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Social psychological research has shown how far-right leaders mobilize people by claiming that majority populations are threatened or silenced. This paper builds on this work to examine a related process in naturalistic interactions: how riotous actions are explained and justified through appeals to 'British values' in online forums. Using discursive psychology, we analyse talk surrounding the riots that followed the stabbing of three young girls in Southport, England-the UK race riots of August 2024. We show that invoking British or English values serves two key functions: it renders rioters' actions self-explanatory and offers a competing account of rioters as the more authentic representation of Britishness and the British people than the government. This reframing of 'British values' offers up a challenge to those attributing riots to 'far right' motivations and instead portrays the riots as effortful and even ideal expressions of British citizenship. Thus, British values operate not merely as symbols but as rhetorical tools that can sanitize the 'far-right' label linking the riots, immigration, state policy and national identity.
Severe combined immunodeficiency is an inherited condition arising from mutations in at least 19 known genes. Severe combined immunodeficiency can be identified through screening, family history or clinical presentation. Severe combined immunodeficiency is usually asymptomatic at birth and presents, in infancy, as recurrent and frequently severe infections. Without treatment, severe combined immunodeficiency is usually fatal in the first year of life. To summarise the available evidence relevant to newborn screening for severe combined immunodeficiency in the UK NHS newborn blood spot screening programme. Three research questions, concerning the accuracy of screening tests, the efficacy of early treatment and the acceptability of screening, were developed to address this objective. Eleven bibliographic databases were searched for relevant studies from 2011 to April 2024. Separate inclusion criteria were specified for each research question. Study selection, data extraction and assessment of methodological quality followed standard systematic review methods. A narrative synthesis of results is presented, structured by research question. No meta-analyses were conducted. Most positive predictive values, calculated from reports of newborn blood spot screening programme experience, were between 3.6% and 26%. Screening algorithms incorporating repeat sampling in preterm babies appeared to reduce false positives due to prematurity. However, the large number of other conditions that can give rise to a positive screening result mean that the positive predictive value for severe combined immunodeficiency remains consistently poor. Two small studies reported that early diagnosis of severe combined immunodeficiency, via newborn blood spot screening or family history and following the introduction of newborn blood spot screening, respectively, was associated with non-statistically significant improvements in post-transplant survival. A third study analysed data on n = 902 United States patients with severe combined immunodeficiency collected over a 28-year period and reported the results of multivariable Cox regression analyses, adjusted for demographic disease-related and transplant-related variables found to be significant on univariate analysis, showing that diagnosis of severe combined immunodeficiency via newborn blood spot screening significantly improved survival compared to diagnosis via clinical presentation. Qualitative data from the publications included in this evidence summary were generally indicative of parental support for newborn blood spot screening for severe combined immunodeficiency, but was mainly derived from parents of healthy newborns. The systematic review component of this evidence summary was limited by a restriction to full publications in the English language. The current published evidence base alone is not adequate to fully support implementation of newborn blood spot screening for severe combined immunodeficiency. With respect to UK National Screening Committee population screening criteria, criterion 4 was partially met and there was insufficient evidence to adequately assess whether criterion 6 was met. The findings of this evidence summary should be considered alongside findings from the recent in-service evaluation of newborn screening for severe combined immunodeficiency conducted in the NHS in England and the results of cost-effectiveness modelling. Further work is needed to inform policy on how the identification of non-severe combined immunodeficiency T-cell lymphopenia conditions by screening should be treated. Stakeholder dialogue and patient and public involvement activities may be helpful. In particular, the views of parents who have lived experience of a non-severe combined immunodeficiency (incidental) finding from newborn blood spot screening for severe combined immunodeficiency should be sought. This study is registered as PROSPERO CRD42024544200. This award was funded by the National Institute for Health and Care Research (NIHR) Evidence Synthesis programme (NIHR award ref: NIHR168307) and is published in full in Health Technology Assessment; Vol. 30, No. 45. See the NIHR Funding and Awards website for further award information. The UK National Screening Committee wants to know if screening all newborn babies for severe combined immunodeficiency would help babies and their families. Severe combined immunodeficiency is a rare, inherited condition that results in low numbers of white blood cells and prevents the body from fighting infection properly. There are usually no symptoms of severe combined immunodeficiency when an affected baby is born; however, a diagnosis of severe combined immunodeficiency is considered an emergency because the condition usually results in death in the first year, unless the child receives treatment. There is a test that can be used to screen for severe combined immunodeficiency; however, it is important to note that this test also identifies a large number of other conditions that affect the immune system. The UK National Screening Committee does not currently recommend screening newborn babies for severe combined immunodeficiency. This evidence summary was commissioned by the UK National Screening Committee as part of its regular, scheduled reviews of existing recommendations. There is evidence that babies with severe combined immunodeficiency who are diagnosed early, through screening, do better after treatment than those who are not diagnosed until they develop symptoms. However, most babies who have a screening test suggesting severe combined immunodeficiency do not actually have severe combined immunodeficiency. There is some evidence that parents support newborn screening for severe combined immunodeficiency; however, most of this evidence comes from parents of healthy newborns. There is a lack of information about the views of parents whose babies had a screening test suggesting severe combined immunodeficiency but did not have severe combined immunodeficiency. The evidence is not currently good enough to fully support implementation of newborn blood spot screening for severe combined immunodeficiency. The findings from the recent in-service evaluation of newborn screening for severe combined immunodeficiency conducted in the NHS in England should be considered with the findings from this evidence summary.
