This study evaluates the feasibility and acceptability of using short message service (SMS) as a recruitment strategy for cervical cancer screening in an urban sector of Kigali, Rwanda. This pilot invited 300 women who had not attended cervical screening during the local campaign and had access to a mobile phone to provide a mobile number for cervical cancer screening invitation. Up to three SMSs were sent out, inviting women to visit a local health center for cervical cancer screening. There, attendance rates were recorded, self-collected vaginal samples for human papillomavirus testing were taken, and a short survey was administered. Those who did not attend received a phone call and were surveyed on reasons for non-attendance. A descriptive analysis was used to detail attendance rates and evaluate survey questions on the perceived feasibility and acceptability of the intervention. A total of 294 women met the inclusion criteria. Of these women, 86.4% (254/294) attended the health center for cervical cancer screening and 92.9% (236/254) of attendees reported they participated due to the SMS reminder. Survey items evaluating acceptability and feasibility indicated high message comprehension, strong attendance following a single SMS prompt, and high agreement that SMS was a helpful reminder to attend screening. Most non-attendees reported having received the SMSs but not attending due to circumstantial factors. SMS recruitment was highly feasible and well accepted in this pilot study in an urban sector of Kigali, Rwanda. Future research should aim to understand the efficacy of this strategy compared to usual recruitment methods across diverse settings in Rwanda.
First-degree relatives (FDRs) of type 1 diabetes (T1D) patients are at high risk for T1D. Early screening enables timely intervention, yet participation remains suboptimal, missing opportunities in this high-risk group. Understanding determinants of screening participation and translating them into actionable, theory-informed, family-centered strategies is essential to optimize preventive care. In this qualitative study in China, semi-structured interviews were conducted with 21 adult T1D probands or parents of pediatric T1D patients who have unaffected children. The Theoretical Domains Framework (TDF) guided data collection and analysis. Barriers were mapped to Behavior Change Techniques (BCTs). We identified 18 facilitators, 11 barriers, and 2 neutral factors, mapped across 12 TDF domains. Key barriers included limited awareness, misconceptions, cost, restricted medical resources, insufficient publicity, and anxiety; key facilitators included perceived benefits, optimism, health beliefs, and social support. Through TDF-BCT mapping, 34 intervention strategies were categorized into 13 categories targeting knowledge enhancement, environmental adaptation, social and emotional support, and self-efficacy building. This study provides a systematic, theory-based analysis of factors influencing screening participation for T1D. The resulting strategy map offers a set of theory-informed, family-centered suggestions to guide nurses and educators in supporting parents and improving early detection in clinical practice, subject to future empirical validation. Nurses and educators should develop localized, family-centered screening promotion programs guided by theory-driven frameworks and BCTs. Concurrently, systemic enablers-such as resource allocation, financial support, and routine follow-up guidance-must be established to comprehensively address barriers to participation in screening.
Community college (CC) students face significant mental health concerns but are unlikely to receive treatment. Barriers to mental health service uptake among CC students have been delineated, but few studies have identified strategies to improve uptake. Text messaging has been used to address engagement barriers to mental health services among adolescents and adults, but little research has explored this strategy for CC students. The goal of this study was to partner with CC students to co-design and conduct pilot usability testing of a text messaging intervention to address barriers and increase uptake of a mental health screening and treatment program, called Screening and Treatment for Anxiety and Depression (STAND), offered to CC students. We conducted 2 parallel sets of 4 co-design focus groups with CC students who had varying levels of engagement with STAND. We used rapid qualitative analysis to extract key themes, create text message prototypes and refine them, and present updated prototypes to gather feedback across workshops. We also assessed six usability factors on a 5-point Likert scale: satisfaction, helpfulness, attractiveness, readability, comprehension, and likelihood of getting started with STAND after receiving texts. Key themes emerged about perceptions of texting, barriers to STAND, a basic framework for the text message intervention, feedback about the format of messages, and feedback about the content of messages. Students expressed positive regard for text messaging and general agreement on key barriers to STAND. Students codeveloped a framework for the intervention, including (1) delivering introductory texts to engage students in the text messages, (2) providing a personalized approach for students to select barriers most salient for them, and (3) delivering tailored content designed by students to address each barrier. Across workshops, several themes emerged with regard to how messages should be formatted and delivered, including the following: use short messages; use not too many messages; use relevant language; use images, memes, and short videos; and make messages "human-like." Themes related to the content of messages included the following: reminders that you are not alone, knowledge that STAND has worked for other students, expressing understanding of student context and stressors, and providing an option to speak to a team member. Mean ratings on usability factors ranged from 3.88 (SD 0.64) to 4.25 (SD 0.46). This study describes a process for co-designing a text messaging mental health engagement intervention with CC students that is grounded in a human-centered design approach. Further research is needed to rigorously test this intervention and make iterative refinements to improve response and effectiveness.
