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Humans often struggle to accurately determine whether two different unfamiliar voice samples or face images belong to the same person. One method shown to boost face-matching performance is to have participants perform the task in pairs, which results in subsequent improvements for the poorer performers. This is a phenomenon known as 'the pairs training effect'. Previous studies have explored the pairs training effect using simultaneous face matching tasks whereby the two face images are presented side by side at the same time. Here we tested the efficacy of the pairs paradigm in unfamiliar voice matching (Experiment 1) which requires sequential presentation of the voices. We also tested sequential face matching (Experiment 2) to align the face task with the temporal demands of the voice task. In both experiments, participants completed one third of trials individually, one third in a pair, and a final third individually again. Across both tasks, we found that participants who initially performed poorly in the first individual task improved when completing the task in a pair and, importantly, retained this improvement in the final individual phase. Our findings show that the pairs training effect extends to identity matching of unfamiliar voices and remains even when stimuli are presented sequentially.

Shigella spp. is recognized by the World Health Organization as a high-priority pathogen due to its global prevalence, unique pathogenic mechanisms, and growing antimicrobial resistance (AMR). Nearly half of all Shigella strains worldwide are now multidrug-resistant (MDR), and the emergence of extensively drug-resistant (XDR) variants-resistant to ciprofloxacin, ceftriaxone, and azithromycin-has severely limited effective treatment options. The present study is based on prospective laboratory surveillance involving 323 Shigella isolates collected during 2021-2023, with pre-COVID-19 pandemic data included from a previously published study solely for historical comparison. The presence of antibiotic resistance genes (ARGs) was investigated, and whole-genome sequencing (WGS) was performed on representative isolates to assess phylogenetic relatedness with global isolates. Approximately 10% of isolates exhibited resistance to third-generation cephalosporins. While only 3% of Shigella isolates carried the blaCTX-M-15 gene from 2013 to 2019, its prevalence increased to 26% by 2022-2023. Among 38 ceftriaxone-resistant S. sonnei isolates, 33 were also resistant to azithromycin, categorizing them as XDR. These isolates showed 48% clonal similarity and high phylogenetic resemblance to the isolates reported from England. Hybrid genome assembly revealed a plasmid harboring both the blaCTX-M-15 and mphA ARGs. Conjugation experiments and plasmid profiling confirmed the plasmid's transferability. We report a rising trend in third-generation cephalosporin resistance among Shigella spp., primarily driven by the spread of extended-spectrum β-lactamase-producing S. flexneri and the emergence of XDR S. sonnei. These findings underscore the urgent need for strengthened national AMR containment strategies and enhanced international surveillance of cephalosporin-resistant Shigella to mitigate this growing public health threat.IMPORTANCEShigella is a leading cause of diarrheal disease globally and has been prioritized by the World Health Organization due to its rapid acquisition of antimicrobial resistance. Our prospective surveillance in Kolkata, India, reveals a worrisome escalation of third-generation cephalosporin resistance over the past decade, primarily associated with the spread of blaCTX-M-15 and the emergence of extensively drug-resistant (XDR) S. sonnei. The detection of plasmids carrying both blaCTX-M-15 and mphA, coupled with evidence of their transferability, highlights the potential for accelerated dissemination of multidrug resistance. When compared with a global data set of international genomes, the Kolkata XDR isolates were found to cluster closely with isolates reported from England. By linking local surveillance with global genomic context, our findings provide critical insights for treatment guidelines, antimicrobial stewardship, and the design of international containment strategies aimed at curbing the rise of cephalosporin- and azithromycin-resistant Shigella.

Tooth avulsion accounts for 0.5% to 16% of dentoalveolar traumas, and prognosis depends on immediate management. The International Association of Dental Traumatology developed an educational poster to guide laypeople in responding to such injuries. This study evaluated children's perceptions of the "Save a Tooth" poster and the knowledge acquired from it. Children aged 8 to 10 years were recruited. The poster's illustrations, children's comprehension, and readability were assessed using instrument 1, while knowledge acquired about emergency management of avulsion was assessed using instrument 2. Both instruments were administered after the poster presentation. Responses to instrument 1 were analyzed by categories, and responses to instrument 2 were classified as correct or incorrect. A total of 58 children from third to fifth grade participated. Most children reported that the poster was easy to understand, used accessible language, presented a new topic, required only one reading, had an adequate length, and would be understandable to peers of the same age. However, participants did not identify with the characters depicted, and fourth-grade students suggested that the poster could include more illustrations. The reported frequency of dental trauma among acquaintances ranged from 36.8% to 65%. All participants expressed interest in reading similar materials. Regarding knowledge acquisition, 65% of third graders, 63.16% of fourth graders, and 66.67% of fifth graders answered the sequence of emergency procedures incorrectly. Although the "Save a Tooth" poster was perceived as engaging and accessible, children demonstrated limited identification with the characters and a low level of knowledge retention regarding the correct sequence of emergency management for tooth avulsion.