During early vocabulary growth, infants use single words to express complete ideas. Requests ("milk") and protests ("no!") are fundamental ways that infants communicate their needs. However, understanding what an infant wants from a single word can be challenging. Caregivers likely rely on infants' gestures and actions to interpret single-word utterances. How common are requests and protests during everyday activities? To what extent do infants accompany their requests and protests with gestures (e.g., points to request) and/or actions (e.g., flailing arms to protest)? Are caregivers more likely to respond to such "multimodal" requests and protests than to infants' words alone (i.e., unimodal speech)? We observed 31 toddlers (12-24 months) with their mothers during everyday interactions at home. In aggregate, infants expressed 2580 single-word utterances, with nearly half being requests (35%) or protests (8%). Most requests and protests (84%) were multimodal, occurring in the context of actions (mostly) or gestures. Unexpectedly, although infants' gestures/actions often "aligned" with their words in meaning or intent (e.g., saying "no" while pushing a toy away), infants also displayed "misaligned" gestures/actions (e.g., saying "no" to one toy while reaching for another). In particular, infants' aligned' multimodal requests and protests were more likely to elicit a response from mothers than were their words alone. Findings underscore the embodied and embedded nature of early communication in the natural home setting: Infants express their intentions by coupling words with gestures/actions, and certain types of multimodal communications are more effective than others in fulfilling their goals.
Autistic children often show reduced theory of mind (ToM). However, existing ToM measures neither sufficiently distinguish ToM ability from performance nor interpret both scores effectively, limiting their interpretability and clinical utility. To resolve these limitations, we characterized the measurement-based functioning levels and correspondence between ToM ability and performance among preschool to school-aged children. Data from 288 autistic and 168 neurotypical children were analyzed using a multidimensional Rasch model. The functioning levels and correspondence were established using expected responses across statistically distinguishable ToM levels. The results revealed three levels of ToM ability-Early (failure on all items), Basic (success on desire-based emotion), and Advanced (success on all items)-and five levels of ToM performance: Pre-ToM (understanding needs and wants), Emerging (simple emotion recognition), Transition (first-order false belief), Premature (contextual understanding), and Mature (pragmatic understanding). Importantly, while ToM performance tended to improve with ToM ability, only 20% of the items were comparable with neurotypical children. In conclusion, our findings highlight a critical gap in autistic children and provide the first empirically derived functioning framework linking ToM ability and performance. Beyond theoretical contribution, this study offers a practical pathway toward valid assessments and tailored interventions that target children's specific social-cognitive needs. Autistic children often face challenges in everyday social situations, which are partially related to reduced theory of mind (ToM). Most existing ToM measures either focus on performance in structured tasks (ToM ability) or real‐life behaviors (ToM performance). However, they rarely explain how these two aspects are related or which scores can be attributed to basic or advanced levels. In this study, we analyzed data from autistic and neurotypical children within the preschooler to school‐aged period to define three levels of ToM ability, five levels of ToM performance, and how these levels correspond. We found that many autistic children can pass ToM tasks, but only a small proportion of everyday ToM behaviors can reach levels similar to those of their neurotypical peers. This framework can help clinicians and researchers to collectively interpret ToM ability and performance scores and to optimize individual goals based on their strengths and weaknesses.
Bisphenols are emerging organic contaminants often released into the environment, especially in aquatic systems. Specifically, Bisphenol A (BPA) is generally used in synthetic polymers and thermal paper production, and has been found in different environments and organisms, affecting ecosystems and human life. However, bisphenol contamination in karst systems remains poorly studied, although karst groundwaters are widely exploited for drinking use. This study presents a preliminary screening of BPA, bisphenol AP (BPAP) and C (BPC) in a karst system, from surface watercourses to cave groundwaters, using the novel AptaStick system for bisphenol family. Results confirmed BPA pollution in the karst system, with highest values inside a cave. BPAP and BPC were not detected in water samples. Potential pollution sources are likely linked to diffuse anthropogenic inputs within the catchment area, combined with event-driven transport dynamics. As a potential source of BPA contamination, microplastic (MP) pollution was concurrently investigated during high-flow conditions, finding from 0 to 7.7. MPs/L. These data expand previous assessments conducted under low-flow conditions in the same karst system. Natural and regenerated microfibres (MFs) were analyzed too, finding from 0 to 136 items/L. This work wants to be a first evaluation of both bisphenol and MP pollution in karst systems, stressing the importance of monitoring pollutants in these highly vulnerable environments. Moreover, it provides a first evaluations of how pollutant distribution may vary within the different hydrological compartments of a karst system, not only between surface and groundwater environments, but also among flowing, percolation, and stagnant waters within the subterranean network. This approach contributes to a better understanding of the spatial heterogeneity and transport dynamics of emerging contaminants in karst environments, supporting the development of appropriate conservation measures for habitats and species protection, and suitable drinking water resources management.
