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Surgical telementoring enables a remote expert surgeon (mentor) to guide an operating surgeon (mentee) during surgery and facilitates the transfer of surgical skills. However, commonly used audio and static visual cues are inadequate to demonstrate complex tool-tissue interactions. To overcome this limitation, dynamic augmented reality (AR)-based visual cues are overlayed on the operative field to demonstrate precise instrument movements. The objective of this work was to evaluate dynamic AR cues and identify the most suitable cue that effectively demonstrates the required motions of surgical instruments during laparoscopy. A user study was conducted in a simulated environment among mentor-mentee pairs using 3 dynamic AR cues (hand gestures, a 3D pointer, and a virtual tool). The task assessed how closely the mentee was able to follow the mentor. The outcomes measured were (1) dynamic time warping distance, representing the closeness of the paths followed; (2) angular error in tooltip orientation; and (3) the NASA Task Load Index, assessing cognitive workload during telementoring. Telementoring using the virtual tool resulted in a reduced dynamic time warping distance compared with hand gestures (P<.01 for 12/13, 92.3% of the trials) and the 3D pointer (P<.05 for 11/13, 84.6% of the trials). Lower orientation error was also noted while using the virtual tool as compared with hand gestures (P<.05 for 5 of 6 poses). There were no substantial differences in the NASA Task Load Index scores. Use of a virtual tool (as a dynamic AR cue) enabled the mentee to follow the mentor's instructions with fewer errors than both hand gestures and a 3D pointer without increasing cognitive workload. Further research is needed to assess the clinical effectiveness of the virtual tool during live surgery.

Cervical auscultation (CA), used an adjuvant to the clinical feeding examination by Speech-Language Pathologists (SLPs), has high sensitivity and reliability for detecting aspiration in neonates and children. CA can only be considered reliable if there are clear distinctions in the acoustic and perceptual swallow sound profiles between swallow sounds associated with and without aspiration. We aimed to determine whether the acoustic and perceptual swallow sound profile differs between swallows associated with and without aspiration in preterm neonates. We simultaneously recorded video and swallow sounds during videofluoroscopic swallow studies. We used the Penetration-Aspiration Scale to define aspiration. Acoustic parameters were obtained using a Python program. Two SLPs independently rated the presence/absence of perceptual parameters from 1&#xa0;s audio wavefiles. Differences between swallow types were analyzed using mixed linear regression modelling to account for clustered data, and a test of two proportions for acoustic and perceptual parameters, respectively. Penalized logistic regression analysis was used for perceptual sound predictors of aspiration. A total of 293 swallows (7 aspiration, 286 no aspiration) from 13 preterm neonates [69%; median birth gestation 31 (range&#x2009;=&#x2009;24-36 weeks)] were analyzed. There were significant differences between these two swallow types for both acoustic and perceptual swallow sound parameters. Combinations of perceptual sound parameters (wet/stridor pre-swallow sounds; quick, loud, initial discrete sound, bolus transit sound, final discrete sound, glottal release sound during swallow sounds; and wheeze post-swallow sounds were most predictive of aspiration (area under the curve, 0.82: 95%CI0.60-1.00). In conjunction with a clinical feeding examination, CA-obtained sound features can likely help guide SLP's evaluation of aspiration risk in preterm neonates.

To explore women's thoughts about and experiences with using period tracking apps, including their perceived benefits and harms. Qualitative phenomenological approach using semi-structured interviews with 32 women across Australia between the ages of 18-55 years who had used a period tracking app within the past year. Women were recruited via social media advertising. Audio recordings were transcribed verbatim and analysed thematically using Framework analysis. Findings were categorised into three overarching themes: 1) benefits of using a period tracking app, 2) harms of using a period tracking app, and 3) other described app limitations. While some women found value in having an accurate record of their cycle and experienced an increased sense of control and understanding of bodily cues, others received inaccurate predictions, alarmist notifications that they may have a disorder or were left with unmet expectations, highlighting app inaccuracies and the risk of overmedicalisation. Concerns were also raised around unethical advertising, paywalled information and data privacy. This study provides nuanced insights to the benefits and harms of period tracking apps for women in the Australian community. In addition to the benefits of having access and control over one's health information, and concerns about privacy, this study contributes novel findings about the risk of overmedicalising women's cycles through alarmist and sometimes incorrect app notifications, and how this impacts women's perceptions of and feelings about their bodies. Findings may be used by policy professionals to advocate for increased transparency, safety, and regulation of period tracking apps, as well as for health professionals to recognise the role period tracking apps may have in supporting women's needs but also the risks.

