to understand the experience of children/adolescents undergoing cancer treatment, their families and healthcare professionals with the educational book "Guia Beaba do Câncer". this is an exploratory, qualitative study, based on Symbolic Interactionism. Data collection was conducted online with nine children/adolescents with cancer, nine family members, and nine healthcare professionals. Semi-structured interviews were conducted, recorded, and transcribed, and analyzed using inductive thematic analysis. two categories emerged: 1) Reinterpreting words: enhancing children/adolescents' understanding of cancer with the educational book; and 2) "A watershed moment": the educational book as a way of connecting family members to the world of cancer and professionals with children. the educational book was recognized for its playful and accessible language, promoting the redefinition of experiences and symbols related to the experience of cancer, in addition to demystifying information, reducing negative reactions, and disseminating knowledge. comprender las experiencias de niños/adolescentes en tratamiento oncológico, sus familias y profesionales sanitarios con el libro educativo “Guia Beaba do Câncer”. estudio exploratorio cualitativo basado en el Interaccionismo Simbólico. La recopilación de datos se realizó en línea con nueve niños/adolescentes con cáncer, nueve familiares y nueve profesionales sanitarios. Se realizaron entrevistas semiestructuradas, que se grabaron, transcribieron y analizaron mediante análisis temático inductivo. emergieron dos categorías: 1) Reinterpretando palabras: mejorando la comprensión de los niños/adolescentes sobre el cáncer con el libro educativo; y 2) “Un momento decisivo”: el libro educativo como forma de conectar a los familiares con el mundo del cáncer y a los profesionales con los niños/adolescentes. el libro educativo fue reconocido por su lenguaje lúdico y accesible, promoviendo la resignificación de vivencias y símbolos relacionados con el cáncer, además de desmitificar información, reducir reacciones negativas y difundir conocimiento.
To evaluate whether a tactile-audio Chinese language book can function as an educational assistive technology for children with visual impairment by improving access to curriculum content, supporting comprehension, and enhancing user engagement. A mixed-methods case study was conducted across four phases: needs assessment, iterative product development, user testing, and implementation. Quantitative data included a questionnaire completed by 36 teachers from schools and organisations serving learners with visual impairment across nine Chinese provinces, and a repeated-measures comparison involving 12 visually impaired children (VIC) who used Braille-only materials, tactile graphics, and tactile-audio books. Qualitative data included field notes, design records, and semi-structured interviews with teachers, VIC, designers, and production partners. Teachers reported a substantial shortage of accessible graphic learning materials, with 97% identifying insufficient provision and 91.67% reporting inadequate standardisation. In student testing, the tactile-audio book outperformed Braille-only and tactile-only materials on learning cognition, graphic cognition, and learning interest. Qualitative findings showed that integrated tactile and audio cues improved recognisability, reduced uncertainty during exploration, and increased willingness to participate. Implementation data further indicated that product benefit depended on production quality, teacher mediation, audio access, and institutional support. The findings support the classification of tactile-audio curriculum books as educational assistive technology rather than supplementary teaching aids alone. Their value lies not only in the product itself, but also in the surrounding service system that enables selection, production, teacher use, and classroom integration. Educational tactile-audio books can be treated as assistive technology when they remove barriers to curriculum access for visually impaired children.Product effectiveness depends on the interaction between tactile design, audio support, production quality, and teacher-mediated implementation.Low-tech and mid-tech educational assistive products may offer scalable options in under-resourced contexts when service delivery is planned alongside product design.
Roland Pierik and Marcel Verweij, in their excellent book Inducing Immunity?, draw a distinction between 'best interest' and 'basic interest' and use such distinction as a criterion for legitimate state interference with parental choices, including in the case of vaccination. While protection of children's basic interests does provide a solid basis for the justification of state intervention in vaccination decisions, I want to offer some considerations and raise some questions about how the distinction between best and basic interest is conceptualized in the book, about some assumption on the relationship between freedom of choice and best interest that that distinction implies, and about some broader implications for discussion of child vaccination. I will conclude by raising a question about the justification for mandating vaccination within Pierik's and Verweij's ethical framework.