to report three cases of Silicone Oil-related Vision Loss (SOVRL) with an unreported Optical Coherence Tomography sign before and after removal. Three patients with SOVRL underwent multimodal retinal imaging, including spectral-domain OCT. Three male patients underwent pars plana vitrectomy for rhegmatogenous retinal detachment (RRD). SO was used as intraocular tamponade in two cases with giant retinal tear (GRT) retinal detachment, and one case of macula-on retinal detachment and epiretinal membrane (ERM). In all cases, a foveal columnar hyperreflectivity (FOCOH) was identified before silicone oil removal (ROSO). Following ROSO, all the patients experienced reduction in visual acuity after an initial recovery. Two patients demonstrated regression of the FOCOH sign-one with concurrent visual recovery, while the other experienced persistent visual impairment despite disappearance of the sign (final VA 20/20 and 20/200). In the third case the hyperreflectivity persisted, accompanied by inner retinal cystoid spaces and poor final visual acuity (final VA 20/200). In the first case FOCOH disappeared after three months, in the second case the sign disappeared after one month from ROSO, and in the third case the FOCOH persisted for more than 2 months. The early presence of FOCOH under SO suggests its potential role as a predictive biomarker of visual decline. Recognizing FOCOH may provide additional clues for the early diagnosis of SOVLR and guide therapeutic interventions.

This study explores systemic factors that can influence unethical practices in academic publishing, particularly institutional pressures, editorial practices, and the impact of artificial intelligence (AI) tools. The study shifts responsibility away from individual actors. It takes a qualitative approach to examine how the interactions between researchers, editors, and institutional structures contribute to conditions in which unethical practices may occur. A qualitative research design was used to gather data through semi-structured interviews and observations with 30 participants, comprising university lecturers, postgraduate students, journal editors, and research support professionals from various regions.The results suggest that competition for publication and career advancement, as well as a lack of mentorship, create environments that participants see as encouraging unethical practices - such as author manipulation, use of third-party writers, and inappropriate use of AI - to occur. AI tools were specifically characterized as facilitating interventions that may support these practices in the context of systemic pressures. Furthermore, some participants expressed concerns about the editorial and financial arrangements, which could negatively affect the peer-review process.This study indicates that unethical publishing practices should be understood as resulting from complex systemic and cultural factors, rather than individual actions. The study identifies the need for institutional changes, guidance on AI use, and policies to promote research integrity. The qualitative nature and limited sample size of the study mean the results are explorative and suggestive of perceived patterns, rather than generalizable. We suggest that future research use mixed methods to investigate the extent and effects of these dynamics.

In clinical research, alternatives to venipuncture can reduce participant burden and increase accessibility and sampling opportunities for biomarkers. Residual pancreatic beta-cell function is assessed in clinical research and in diabetes care using fasting and stimulated C-peptide measurements, and changes are assessed over time. Operational, technical, and acceptability considerations of utilizing Tasso+ SST devices for C-peptide collection compared to venipuncture-derived serum samples were investigated. Samples were collected from prospectively enrolled healthy participants via Third Generation Tasso+ SST micro-sampling devices and phlebotomy. Eleven fasted Tasso+ samples collected on-site or remote underwent alternative handling conditions and were evaluated for consistency, quality, and stability. Participants responded to device acceptability questionnaires. The Tasso+ SST micro-sampling device showed excellent concordance with simultaneous venipuncture-derived fasted C-Peptide, with concentration being largely conserved in healthy volunteers despite alternative sample handling. Delayed centrifugation over 72 hours caused no consequential degradation of C-peptide when kept at 4°C. Questionnaire responses indicate acceptable device usability and associated comfort levels. Fasting C-peptide levels can be accurately collected using micro-sampling collection techniques. Tasso+ C-peptide stability is seen when kept at 4°C. Micro-sampling devices can be used with shipping mechanisms (without centrifugation) to decrease participant burden, expand trial populations, and aid biomarker measurements. This study focused on finding an easier way to collect blood samples for measuring C-peptide, a marker used in diabetes research, without needing a traditional needle stick in a vein (venipuncture). Instead, researchers tested a small, easily applied device that collects a small amount of blood from the upper arm. Healthy volunteer participants gave blood samples from both this device (called the Tasso+) and from the standard way (venipuncture). Some of these samples were collected away from a doctor’s office. The researchers checked to see if the small device gave accurate and reliable results for C-peptide, even if the samples were handled in different ways. These different ways included delays before processing and being stored in a fridge or freezer. They also asked participants about their experience with using the device.The study showed that transdermal micro-sampling devices, such as the Tasso+, provided C-peptide measurements similar to those from standard blood draws. The C-peptide in the samples stayed stable for up to 3 days in the refrigerator, even if not processed right away. Participants found the device easy and comfortable to use.In summary, using this device to collect small amounts of blood is a reliable way for samples related to diabetes to be collected and can help with research with less stress. This can make taking part in studies easier, allow for sample collection at home, and help researchers to include more people in studies while still getting trustworthy results.