Genetic testing and counseling have become increasingly prevalent in breast cancer treatment with the advancement of precision oncology. Understanding patients' information-seeking experiences is essential for providing better genetic cancer services. However, these experiences are insufficiently understood. This qualitative study explored the information-seeking experiences during genetic testing and counseling of patients at high risk for hereditary breast cancer. Four focus group interviews were conducted with 17 breast cancer patients who had undergone genetic testing and counseling. Participants were purposively recruited from the National Cancer Center's outpatient clinic in South Korea. Data were audio-recorded, transcribed verbatim, and analyzed inductively using thematic analysis, complemented by a deductive approach informed by Lambert and Loiselle's Health Information-Seeking Behavior (HISB) framework. Three main themes, derived from 24 codes and seven subthemes, captured the characteristics of HISB: (1) type of information sought-stage-specific information needs, (2) amount of information sought-varied preferences for information amount based on coping with information load and uncertainty, and (3) preferred methods of information delivery-desire for clear, reliable, and supportive communication from providers. These findings highlight the need for personalized information delivery at each stage: core decision content before testing, and results-contingent plans after testing-all tailored to individual preferences and coping capacity for information load and uncertainty. This study underscores the critical role of empathic and clear communication from HCPs supported by supplementary materials in facilitating informed decision-making and improving outcomes for patients at high risk for hereditary breast cancer.

To explore the factors that affect communication about contraception and modern contraceptive use among first-time expectant mothers attending antenatal clinics in urban Accra, Ghana. A phenomenological qualitative study was conducted. In-depth interviews were conducted using a semistructured guide until data saturation was achieved. Interviews were audio-recorded and transcribed verbatim. Thematic analysis was performed, with data presented as narratives supported by quotes. The study was conducted at one polyclinic in the city of Accra, Ghana. Participants were 25 first-time expectant mothers who were attending antenatal care clinics. These were purposively sampled. The main outcome of interest was understanding the factors that affect first-time expectant mothers' communication about contraception and contraceptive use with their sexual partners. Secondary outcome was awareness/understanding about contraception and modern contraceptive methods. First-time expectant mothers reported varying levels of understanding about contraception and modern contraceptive methods. While majority reported hearing about contraception and modern contraceptives, only a few knew specific modern contraceptive methods. Information about modern contraceptives came from friends, media and midwives/nurses. As regards communication with their sexual partners about modern contraceptives, majority reported not being able to initiate any conversations. A few however reported open discussions. Key barriers to communication included women's inability to initiate discussions on contraceptive use due to traditional gender role expectations, fear of stigmatisation and religious objections. This study has highlighted that communication about contraception and modern contraceptive use among first-time expectant mothers is hindered by a complex interplay of barriers-gender role expectations, stigma and religious beliefs. These barriers hamper open discussions and informed decision-making about modern contraceptive use. To address these barriers, we call for targeted interventions to improve awareness and knowledge about contraception and modern contraceptive methods, engage both men and women in family planning education and programming, empower women to address gender inequalities and promote open dialogue and mutual decision-making among couples.

This study explores older adults' perceptions of the ageing experience in Trinidad and Tobago, and gains insight into their self-perceptions of ageing. A concurrent mixed-methods approach was utilized, targeting older adults living in Trinidad or Tobago. For this paper, only the qualitative component of the study will be discussed. Thirty-eight (38) participants engaged in six focus group discussions about their physical, mental, and social health and ageing experiences. The focus groups were audio-recorded and transcribed verbatim. The data were analyzed with MAXQDA software and themes found. Participants lived experiences were garnered from various aspects of their lives, including personal matters and cultural and societal influences with major themes such as ageism and disrespect, undesirable cultural norms, and fear of crime. Most themes reflected positive perceptions, including positive outlook on ageing, positive perceptions of one's health, enjoying retirement, satisfaction with available resources, and spirituality/religion. Negative experiences focused on the health system and in navigating financial challenges. The findings of our study show the need for a change in the framing of age and ageing at both the individual and societal level and shows the relevance of continued societal participation and adequate health care among older adults for a healthy ageing society. Multilevel and multisector efforts are required to reduce everyday ageism and promote positive beliefs, practices, and policies related to aging and older adults.