Assessing the study skills of medical students is crucial to understanding their academic preparedness. Effective learning skills are essential for mastering medical curriculum, and their development can influence academic performance. This study aims to evaluate the academic preparedness of the medical students, immediately after their admission using a structured assessment tool. This cross-sectional study was carried out on 250 first year medical undergraduates immediately after their admission. The academic preparedness of the students was assessed using the self-administered "Dennis-Congo Study Skills Inventory" (DCSSI). The study skills assessed through were text-book reading, note taking, memory, test-preparation, concentration and time-management. Data were tested for normality before applying test of significance. p < 0.05 was be considered statistically significant. The analysis included evaluating gender-based differences, study skill effectiveness and their relationship to NEET scores using unpaired t tests and Mann Whitney U test. Students exhibited maximum score in test preparation (47.94 ± 6.894). However, text book reading (29.64 ± 4.445), note-taking (17.67 ± 3.542) and time-management (19.44 ± 5.253) scores were lower among the students. Females showed a trend towards better note-taking skills habits. The group with higher scores above the NEET (National Eligibility and Entrance Test) median score reported better scores in concentration. The use of the Denis Congo Study Skills Inventory to assess medical students' academic preparedness offers valuable insights into their learning strategies and areas for development. The results emphasize the need for focused interventions to improve study habits and strengthen academic resilience.
In their recent book, Inducing Immunity (2024), Roland Pierik and Marcel Verweij develop an account of collective immunization according to which liberal-democratic governments are sometimes justified in restricting people's freedom to refuse vaccination. In this commentary, I focus on a specific argument in the book about misinformation, freedom of expression and mandatory vaccination. Pierik and Verweij argue that, when vaccine misinformation threatens vaccination rates, governments-in order to increase or maintain vaccination rates-should consider mandatory vaccination before restricting freedom of expression. I summarize the argument and raise two issues to help advance the debate.
There are two main ways in which a mandatory vaccination policy is often defended-by accusing vaccine refusers of 'free riding', or by appealing to the 'harm principle'. In their recent book, Roland Pierik and Marcel Verweij take the latter approach-an attractive option, as they note, due to the wide acceptance of the harm principle. But in arguing that vaccine refusal should indeed be thought to constitute harm, they end up endorsing a very controversial version of the harm principle, which we should not automatically expect to secure widespread support. Steven Smith suggests that this (common) argumentative strategy amounts to free riding on the reputation of the harm principle, and is an inevitable consequence of invoking the principle as the foundation of an argument. In its most basic form, the principle is hard to resist. But in order to use it to justify a policy, you need to make some assumptions about what constitutes harm, which will lose you supporters along the way. In appealing to the wide appeal of the harm principle, Pierik and Verweij do not adequately recognise the controversial nature of their claims, and thus the need for stronger and more elaborate arguments in their support.
Epigenetic alterations have emerged as central contributors to the pathogenesis, progression, and therapeutic response in cancer, and in this particular case, which we are discussing, myeloid malignancies. Unlike genetic mutations, epigenetic changes, like DNA methylation and histone modifications, are reversible and dynamic, and this book chapter aims to provide a comprehensive overview of the fundamental principles of epigenetic regulation and explores how these mechanisms are disrupted across different myeloid malignancies. We will examine disease-specific epigenetic landscapes and highlight the key alterations that occur within myeloid malignancies and discuss how such alterations can contribute to leukemogenesis and disease progression. Altogether, this chapter emphasizes the central role of epigenetic dysregulation in shaping the biology and clinical behavior of myeloid malignancies.
