Incorporating the knowledge of people who use/have used drugs into academic research presents the possibility of new ways of understanding drug use, increasing opportunities for equitable outcomes. Community Advisory Boards (CAB) are part of the community-engaged research continuum offering community members clearly defined roles and a structure to advise academic researchers. Acting in an advisory capacity, CAB members have a platform for sharing community-informed knowledge with researchers. The concept of knowledge democracy suggests that not all knowledge is valued equally, with scientific knowledge often considered neutral or more valuable than community knowledge which is sometimes understood as subjective opinion. Transformative change requires an embrace of knowledge that extends beyond the sole perspective of academic research to embrace multiple ways of knowing. We used directed content analysis to analyze minutes from 43 monthly CAB meetings, focusing on member knowledge about opioid use and overdose. We centre the expertise of people who use/have used drugs and propose that academic researchers should listen to and embrace knowledge that is held by the communities and people being studied. (1) identify and describe the knowledge Massachusetts CAB members shared with academic researchers and each other during a federally-funded study to reduce opioid overdose fatalities and (2) centre the contributions of community knowledge for the study. Three themes were identified: (1) CAB members generously shared their knowledge; (2) Members brought attention to root causes of opioid overdose fatalities; and (3) Honest and challenging meeting discussions created solidarity and trust among members and with staff. This case study makes an important contribution to the literature by highlighting the knowledge that a Community Advisory Board, including people with lived and living experience of drug use, can bring to substance use research. By centreing the voices of people with lived and living experience, front line staff, and family members, the study confirms that a substance use research-focused CAB can be an important source of valuable knowledge, contributing to the development of knowledge democracy. The HEALing Communities Study Massachusetts Community Advisory Board members - people with lived and living experience with their own or family member drug use, harm reductionists, recovery coaches, and public health advocates committed to saving the lives of people who use drugs - were active participants in the HEALING Communities Study. They were involved in local, statewide and national levels of the study, including community coalitions, study cores, the national steering committee, and dissemination, acting as advisors and consultants with staff throughout the 4 years of the study and beyond. Eighteen months after the study officially ended, members continue to stay in frequent contact with each other and staff and many chose to be co-authors of this manuscript.
Children and young people with intellectual and developmental disability have long been known to suffer from inequities in accessing safe and quality health care. These challenges are most felt within the emergency department due to its busy, crowded, and overstimulating environments with staff that are not trained to provide reasonably adjusted care. The study is an evaluation using qualitative and quantitative methods of a continuing education and quality improvement programme designed to increase the knowledge, skills, and confidence of healthcare staff in providing reasonable adjustments to children and young people with intellectual disability in hospitals. This study evaluated the Motivated for Change programme, which uses Behavioural change, Adult Learning, and Quality Improvement strategies to drive practice change and service improvement. A hundred and thirty-one and 89 staff participated in a pre- and post-intervention survey. Interviews were conducted with parents of children and young people with intellectual and developmental disability attending the emergency department. Observational studies were also conducted in the pre- and post-intervention phase. These were transcribed, categorised, and coded with themes derived. Consensus was reached through meetings with the research team. The Motivated for Change programme has demonstrated significant increases in staff knowledge, skills, and experience in providing safe and quality care for these children and young people. Evidence of change is reflected in the parent and staff interview and observational study themes. In addition, staff were further motivated to undertake quality improvement projects, develop an in-house training programme to provide ongoing training for new staff, and make further improvements in the department. The Motivated for Change programme has demonstrated its efficacy in enabling changes in the practice of reasonable adjustments and the emergence of local champions for sustained efforts for ongoing improvements in safety and quality of care. The development of the research question and outcome measures was informed by data from previous research publications involving parents and staff. We sought input from a parent advisory committee in the design of the study. Parents were not involved in the recruitment and conduct of the study. Results were presented to the parent advisory at the end of the study.