Spontaneous adverse drug reactions (ADRs) are underreported. Digital reporting systems are increasingly used to address this issue; however, limited knowledge exists about the barriers and facilitators influencing their use by consumers. To explore facilitators and barriers influencing consumers' use of digital tools for ADR reporting, and to identify the factors, expectations and preferences that affect their engagement with these tools. An exploratory qualitative descriptive study using semi-structured in-depth interviews was conducted among Australian adults who self-reported having experienced an ADR. Interviews were conducted face-to-face or via Zoom, audio-recorded, transcribed verbatim, and analysed inductively using reflexive thematic analysis. Themes were mapped onto domains of the Combined Technology Acceptance Model and Theory of Planned Behaviour (C-TAM-TPB) framework. Fourteen participants were interviewed. Consumers expressed positive intentions to use online ADR reporting tools. Identified facilitators included user-friendly and accessible tools that are simple to complete, the use of images to aid comprehension, integration with existing patient health records, the ability to submit reports to both healthcare professionals and regulators, and a tool designed specifically for consumers using layperson language. Identified barriers included lack of awareness that consumers could report ADRs using online tools, the need for registration, complex medical terminology, compulsory fields, and the absence of feedback after submission. Consumers were willing to use online ADR reporting tools but were largely unaware of their existence. Enhancing usability through user-friendly design, and reporting forms specifically designed for consumers may increase engagement. Addressing barriers such as lack of awareness, registration requirements, medical jargon, and lack of feedback may improve usability and contribute to strengthening pharmacovigilance systems.

Video-algorithmic patient monitoring (VAPM) combines remote, noncontact sensors and algorithmic analysis and is increasingly trialed in acute psychiatric and other care settings. While promoted for improving safety and reducing risk, it raises ethical concerns regarding safety, privacy and surveillance. Little is known about how those encountering VAPM in mental health care contexts anticipate its use and potential impacts, including where it has not yet been implemented. This study aimed to explore the views of patients or mental health consumers, specialized mental health nurses and nurse academics, hospital managers, and technology vendors regarding the appropriateness and anticipated implications of VAPM in mental health inpatient care. This qualitative study identified key stakeholders in Australia via networking techniques for participation in a deliberative workshop. A deliberative workshop was held, and the workshop discussion was audio-recorded, transcribed, and thematically analyzed, consistent with methods in health technology research, which enable exploration of different viewpoints, including convergences and divergences across stakeholder groups. In total, 16 stakeholders participated, exploring themes concerning (1) contestation over the rationale for VAPM in mental health settings, (2) VAPM reshaping care and relationships, (3) perceived harms of VAPM, (4) perceived observational support for safety and reduced disruption, (5) serious privacy implications of VAPM, (6) the need for appropriate governance, and (7) the potential for VAPM to transform, not augment, service delivery. General views differed across groups. Patients or service users expressed concerns about privacy, coercion, and the potential to intensify stigma. Mental health nurses were cautious but interested in possible benefits for safety and suicide prevention. Hospital managers and technology vendors largely emphasized safety gains. The findings suggest that the anticipated risks of VAPM are primarily experienced subjectively, as infringements on privacy, dignity, and trust, while purported benefits remain largely untested and unquantified. From a utilitarian perspective, direct comparison is therefore difficult-the risks are set out in the anticipated experiences of those with lived experience, and the benefits remain hypothetical. From this view, robust, independent evidence of real-world outcomes is required. Yet, for some participants, the very premise of such calculation was rejected, with privacy, dignity, and trust regarded as nonnegotiable, rather than items for trade-off. If VAPM is to be pursued at all, it should proceed only with extreme caution, with transparent evidence of outcomes, and with meaningful participation from those whose lives and care are most directly impacted.