The rapid expansion of compound libraries has significantly advanced drug discovery, especially through ultralarge library screenings that provide access to vast chemical spaces. However, the sheer scale of these libraries introduces substantial challenges in the early stages of drug discovery. While it is true that searching larger libraries can improve the hit rate of a virtual screening campaign, as the available chemical space has increased to over 64 billion molecules, identifying relevant information becomes a complex and time-consuming task. Machine learning (ML)-based docking methods and scoring functions offer a potential solution by providing increased speed and scalability. However, much of their reported success is based on benchmark data sets that rely on constructed decoys and ligand sets, which often have hidden biases that can artificially inflate performance and fail to capture the challenges of real-world screening. In this work, we systematically evaluate the performance of a popular ML-based docking method, DiffDock-Pocket, on high-throughput screening (HTS) data sets derived from the PubChem BioAssay database, a premier source of bioactivity data. By using HTS data sets as a more realistic benchmark, we aim to provide a clearer picture of how ML models perform in practical virtual screening scenarios compared to traditional physics-based docking approaches. Our work highlights the strengths and limitations of current ML methods and offers insights into their reliability and applicability to prospective applications in drug discovery.
Semiconductor materials are widely used in electronic, optoelectronic, and energy applications. While DFT-based phonon calculations provide highly accurate assessments for dynamical stability of structures, their prohibitive computational cost poses a significant bottleneck for large-scale materials screening. Herein, we develop DynStabNet, an E(3)-equivariant graph neural network (E3GNN) framework that learns dynamical stability from phonon-informed data, enabling rapid prediction without the need for explicit phonon calculations at the inference stage. Rather than serving as a replacement for first-principles phonon calculations, DynStabNet is designed as a fast surrogate model to accelerate the prescreening of candidate structures prior to subsequent MLIP- or DFT-based phonon validation. Specifically, a crystal structure generation model is utilized to produce diverse candidates, and a pretrained machine learning potential is employed to rapidly compute their phonon spectra to construct the training data set. The E(3)-equivariant architecture enables DynStabNet to capture the complex relationships between crystal structures and their dynamical stability. Consequently, unstable configurations can be rapidly eliminated early in the materials design pipeline. The DynStabNet model achieves an accuracy of 97% while reducing the evaluation time per structure from several hours to approximately 1 ms. By dramatically accelerating the overall screening process, this approach provides an efficient framework for large-scale materials screening.