Background: Spinal epidural abscesses (SEA) are rare, occurring 2.5-3 times per 10,000 hospital admissions. While streptococcus species comprise 7% of reported SEAs, Group A Streptococcus (GAS) has been described only once in the medical literature to our knowledge. Case presentation: We present a case of GAS pharyngitis with subsequent paraplegia from a GAS SEA. A 33-year-old female presented to the emergency department (ED) and was initially diagnosed with GAS pharyngitis and a suspected strained lower back. Following treatment with amoxicillin, she returned with worsened back pain, radiculopathy, and leukocytosis, for which she was treated with cyclobenzaprine. On her third presentation, she had new bilateral lower extremity weakness with decreased sensation, bilateral ankle clonus, and hyperreflexia. MRI of the thoracic and lumbar spine revealed a multiloculated SEA at T5-T10 requiring laminectomy and abscess evacuation. Intraoperative cultures grew Streptococcus pyogenes. Despite surgery, medical management, and physical therapy, she remained paraplegic. Conclusions: To our knowledge, this is the first report of SEA preceded by GAS pharyngitis. This case exposes the critical association between a recent infection, progression of back pain, eventual neurologic symptoms, and inflammatory markers that should trigger concern for SEA and early evaluation with MRI.

Objectives: This study aimed to examine the intra- and inter-rater reliabilities of panoramic ultrasonographic measurements of the pectoralis minor length (Pm_L), pectoralis minor thickness (Pm_T), and pectoralis minor cross-sectional area (Pm_CSA). Methods: Twenty young male participants aged 19-35 years were recruited for this study. All participants had asymptomatic rounded shoulder posture (RSP), with a mean acromion-to-table distance of 59.316 &#xb1; 9.631 mm. Longitudinal panoramic scans of the Pm of the dominant arm were acquired in three trials of four measurements for all participants. The first two measurements were examined by the same rater on the same day, and the third measurement was performed by a different rater. The same procedure was carried out by the first rater after 30 days for inter-day reliability. Intraclass correlation coefficients (ICCs), standard errors of measurement (SEMs), and minimal detectable changes (MDCs) were calculated to estimate the reliabilities. Results: The intra- and inter-rater reliabilities of Pm_L, Pm_T and Pm_CSA were excellent (all ICC > 0.932; all SEM < 7.4%; all MDC < 20%). Bland-Altman plots demonstrated good agreement with nearly zero mean differences between measurements. Conclusions: Using panoramic ultrasonography to measure Pm_L, Pm_T and Pm_CSA may be considered a reliable method with excellent inter-day, intra- or inter-rater reliabilities.