This paper details the design and development of a discipline-specific English for Academic Purposes (EAP) syllabus for undergraduate students majoring in architecture and design related disciplines in an art school in China. Guided by the comprehensive needs analysis model established by Dudley-Evans and St. John [Developments in English for specific purposes: a multi-disciplinary approach. Cambridge University Press (1998)] and Swales [Genre analysis: English in academic and research settings. Cambridge University Press (1990)] genre theory, this study employed a university-wide questionnaire to gather data from 650 participants, including students and faculty. The needs analysis identified a critical disparity between students' target academic aspirations-such as engaging in international collaboration, pursuing studies abroad, and understanding foreign lectures-and their present situational capabilities, particularly in listening comprehension and command of disciplinary vocabulary. In response to these findings, the proposed "Architectural Art English" syllabus is constructed around a genre-based, content and language integrated learning (CLIL) as well as task-based language teaching (TBLT) approach. It systematically incorporates seven key academic and professional genres relevant to the field: textbooks and monographs, research papers, case studies, and lecture scripts as input genres; and design statements, presentation scripts, and research abstracts as output genres. Each instructional unit is organized around a central architectural theme, utilizing authentic cases and genre analysis of move structures to make disciplinary discourse conventions explicit. The pedagogical framework emphasizes task-based learning, featuring authentic activities such as case analysis, design project presentations, and paper abstract writing to bridge the gap between language skills and disciplinary knowledge. This syllabus aims to addresses the complex interaction of learners' target needs, subjective wants, and current proficiencies, facilitating their active participation in the global academic community of architecture and design.
The Standardised Endpoints in Perioperative Medicine Initiative recommends the 12-item WHO Disability Assessment Schedule (WHODAS) 2.0 to measure postoperative functional impairment. However, evidence describing long-term postoperative disability, particularly at 1 year, remains limited. This study aimed to: describe disability up to 1 year after non-cardiac, non-neurosurgical procedures; examine associations between periprocedural risk, postoperative complications and new-onset disability; and evaluate associations between social support, delirium, and frailty and postoperative disability. We conducted a prospective, multicentre cohort study. The primary endpoint was new onset clinically significant disability (an increase in WHODAS 2.0 score ≥ 5% points from baseline to a final score ≥ 35%) or death at 1 year. Independent variables included: periprocedural risk; postoperative complications; frailty; and patient-reported social support. In total, 1081 patients were included: 726 (67%) male, median (IQR) [range] age 67 (60-75 [50-101]) y. New onset clinically significant disability was present in 139/1081 (12.9%) patients at 1 year and in 238/1066 (22.3%) patients at 30 days. Periprocedural risk (adjusted odds ratio (aOR) 1.05, 95%CI 1.03-1.07, per percent in American College of Surgeons National Surgical Quality Improvement Program score) and postoperative complications of all grades were associated with 1-year new onset clinically significant disability. New onset (1 year) clinically significant disability was not associated with social support: OR 0.87, 95%CI 0.54-1.39 for moderate; and OR 0.76, 95%CI 0.47-1.24 for strong social support. Frailty was strongly associated with new onset clinically significant disability after 1 year (aOR 3.97, 95%CI 2.54-6.21). One year after non-cardiac surgery, 13% of surviving patients experienced a new onset clinically significant disability. Postoperative complications, even those of low severity, were associated with new onset postoperative disability. We followed a large group of people who had surgery that was not on the brain or heart. We checked how well they were able to do everyday activities before surgery, then again after 30 days and after 1 year. We also looked at things like how risky their surgery was, if they had problems after surgery, how strong or frail they were and whether they had support from others. We wanted to understand how surgery affects people in the long term, especially whether they develop new disabilities that make daily life harder. This helps doctors know who might need extra care and support after surgery. We found that about 1 in 8 people had new problems with daily activities one year after surgery. More people had problems soon after surgery, but some improved over time. People who had higher risk for surgery, had complications after surgery, or were already frail were more likely to have long‐term disability. Having social support did not seem to make a big difference in this study. This shows that preventing complications and supporting frail patients is very important for recovery.