Osteoporosis can cause painful, disabling, fatal fractures and impose substantial socioeconomic burdens. Because menopause-related bone loss accelerates during midlife, women with limited income may have difficulty accessing screening, counseling, and bone-healthy nutrition before the first fragility fracture occurs. Assessing bone-health awareness and preventive practices in this group may help identify modifiable gaps and guide targeted prevention for low-income midlife and older women. (1) What were the attitudes, awareness, and preventive practices regarding bone health among women age 40 to 65 years with limited income in Shanghai, China? (2) Which sociodemographic and health-related factors were associated with bone-health knowledge scores? We conducted a multidistrict, cross-sectional survey from January to September 2023. We approached 6429 eligible women with limited income at 10 health facilities and community outreach sites in seven Shanghai districts; 94% (6068) completed valid questionnaires and were included in the analysis. Eligible participants were 40 to 65 years of age, had lived in Shanghai for at least 5 years, and received minimum living security assistance. We believe that this group likely is representative of women in this demographic in Shanghai, and may be relevant to similar urban and periurban populations in China and parts of Asia. Data were collected using a researcher-developed questionnaire on osteoporosis knowledge, attitudes, and practices. Multivariable linear regression was used to identify factors associated with knowledge scores. A clear attitude-practice gap was observed. Although 61% (3698 of 6068) of participants considered bone health important, preventive practice was uncommon in the overall cohort: 12% (720) reported calcium supplementation, 9% (520) reported vitamin D supplementation, and 2% (106) reported menopausal hormone therapy use. Twenty percent (1228) selected dual-energy x-ray absorptiometry (DEXA) as their preferred screening method, while 4% (226) had previously undergone DEXA. Higher educational attainment (β = 1.18; p < 0.001), being married (β = 1.14; p < 0.001), and regular physical activity (β = 1.28; p < 0.001) were associated with slightly higher knowledge scores. Hypertension (β = -0.73; p < 0.001) and diabetes (β = -1.10; p < 0.001) were associated with slightly lower scores. Although most participants believed that bone health was important, women age 40 to 65 years with limited income in Shanghai had limited bone-health knowledge and generally did not take preventative steps that could have improved their bone health. These findings support practical, bone-health education in women's screening programs, community clinics, and chronic disease visits. These materials should be tailored to the anticipated reading levels of the populations served. Programs should explain calcium and vitamin D sources, weightbearing exercise, DEXA referral, and postfracture follow-up. Our findings may also be relevant to other urban and periurban populations in China and in other parts of Asia with similar social and economic characteristics.
Subjective cognitive decline (SCD) is an at-risk condition for future cognitive decline, making its early identification crucial. We examined whether two widely used screening tools, the Addenbrooke's Cognitive Examination-Revised (ACE-R) and the Mini Mental State Examination (MMSE), can distinguish SCD individuals from healthy elderly (HS) and from individuals with objective cognitive impairment. 110 participants were recruited: 22 HS, 25 SCD, 31 amnestic mild cognitive impairment (aMCI), and 32 Alzheimer's disease (AD) patients. All participants underwent an extensive neuropsychological battery and the ACE-R, which incorporates the MMSE. Partial ACE-R (ACER_P) scores were derived. Between-group comparisons were performed and discriminant analyses were run to evaluate sensitivity, specificity, and accuracy of total ACE-R (ACER_TOT), ACER_P, and MMSE. Despite no screening test significantly distinguishing SCD from HS, a progressive downward trend emerged across groups, with AD performing worst, followed by aMCI, then SCD and HS. Discriminant analyses indicated ACER_TOT had the highest sensitivity for AD (84.4%), with overall accuracy of 59.1%. Sensitivity for HS (68.2%) and aMCI (51.6%) was good but weaker. ACER_P and MMSE yielded similar or lower accuracy. Importantly, all measures poorly detected SCD, with sensitivity below 30%, leading to frequent misclassification as HS or aMCI. Although ACE-R and MMSE are moderately effective for identifying AD, HS and aMCI, they fail to distinguish SCD from other groups. Given the higher risk of SCD of being in AD continuum, such misclassification may prevent appropriate clinical follow-up. More sensitive screening instruments are needed to capture subtle cognitive changes and support early intervention strategies.