Are higher ambient temperatures before oocyte retrieval associated with adverse oocyte-related outcomes in women undergoing their first IVF or ICSI cycle? Higher pre-retrieval temperatures are associated with reduced oocyte yield, an effect partially mediated through LH and partially counteracted by compensatory increases in FSH and estradiol (E2). Evidence on the impact of ambient temperature on IVF/ICSI outcomes is emerging but limited. A recent study reported weak negative associations between higher ambient temperatures during folliculogenesis and oocyte yield, though the effect was modest and findings across populations remain inconsistent. However, these findings are further limited by small sample sizes, specific clinical subpopulations or geographic regions, which prevents the establishment of a generalizable dose-response relationship and leaves the underlying biological mechanisms largely unexplored. A retrospective cohort study of 58 468 women undergoing their first IVF/ICSI cycle with oocyte retrieval between 1 January 2018 and 31 May 2024. Women undergoing their first IVF/ICSI cycle were included. The primary outcomes were total oocytes retrieved, mature oocytes retrieved, and 2PN (two pronuclei) fertilized oocytes. Secondary outcomes included rates of oocyte maturation, normal fertilization, and blastocyst formation. Basal sex hormone levels were measured during the early follicular phase (cycle days 2-4). Environmental exposure data, including both ambient temperature and apparent temperature (integrating air temperature and humidity), were assessed over biologically relevant exposure windows. Generalized linear mixed-effects models were used to estimate associations between temperature exposures and oocyte-related outcomes. Restricted cubic spline models assessed nonlinearity. A counterfactual causal mediation analysis examined the roles of basal sex hormones. Stratified analyses by age, BMI, antral follicle count, anti-Müllerian hormone, season, COVID-19 period, and the distance to ART center, along with sensitivity analyses, were performed to evaluate robustness. Each 1°C increase in apparent temperature was associated with significant decreases in total oocytes retrieved (-0.20%; 95% CI: -0.28%, -0.12%), mature oocytes retrieved (-0.17%; 95% CI: -0.26%, -0.09%), and 2PN fertilized oocytes (-0.19%; 95% CI: -0.28%, -0.09%); consistent associations were observed for ambient temperature (-0.25%, -0.22%, and -0.22% per 1°C, respectively). For rate-based outcomes, no significant associations were observed for the normal fertilization rate or blastocyst formation rate; the mature oocyte rate showed small positive associations in longer-term exposure windows (3-week and 90-day). Mediation analyses indicated that LH partially mediated these associations, accounting for up to 5.23% of the total effect, while both FSH and E2 exhibited suppression effects. The observational design cannot definitively establish causality. Unmeasured confounding (e.g. individual indoor climate control, occupational heat exposure) and residential address-based exposure assessment are potential sources of bias. Restricting the primary analysis to completed cycles may introduce selection bias, although sensitivity analyses incorporating canceled cycles yielded consistent estimates. Higher ambient temperatures represent a modifiable environmental risk factor for oocyte yield in ART treatment, with basal sex hormone pathways, including LH as a partial mediator and compensatory shifts in FSH and E2, providing a plausible biological basis for this effect. In the context of rising global temperatures, these findings suggest that ambient thermal exposure during the peri-folliculogenesis period warrants clinical attention, and that monitoring basal sex hormone levels may help identify patients at risk of a suboptimal ovarian response in high-temperature settings. This study was supported in part by the Technology Innovation and Research & Development Project of the Chengdu Science and Technology Bureau (No. 2024-YF05-02159-SN), the Open Fund of Chongqing Maternal and Child Disease Control and Public Health Research Center (No. CQFYSJ01001), the Program of Inheritance and Innovation of Traditional Chinese Medicine in Chongqing (Chongqing Traditional Chinese Medicine [2022] No. 33), and Chongqing Yuzhong District Natural Science Foundation Project (No. 20240118). All authors declare that they have no conflicts of interest related to this study. N/A.
Children with molar incisor hypomineralisation (MIH) frequently experience tooth hypersensitivity (TH), affecting functional, emotional and social wellbeing. Various assessment methods have been used to investigate these impacts; however, there are concerns about the relevance and sensitivity of these methods as they have not involved children with MIH in their development. The aim of this study was to develop and evaluate a child-centred, condition-specific OHRQoL for MIH-related TH. Children aged 6-16 years were included across three stages: Stage 1: semi-structured interviews to explore children's experiences of TH (N = 17); Stage 2: cognitive interviews and refinement (N = 29), patient and public involvement (PPI), a Delphi survey, and stakeholder consensus group meeting; Stage 3: psychometric evaluation and Rasch analysis of the measure and comparison with CPQ11-14-ISF:16 (N = 103). In Stage 1, five themes were identified: description, triggers, impact, responses, and experiences within the dental setting. Daily activities and emotional wellbeing were affected by TH, with cold stimuli reported as a common trigger. Children described adaptation strategies and the invisible nature of TH using rich vocabulary. The final measure demonstrated good internal consistency (McDonald's omega: 0.87) and test-retest reliability (ICC = 0.74). There was a strong correlation with the global question (r = 0.78), evidence of convergent validity with CPQ11-14-ISF: 16 (r = 0.49) and responsiveness to change. MIH-TH is the first child-centred OHRQoL patient-reported outcome measure for MIH-related TH in children, demonstrating good validity, reliability and responsiveness, with potential for use in clinical settings and research studies.