To quantify and characterize aggression and violence against nurses, identify associated clinical characteristics, evaluate measures in response, and explore predictors of recurrent incidents in the ICU. Retrospective single-center study. Incidence and characteristics of aggression and violence against ICU nurses were the primary outcomes. Aggression was defined as hostile behavior or resistance to care without intent to harm. Violence comprised verbal, physical, or sexual acts to threaten or inflict harm. Secondary outcomes included risk factors for recurrent incidents, defined as multiple episodes of aggression/violence separated by greater than or equal to 24 hours. Multivariable analyses were performed to identify potential independent associations. Data were collected from 2023 to 2024 at the tertiary medical-surgical ICU with up to 35 beds at the University Hospital Basel. Nursing operations followed a three-shift system: day (07:00-15:00), late (15:00-23:00), and night (23:30-07:00). Clinical reports from ICU nurses were screened. None. During 2190 shifts, 308 aggressive or violence incidents (14% of shifts) were reported. Most occurred during late (37%) or night (34%) shifts; 75% involved violence. Violent incidents were combined in nature (79% physical, 43% verbal, and 3% sexual). Patients were mainly involved (97%) and predominantly male (71%; median age 67; 90% emergency admissions). Psychiatric comorbidities, drug, and alcohol abuse were found in 20-33%. Recurrent aggression/violence occurred in 27%, predicted by longer ICU stay (adjusted odds ratio [OR] = 1.05/every additional hour), aggression as the first incident (adjusted OR = 6.9), and verbal violence as the first incident (adjusted OR = 4.3). Nurses (89%, two-thirds female, median 7 yr' experience) rarely documented harm (1.3%), but patients were reported to suffer complications in 60% of incidents, mainly from oversedation and physical harm from restraints. Violence in the ICU is frequent and almost always caused by patients. Recurring violence was independently associated with longer ICU stay, initial aggression, and verbal violence. Staff harm was rare, but incidents were frequently associated with complications in patients.

Fecal calprotectin (FC) is a potential biomarker of gastrointestinal inflammation; however, its physiological behavior in preterm newborns remains poorly understood. This prospective cohort study aimed to characterize the longitudinal variability of FC concentrations during the first month of life in preterm newborns of &#x2264;34 weeks of gestational age admitted to a neonatal intensive care unit. Altogether, 48 preterm newborns and 42 mothers were examined, with 124 fecal samples collected weekly. The median FC levels exhibited wide interindividual and intraindividual variations, ranging from 56 &#xb5;g/g in the first week to 65 &#xb5;g/g in the third week, with no significant association with clinical or laboratory variables. No confirmed cases of NEC occurred during follow-up. Among the five preterm newborns with clinical suspicion of NEC, FC levels fluctuated without a consistent temporal pattern or discriminatory profile. Because stool samples were collected according to a predefined weekly schedule rather than at symptom onset, transient FC changes associated with acute gastrointestinal events may not have been captured. The very small number of newborns with clinically suspected NEC, particularly during later follow-up, substantially limited the statistical power of subgroup analyses. Therefore, statistical comparisons involving this subgroup should be interpreted as exploratory and hypothesis-generating rather than confirmatory. Therefore, FC levels may vary substantially in preterm newborns and, within the limitations of this study, these findings primarily characterize the baseline longitudinal variability of FC rather than its diagnostic value for NEC and support cautious interpretation of isolated FC measurements in this population.

Fetal lung interstitial tumor (FLIT) is a rare benign mesenchymal lung tumor that is often mistaken for more common congenital lung lesions such as congenital pulmonary airway malformation (CPAM). Prenatal detection is exceedingly uncommon. Here, we report a case of prenatally detected FLIT presenting in the third trimester with rapid interval growth, mediastinal shift, and fetal hydrops, raising concern for a malignancy, including pleuropulmonary blastoma. Prenatal ultrasonography and fetal magnetic resonance imaging (MRI) demonstrated a rapidly enlarging right lung mass first identified late in gestation with associated findings of pleural effusion, ascites, and diffuse skin edema consistent with hydrops. Progressive mass effect prompted expedited delivery. Postnatal imaging confirmed a large pulmonary lesion, and the neonate developed significant respiratory distress requiring lobectomy. Histopathologic evaluation revealed an immature mesenchymal proliferation diagnostic of FLIT. This case highlights the imaging overlap between FLIT, CPAM, and pleuropulmonary blastoma and underscores the importance of considering FLIT in the differential diagnosis of late-presenting fetal lung masses. Although imaging is essential for detection and prenatal planning, definitive diagnosis requires histopathologic confirmation, and complete surgical resection yields an excellent prognosis.