to analyze caregivers' and health professionals' perceptions of interventions that promote self-care in stroke survivors. qualitative study within an interpretivist paradigm; we conducted nine interviews with family caregivers and three focus groups with health professionals. Data were collected in Angola (December 2024-January 2025), audio-recorded, transcribed, and analyzed using content analysis in webQDA&#xae;. central concerns include planning and continuity of individualized rehabilitation programs to ensure ongoing support, communication, and access to resources; training stroke survivors and their families for self-care management through information and education, prevention of self-neglect, and support for therapeutic regimen management; and training family caregivers to promote self-care and transition into the caregiver role. the findings clarify caregivers' and health professionals' perceptions of how self care is promoted among stroke survivors and yield recommendations for clinical practice and research.

Climate change is a global health emergency that affects both physical and mental health due to causes including heat stress, spread of vector-borne diseases, and nutritional deficiencies. As healthcare systems face growing demands, future healthcare professionals must be prepared to respond, adapt and support mitigation. This research aims to explore medical students' perspectives on climate change, perceived climate-health education gaps in medical curricula, and how climate action manifests in their professional identity as future physicians. A qualitative study using semi-structured interviews exploring the aforementioned topics of interest was conducted on 20 medical students in Singapore. Participants were recruited across all cohorts of existing students via convenience sampling. Interviews were audio-recorded, transcribed, and analysed using reflexive thematic analysis. Seven themes were identified: (1) awareness of climate change as a health determinant; (2) psychological responses towards climate change such as climate-related anxiety; (3) perceptions of climate change as important yet distant; (4) marginalisation and absence within medical education; (5) healthcare's dual role as contributor and responder; (6) tensions in professional identity and responsibility; and (7) calls for experiential, clinically integrated climate competence training. Collectively, these themes reflected strong recognition of climate-health links alongside uncertainty about professional roles and limited curricular integration. Medical students view climate change as clinically relevant but underrepresented in training. Embedding applied climate-health education and defining professional responsibilities within the curriculum may better prepare physicians for the evolving health challenges of a warming world.

To explore the perspectives of patients and healthcare researchers on their participation in clinical studies, in order to identify barriers and propose actions that promote more active, informed and equitable participation. Qualitative study with a phenomenological approach, based on a focus group technique. The session included five patients with experience in clinical trials and two oncology researchers. It was audio-recorded, transcribed verbatim, and analysed through thematic coding in three phases (open, axial and selective), following COREQ quality standards. Four main categories emerged: (1) the value of participation in clinical trials, with patients and professionals highlighting benefits such as safety, access to innovation, and knowledge generation; (2) the need for clear and adapted communication, pointing out the challenges of informed consent and the importance of trust-based relationships; (3) the key role of patient associations as intermediaries between the healthcare system and the community; and (4) the integration of a gender perspective, especially regarding conditions with a strong impact on young women. Structural, communicative and organizational barriers were identified. Active patient involvement in research improves the quality, relevance and equity of generated knowledge. Specific proposals are presented, including the creation of accessible information spaces, citizen participation channels and expert patient committees. These actions aim to promote more inclusive and person-centred research practices.

Background: More than three decades after the Bosnian war (1992-1995), its psychological consequences persist. While early post-war mental health outcomes have been extensively studied, little is known about the long-term psychological experiences of women who lost multiple family members.Objective: This study aimed to explore the current mental health status and lived psychological consequences of women from Srebrenica and surrounding regions who experienced multiple war-related losses.Methods: Two focus group discussions were conducted with 25 women. Audio-recorded data were transcribed, translated, and analysed using qualitative content analysis to identify central themes and subthemes.Results: Five overarching themes emerged: (1) enduring war trauma, loss, and emotional consequences; (2) justice, institutional responses, and systemic failures; (3) stigma and barriers to mental health care; (4) personal and everyday coping strategies; and (5) external support systems. Participants described persistent traumatic grief, chronic psychological distress, and ongoing somatic and emotional symptoms three decades after the conflict. Narratives revealed diverse coping strategies rooted in meaning-making, work, family, spirituality, and peer support. Institutional neglect, stigma, and limited access to mental health care were identified as major obstacles to recovery, whereas NGO-based and group-based interventions were experienced as particularly valuable.Conclusions: Thirty years after the Bosnian war, women survivors from Srebrenica and surrounding regions continue to live with profound and enduring psychological consequences of trauma and loss. Their narratives highlight the long-term nature of war-related suffering, the central role of social and institutional context, and the importance of culturally embedded, relational forms of support. These findings underscore the need for sustained, survivor-centered, and trauma-informed mental health services in post-conflict settings and contribute to a deeper understanding of long-term female survivor consequences following mass violence. Many women continue to live with the psychological consequences of war-related loss and trauma decades after the conflict.The experience of grief was characterized as unresolved and enduring, influenced by uncertainty and repeated encounters with loss.Women described everyday coping through work, family responsibilities, spirituality, and support from NGOs and peer groups.