Digital health technology has the potential to increase access to home-based reablement programmes for people living with dementia (PLwD) or mild cognitive impairment (MCI) to support everyday living. Digital Voice Assistants (DVAs) offer a possible solution to overcome usability issues with traditional technologies due to associated cognitive, motor and visual impairments. This paper describes the co-design of a personalised reablement programme to be delivered via DVA. PLwD or MCI (n = 9), their care partners (n = 9) and health professionals (n = 8) participated in the co-design via online workshops and semi-structured interviews. Phases 1-7 of the IDEAS (Integrate, Design, Assess and Share) framework guided this iterative process to develop a product for future feasibility testing. Consensus on essential functions and features was facilitated using the MoSCoW prioritisation method. Transcripts were analysed using a modified thematic framework to inform the reablement programme. Thematic requirements of a cognitive reablement program to be delivered via DVA included (1) Daily Living (self-care, household and cooking), (2) Activity Participation (leisure activities, home hobbies and ad hoc appointments), (3) Emotional Well-being (social connection and coping strategies) and (4) technical requirements (activation, adaptable content, adherence, auditory processing, awareness and training). The IDEAS framework successfully facilitated meaningful engagement from PLwD or MCI, their care partners, and health professionals to integrate user insights and feedback to co-design a personalised reablement program via DVA for subsequent pilot feasibility testing. PLwD and/or MCI, and their care partners contributed by sharing lived experiences for researchers to gain insights; collaboratively identifying behaviours requiring support; creating ideas for solutions; feeding back on prototypes and prioritising program features and functions. Health professionals fed back improvements on prototypes, identifying potential barriers and solutions to implementation of the program.
Global increases in occupational heat exposure are raising concerns about worker safety and cognitive performance during prolonged and repeated shifts. At present, the cumulative effects of repeated heat exposure on cognitive performance remain unclear. This exploratory study examined cognitive performance and perceived workload across three consecutive days of simulated occupational heat stress. Twenty physically active adults (age: 27 ± 6 years [5 female]) completed two randomized crossover trials comprising three consecutive 8-h workdays under hot (35°C; 63% RH; WBGT 31°C) and control (18°C; 53% RH; WBGT 14°C) conditions wearing minimal clothing (< 1 Clo). Participants performed moderate-intensity physical work (~4.3 METs) using a 30-min work:30-min rest schedule. Cognitive performance was assessed at start-of-day, midday, and end-of-day using the Joggle Research battery, evaluating sensorimotor speed, processing speed, and attention, visuospatial perception, sustained attention, and visual memory. Perceived workload was assessed at start-of-day and end-of-day using the NASA Task Load Index. Cognitive performance was largely preserved across domains within and across repeated workdays, with no evidence of cumulative impairment (p ≥ 0.170). Unexpectedly, sustained attention improved in the heat. Perceived physical workload was higher in the heat, while perceived mental workload was unchanged. Under prescribed work-rest conditions, cognitive performance appears to be maintained across consecutive days of occupational heat exposure in young, physically active adults. Future work should explore the relationship between heat and cognition in larger, more diverse work populations and in more challenging conditions.