Background: Walking is a dynamic activity that relies on inputs from the multisensory system, i.e., somatosensory, vision, and vestibular. These inputs are processed and integrated in the central nervous system to produce motor impulses for efficient walking balance. The Sensory Organization Test (SOT) is established as the gold standard for assessing sensory contributions to standing balance. However, no comparable assessments have been developed for the clinical evaluation of balance during gait. This study evaluated the Gait Sensory Interaction Test (GaitSIT), a novel virtual reality (VR)-based assessment for characterizing sensory-condition-specific changes in walking balance. Methods: The GaitSIT comprises a VR environment with a physical compliant foam walking surface that evaluates gait-balance by systematically manipulating and evaluating the sensory systems. Twenty-nine healthy young adults (mean age 24.9 &#xb1; 6.4 years) were instructed to complete 6 m walking trials under six standardized conditions (C): eyes open, eyes closed/dark scene, and rotating visual scenes on a firm surface, then repeated on a foam surface. Wearing an Oculus VR headset, participants were instructed to walk in a straight line at their preferred speed, as naturally as possible, in two test sessions on the same day, followed by a third test session 24 h later. Headset-derived sway measures, including position, velocity, and acceleration data, were recorded, and the continuous trajectory deviation angle (i.e., directional control) and sensory ratios were calculated. Linear mixed-effects models included trial-level walking speed as a covariate. Additionally, participants completed the modified Clinical Test of Sensory Interaction on Balance (mCTSIB) as a clinical standing-balance reference measure; its concurrent-validity findings will be reported separately. Results: Significant condition effects were observed for position, velocity, acceleration, and CTDA after adjustment for trial-level walking speed (all p<0.001), indicating that the six sensory conditions elicited distinct gait-balance responses. Significant differences relative to the baseline condition (C1) were observed across conditions C2-C6 for position, C3-C6 for velocity, and C2 and C5 for acceleration. Session effects were not significant for any primary kinematic outcome after speed adjustment. A significant condition &#xd7; session interaction was observed for position (p<0.001), whereas velocity, acceleration, and CTDA demonstrated no significant interactions. Walking speed was significantly associated with position, acceleration, and CTDA, but not velocity. Sensory-ratio analyses revealed larger visual and vestibular ratios relative to somatosensory ratios, with the visual and vestibular ratios generally decreasing across sessions. Conclusions: GaitSIT successfully manipulated sensory conditions during overground walking and produced significant changes in gait-related sway, directional control, and sensory-ratio measures. These findings support the feasibility of GaitSIT as a portable, low-cost, and immersive assessment framework for characterizing sensory-condition-specific gait-balance responses after accounting for walking speed and providing indirect behavioral indices related to sensory reweighting.

Pulmonary embolism (PE) is a leading cause of morbidity and mortality worldwide, ranking third among cardiovascular-related deaths after myocardial infarction and stroke. Despite extensive research, data on PE incidence and characteristics within the Israeli population remain limited. This study aimed to investigate the demographic, clinical, and prognostic factors associated with provoked (PPE) and unprovoked PE (UPE) cases in Israel. We conducted a retrospective observational study analyzing medical records of patients diagnosed with PE at Ziv Medical Center, Safed, Israel, from 2017 to 2022. Patients were classified into PPE or UPE groups based on identifiable risk factors. Demographic data, clinical characteristics, and mortality outcomes were compared using descriptive and inferential statistical methods, including the Mann-Whitney U test, chi-square test, logistic regression, Kaplan-Meier survival analysis, and Cox proportional hazards modeling. A total of 348 patients (mean age: 68.6 &#xb1; 17.6 years; 54.3% female) were included, with 189 (54.3%) classified as PPE and 159 (45.7%) as UPE. Female patients were significantly older than males (p < 0.001), and Jewish patients were slightly older than Arab patients (p = 0.060). The average hospital stay was 10.7 &#xb1; 16.2 days. Although no group differences emerged in unadjusted analyses, male sex was associated with longer hospitalization and UPE with shorter hospitalization than PPE in the adjusted model. Ethnicity emerged as a significant predictor of PE type, with Jewish patients less likely to have UPE (OR = 0.457, 95% CI 0.256-0.817, p = 0.008). Among PPE cases, 67.2% were of Jewish origin and 32.8% were Arab, compared to 56.0% and 44.0%, respectively, in the UPE group. In-hospital mortality was 16.1% (n = 56). Age was a significant predictor of mortality (HR = 1.03, 95% CI 1.00-1.06, p = 0.020), while ethnicity, gender, and PE type showed no significant associations in multivariable models. Our findings highlight key demographic and clinical factors influencing PE outcomes in Israel. The significant association between ethnicity and PE type warrants further investigation to refine diagnostic and therapeutic strategies for high-risk populations.