Patient navigation is a critical component of health care delivery, facilitating connections with appropriate services. A new era of virtual navigation systems has emerged, with systems that can be accessed through websites or smartphone apps. However, it is unknown which features of these novel systems impact patient outcomes. The objective of this scoping review is to understand the current landscape of existing virtual navigation systems. In this review, we will determine the features of these systems, as well as the patient outcomes and accessibility barriers associated with them that have been reported in the literature. This review will follow the guidelines for scoping reviews outlined by the Joanna Briggs Institute methodology. This will include systems that provide recommendations for health care, mental health and addiction services, and social services. This will include systems designed for patients, caregivers, and/or care providers. A search strategy will be used to locate both published and unpublished literature. The databases to be searched include PubMed, PsycINFO (ProQuest), Cochrane Library, Web of Science Core Collection (Clarivate), Cumulative Index of Nursing and Allied Health Literature (EBSCO), ScienceDirect, IEEE Xplore, and ACM Digital Library. Papers will be screened and selected, and data will be extracted by 2 independent members of the research team. The extracted data will primarily focus on outcomes and features of the virtual navigation systems. This will include the information they ask of users and the content and format of the information on services they provide. Funding for this project was received in May 2024. As of June 2026, abstract and full-text screening have been completed, data extraction is underway, and data analysis has not begun yet. Our search resulted in the retrieval of 14,461 studies that were eligible for screening. We anticipate that the full scoping review manuscript will be prepared for submission by winter 2027. Results will be presented in tabular format and accompanied by a narrative summary. This review will synthesize the current literature on virtual navigation systems that aim to connect patients to appropriate health care services. By identifying trends and gaps, this review will provide critical information for the development of new and innovative systems that can support health care and public health systems.
Nanobodies are small but specific heavy chain-only antibody fragments. Their small size, relative stability, and ability to access difficult to reach deep-tissue antigens makes them valuable research, diagnostic, and therapeutic tools. Nanobodies are derived from the variable heavy (VH) domain of heavy chain-only antibodies that are unique to camelids, including alpacas, llamas, and camels. The approaches employed to produce nanobodies, have been evolving and expanding since the initial discovery of heavy chain-only antibodies 30 years ago. Traditional nanobody development involves camelid immunization with a soluble, purified protein, followed by blood collection and processing, enrichment for potent nanobody sequences, and eventual expression and purification of candidate nanobodies for testing and validation. Alternative nanobody generation strategies aim to identify novel nanobodies utilizing synthetic or animal-derived naïve nanobody libraries in combination with phage-, yeast surface-, or ribosome displays for nanobody selection. This article outlines a novel protocol series for nanobody production using a commercially available transgenic "nanomouse", engineered to produce heavy chain-only antibodies containing camelid VH domains from alpacas, dromedaries, and Bactrian camels. These protocols will cover the following aspects: (1) Nanomouse breeding, genotyping, and colony establishment; (2) Nanomouse immunization and tissue collection; (3) RNA extraction from nanomouse immune cells isolated from blood and tissues; (4) Generation and amplification of VHH DNA from nanomouse cDNA; (5) Digestion of VHH DNA and ligation into a phagemid expression vector; (6) Preparation of a screenable Escherichia coli TG1-based phagemid library; (7) Antigen-driven VHH selection using phage display; (8) Single colony VHH ELISA screening; (9) Sequencing of ELISA hits and candidate VHH sequence identification; (10) Geneblock design of candidate VHH and Gibson Assembly into a nanobody expression vector; and (11) Nanobody over-expression and purification. We provide a comprehensive toolkit to facilitate nanobody development and make it more accessible to the greater research community. © 2026 The Author(s). Current Protocols published by Wiley Periodicals LLC. Basic Protocol 1: Nanomouse breeding, genotyping, and colony establishment Basic Protocol 2: Nanomouse immunization and tissue collection Basic Protocol 3: RNA extraction from nanomouse immune cells isolated from blood and tissues Basic Protocol 4: Generation and amplification of VHH DNA from nanomouse cDNA Basic Protocol 5: Digestion of VHH DNA and ligation into a phagemid expression vector Basic Protocol 6: Preparation of a screenable E. coli TG1-based phagemid library Basic Protocol 7: Antigen-driven VHH selection using phage display Basic Protocol 8: Single colony VHH enzyme-linked immunosorbent assay (ELISA) screening Basic Protocol 9: Sequencing of ELISA hits and candidate VHH sequence identification Basic Protocol 10: Geneblock design of candidate VHH and Gibson Assembly into a nanobody expression vector Basic Protocol 11: Nanobody over-expression and purification.