Bathing Without a Battle is a widely circulated video training resource in residential dementia care, but the assumptions it advances about bathing, refusal, and appropriate nursing practice have received limited critical attention. This paper analyzes how the text constructs resistance to assisted bathing and how it frames legitimate nursing responses to that resistance. A three-part Faircloughian critical discourse analysis is used, attending to social structures, processes of production and dissemination, and the textual features through which meaning is enacted. The bulk of the analysis focuses on genre, discourse, and style to examine how the video governs practice and moral reasoning. Findings indicate that the program positioned itself as an early form of clinical practice guideline by linking instructional conventions with the authority of academic research. It also illuminates the lexical choices used to portray cleanliness as a non-negotiable objective, while clients' refusals are positioned as problems (of technique, discomfort, or pathology) to overcome rather than expressions of agency. Finally, the paper demonstrates how the video's emphasis on pleasure operates as a stylistic and moral device that shapes nurses as responsible for producing care that is both hygienic and affectively acceptable. The paper concludes by considering the ethical implications of this framing for autonomy in dementia care and the normalization of persuasion when care outcomes are predetermined. Trial Registration: Clinical trial registration is not applicable, as this study did not involve a clinical trial.
Protein supplements have gained popularity among gym users in Saudi Arabia. This study aimed to collect data from adults in Saudi Arabia focusing on six components related to protein supplements: demographic characteristics of participants, health and physical activity information, knowledge and attitudes, use, health beliefs, and safety concerns. This study was a cross-sectional, observational online survey targeting adults in Saudi Arabia. Participants included males and females aged 18 and older. Participants who did not complete the survey, as well as pregnant or breastfeeding women, were excluded. Ethical approval was obtained from the Deanship of Scientific Research at Qassim University. Data were analyzed by gender using SPSS version 25, with descriptive statistics and chi-square tests. A total of 358 participants completed the online questionnaire, while two participants did not complete it between March 29, 2024 and December 31, 2024. Regarding knowledge and attitudes, about 68.2% of participants (including both users and non-users of protein supplements) were aware of protein supplements, with males (81.3%) showing significantly higher awareness than females (63.7%). Additionally, 64.8% of participants (both male and female) were unaware of the risks associated with protein supplements. Of all participants, 56% of males and 39.3% of females did not believe that natural protein sources are enough for muscle building, indicating a significant difference. About 127 participants (35.5%) reported using protein supplements either currently or in the past, with no significant difference between males and females. Of those who reported using protein supplements, 11.8% experienced some side effects and were significantly less knowledgeable about the amount of protein they should consume from food and how much protein is enough for their needs. The majority of protein supplement users (48.8%) did not know if protein powders could contain doping agents, with females reporting significantly higher responses than males. Regarding safety concerns, only 43.3% of protein supplement users looked for protein supplements marked with NSF Certified for Sport® on the package, with no significant difference between males and females. Finally, 78% of protein supplement users expressed a need for more information on how to select the best protein supplements, with the highest need found in females and participants who exercise regularly, who showed significantly higher needs for additional guidance. There remains a significant need for increased education about the proper use of protein supplements to minimize potential side effects and increase understanding of their health risks and safety concerns.
Wearable fabrics embedding crystalline semiconductor materials (e.g. germanium, silicon) are promising biomedical devices for their therapeutic potential in musculoskeletal disorders, including osteoarthritis, tendinopathies, and chronic pain, and for supporting tissue healing and regeneration. These fabrics exert their bioactive functions without applying mechanical pressure or drug delivery systems, offering a non-invasive and comfortable therapeutic alternative that operates through mild thermal stimuli at body temperature. Recent peer-reviewed literature on semiconductor-based wearable textiles, far-infrared-emitting biomaterials, bioelectric signalling in tissue repair, and their clinical application in musculoskeletal disorders. At body temperature, semiconductor-containing fabrics consistently emit far-infrared radiation, experimentally associated with improved microcirculation and modulation of inflammation. Limited clinical studies report improvements in pain and functional outcomes in chronic musculoskeletal conditions, with good tolerability during prolonged wear. Proposed mechanisms include thermally induced electron release, ion generation, and piezoelectric or piezoresistive activity during movement, but direct biological evidence remains limited. The specific contribution of far-infrared emission is difficult to distinguish from thermal or placebo effects. Advances in bioelectric signalling research and textile engineering provide a framework to investigate electroactive interactions between semiconductor fabrics and biological tissues. Well-designed randomized trials, quantitative characterization of emitted physical stimuli, and mechanistic cellular studies are needed to establish clinical efficacy and inform regulatory classification.