Differences in typical-use contraceptive failure rates between long-acting reversible contraception (LARC; such as intrauterine devices [IUDs] and implants) and shorter-acting methods (depot medroxyprogesterone acetate [DMPA], pills, rings, and male condoms) are often the focus of contraceptive counseling, but assessments of contraceptive counseling have not focused on contraceptive effectiveness over time. To assess 3-year continuation and typical-use contraceptive failure rates for 7 reversible contraceptive methods provided with access barriers removed. The HER Salt Lake Contraceptive Initiative was a 3-year prospective longitudinal cohort study (September 2015 to March 2017, with follow-up data collected through June 2020). Participants (new contraceptive users 18-45 years who indicated they wanted to avoid pregnancy for at least 1 year) enrolled at 4 family planning clinics in Salt Lake County, Utah, and received person-centered contraception counseling and same-day access to the reversible contraceptive method of their choice. Data were analyzed from June 2024 to February 2026. The exposure was contraceptive method selected at baseline (copper IUD, DMPA, implant hormonal IUD, condoms, pill, or ring). The outcome was experiencing a contraceptive failure, defined as an unintended pregnancy (self-reported or identified through electronic medical record) experienced while using a contraceptive method in the previous 4 weeks. Method-specific continuation and failure rates were calculated using a life table analysis. Among 4275 contraceptive users (1759 [41%] aged 20-24 years), 96 pregnancies resulting from contraceptive failures of methods initiated at baseline were identified. Of all participants, 529 (11%) selected a copper IUD, 558 (13%) selected DMPA, 823 selected an implant (19%), 1025 (24%) selected a hormonal IUD, 52 (<1%) selected condoms, 1065 (25%) selected pills, and 223 (5%) selected the ring. Cumulative continuation at 3 years included 741 hormonal IUD users (72%), 455 implant users (55%), 321 copper IUD users (61%), 186 DMPA users (33%), 75 ring users (34%), 376 pill users (35%), and 8 male condom (15%). Three-year contraceptive failure rates per 100 person-years were 0.7 (95% CI, 0.4-1.1) for hormonal IUD users, 0.8 (95% CI, 0.5-1.3) for implant users, 1.1 (95% CI, 0.6-1.8) for copper IUD users, 1.1 (95% CI, 0.6-2.1) for DMPA users, 1.4 (95% CI, 0.6-3.2) for ring users, 1.6 (95% CI, 1.1-2.3) for pill users, and 2.6 (95% CI, 0.5-10.0) for male condom users. In this cohort study of individuals initiating a contraceptive method following person-centered contraceptive counseling and removal of access barriers, low 3-year contraceptive failure rates were observed for all methods, and shorter-acting methods had lower failure rates than previously reported typical use rates. These findings suggest that removing access barriers to preferred contraceptive methods may support access to clinician-dependent LARC methods, like IUDs and implants, and improve the contraceptive effectiveness of user-controlled, shorter-acting methods.
Shared decision making (SDM) is a patient-centered approach for conditions where multiple, preference-sensitive treatment options exist and there is no single best choice. Eosinophilic esophagitis (EoE), an increasingly prevalent chronic immune-mediated disease, offers an example of how patients and physicians use SDM to navigate the challenging tradeoffs of weighing pharmacologic and dietary therapies. We aimed to identify communication challenges for SDM in EoE care from physician and patient perspectives and to explore how patient treatment preference archetypes influence SDM. We conducted a qualitative study with one-on-one, semi-structured interviews with adult patients with EoE and physicians. Patients (n = 35) were recruited from a single academic center (mean age 41 years [(SD 15.2]; 51% male; predominantly White 83%). Physicians included gastroenterologists (n = 9) and allergists (n = 7) from varied practices across Michigan. Interview guides were informed by the Theoretical Domains Framework and iteratively refined. Interview transcripts were coded using both deductive and inductive strategies and analyzed thematically via descriptive content analysis. Three central themes emerged: 1) Patients often lack knowledge or have misconceptions about EoE and its treatments, but differed in how and from where they want to gain disease-focused information, 2) Physicians generally supported SDM, but patients varied in how they want to be involved in decisions about their care, and 3) Both patients and physicians wanted accurate and user-friendly informational resources about EoE to support effective communication and SDM. Our analysis revealed that patients with EoE have diverse preferences for disease-related learning, decision making, and communication. There is a clear need for accurate, accessible, and personalized information to improve patient-physician understanding and communication, without which SDM and patient-centered care in EoE cannot be achieved. What we learned can be applied to other health conditions where there is clinical equipoise between various effective management options.
This study investigated the effect of virtual simulation of parenteral medication administrations on nursing students' knowledge and skills. This randomized controlled experimental study adopted a pretest-posttest research design. The sample consisted of 103 first-year nursing students from a university. They were divided into an experimental (n=51) and a control (n=52) group. The control group received traditional education, while the experimental group logged into the simulation at "parenteralilacuygulamalari.com.tr" and did the medication administration as many times as they wanted in the virtual environment. There was no statistically significant difference in intramuscular, subcutaneous, and intravenous medication administration scores between the experimental and control groups. However, the experimental group showed a statistically significant difference between the pretest and posttest knowledge and skill scores (P<.05). Nursing students who engage in virtual games acquire more knowledge and develop more skills.