Hybrid technologies enable the blending of physical and digital elements, creating new ways to experience and interact with the world. Such technologies can transform engagement with relics-both secular and sacred-but they present challenges for capturing faith, belief, and representation responsibly. Given the complexities of digital representation and the ethical challenges inherent in digitising culturally significant objects, a transdisciplinary understanding of these issues is needed. To inform this discussion from a linguistic perspective, we examined the representation of relics in historical and contemporary texts. Using a corpus linguistic approach to extract modifiers of the word 'relic' in corpora of Early Modern English books and contemporary web-sourced texts from 2021, we examined the multifaceted ways in which relics have been perceived and evaluated over time. Early texts consider relics as both objects of moral and spiritual significance, and tools of religious and political control, while they are more often framed as heritage symbols, reflecting past events, places, and traditions in contemporary texts. We discuss how hybrid, sometimes AI-based technologies can enhance accessibility and engagement, whilst also challenging traditional sensitivities around authenticity and sensory experience, which are integral to the meaning and significance of relics. The online version contains supplementary material available at 10.1007/s42803-026-00120-4.
Patient narratives are foundational to diagnosis, yet clinicians frequently and unintentionally distort, minimize, or reinterpret these narratives during clinical encounters. These distortions - termed patient narrative distortion - are unmeasured contributors to diagnostic error [G.D. Schiff, O. Hasan, S. Kim, R. Abrams, K. Cosby, B.L. Lambert et al., Diagnostic error in medicine: analysis of 583 physician-reported errors, Arch Intern Med 169 (2009) 1881-1887; P. Croskerry, The importance of cognitive errors in diagnosis and strategies to minimize them, Acad Med 78 (2003) 775-780; H. Singh, A.N.D. Meyer, E.J. Thomas, The frequency of diagnostic errors in outpatient care, BMJ Qual Saf 23 (2014) 727-731; and M.L. Graber, N. Franklin, R. Gordon, Diagnostic error in internal medicine, Arch Intern Med 165 (2005) 1493-1499], emotional harm [J. Conway, F. Federico, K. Stewart, M.J. Campbell, Respectful Management of Serious Clinical Adverse Events, IHI Innovation Series White Paper, IHI, Cambridge, MA, 2011], and inequity [E.N. Chapman, A. Kaatz, M. Carnes, Physicians and implicit bias: how it affects clinical decision making, Acad Med 88 (2013) 354-360; and M. Marmot, R.G. Wilkinson (Eds.), Social Determinants of Health, 2nd ed., Oxford University Press, Oxford, 2005]. No existing safety tool captures the fidelity with which clinicians preserve patient stories [T. Greenhalgh, B. Hurwitz (Eds.), Narrative Based Medicine: Dialogue and Discourse in Clinical Practice, BMJ Books, London, 1998; and W. Levinson, D.L. Roter, J.P. Mullooly, V.T. Dull, R.M. Frankel, Physician-patient communication: the relationship with malpractice claims, JAMA 277 (1997) 553-559]. The stages at which narrative distortion emerges are illustrated in Figure 1. The objective of this article was to define patient narrative distortion as a measurable construct, develop a five-domain taxonomy, propose a scoring system (PNDI), and outline a workflow and validation strategy for clinical use. We conducted iterative conceptual modeling and structured synthesis of the diagnostic-safety and narrative-medicine literatures [G.D. Schiff, O. Hasan, S. Kim, R. Abrams, K. Cosby, B.L. Lambert et al., Diagnostic error in medicine: analysis of 583 physician-reported errors, Arch Intern Med 169 (2009) 1881-1887; P. Croskerry, The importance of cognitive errors in diagnosis and strategies to minimize them, Acad Med 78 (2003) 775-780; H. Singh, A.N.D. Meyer, E.J. Thomas, The frequency of diagnostic errors in outpatient care, BMJ Qual Saf 23 (2014) 727-731; and M.L. Graber, N. Franklin, R. Gordon, Diagnostic error in internal medicine, Arch Intern Med 165 (2005) 1493-1499] to identify core