Precise quantification of α-synuclein (α-Syn), an important species associated with Parkinson's disease and related neurodegenerative disorders, is of paramount importance for early diagnosis and intervention. While electrochemiluminescence (ECL) has emerged as a powerful analytical technique owing to its low background interference and high sensitivity, the performance of MOF-based ECL systems is often limited by sluggish interfacial charge transfer and insufficient co-reactant activation at a single type of catalytic site. To overcome these bottlenecks, a two-dimensional (2D) ZnCu metal-organic framework/TiO2 (ZCMT) heterojunction sensing system was constructed by coupling interface engineering with a dual-site synergistic catalysis strategy. Specifically, the heterojunction facilitates directional charge transport by promoting electron delocalization and interfacial charge redistribution. Concurrently, the Cu- and Ti-based redox-active centers synergistically facilitate K2S2O8 activation and accelerate its reduction. This synergistic mechanism substantially enhances its ECL performance. By integrating the ZCMT platform with DNAzyme-assisted amplification strategy, a high-performance ECL biosensor was constructed for the ultrasensitive quantification of α-Syn. Overall, this study provides an effective strategy for overcoming the charge-transfer and catalytic limitations of MOF-based ECL systems and establishes a promising platform for the ultrasensitive analysis of α-Syn, with potential applications in the early screeningof Parkinson's disease.
The implementation of a Staff Safety Intervention Bundle reduced patient-initiated violence at a large academic health system. This bundle integrated Dynamic Appraisal of Situational Aggression screening into electronic health record workflows, leveraged adaptive learning technology for scalable staff education, and implemented visual risk indicators (door magnets) for team awareness. Sustainability strategies and lessons learned provide a replicable framework for nurse executives to address workplace violence through interdisciplinary partnerships within an organizational safety infrastructure.
Cotinus coggygria Scop. is a polyphenol-rich medicinal plant traditionally used in topical preparations, and the formulation-dependent effects of its extracts on fibroblast behavior remain insufficiently characterized. In this study, a 60% ethanol extract of C. coggygria was prepared and chemically profiled by LC-HRMS, identifying 6-OH-luteolin-7-O-glucoside as a major constituent. In silico bioactivity prediction of this compound indicated the highest mean probability of activity within the membrane/barrier-associated category (mean Pa = 0.895). An optimized Pluronic F127-HPMC gel formulation incorporating the extract was developed and evaluated using human fibroblasts as an in vitro screening model. Intracellular ATP levels were measured to examine potential effects on cellular bioenergetics, and cell migration was assessed by scratch assay. Within the tested concentration range (5-15 µg/mL), treatment with the extract-loaded gel resulted in reduced intracellular ATP levels by 25% and decreased migration modestly, whereas the extract alone did not significantly alter these parameters, indicating a formulation-dependent modulation of cellular response. In an exploratory Caenorhabditis elegans assay, the extract exhibited a biphasic concentration-dependent response, with the lowest concentration tested (3 µg/mL) producing the greatest lifespan extension, whereas higher concentrations (3000-50,000 µg/mL) progressively reduced survival. Collectively, these findings demonstrate that incorporation of C. coggygria extract into a gel matrix alters cellular bioenergetics and motility.