21st Century Cures Act information blocking regulations led to many organizations altering policies to electronically release test results to patients immediately upon their availability. This study aims to understand the prevalence and variation in how often patients view test results in the patient portal before hearing from their health care provider (HCP), are given the option to decide how results are communicated, and understanding of results viewed before hearing from their HCP. In this cross-sectional analysis, we analyzed data from the 2024 Health Information National Trends Survey on US adults with complete information who received test results via patient portal (n=6045). We examined the share of all patients and "portal users" (accessed their portal in the last year) who viewed test results in their portal, viewed results before hearing from their HCP, and were given the option to decide how results were communicated. We examined patients' understanding of results viewed before hearing from their HCP and compared it with their understanding of other health information. Finally, we examined differences in weighted proportions of outcomes by individual characteristics using survey-weighted linear regression. Differences were assessed using design-adjusted Wald tests. In 2024, 70% of patients (92% of portal users) viewed results in their patient portal, and 58% (76% of portal users) viewed the results before hearing from their HCP. Overall, 28% of patients and 33% of portal users reported being given the option to decide whether they wanted to receive test results before hearing from their HCP. Only 66% of patients reported that they understood the results they viewed in their patient portal. Provider encouragement, higher education, and digital literacy were most strongly associated with higher rates of viewing test results overall and before hearing from their HCP (eg, 70% of those encouraged viewed results vs 24% not encouraged; P<.001). Associations with age and chronic condition were also observed but were weaker. While higher education and digital literacy, age, and provider encouragement were strongly associated with being given the option to decide how to receive results, only high digital literacy and provider encouragement were strongly, positively associated with understanding results viewed before hearing from their HCP (eg, 77% of patients with high digital literacy understood results compared to 53% of those with low digital literacy; P<.001). This study is the first to provide a national estimate of patients who access immediately released test results and whether patients are given the option to decide how their results are communicated to them. While most patients view results before discussing them with their HCP, rates varied by individual characteristics, and substantially fewer patients report being given the option to decide how results are communicated. Incorporating patient preferences in portal communications may empower patients while preserving immediate access.
The incidence of inflammatory bowel disease (IBD) is rising across Southeast Asia, yet real-world data on clinical phenotypes, treatment strategies, and outcomes in tuberculosis (TB)-endemic, resource-constrained settings remain scarce. To characterize disease phenotypes, treatment utilization, and 1-year outcomes in a Vietnamese inception cohort of newly diagnosed IBD patients in a tuberculosis-endemic, resource-constrained setting. Single-center, hybrid retrospective-prospective inception cohort study. Consecutive adults diagnosed with Crohn's disease (CD) or ulcerative colitis (UC) at a tertiary referral center in Ho Chi Minh City, Vietnam, between June 2019 and June 2024. A Baseline Cohort (N = 126) was analyzed for phenotypic characterization. Patients completing ⩾12 months of follow-up comprised the Outcome Cohort (N = 66) for assessment of treatment patterns and clinical, biochemical, and endoscopic outcomes. Treatment followed an accelerated step-up strategy with originator anti-tumor necrosis factor (TNF) agents (infliximab/adalimumab) after mandatory TB screening. Among 126 patients (80 CD, 46 UC), CD was characterized by substantial diagnostic delay (median 12 months), with 57.6% presenting stricturing or penetrating behavior and 25.0% having undergone intestinal resection before IBD confirmation. Extensive colitis (E3) predominated among UC patients (63.0%), and 78.3% had moderate-to-severe disease. Anti-TNF utilization increased from 13.6% within the first 2 months after diagnosis to 45.5% at 1 year. In the Outcome Cohort (N = 66), steroid-free clinical remission was achieved in 63.6%, and mucosal healing was documented in 62.3% of endoscopically evaluated patients. Serious infections occurred in 9.1%, with TB reactivation in 4.5%. IBD in Vietnam presents with diagnostic delays, complicated phenotypes, and high surgical rates at initial presentation. Despite these challenges, an accelerated step-up strategy with early anti-TNF escalation was associated with favorable 1-year steroid-free remission and mucosal healing rates. These findings suggest that treat-to-target care with early biologic escalation may be feasible in selected patients in TB-endemic, resource-constrained settings, provided that structured TB monitoring is implemented. Successful one-year treatment of severe, newly diagnosed inflammatory bowel disease in Vietnam using early, strong medications despite high tuberculosis risks Inflammatory bowel disease (IBD) is becoming more common in Southeast Asia, including Vietnam. However, diagnosing it is difficult because its symptoms are very similar to intestinal tuberculosis (TB), a common infection in the region. Because of this confusion, patients often suffer for a long time—sometimes up to a year—before finding out they have IBD. By the time they are properly diagnosed, their disease is often severe, and some even require surgery before receiving the correct diagnosis. In this study, we looked at 126 adults newly diagnosed with IBD at a major hospital in Vietnam. We wanted to see if treating them quickly with strong, advanced medications (known as biologics) would be safe and effective. We found that this treatment approach was associated with encouraging one-year outcomes. After one year of treatment, about 64% of the patients felt completely well without needing to take steroid medications. Furthermore, tests showed that the inside of the intestines had healed completely in 62% of the patients. However, because these strong medications can lower the body’s immune defenses, we carefully tested everyone for TB before starting treatment. Even with negative initial TB tests, 4.5% of patients still developed TB later. This highlights that ongoing monitoring for tuberculosis may be important throughout the course of biologic treatment, rather than relying solely on a single test before starting therapy.