Social disconnection is associated with all-cause mortality and multiple morbidities. Varying disconnection across caregiver generations may be explained by varying social technology use. Insight into social technology use across caregiver generations is lacking. To describe the experiences of caregiving and enhanced connectedness through social technology for three generations of family caregivers for chronically ill older adults. Guided by the Convoy Model, this qualitative descriptive study sampled caregivers of older adults with chronic illness across three age groups representing three generations. Three focus groups were conducted, audio recorded and transcribed. Life course and thematic analysis approaches were utilized. Consistent across generations, caregivers reported altered connectedness as part of their caregiving experience. However, the need for connectedness varied across generations as well as preferences for social technology. Theme variation for each group indicated distinct social expectations reflecting life course stages. Impact on future intervention development is discussed.

This study investigates how Chinese undergraduates cope with obstacles in learning English as a foreign language (EFL). Drawing on coping theory and self-regulated learning theory, the study analyzed survey and open-ended response data from 1528 freshmen and sophomore students at seven universities across eastern, southern, western, northern, and central China. The analysis focused on students' reported coping strategies across eight EFL learning areas: listening, speaking, reading, writing, pronunciation, grammar, vocabulary, and cultural knowledge. The findings identified 24 recurring strategy types. Listening and speaking were the most frequently reported challenge areas, with students commonly reporting strategies such as using English audio-visual media, creating speaking opportunities, thinking directly in English, comparing English and Chinese language forms, reading extensively, and building self-created English cultural environments. The findings show that Chinese undergraduates' coping behaviors combine cognitive, metacognitive, social, affective, and self-regulated learning strategies. The study contributes large-scale, multi-site evidence to a research area often dominated by single-skill or small-scale studies. Pedagogically, the results suggest that Chinese university English instruction should include explicit, skill-specific strategy training and provide more opportunities for authentic language use.

Breastfeeding offers significant health benefits for mothers and infants, but global breastfeeding rates continue to fall short of the World Health Organization's goals. Migration presents additional challenges that influence breastfeeding practices. This qualitative study explored the lived breastfeeding experiences of Black African immigrant women before and after migration, identifying key facilitators and barriers to breastfeeding. Using an interpretative phenomenological approach, we recruited five participants between August and October 2024 through purposive and snowball sampling. Semi-structured interviews were audio-recorded, transcribed, and analyzed using interpretative phenomenological analysis. Data was managed using Microsoft Word and Excel. Rigour was ensured through member checking, peer debriefing, and reflexive journaling. The Behavioural Research Ethics Board of the University of Saskatchewan granted ethics approval. Five themes emerged: (a) positive breastfeeding experiences and maternal satisfaction, (b) family and community support, (c) cultural practices and societal acceptance, (d) healthcare support and access to resources, and (e) barriers and challenges to breastfeeding. Although the first three themes relate to overall breastfeeding experiences, the fourth and fifth themes highlight critical facilitators and obstacles. Migration introduced barriers such as cultural transitions, navigating healthcare systems, language barriers, and social isolation. Despite these barriers, the women demonstrated resilience, drawing on traditional knowledge and community support to continue breastfeeding. This study underscores the need for culturally sensitive support services and healthcare interventions that empower Black African immigrant women to overcome breastfeeding challenges in Canada and promote positive health outcomes for mothers and children.