Childhood cancer is the second leading cause of pediatric death. Diagnosis and treatment frequently trigger anxiety and depressive symptoms. Play interventions match children's developmental needs to relieve distress but vary in efficacy. This meta-analysis quantified such interventions' effects on symptom improvement in children with cancer. To characterize play intervention designs and quantify their effects on anxiety and depressive symptoms among children with cancer. Systematic searches covered 12 databases from inception to April 27, 2026. Independent screening, data extraction, and quality appraisal were completed by two researchers, and meta-analyses were performed via RevMan 5.4 and Stata 18.0. Overall, 23 studies involving 1541 children with cancer were included. Pooled analyses showed that play interventions significantly alleviated anxiety (SMD = -1.84, 95%CI: -2.35 to -1.32, P < 0.001) and depressive symptoms (SMD = -1.62, 95%CI: -2.14 to -1.11, P < 0.001) in pediatric cancer patients. Subgroup analyses indicated medical play yielded the greatest improvement in anxiety (SMD = -1.87, 95%CI: -2.56 to -1.18, P < 0.001), while group play exerted the optimal effect on depressive symptoms (SMD = -2.09, 95%CI: -2.49 to -1.70, P < 0.001, I2 = 0%). As practical non-pharmacological mental health interventions for pediatric oncology, play interventions ease anxiety and depressive symptoms in children with cancer. Tailored play interventions are recommended for children with cancer. Thrice-weekly offline medical or group play suits children with severe anxiety symptoms, while online group or video play fits those with prominent depressive symptoms.
Enterotoxigenic Escherichia coli (ETEC) causes significant mortality and economic losses in piglet production. This study aimed to identify a safe, effective probiotic for E. coli control under practical conditions. Using a green fluorescent protein-tagged ETEC screening platform, we identified three Lactobacillus johnsonii (LJ) strains with potent antimicrobial activity. LJ FBU1718 demonstrated superior efficacy against multidrug-resistant ETEC, high gastrointestinal tolerance, and strong mucin adhesion. In IPEC-J2 cells, LJ FBU1718 reduced ETEC-induced inflammation, preserved epithelial integrity, and decreased cytotoxicity. Whole-genome sequencing confirmed its safety, showing an absence of mobile antimicrobial resistance elements. In suckling piglets, LJ FBU1718 supplementation improved growth and survival while enhancing fecal consistency. These benefits were underpinned by gut microbiota modulation, where Lactobacillus enrichment and E. coli reduction correlated with a significant decrease in diarrheal incidence. These findings establish LJ FBU1718 as a safe, practical probiotic candidate to enhance productivity in swine production.
Extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) pose a major global public health challenge, as they are associated with frequent empirical antibiotic treatment failure and increased patient morbidity and mortality. In this context, contact precautions (CP) have traditionally been recommended for hospitalized patients colonized or infected with ESBL-E to prevent healthcare-associated transmission. However, growing evidence has questioned the effectiveness of this strategy in certain care settings. The primary objective of this study is to assess the non-inferiority of standard precautions (SP) compared with clinically triggered CP in reducing the incidence density of ESBL-E acquisition in acute-care geriatric wards. By doing so, this study aims to inform the evaluation of pragmatic infection prevention policies implemented at the institutional level in vulnerable hospital populations. We will conduct a prospective, two-site interventional study in two geriatric departments of the Metz-Thionville Regional Hospital Center (Metz, France) using an alternating-period (crossover-like) design at the site level, with random allocation of the starting condition (CP first vs SP first). Patients will be screened for ESBL-E carriage at admission and at discharge. During CP periods, contact precautions are implemented only for patients with clinically detected ESBL-E infections identified through routine clinical cultures; asymptomatic ESBL-E carriage identified through surveillance screening does not trigger contact precautions. During SP periods, patients are managed using SP alone. The primary outcome is the incidence density of ESBL-E acquisition per 1,000 patient-days. Secondary objectives include species-specific analyses comparing ESBL-producing Escherichia coli and non-E. coli Enterobacterales. The total inclusion period is four years. Incidence rates will be compared using count regression models adapted to clustered period-based data.