What is this summary about?While there are topical treatments available for managing atopic dermatitis (AD), the most common form of eczema, their use is constrained for reasons including restrictions on long-term application and/or skin irritation at the application site. Because of these concerns, researchers are investigating better ways to treat AD. After once-daily application for 4 weeks, a novel treatment, roflumilast cream, improved the appearance and symptoms of AD more than vehicle cream (cream that looked and felt like roflumilast cream but did not contain medicine) in two clinical studies (INTEGUMENT-1 and INTEGUMENT-2). Researchers wanted to learn more about long-term therapy with roflumilast cream; therefore, patients 6 years of age or older with AD who completed INTEGUMENT-1 or INTEGUMENT-2 could volunteer for the INTEGUMENT-OLE study. This article summarizes published results from INTEGUMENT-OLE, a study designed to determine if longer-term treatment with roflumilast cream had side effects and/or continued to improve AD.What are the key takeaways?Patients applied roflumilast cream once daily for up to 52 weeks. When a study clinician saw that AD was clear (no active AD), the patient was switched to twice-weekly application in areas where AD was previously being treated. Most patients did not have side effects while using roflumilast cream. AD signs and symptoms were reduced and/or improved over time. For patients with no active AD who switched to twice-weekly application, signs and symptoms of AD remained clear or almost clear for a median (mid-point of a set of values) duration of 281 days (9 months).What were the main conclusions reported by the researchers?Long-term treatment with roflumilast cream 0.15% was well tolerated by patients and also improved the appearance and symptoms of AD. These results support roflumilast cream 0.15% as an appropriate therapeutic option for mild-to-moderate AD, potentially reducing the need for treatments that contain steroids.[Box: see text][Box: see text][Box: see text]Link to original article here.
In 2024, the U.S. Department of Health and Human Services added infantile Krabbe disease to the Recommended Uniform Screening Panel for Newborn Screening (NBS). Families have previously expressed wanting their established general outpatient pediatrics clinicians involved in sharing NBS results. In this study, we aimed to understand pediatrics clinicians' perspectives on barriers, facilitators, and ideas for interventions regarding their involvement in sharing positive NBS results for Krabbe disease. We conducted individual semi-structured interviews with clinicians (physicians and advanced practice providers) in general outpatient pediatrics in Western Pennsylvania. Interviews were audio-recorded and transcribed. Two coders performed content analysis, coding transcripts, and identifying themes with representative quotations. Themes were mapped to the Consolidated Framework for Implementation Research. Twenty-five clinicians participated. Barriers, facilitators, and ideas for interventions spanned the individual level, inner setting, and outer setting of the Consolidated Framework for Implementation Research. Barriers included: limited clinician knowledge of Krabbe disease, time in the clinical schedule, and accessibility of specialists. Facilitators included: prior clinical training in communicating serious diagnoses, protected time for Continuing Medical Education activities, and trustworthy online medical resources. Ideas for interventions included: fact sheets/scripts/algorithms for clinicians; integration of clinician education with NBS result notifications; and improvements in care coordination with specialists. While primary care pediatrics noted lack of time, knowledge, and access to specialists as barriers to sharing Krabbe disease newborn screening with families, they highlighted that communication tools/tips, easy training or access to disease information, and assistance coordinating specialty care would facilitate their involvement.
Climate change is threatening crop yield of a broad range of agricultural species, impacting global food security and trade. Crop wild relatives may contain climate adaptations that can be quickly introduced into cultivars, especially in perennial tree crops that use rootstock. Identifying climate resilient genotypes that can potentially be used as alternative rootstock is imperative to mitigate the impacts of climate change. Here, we used whole genome sequence data of 59 wild Juglans hindsii (Northern California black walnut) and 39 wild J. californica (Southern California black walnut) adult trees to: (i) determine predicted adaptedness to future climate based on landscape genomic models, (ii) explore their adaptedness if used as rootstock in existing walnut orchards and (iii) identify potential future planting sites within existing croplands. Wild J. hindsii has the highest predicted adaptedness to the future climate of Northern and Central California walnut orchards, while wild J. californica has the highest predicted adaptedness to Southern and Central California walnut orchards. Juglans californica has high adaptedness to the future climate of more existing cropland than J. hindsii does. If walnut farmers wanted to test new rootstock sources for their existing orchards or convert their farmland into walnut orchards, this study informs the exploration of such ideas. We illustrate how landscape genomic tools can be utilized in agricultural contexts as first steps in identifying climate adapted genotypes.