distortion modes, develop domain definitions, item-level anchors, and scoring thresholds. We propose a multi-phase validation plan including content validity, inter-rater reliability, construct validity, criterion validity, and responsiveness. The PNDI taxonomy includes five domains: Narrative Completeness Distortion, Meaning Substitution Distortion, Salience Distortion, Context Stripping Distortion, and Bias-Driven Distortion [E.N. Chapman, A. Kaatz, M. Carnes, Physicians and implicit bias: how it affects clinical decision making, Acad Med 88 (2013) 354-360]. Each domain includes 0-3 severity anchors and real-world clinical examples. The total PNDI score ranges from 0-15, with interpretation bands for narrative integrity and safety risk. Encounter-level, unit-level, and organizational-level workflows for implementation are outlined. The five-domain PNDI taxonomy is shown in Figure 2. PNDI operationalizes narrative integrity as a measurable dimension of diagnostic safety [The Joint Commission, National Patient Safety Goals: Improving Diagnosis in Health Care 2024-2026, The Joint Commission, Oakbrook Terrace, IL, 2024]. It provides clinicians, educators, and safety teams with a practical tool to detect narrative loss, reduce diagnostic error [G.D. Schiff, O. Hasan, S. Kim, R. Abrams, K. Cosby, B.L. Lambert et al., Diagnostic error in medicine: analysis of 583 physician-reported errors, Arch Intern Med 169 (2009) 1881-1887; P. Croskerry, The importance of cognitive errors in diagnosis and strategies to minimize them, Acad Med 78 (2003) 775-780; H. Singh, A.N.D. Meyer, E.J. Thomas, The frequency of diagnostic errors in outpatient care, BMJ Qual Saf 23 (2014) 727-731; and M.L. Graber, N. Franklin, R. Gordon, Diagnostic error in internal medicine, Arch Intern Med 165 (2005) 1493-1499], and strengthen patient trust [W. Levinson, D.L. Roter, J.P. Mullooly, V.T. Dull, R.M. Frankel, Physician-patient communication: the relationship with malpractice claims, JAMA 277 (1997) 553-559].
The development of electronic technologies capable of withstanding high-energy cosmic radiation is urgently needed to enable scientific exploration in increasingly extreme application scenarios, such as nuclear facilities, deep-space missions, and orbiting space stations. Conventional silicon-based integrated circuits (ICs) typically require additional radiation-hardening processes after design, resulting in structures that are more complex than standard devices. Moreover, many standard silicon-based ICs remain susceptible to total ionizing dose (TID)-induced degradation without dedicated hardening, leading to limited radiation tolerance. Consequently, the development of new materials, devices, and ICs with intrinsic radiation tolerance has emerged as a critical research frontier in recent years. Single-walled carbon nanotubes (SWCNTs) offer significant inherent advantages over conventional silicon-based technologies owing to their strong sp2 carbon-carbon bonds, one-dimensional quantum confinement, and minimal charge-trapping interfaces. This Review highlights the progress made at the Suzhou Institute of Nano-Tech and Nano-Bionics (SINANO), Chinese Academy of Sciences (CAS), in the development of semiconducting SWCNTs (sc-SWCNTs) as well as radiation-hardened SWCNT field-effect transistor (FET) devices and ICs. In this field, researchers at SINANO have also authored several books on carbon-based electronic materials, devices, and circuits, alongside publishing more than 200 papers and being granted more than 50 patents. Specifically, this Review covers the purification of sc-SWCNTs and single-chirality sc-SWCNTs by both commercial and self-designed conjugated organic compounds; the deposition of high-quality networked and aligned sc-SWCNT thin films on flexible and rigid substrates; and the design and fabrication of record-performance radiation-hardened SWCNT FET devices and ICs. Finally, the remaining challenges in sc-SWCNT materials, FET devices, and ICs for reliable radiation-hardened applications are discussed, followed by perspectives on future practical deployment in space and other nuclear extreme environments.