Metachromatic leukodystrophy (MLD) is a rare, autosomal recessive lysosomal storage disorder caused by a deficiency of the enzyme arylsulfatase A (ARSA, MIM #250100), which leads to progressive demyelination in the central and peripheral nervous systems, resulting in severe neurodegeneration and premature death. With the recent approval of the first ex vivo gene therapy for MLD, newborn screening (NBS) programs have begun to implement pilot studies for early detection, as identifying affected individuals during the pre-symptomatic therapeutic window is crucial. We present the analytical workflow and the NBS algorithm developed during the first year of MLD screening in Lombardy. The screening strategy comprised a first-tier test (1TT) using mass spectrometry to quantify sulfatide concentrations, a second-tier test (2TT) measuring ARSA enzymatic activity, and a third-tier test (3TT) based on whole-exome sequencing. A total of 16,130 newborns were screened for MLD. Of these, 6.41% required retesting (1TT), 1.53% underwent duplicate 2TT, and 0.36% proceeded to 3TT. No neonates were recalled, and no cases of MLD were identified through the screening program. The first-year implementation of MLD NBS in Lombardy demonstrates that a mass spectrometry-based sulfatide assay combined with a multi-tiered screening algorithm is feasible and reliable. Incorporating genetic analysis alongside expanded validation of additional sulfatide species may enhance specificity, reduce false positives, and facilitate timely identification of infants affected by MLD.

Background: Effective treatments for patients with complex dissociative disorders (CDDs) are urgently needed. The psychoeducational programme Finding Solid Ground (FSG) has been shown to be effective as an adjunct to individual outpatient therapy.Objective: This naturalistic pilot study evaluates changes in adaptive capacities and symptoms in adults with CDDs during a 1&#x2005;year follow-up period, including a 3&#x2005;month inpatient FSG-based treatment followed by patients' continuation of the FSG programme in their outpatient treatment setting.Method: Thirty adult patients with CDDs were included in the study. Patients were admitted in four consecutive groups to the inpatient FSG-based programme, combining group and individual therapy. FSG has 30 topics, each consisting of a short educational video, a psychoeducational script, and written and practical exercises. Patients completed eight topics during the inpatient stay and continued with the remaining topics during their 9&#x2005;month outpatient period. Changes in adaptive capacities and symptoms were explored, using mixed-model analysis and calculating reliable change.Results: Patients completed on average 19 of the 30 topics during the 1&#x2005;year study period. They improved with large effect sizes on adaptive capacities, post-traumatic stress disorder (PTSD) symptoms, and self-compassion; a moderate effect size on difficulties in emotion regulation; and a small effect size on dissociation. The majority reliably improved on adaptive capacities, PTSD symptoms, difficulties in emotion regulation, and self-compassion; while almost one-third reliably improved on dissociation. Deterioration rates were small. The highest improvement rates were observed in patients who had completed the highest number of FSG topics.Conclusions: This naturalistic pilot study shows the feasibility of the FSG programme in an inpatient treatment context, followed by patients' continuation of the programme in their local treatment setting. The results also suggest that progress with FSG topics is associated with better outcomes. Further studies are needed to replicate the findings. This 1-year naturalistic pilot explored adaptive capacities and symptoms in 30 patients with dissociative disorder using the psychoeductional programme, Finding Solid Ground. in a context involving inpatient and outpatient treatment.Most patients showed clinically meaningful improvements in adaptive capacities and symptoms.Findings suggest that progress on the programme is associated with better outcomes, underlining the importance of strengthening interactions between actors at different levels of health services for patients with prolonged treatmen needs.

Dietitians require robust behaviour change skills to promote dietary modifications to improve client outcomes. However, behaviour change education varies across institutions and placement opportunities. The aim was to develop and evaluate an online intervention to improve Australian dietitians' COM-B factors (capability, opportunity, motivation, and behaviour) for implementing behaviour change techniques. Australian Accredited Practising Dietitians were recruited via social media, newsletters, and word-of-mouth to complete two online behaviour change workshops. Mixed methods surveys were administered at baseline, post-intervention, and 3-month follow-up. Seventy-two dietitians completed all study components. Repeated measures ANOVAs showed significant improvements in self-reported capability, opportunity, motivation, and self-reported behaviour (frequency and technique use). Pairwise comparisons revealed sustained improvements at follow-up for all constructs, with approximately two-thirds of dietitians (68%) reporting practice changes. These changes included the integration of specific techniques. Where no changes occurred, dietitians cited opportunity-based barriers or noted they were already using techniques in daily practice. The intervention was successful at improving dietitians' capability, opportunity, motivation, and self-reported behaviour. However, long-term skill development may require support structures to foster opportunities. Future research should explore professional development models that provide sustained learning and organisational support to embed behaviour change techniques into dietetic practice.