Background: Bereaved parents face substantial mental health risks. In addition to seeking help from mental health professionals, bereaved parents often adopt their own grief coping strategies. Among these, some Chinese parents who have lost their only child (shidu parents) adopt a unique, culturally shaped coping strategy known as 'living on behalf of the child.'Methods: A purposive sampling method was used in this study to invite shidu parents who were living on behalf of the child to participate in interviews. In total, 10 interviewees were included in the analysis; specifically, 8 participated by telephone, and 2 participated face-to-face. A thematic analysis was performed to code the data and extract themes.Results: For China's shidu parents, living on behalf of the child refers to doing what the child was doing when the child was still alive, doing things that the child wanted to do but had not been able to do, fulfilling the child's unmet responsibilities, maintaining relationships with the child's friends, and experiencing life from the child's perspective. This approach supports shidu parents by helping them regain a sense of purpose in life, improve their emotional stability, and increase their level of interpersonal support; however, it may also increase their level of life stress.Conclusion: As a culturally unique grief coping strategy, living on behalf of the child is practiced among shidu parents as they adjust part of their identity from being parents to being children. This strategy facilitates meaning reconstruction among shidu parents. The effects of this strategy on shidu parents are mainly positive. However, some negative effects can also occur, which makes finding an appropriate balance necessary. Living on behalf of the child is a unique grief coping strategy used by shidu parents in the Chinese cultural context.Living on behalf of the child facilitates meaning reconstruction among shidu parents.When shidu parents practice living on behalf of the child, part of their identity shifts from being parents to being children.The effects of living on behalf of the child on shidu parents are mainly positive, although negative effects can also occur. Antecedentes: Los padres en duelo enfrentan riesgos sustanciales para su salud mental. Además de buscar ayuda de profesionales de la salud mental, los padres en duelo suelen adoptar sus propias estrategias de afrontamiento. Entre estas, algunos padres chinos que han perdido a su único hijo (padres shidu) adoptan una estrategia de afrontamiento única y moldeada culturalmente, conocida como ‘vivir en representación del hijo/a’. Métodos: En este estudio se utilizó un método de muestreo intencional para invitar a participar en entrevistas a padres shidu que estuvieran viviendo en representación de su hijo/a. En total, se incluyeron 10 entrevistados en el análisis; específicamente, 8 participaron vía telefónica y 2 de forma presencial. Se realizó un análisis temático para codificar los datos y extraer los temas principales. Resultados: Para los padres shidu de China, vivir en representación del hijo se refiere a: realizar las actividades que el hijo hacía cuando aún vivía, llevar a cabo aquello que el/la hijo/a deseaba, pero no pudo cumplir, asumir las responsabilidades pendientes del hijo, mantener relaciones con los amigos del fallecido y experimentar la vida desde la perspectiva del hijo/a. Este enfoque sostiene a los padres shidu ayudándoles a recuperar el sentido de propósito en la vida, mejorar su estabilidad emocional y aumentar su nivel de apoyo interpersonal; no obstante, también puede incrementar sus niveles de estrés vital. Conclusión: Como estrategia de afrontamiento del duelo culturalmente única, el vivir en representación del hijo/a es practicado por los padres shidu mientras ajustan parte de su identidad, pasando del rol de padres al de hijos. Esta estrategia facilita la reconstrucción del significado entre los padres shidu. Los efectos de esta estrategia son mayoritariamente positivos. Sin embargo, también pueden presentarse efectos negativos, lo que hace necesario encontrar un equilibrio adecuado.
Patient-reported outcome measures (PROMs) are important tools for assessing the impact of skin diseases on health-related quality of life (HRQoL). However, comparative data on the measurement properties of commonly used instruments are limited. The objective of this study was to compare the measurement properties of the Dermatology Life Quality Index (DLQI), DLQI-Relevant (DLQI-R), and Skindex-29 in a cohort of patients with chronic skin disease. Participants completed the DLQI, Skindex-29, and Patient-Reported Outcomes Measurement Information System (PROMIS) measures at baseline and 3 months. Structural validity was assessed with confirmatory factor analysis; internal consistency with Cronbach's alpha; construct validity via known-groups comparisons and PROMIS correlations; informativity with Shannon's index; and responsiveness with standardized response means, Cohen's d, and change score correlations. Of 549 participants (mean age 37.8 years; 52.3% female), 406 (74.0%) completed follow-up. All instruments demonstrated high internal consistency (α ≥ 0.85) and no floor or ceiling effects. Skindex-29 domains demonstrated stronger structural validity and informativity compared to DLQI and DLQI-R. Construct validity was supported by expected associations with patient global assessment (PtGA) and PROMIS correlations. The DLQI, DLQI-R, and Skindex Symptoms and Emotions showed moderate responsiveness. The DLQI, DLRI-R and Skindex-29 demonstrated strong measurement properties in a heterogeneous cohort of individuals with chronic skin disease. Skindex-29 showed stronger structural validity and informativity, while the DLQI and DLQI-R demonstrated slightly greater responsiveness. Selection of PROM should depend on the intended clinical or research purpose. Chronic skin conditions, such as acne, eczema, psoriasis, and hidradenitis suppurativa, can affect many areas of daily life, including symptoms, emotional wellbeing, and social interactions. Physicians and researchers often use questionnaires, called patient-reported outcome measures, to better understand this impact from the patient’s perspective. Two of the most widely used in dermatology are the Dermatology Life Quality Index (DLQI), and the Skindex-29. A newer scoring approach to the DLQI, known as the DLQI-Relevant (DLQI-R), was developed to improve accuracy by adjusting how responses are scored when patients indicate that certain questions do not apply to them. In this study, we wanted to understand which of these questionnaires works best in people living with chronic skin conditions. We surveyed over 500 adults in the United States who reported having one or more skin condition. The participants completed the DLQI and the Skindex-29 at the start of the study, and again 3 months later. We found that the Skindex-29 provided a broader and more detailed picture of how skin conditions affect health-related quality of life. The DLQI and DLQI-R, on the other hand, were slightly better at detecting changes in health-related quality of life over time, although the differences between the questionnaires were small. These results show that no single instrument is best for all situations. The choice of questionnaire should depend on the purpose—whether the goal is to capture the full burden of disease, or to measure how much a patient improves with treatment.