Gastric ulcer (GU), characterized by complex and multifactorial etiology, remains a prevalent gastrointestinal disease globally. The traditional Chinese medicine Astragalus membranaceus (Fisch.) Bunge is recorded in numerous ancient books such as "Shennong Bencao Jing", "Bencao Gangmu", "Yao Lei Fa Xiang", and "Zhenzhu Nang" to have the functions of tonifying qi, strengthening the spleen, harmonizing the stomach, and promoting ulcer healing. Astragalus membranaceus, a classical Chinese medicinal plant embodying the concept of "medicine-food homology," prominently features astragaloside IV (AS-IV) among its active pharmacological constituents. Accumulating evidence suggests AS-IV confers gastroprotective benefits in various experimental gastric injury models through mechanisms likely involving antioxidant, and anti-apoptotic effects. However, the specific molecular nodes through which AS-IV modulates its gastroprotective effects have not been fully defined. This experiment combined network pharmacology and transcriptomics to elucidate the underlying mechanisms of AS-IV in alleviating acute ethanol-induced GU in a rat and cell model. This investigation employed Sprague-Dawley (SD) rats subjected to ethanol-induced gastric injury and human gastric epithelial GES-1 cells to establish robust in vivo and in vitro GU models, respectively. Initially, we comprehensively assessed the protective efficacy of AS-IV on gastric mucosal lesions using diverse analytical techniques such as Hematoxylin and Eosin (H&E) staining, Alcian Blue-Periodic Acid-Schiff (AB-PAS) staining, Enzyme-Linked Immunosorbent Assays (ELISA), real-time quantitative PCR (RT-qPCR), immunohistochemical (IHC) analysis, and immunofluorescence (IF). Next, we identified essential molecular targets and signaling cascades influenced by AS-IV through integrated analyses encompassing network pharmacology predictions and transcriptomic profiling. Furthermore, the transcriptome further revealed five key molecular nodes (Ereg, Tnfsf11, Nr1d1, Socs3, IL-6β), from which we proposed the "triple imbalance - triple repair" model. Finally, in vitro and in vivo experiments verified the inhibitory effect of AS-IV on the EGFR-mediated PI3K/Akt/NF-κB signaling axis. Our in vivo findings revealed that AS-IV substantially ameliorated pathological manifestations in gastric tissues, markedly reduced inflammatory markers, alleviate oxidative stress, and decreased apoptotic cell death. Network pharmacology and molecular docking predicted EGFR as the key target. MD simulation and CETSA confirmed that there was a stable direct binding between AS-IV and EGFR. Transcriptomics analysis further identified five key molecular nodes on the EGFR/PI3K/Akt/NF-κB signaling axis - Ereg, Tnfsf11, Nr1d1, Socs3 and IL-6β. Both in vitro and in vivo experiments confirmed that AS-IV exerted a protective effect against ethanol-induced gastric injury by inhibiting the abnormal activation of the PI3K/Akt/NF-κB signaling pathway mediated by EGFR. AS-IV has a significant gastric protective effect against acute gastric injury induced by ethanol. Transcriptomics screening identified five key molecular nodes on the EGFR/PI3K/Akt/NF-κB signaling axis - Ereg, Tnfsf11, Nr1d1, Socs3 and IL-6β. Based on this, the "triple imbalance - triple repair" model was proposed. Experimental verification confirmed that AS-IV exerts anti-inflammatory and anti-apoptotic effects by inhibiting the EGFR-driven PI3K/Akt/NF-κB pathway. These findings provide valuable scientific basis for the development of new therapeutic strategies for gastric mucosal protection.
A cross-sectional study across 80 Anganwadi centres in Kolhan, Jharkhand, involving 146 participants (80 Anganwadi Workers, 27 pregnant women, and 39 lactating mothers), found that while take-home ration (THR) was universally distributed, only 42% of it was consumed exclusively by beneficiaries. Dietary shifts toward packaged foods, erosion of traditional practices, and limited THR awareness emerged as key barriers. Locally co-developed recipe books, training of 4600 Sahayikas, and live demonstrations during Village Health Sanitation and Nutrition Days and Annaprashan events improved THR adoption. Findings suggest that integrating indigenous food knowledge with frontline capacity-building can enhance the effectiveness of government nutrition programs in tribal areas.