Certain Clostridium pasteurianum strains encode up to four FeFe-hydrogenases, which are homologous (identity > 20%) but can be readily distinguished by their number of residues (450-550), the nature and number of accessory iron-sulfur clusters (up to four), and the composition of the so-called P1 motif (TSCCP in CpI and CpII, TSCCCP in CpIII, or NSCCP in CpIV). CpI is one of the most extensively characterized FeFe-hydrogenases; here we compare it with CpII using protein film electrochemistry, the technique invented and popularised by Fraser Armstrong in Oxford. In this approach the enzyme is wired to an electrode and then interrogated to obtain information on their catalytic responses and reactions with the inhibitors. With the aim of elucidating the relation between structure and function within the FeFe-hydrogenase family, we also examined the effects of replacing three CpII residues with the corresponding residues from CpI: S99A, near the active-site dinuclear cluster; T377A, between the cubane and the proximal cluster; and S73A, near the distal cluster. Small effects are observed on the catalytic bias (S99A) and the Michaelis constant for H₂ (S99A), but not on the irreversibility of the catalytic response of CpII. The most significant changes concern the reaction with O₂: unlike CpI, CpII reacts fully irreversibly with O₂; the T377A and S99A mutations significantly slow this reaction, whereas the S73A mutation makes it more reversible. These findings have far-reaching implications for ongoing research aimed at understanding why homologous hydrogenases exhibit distinct catalytic properties, by suggesting that these differences likely arise from a combination of small changes rather than a single underlying cause.
Ultra-widefield scanning laser ophthalmoscopy (UWF SLO), a confocal scanning-based ophthalmic imaging modality widely used in clinical and research ophthalmology, offers an ultra-wide field of view, high resolution, and real-time dynamic imaging. However, multiwavelength imaging-induced transverse chromatic aberration (TCA) is markedly exacerbated in the peripheral retina, causing ghosting artifacts of retinal vessels and other critical anatomical structures. This severely limits image quality and the reliability of downstream quantitative analysis. We aim to correct TCA in multiwavelength UWF SLO images using a subregion-based maximum similarity search registration method, thereby eliminating vascular ghosting artifacts to enhance image quality for reliable clinical analysis. In this study, we address the nonuniform TCA between the red and green channels in multiwavelength UWF SLO imaging through three core steps: grid-based subregion sampling, high-precision control point extraction via local optimal matching guided by zero-mean normalized cross-correlation (ZNCC), and global perspective transformation model fitting. The effectiveness of the proposed method was validated on fundus image samples acquired by our in-house-developed UWF SLO system, through both qualitative visual assessment and quantitative evaluation metrics. The proposed correction method significantly mitigated TCA in UWF SLO images and greatly improved the spatial alignment of retinal vascular contours between the red and green channels. Validation on 11 fundus images showed a significant enhancement in vascular matching performance: the mean dice similarity coefficient increased by 26.7% relatively (from 0.595 ± 0.060 to 0.754 ± 0.035 ) and the mean intersection over union increased by 42.5% relatively (from 0.426 ± 0.061 to 0.607 ± 0.044 ). Paired samples t-test verified highly statistically significant improvements in both metrics (all p < 0.001 ). The proposed subregion-based maximum similarity search registration method effectively corrects TCA in multiwavelength UWF SLO fundus images, significantly improves image quality, and provides reliable technical support for clinical ophthalmic practice and downstream quantitative fundus image analysis.
Acculturative stress, arising from cultural and psychological changes following intercultural contact, may increase vulnerability to maladaptive coping behaviors, including emotional eating. Evidence suggests that the association between acculturative stress and disordered eating differs by sex; however, Arab migrant populations remain underrepresented in this field. This study aimed to examine sex-stratified, migration-related predictors of emotional eating among Arab migrants living in Türkiye. This cross-sectional research was conducted between June 2022 and March 2024 and included 528 adults who migrated to Türkiye from Arab countries. Sociodemographic and migration-related characteristics were collected. Acculturative stress was assessed using the Acculturative Stress-Social, Attitudinal, Familial, and Environmental-Revised Short Form (SAFE-Short), and emotional eating was evaluated with Emotional Eating Scale (EES). Body mass index (BMI) was calculated from self-reported weight and height. Sex-stratified regression analyses were performed. BMI was positively associated with all EES subscales in both female and male participants. However, among male participants, the overall regression models for the Anger and Anxiety subdimensions were not statistically significant. Also, no sociodemographic or migration-related variables were associated with emotional eating among male participants. In females, higher age was associated with lower depression-related emotional eating, while single marital status was associated with higher anger-related emotional eating. Employment was associated with lower anger- and anxiety-related emotional eating. Migration due to personal safety concerns, living with individuals from different countries, and higher acculturative stress were associated with higher emotional eating scores in females. These findings may indicate that in social contexts where direct emotional expression is less acceptable for females, emotions are more likely to be regulated through eating-related behaviors.
