diagnosis, prevent iatrogenic bladder injury, and optimize surgical management.

People living in regional, rural and remote communities experience inequitable access to health services compared with people living in metropolitan areas, in part due to the maldistribution of the health workforce. Health student placements in rural settings, a type of work-integrated learning, are a key approach to developing a sustainable rural health workforce in Australia and internationally. Proxies for quality in rural health student placements, including student satisfaction and intention to practice in rural settings, have been used to inform rural health placement development and facilitation. However, the determining constructs of high-quality rural health student placements in Australia are unknown. A multiple case study design was adopted, drawing on the Employing COnceptUal schema for policy and Translation Engagement in Research (ECOUTER) methodology to iteratively collect and analyse data. Within each case, participants comprised Australian University Departments of Rural Health staff involved in designing, delivering, administrating and/or evaluating rural health student placements. In each case, participants identified features that contribute to high-quality rural health student placements and listed these on a virtual case mindmap. Case focus groups were conducted to refine top-level and sub features on each mindmap. Cross-case analysis identified overarching constructs and sub-constructs, which were refined by cross-case focus group participants. Eighty-six people across ten cases participated in this study. Nine constructs determining high-quality rural health student placements were identified: placement planning, student selection, stakeholder communication and collaboration, placement orientation, student supervision, logistical resources, learning opportunities, connecting with the rural community, and student wellbeing and supports. The final cross-case focus group resulted in strong construct agreement from participants across diverse regional, rural, and remote Australian contexts. Nine interconnected and contextually dependent constructs determine high-quality health student placements in regional, rural and remote communities, emphasising the complexity associated with providing a high-quality form of this work-integrated learning opportunity.

Nurses show low enthusiasm for senior title promotion despite its career benefits. Understanding their experiences and difficulties can inform more effective policy implementation. The nurse promotion system directly affects remuneration and work enthusiasm. Mobilizing nurses' initiative within this framework remains a key challenge for policymakers and hospital administrators. To explore the views and experiences of clinical nurses with intermediate titles on the promotion system of senior titles. A descriptive phenomenological study was conducted. A total of 13 clinical nurses with intermediate professional titles from 11 different departments (the average years of obtaining the intermediate title were 7.54&#x2009;years) participated in face-to-face semistructured interviews. The data were analyzed using Colaizzi's seven-step data analysis method (1978). The COREQ guidelines were followed for reporting. Rigor was ensured through member checking and peer debriefing. Five categories emerged: Escape (perceived inadequacy, clinical/family burden, and lack of guidance/role models); Transform (clinical influence, environmental impact, and enhanced self-awareness); Challenge (research learning, degree hurdles, and trial/failure); Reflection (early career planning, perseverance, and continuous self-growth); and Expect (career/psychological support, research environment, and diversified criteria). These categories formed a cyclical process from Escape to Transform, interrupted by Challenge, leading to Reflection, and culminating in Expect for systemic change. Nursing managers and educators should attach great importance to the promotion experience of nurses, promptly address their promotion needs, and provide career planning training and guidance as early as possible. By planning career development in advance, actively learning and enhancing professional and research capabilities, the comprehensive ability and professional pride of nurses can be strengthened, and the promotion rate of senior professional titles for nurses can be increased. Nurse managers, policy makers, and nursing schools should jointly design a career development framework including mentorship, protected research time, methodological support, career planning workshops, diversified criteria, and innovation-friendly environments. Context-tailored implementation may enhance nurses' promotion enthusiasm and success rates.