Achieving reproducible probiotic performance under industrial manufacturing conditions remains a central unresolved challenge in applied microbial biotechnology. Despite substantial investment in strain development and formulation technologies, commercially produced probiotic products continue to exhibit inconsistent viability and functional stability, largely because the mechanistic connections between stress physiology, carrier architecture, and downstream processing have not been systematically integrated. This review addresses that gap through a production lifecycle systems framework that explicitly links cellular stress biology with carrier-mediated protection, industrial processing constraints, and delivery-associated recovery (Fig.&#xa0;1). The review is organized across four interconnected domains. First, major stressors including acid exposure, bile salts, oxidative injury, dehydration, and thermal fluctuations are examined in terms of their disruption of membrane integrity, redox balance, and metabolic activity, along with the adaptive mechanisms - proton pumping, lipid remodeling, compatible solute accumulation, and chaperone induction - that modulate stress outcomes. Second, carrier-mediated protection is analyzed across encapsulation platforms including alginate multilayer systems, protein-polysaccharide composites, pH-responsive hydrogels, and synbiotic matrices, with particular attention to how crosslinking density, oxygen permeability, and release geometry determine the protection-recovery trade-off. Third, industrial translational challenges are critically examined, including fermentation scale-up variability, spray drying and freeze-drying losses (typically 1-3 log units per stage under commercial conditions, varying with strain, inlet temperature, and excipient composition), encapsulation inefficiency, packaging oxygen ingress, and the systematic mismatch between CFU metrics and viable functional dose at the target site. Fourth, regulatory considerations and quality-control requirements for commercial probiotic products are discussed in the context of translational implementation barriers. The evidence synthesized here supports reconceptualizing commercial probiotic production through an integrated manufacturing continuum - one that explicitly maps fermentation physiology, carrier architecture, drying operations, packaging, storage, and post-release metabolic recovery as co-determined variables governing viable functional dose delivery. Practical progress may require coordinated advances in microbial stress biology, encapsulation engineering, process optimization, functional quality assurance, and regulatory science.

Anthracosilicosis is a legally recognized occupational disease that imposes a significant public health and economic burden on developing countries. Environmental exposure to mixed metals may influence the onset and progression of the disease, but relevant evidence among Chinese coal miners remains inconclusive. To evaluate the association between exposure to individual metal elements and their mixtures and the risk of anthracosilicosis using a case-control design. This case-control study included 154 coal miners (84 anthracosilicosis cases and 70 controls) who applied for occupational disease diagnosis at the Third People's Hospital of Xinjiang Uygur Autonomous Region between 2020 and 2024. Controls were frequency-matched to cases by age and work tenure. Plasma levels of seven metal elements (Al, Cd, Co, Cu, Ga, Mn, Sr) were measured by inductively coupled plasma mass spectrometry (ICP-MS). Single-metal exposure was analyzed using binary logistic regression and restricted cubic splines (RCS). Mixture effects were evaluated using quantile g-computation (QGC), weighted quantile sum (WQS) regression, and Bayesian kernel machine regression (BKMR). The case group had higher concentrations of Cd, Co, Cu, and Mn than the control group (P&#x2009;<&#x2009;0.05). Serum levels of Cd, Cu, Mn, and Sr were positively correlated with the risk of anthracosilicosis (P&#x2009;<&#x2009;0.05), whereas an inverse association was observed for Ga (P&#x2009;<&#x2009;0.05). Both QGC and WQS analyzes indicated that the mixture of seven metals (Al, Cd, Co, Cu, Mn, Sr, and Ga) was positively associated with anthracosilicosis risk (P&#x2009;<&#x2009;0.05). The BKMR model indicated that when the overall mixture exposure level exceeded the 50th percentile, the joint exposure to metals was positively associated with an increased risk of anthracosilicosis (P&#x2009;<&#x2009;0.05). Mn may be the largest contributor to the cumulative effect of mixed metal exposure on risk, and Ga was negatively associated with the risk of anthracosilicosis. The combined exposure to 7 metals (Al, Cd, Co, Cu, Mn, Sr, and Ga) was positively associated with the risk of anthracosilicosis.