The development of organisms and the maintenance of tissue homeostasis depend on complex intercellular signaling networks that govern basic cell functions. Because cells are typically exposed to many diverse ligands simultaneously, distinct intracellular mechanisms of cell signaling have evolved, allowing cells to accurately sense and respond to their environment. Here, we discuss the concept of ligand bias, which describes the ability of different ligands to preferentially activate specific signaling pathways, and thus produce divergent responses through the same receptor. Although bias can be challenging to identify and quantify, protocols have been established to (i) determine whether preferences exist and (ii) quantify these preferences. We review these protocols and their utility in studies of signaling by RTKs, the largest family of single-pass membrane receptors. We summarize the literature suggesting that RTKs engage in biased signaling and discuss the utility of signaling bias in therapeutics design. We discuss parallels with GPCR biased signaling, and lessons that have been learned after years of GPCR signaling research. Finally, we propose that RTK ligand bias appeared in evolution to diversify the morphogen signaling pathways that direct the development of tissues and organs in the mammalian body.
Clinical ethics scholarship on deepfakes has focused primarily on patients as targets of synthetic deception, in which fabricated audiovisual material alters patient beliefs about clinicians and care. This focus neglects the reverse epistemic vulnerability: clinicians themselves as recipients of synthetic, adversarially generated clinical information. To develop a conceptual analysis of clinician-facing deepfakes and their implications for clinical epistemology, diagnostic reasoning, and institutional trust. Normative and conceptual analysis drawing on virtue epistemology, philosophy of testimony, diagnostic error theory, automation bias research, and socio-technical systems theory. Clinician-facing deepfakes constitute a distinct epistemic risk category producing three primary harms: (1) diagnostic error cascades, (2) testimonial contamination of clinical knowledge transmission, and (3) institutional epistemic fragility. We introduce the concept of epistemic role reversal, defined as the systematic decoupling of perceptual reliability from epistemic justification under adversarially generated clinical inputs, resulting in the collapse of expert perceptual advantage in bounded domains. Clinical ethics must address both sides of the epistemic encounter in medicine. Clinician-facing deepfakes are not merely a symmetrical extension of patient-facing deception but a structurally distinct class of epistemic threat. While empirical prevalence remains unknown, evidence from adjacent literatures supports their plausibility. A precautionary framework of clinical epistemic hygiene is therefore warranted, combining institutional verification infrastructure, workflow-level safeguards, and professional epistemic norms adapted to adversarial information environments.
Purpose: Public agencies often fail to involve people with disabilities in decision-making on the accessibility of community environments, thus perpetuating barriers to participation. Research suggests that formal involvement of people with disabilities, such as on advisory committees, could strengthen the implementation of accessibility initiatives. However, little is known about the experiences of people with disabilities serving on accessibility-focused committees. Methods. We conducted a scoping review to map the current literature on civic engagement experiences of people with disabilities on public advisory boards and committees related to accessibility. Thirteen studies met the inclusion criteria identified through the search process. Using content analysis, we identified three key themes that described people with disabilities' experiences on advisory committees. Results. The context and circumstances of civic engagement highlighted the importance of political context and representation in leadership opportunities. We identified barriers, such as unclear roles and accessibility issues, within the challenges of civic engagement processes. The impacts of civic engagement opportunities concerned increasing access to advocacy spaces and reinforcing a positive disability identity. Conclusion. Our findings emphasize the need for a deeper understanding of the quality of experiences in advisory boards and for better support for people with disabilities in their civic engagement roles. Social participation and environmental accessibility can be improved through civic engagementA review of the literature was needed to understand participation in advisory committees as a form of civic engagement.Civic engagement of people with disabilities has positive outcomes for people with disabilities and numerous challenges.More support, training, and clarity in roles are needed to support civic engagement of people with disabilities.