Cadmium, a ubiquitous environmental toxicant, poses significant risks to human health, including ocular surface damage. This study investigates the link between cadmium exposure and pterygium, a common ocular fibrovascular proliferative disorder, using human conjunctival fibroblasts (HconFs) as an in vitro model. We demonstrated that low-dose cadmium chloride (CdCl2, 1 μmol/L) significantly enhanced HconFs proliferation and disrupted cell cycle progression by reducing the G₀/G₁ phase population and increasing G₂/M phase entry. Transcriptome analysis identified 724 differentially expressed genes (DEGs), predominantly enriched in metal ion response, detoxification, and mineral absorption pathways. Bioinformatic screening and validation revealed significant upregulation of FGF18, PTPRC, NDP, and MT1X, alongside downregulation of MX1. Critically, FGF18 and MT1X were consistently upregulated in clinical pterygium tissues, suggesting their pivotal role in linking cadmium toxicity to disease pathogenesis. Furthermore, calcium chloride (CaCl₂, 3 mmol/L) co-treatment effectively mitigated cadmium-induced proliferation, supporting a protective role of calcium via competitive inhibition. These findings indicate that cadmium promotes HconFs proliferation by disrupting intracellular metal homeostasis and activating proliferative and fibrotic gene programs, including MT1X and FGF18, via pathways potentially involving ERK/MAPK and Wnt/β-catenin signaling, thereby contributing to pterygium development. This study provides novel insights into environmental etiologies of pterygium and proposes calcium supplementation as a potential preventive strategy against cadmium-related ocular surface disorders.
Children can reliably identify their mental health needs, yet research on characteristics of children who self-identify a need for care is limited. This study examined demographic, mental health, and protective factors associated with fifth-grade students' self-identification of mental health care need, using data from the 2024-2025 California Healthy Kids Survey (N = 19,132 students). Multivariable logistic regression models with restricted cubic splines were used to examine nonlinear associations between self-identified need for care and negative emotions, victimization experiences, and parental involvement. A need for mental health care was self-identified by 39% of study participants. Females were more likely and Asian/Pacific Islander youth were less likely than their peers to self-identify a need for care. Unadjusted and adjusted odds of self-identifying a need increased significantly with increasing frequency of negative emotions. The adjusted association with victimization was non-linear, with participants with moderate and high levels most likely to identify a need for care. The adjusted association with parent involvement in school was weakly negative. Future research should evaluate whether a brief question assessing need can serve as a valid and reliable initial indicator to identify children who may benefit from further screening and support.
Outdoor play supports children's physical, social, and cognitive development; yet, opportunities are declining as indoor, screen-based childhoods become the norm. Early Learning and Child Care (ELCC) centers are key settings for promoting outdoor play, but limited evidence exists on the health and developmental outcomes of licensed nature-based ELCC programs, particularly for children with and those without disabilities. The Sending Preschoolers Outside (SPROUT) and SPROUT-able studies aim to examine the impact of one of Canada's first purposely designed and built licensed outdoor-focused ELCC programs. The primary objective is to examine the health and developmental outcomes of children aged 10-59 months, with and those without disabilities, attending an outdoor-focused, full-day licensed ELCC program compared to those in conventional (eg, not outdoor-focused) ELCC settings. Secondary objectives are to (1) examine educator job satisfaction, health, well-being, and attitudes toward teaching outdoors for children with and those without disabilities; (2) examine caregiver beliefs and attitudes toward children's participation in outdoor play and learning; and (3) identify barriers and facilitators to outdoor play and learning for children with and those without disabilities (ie, the SPROUT-able substudy) in an outdoor-focused ELCC program. This prospective longitudinal open cohort study follows children, caregivers, and educators over 3 years. Participants are recruited from 1 outdoor-focused (experimental) and 3 conventional (usual care) ELCC centers in Ontario, Canada; all sites are licensed. Assessments occur every 6 months and include direct measures of children (eg, anthropometry, motor skills, and accelerometry) and caregiver and educator questionnaires. Mixed-effects modeling will examine changes over time and between groups (experimental vs usual care). As of August 2025, 86 caregiver-child dyads are enrolled in the study (67 experimental and 43 control). Of these, 70 children who enrolled at study initiation have completed baseline and T1 and T2 assessments (43 experimental and 27 usual care), while 18 children enrolled at the 6-month time point (T1; 13 experimental and 5 usual care) have completed T1 and T2 (with a missing baseline assessment). A total of 19 children from the experimental group were identified as having a disability meeting criteria for the SPROUT-able substudy: 4 with a formal diagnosis, 3 with caregiver-reported functional difficulties, and 12 receiving additional support from an inclusion support worker. By combining a holistic and comparative approach with a focus on children with and those without disabilities, the SPROUT and SPROUT-able studies will generate comprehensive evidence to inform ELCC practice and policy in Canada and internationally. This model within Canada provides timely evidence on outdoor-focused ELCC delivery, integrating disability inclusive outdoor play into ELCC settings, and has the potential to guide meaningful improvements in child development, educator well-being, and community health.