Focused attention (FA) and open monitoring (OM) are distinct mindfulness practices that produce unique psychological effects. Prior research has frequently investigated the neural correlates of FA and OM states utilizing electroencephalographic (EEG) methods, focusing on changes in spectral power within theta and alpha bands. Yet the functional significance of these neural changes has remained unclear. Here we utilized a fully within-subject state induction protocol to more directly test whether EEG spectral power during FA and OM is differentially associated with subjective ratings of state mindfulness. While continuous EEG was recorded, participants engaged in eyes-open audio-guided FA and OM practices, as well as an active control condition (C), and then self-reported their state mindfulness afterwards. Linear mixed-effects models were used to rigorously assess how condition-level variation in spectral power predicted state mindfulness scores across the three inductions. Validating the approach, participants reported higher state mindfulness and decreased theta power during both FA and OM relative to C; additionally, reduced alpha power was found in OM relative to FA. Most importantly, increased theta power was associated with higher state mindfulness in FA and even more strongly in OM, whereas reduced alpha power was linked to higher state mindfulness selectively in OM. These findings add to the growing literature suggesting that FA and OM represent distinct mindfulness states. We further establish that the functional significance of theta and alpha power is context-dependent, clearly linking these neural measures to the subjective quality of specific meditation states and practices. The online version contains supplementary material available at 10.1007/s12671-026-02850-6.

Despite the introduction of the Maternal Death Surveillance and Response (MDSR) program in Malawi in 2002, preventable maternal deaths remain a significant concern. Malawi's maternal mortality ratio (MMR) declined from 439 deaths per 100,000 live births in 2015 to 224 in 2024 (MDHS 2024) but remains well above the Sustainable Development Goal target of fewer than 70 deaths per 100,000 live births by 2030. In 2023/2024, Mwanza District Hospital recorded nine alarming maternal deaths. This study explored midwives' experiences in maternal death identification, notification, and reporting within the MDSR cycle. An exploratory descriptive qualitative design was employed. Nineteen purposively selected midwives participated in semi-structured audio-recorded interviews. Data were analyzed thematically following Braun and Clarke's six steps, supported by NVivo 12 software. Ethical approval was obtained from the College of Medicine Research Ethics Committee (P.10/23-0358). Midwives identified challenges across all stages of the MDSR cycle. During identification and notification, psychological distress and cross-border care complexities hampered accurate reporting. In the review and analysis stage, inconsistent documentation, weak coordination, and a prevailing culture of blame limited open discussion and learning. In the response and action stage, follow-up was fragmented, and fear of punishment discouraged active participation. In the monitoring and evaluation stage, feedback loops were weak, and lessons from reviews were not consistently shared with frontline providers, undermining system-wide improvement. Midwives at Mwanza District Hospital experience significant emotional strain and systemic barriers in executing MDSR responsibilities. Strengthening support for timely identification and notification, promoting a blame-free culture in reviews, ensuring structured follow-up actions, and reinforcing feedback mechanisms are critical to improving maternal death surveillance and response. Organizing midwives' experiences through the MDSR cycle highlights key intervention points. Addressing gaps in identification, review, response, and monitoring can enhance both provider well-being and system accountability, ultimately contributing to the reduction of preventable maternal mortality in resource-limited settings.

Age-related changes in cognitive function and social participation can jointly affect well-being in later life. Digital delivery models may provide a practical approach for supporting older adults, yet reproducible protocols that integrate cognitive training with structured online social participation remain insufficiently described. This article presents a protocol for a four-arm randomized controlled study designed to examine the implementation of a dual-platform digital intervention delivered over 12 weeks. The intervention includes a web-based Virtual Learning Environment (VLE) for adaptive cognitive training and a moderated Online Social Platform (OSP) for guided peer interaction. The protocol describes participant recruitment and screening, digital onboarding procedures, intervention scheduling, adherence monitoring, and safety governance for remote participation. Outcome collection includes measures of global cognitive performance, processing speed, loneliness, and social participation, together with process indicators relevant to protocol implementation. Representative findings are included to illustrate platform uptake, retention patterns, and expected outcome trajectories across study arms. These findings are preliminary and are presented to demonstrate protocol implementation rather than to establish clinical efficacy. This protocol may support researchers and practitioners seeking to replicate or adapt remote, multi-component digital interventions for older adult populations.