Penile fracture is a rare and underreported urological emergency, defined as traumatic rupture of the tunica albuginea of the corpus cavernosum. Most cases result from vigorous sexual intercourse or direct blunt trauma to an erect penis. While conservative management was once standard, high rates of long-term complications - including severe penile curvature, fibrotic plaques, and permanent erectile dysfunction (ED) - have led to a universal preference for immediate surgical repair. Although anatomical and physiological outcomes after surgery are well documented, the long-term psychosexual impact remains poorly characterised. Many patients report performance anxiety, fear of recurrence, and changes in sexual habits, but these experiences are often overlooked in favour of objective hemodynamic assessments. This scoping review aims to map and synthesise current evidence on functional, sexual, and psychosexual outcomes after surgical repair of penile fractures. Specifically, it examines the impact of surgical timing on erectile function, identifies independent risk factors for postoperative ED, and evaluates psychological effects on sexual satisfaction, relationship dynamics, and ejaculatory function. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) framework. Comprehensive searches were conducted in PubMed/MEDLINE, EMBASE, the Cochrane Library, SCOPUS, and Web of Science. Data charting included patient demographics, injury mechanisms, diagnostic methods, surgical timing, and validated psychometric assessments across nine core studies. Immediate surgical intervention, ideally within 24 hours, is the gold standard and is associated with lower postoperative ED rates (6.5% to 16.5%) than delayed surgery (up to 42.9%) and conservative management (up to 52.9%). Independent predictors of poor outcomes include age over 50, urethral injury, bilateral corporal involvement, and tunical defects larger than 2 centimetres. Early repair reduces scarring and penile curvature. However, psychosexual outcomes remain complex. While erectile function is usually preserved, many patients experience psychogenic issues. Up to 77.5% report persistent fear of recurrence, and nearly 69% change their sexual habits. Changes in ejaculatory latency are also observed and correlate with higher depressive scores. Broad psychiatric screening tools do not show increased rates of clinical depression or generalised anxiety, indicating that psychological distress is specific to sexual performance and relationships. Immediate surgical repair remains the standard approach for preserving erectile function and anatomical integrity after penile fracture. However, postoperative recovery should not be assessed solely by structural or hemodynamic outcomes. The available evidence suggests that some patients experience persistent fear of recurrence, avoidance behaviours, performance anxiety, and reduced sexual confidence after repair. These findings highlight the need for more consistent assessment of psychosexual outcomes in follow-up studies. Multidisciplinary postoperative support, including psychological counselling, sexual health assessment, and partner-centred care, may be considered where clinically appropriate, but further research is needed to define optimal follow-up and rehabilitation strategies.
Revitalization measures currently represent an important tool in ecological practice for the recovery of disturbed habitats, and their effectiveness is increasingly assessed using bioindicator groups, including ground beetles (Carabidae). Between 2020 and 2023, we conducted research in the European habitat of the Danube Floodplains, where we evaluated the impact of revitalization measures on ground beetle assemblages. The study was carried out at 15 study sites representing eight habitat types. At each site, five pitfall traps were installed in a linear arrangement. In total, 5,292 individuals belonging to 47 species were analyzed, with a mean ellipsoid biovolume of 192 mm3 per individual. PCA analysis revealed a division of species into two main clusters according to their preference for forest and open habitats, with reference sites without management characterized by a higher proportion of apterous and brachypterous species. In contrast, habitats subjected to restoration measures showed dominance of macropterous species typical of disturbed and dynamic ecosystems. Significant differences in ellipsoid biovolume and all morphometric traits were confirmed among habitats and study years. Habitats with restoration measures exhibited a gradual increase in ellipsoid biovolume and morphometric traits of individuals, indicating improved food availability and more favorable living conditions. Prediction of ellipsoid biovolume development using LSTM models (neural networks) indicated stabilization of Carabidae assemblages in forest habitats after the completion of restoration measures, whereas pronounced fluctuations persisted in open habitats, suggesting the need for a longer time period or more intensive interventions to achieve community stability. The results provide a practical basis for planning and evaluating the effectiveness of restoration and management measures in European habitats of conservation importance, as well as for biodiversity conservation and adaptive landscape management, particularly in optimizing interventions in forest and open ecosystems to achieve long-term stability of Carabidae assemblages.