To explore how patients can be actively engaged in medication adherence communication in a person-centered manner. A design thinking approach was applied, involving patients, next of kin, physicians, nurses, and pharmacists through workshops and individual interviews. Data was analyzed using reflexive thematic analysis. Two main themes were identified. The first, Reassurance as a foundation for person-centered communication about medication adherence, described adherence communication as a multi-layered and co‑constructed process. Reassurance was established through relational engagement and mutual trust, enabling patients to participate more openly and confidently in discussions about their medication use. The second theme, Healthcare professional as fellow human and expert, highlighted patients' need to be met "as a person" while simultaneously relying on the healthcare professional's expertise. Participants emphasized the importance of professionals who "know their stuff but speak my language" translating clinical knowledge into understandable, meaningful dialogue. A "reassuring mindset" where human and expert qualities converge, was identified as central to fostering patient engagement in adherence conversations. Reassurance was identified as a central enabling factor for engaging patients in medication-adherence communication. The findings emphasize that a synergistic combination of human connection and professional competence is essential. These results can inform the development of communication strategies and professional skills aimed at building partnerships in adherence. Further research should explore how reassurance can be operationalized in person-centered adherence interventions and its impact on treatment outcomes. Taking medications as prescribed is essential for managing chronic conditions, yet many people struggle to do so consistently. Less is known about how communication between patients and healthcare providers can support medication adherence. We wanted to understand what makes these conversations helpful and how patients can be actively engaged in them. We used a design thinking approach, conducting workshops and individual interviews with patients, their next of kin, and healthcare professionals (physicians, nurses, and pharmacists). We explored their experiences and perspectives on communication about medication adherence. Two key themes emerged. First, reassurance is central to enabling person-centered adherence communication. Reassurance involves feeling safe, understood, and supported, and is built through ongoing interactions between patients and healthcare professionals. Second, the healthcare professional’s dual role as both a fellow human and an expert is essential. Patients need to be seen as individuals, not just as patients, and they need clear, trustworthy guidance delivered in understandable language. Healthcare providers can support medication adherence by building trusting, person-centered relationships, not just by providing information. Combining empathy and professional expertise fosters the reassurance patients need to engage in their treatment. These findings have implications for training healthcare professionals and designing communication strategies for chronic care settings.
Physical inactivity during pregnancy remains a major public health challenge. Although many interventions have been shown to significantly increase physical activity (PA), their real‑world impact remains limited. Healthcare professionals represent a key lever for addressing this challenge, yet PA is still insufficiently promoted despite recognized health benefits. Embedding PA promotion into maternity care, particularly through midwives, appears promising, but how to ensure equitable implementation that supports informed decision‑making in practice remains unclear. This study therefore aims to better understand how behavioral determinants, professional PA promotion practices, and pregnant individuals' characteristics collectively influence decisions to engage in PA during pregnancy and to inform a framework for implementation. A mixed‑methods study was conducted in two maternity hospitals in Western Switzerland. Ninety‑five pregnant women completed a survey on their perceptions of PA communication across professions, and 16 participated in semi‑structured interviews. Additionally, 19 hospital‑based midwives were interviewed about their practices. Data collected in parallel were analysed separately using descriptive and inferential statistics, and thematic analysis informed by the Theoretical Domains Framework (TDF) and the Capability‑Opportunity‑Motivation‑Behavior (COM‑B) model. Integration of findings occurred after separate analyses using the Pillar Integration Process. Most participants were in their third trimester (76%), highly educated (79%), and followed by private obstetrician‑gynecologists (82%). Access to PA information often relied on women's own proactivity, with 37% receiving no information and 59% wanting more. Incomplete and non-spontaneous communication across professions negatively shaped women's PA decision‑making due to misbeliefs and negative emotions. Hospital‑based midwives frequently forgot or avoided the topic, especially when unconfident or perceiving low interest, due to limited training, procedures, and resources, contributing to inconsistent and inaccurate PA communication. Together, these insights informed a COM‑B‑based framework designed to strengthen hospital-based midwives' capability, opportunity, and motivation and promote spontaneous PA communication targeting knowledge, beliefs about consequences, and emotion to support tailored decision about PA during pregnancy. This study provides insights into how multilevel determinants shape access to PA information. It presents a theory‑driven framework to guide strategies for integrating systematic, spontaneous, and tailored PA communication into care to support informed decisions to engage in PA during pregnancy.
Emotion regulation is initiated when a goal to influence emotions is activated. The goals people pursue when regulating their emotions, however, may differ across cultures. We tested whether individuals from the United States and Japan differ in the goals they pursue in emotion regulation in daily life. In a preregistered ecological momentary assessments study (N = 221), we examined how Americans and Japanese students felt and how they wanted to influence their feelings in daily life. As predicted, Americans were more motivated to decrease their unpleasant emotions and increase their pleasant emotions than Japanese were, even when controlling for differences in experienced emotions. These effects replicated across arousal levels, though their strength varied. The findings demonstrate that the degree to which people want to make themselves feel better when regulating their emotions in daily life varies across cultures. The online version contains supplementary material available at 10.1007/s42761-026-00358-9.