Maternal alcohol use is a modifiable, yet significant public health concern, causing fetal alcohol syndrome and neurodevelopmental disorders. Research has predominantly focused on the neurodevelopmental consequences of maternal alcohol consumption, but growing evidence suggests that these effects may extend to the developing immune system, potentially increasing the risk of allergic and inflammatory conditions such as atopic dermatitis in offspring, which remains underexplored. This scoping review aims to map the available literature on the association between maternal alcohol exposure (preconception and pregnancy) and atopic dermatitis in offspring, including exposure patterns, outcome measures, and hypothesized biological mechanisms. The protocol follows Joanna Briggs Institute methodology with PEO framework (Population: offspring, Exposure: maternal alcohol use, Outcome: atopic dermatitis), and has been registered prospectively on the Open Science Framework (DOI: 10.17605/OSF.IO/EWGPB). A comprehensive search of electronic databases (PubMed, Scopus, Embase, CINAHL, Web of Science) and grey literature sources will be conducted from inception through the final search date. Two independent reviewers will screen titles, abstracts and full texts, with disagreements resolved by consensus or third-reviewer arbitration. Peer-reviewed original research articles in English reporting maternal alcohol use and diagnosed atopic dermatitis in offspring will be included. Data extraction will comprise study characteristics, exposure timing and measurement, outcome diagnostic criteria and age of assessment, key findings, and reported biological mechanisms. The preliminary findings will be validated through consultation with clinical stakeholders, including experts in allergy medicine, paediatricians, dermatologists, psychiatrists and obstetricians, to maximise the review's relevance and to identify practical implications for antenatal care and paediatric dermatology. Results will be presented through narrative synthesis, following PRISMA-ScR guidelines, to identify evidence gaps and inform future research and policy.
The tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP) ratio is a noninvasive surrogate of right ventricular-pulmonary arterial coupling. Previous evidence focused mainly on in-hospital, 90-day, or 1-year outcomes; long-term prognostic value across heart failure phenotypes remains unclear. This cohort included 440 chronic heart failure patients admitted between 2019 and 2021. Median age was 67 years; 31.1% were female; median follow-up was 41 months. Restricted cubic spline analysis assessed association between TAPSE/PASP and major adverse cardiovascular events (MACEs), defined as all-cause mortality, nonfatal myocardial infarction, nonfatal stroke, or heart failure rehospitalization. Kaplan-Meier and multivariable Cox regression analyses evaluated associations. Incremental value was assessed using C-statistics, net reclassification improvement (NRI), and integrated discrimination improvement (IDI). During follow-up, 193 patients experienced MACEs. TAPSE/PASP showed an approximately linear inverse association with MACE risk, with an exploratory cut-off of 0.036. After adjustment including natriuretic peptides, each 0.01-unit increase in TAPSE/PASP was associated with lower MACE risk (HR 0.75, 95% CI 0.66-0.87; p = 6.02 × 10-5), whereas TAPSE/PASP ≤0.036 was associated with higher risk (HR 1.98, 95% CI 1.37-2.85; p = 2.57 × 10-4). Adding TAPSE/PASP modestly improved discrimination (C-statistic 0.80 vs. 0.77), reclassification (NRI 0.31), and IDI (0.04) (all p < 0.05). Associations were consistent across prespecified subgroups. In chronic heart failure patients, lower TAPSE/PASP was independently associated with long-term MACE risk across LVEF-defined phenotypes. TAPSE/PASP may provide complementary prognostic information, but its clinical utility requires prospective external validation.