Healthcare systems worldwide face mounting pressure to deliver high-quality care while enhancing efficiency and sustainability. Nurse-led interventions have emerged as promising strategies to optimize care delivery, particularly within value-based health systems. However, a comprehensive understanding of their clinical impact and economic value remains limited. This systematic review conducted following PRISMA guidelines, searched nine international databases to identify and synthesize formally evaluated nurse-led interventions, programs, and strategies. Twenty-eight studies were included, encompassing diverse care settings and patient populations. Most studies reported improvements in clinical outcomes, including reduced hospital readmissions, enhanced quality of life, and improved chronic disease management. Several interventions analyzed effectiveness, particularly those involving advanced nursing roles such as nurse practitioners and case managers. Findings suggest that clinical effectiveness does not necessarily translate into increased professional authority: nurse-led interventions consistently generate value across patient, organizational, and systemic dimensions, yet nursing leadership remains structurally subordinate within healthcare governance. A systematic agenda for rigorous economic evaluation embedded in nursing research programs is urgently needed, alongside structural reforms that redistribute authority-not merely develop competencies-within healthcare organizations.
Impostor phenomenon (IP) is widely recognised among doctoral candidates but remains insufficiently understood, particularly within nursing academia. It is commonly framed as an individual deficit, overlooking the broader social and linguistically mediated experience that shapes scholarly identity. This discursive exploration draws on Fairclough's Critical Discourse Analysis (CDA) to examine micro, meso and macro social orders across diverse textual sources and reflexive accounts, exploring how language and institutional norms position nursing doctoral candidates as impostors. Findings reveal tensions between professional, social and ideological expectations and the formation of a doctoral nurse identity, where dominant discourses individualise systemic constraints, reproduce hierarchies and marginalise nursing expertise through gendered, caring and knowledge-ownership narratives. Doctoral preparation can disrupt these dynamics by fostering visibility, authority and knowledge production, yet limited support and persistent hierarchies intensify impostor subjectivities. Shifting from deficit framings to critical discourse perspectives enables supervisors, institutions and candidates to cultivate relational, reflective and inclusive practices that mitigate impostor experiences and strengthen nurse-academic identity. Doctoral education thus becomes a vehicle for structural transformation, advancing nursing's research leadership, policy influence and patient care outcomes.
This study aims to evaluate the content quality and reliability of YouTube videos on limb lengthening surgery. On July 5th, 2025, a YouTube search was performed using the keywords "limb lengthening surgery" and "leg lengthening surgery." The first 100 videos were reviewed; duplicates and those without English audio were excluded, resulting in 53 videos for analysis. Basic characteristics including views, upload time, duration, comments were recorded. Videos were categorized by source as "physician," "speaker," or "patient," and by theme as "general information" or "patient testimony." Video content quality, including accuracy, reliability, and comprehensibility of information, was assessed using the DISCERN, Journal of the American Medical Association (JAMA) Benchmark Score, Global Quality Score (GQS), and a researcher-developed Limb Lengthening Scoring System (LLSS). Two orthopedic surgeons independently evaluated all videos. The median view count of the 53 videos was 48,036 (range, 1,229 to 3,734,177), and the mean number of days since upload (as of July 5th, 2025) was 1,331 ± 735 days. The mean DISCERN was 24.4 ± 6.9, median JAMA 2 (range, 1 to 2), median GQS 1.5 (range, 1 to 3.5), and mean LLSS 1.1 ± 0.9. Physician-generated videos achieved significantly higher DISCERN and GQS scores (p = 0.031 and p = 0.040, respectively) than patient-generated videos. Speaker-generated videos had higher LLSS scores than patient-generated videos (p = 0.013). General information videos scored higher than patient testimonies for DISCERN (p = 0.035) and GQS (p = 0.025). Video duration and comment count positively correlated with LLSS (p < 0.001 and p = 0.047, respectively), whereas view counts and ratios showed no significant association with quality scores. YouTube videos on limb lengthening surgery are usually of low quality, with limited scientific accuracy and educational value. Physician-produced videos receive higher scores; however, their overall quality still remains limited, while patient-generated content shows the lowest reliability. These findings highlight that inaccurate or incomplete online information may influence patient expectations prior to consultation and complicate shared decision-making. Greater involvement of orthopedic surgeons and academic institutions is needed to provide clear, evidence-based, and reliable online educational content to improve patient understanding and clinical communication.