Previous research on Debussy's Préludes has largely focused on harmony and texture, with tempo and rhythm receiving less attention and rarely being supported by quantitative analysis. This study investigates Canope (Préludes, Book II), a work whose impressionistic, Eastern-inspired soundscape is fundamentally shaped by layered tempo and rubato-driven rhythms. Using the visualization platform Vmus, we comparatively analyze 15 recordings (1953-2018) by pianists from French, Russian, Polish, German, and Chinese backgrounds. Macro-level tempo structures and note-to-note inter-onset intervals (IOIs) are examined to capture micro-temporal deviations and phrase-level flexibility, revealing interpretative nuances in rhythmic articulation. Our findings indicate that performances of Canope creatively reconstruct the score through temporal elasticity. A dual pattern emerges across both macro-level shaping and micro-rhythmic rubato: shared characteristics aligning with provisional artistic-tradition clusters, alongside individual idiosyncrasies that resist such categorization. Together, these elements shape the realization of Debussy's Eastern-inspired imagery. Contemporary trends reveal both cross-school integration and a shift toward personalized artistic expression, with individual deviations acting as sites of innovation and cross-tradition dialogue.
High-frequency trading now plays out at microsecond and even nanosecond granularity, and profitability is shaped jointly by adversarial market dynamics and by acute sensitivity to execution latency. Most existing frameworks, somewhat surprisingly, still treat these two pressures in isolation, leaving robustness and timing largely uncoupled. This study sets out to unify adversarial robustness training with latency-aware policy optimization inside a single strategy-design framework, hereafter referred to as MAGAT - a multi-agent game-theoretic adversarial trading system. Methodologically, MAGAT pits a Protagonist Agent - trained by multi-agent proximal policy optimization under centralized training with decentralized execution - against an Adversary Agent that searches for worst-case perturbations using gradient-free evolution strategies; the two roles alternate in a minimax loop whose fixed point is interpreted as an approximate, not certified, equilibrium, and the approximation is itself diagnosed by tracking the joint best-response gap. A Latency-Aware Reward Shaping (LARS) term penalizes aggressive orders in proportion to the logarithm of realized delay, while an FPGA, INT8-GPU, and kernel-bypass pipeline targets sub-700-nanosecond tick-to-order latency. Performance is assessed entirely through event-driven simulation: matching-engine replay over Level-3 LOBSTER limit order book data for three U.S. equities (AAPL, MSFT, INTC, 2022), with a configurable delay-injection platform reproducing uniform, Pareto, and bursty latency profiles. Across the four stress scenarios MAGAT sustains Sharpe ratios of 1.97-2.31 (95% bootstrap CI ± 0.06) and survival rates of 89-96% (± 2.1pp), against 1.18 and 69% for the strongest single-agent baseline; latency elasticity falls roughly fourfold (from 0.54 to 0.12) and the measured 99th-percentile execution latency stays near 683 nanoseconds. These results refer strictly to simulation and should not, on their own, be read as evidence of deployable live performance.
Transcriptional gene regulatory networks (GRNs) depict the directed relationships between regulators and target genes, determining gene expression patterns in a cell-type-specific manner. Single-cell multi-omics technologies, such as single-cell RNA sequencing (scRNA-seq) and single-cell Assay for Transposase-Accessible Chromatin using sequencing (scATAC-seq), enable high-resolution measurement of cell-type-specific gene expression and regulation in an unprecedented way. However, tools for inferring cell-type-specific GRNs and modeling their dynamics remain scarce. To facilitate the inference and analysis of cell-type-specific GRNs in contexts such as cellular development or disease progression, where cell lineage structure and dynamics are important, we developed a multi-task learning framework, single-cell Multi-Task Network Inference (scMTNI). scMTNI and its associated network analyses tools offer a comprehensive package to define cell-type-specific GRNs and examine their dynamics. This book chapter describes the scMTNI tool and demonstrates its application to an existing cellular reprogramming single cell multi-modal dataset to infer cell-type-specific GRNs and identify key regulators of cellular fate transitions during cellular reprogramming.
To map the available evidence on the assessment of migrant nurse and midwife workplace integration in global healthcare settings. Globally, migrant nurses and midwives are important resources in mitigating workforce shortages. Existing evidence focuses on the orientation stages of migrant nurse and midwife transition into the healthcare setting rather than their long-term workplace integration. The nine databases searched were CINAHL, Medline, Web of Science, Embase, PsycINFO, ASSIA, SicELO, Maternity & Infant Care and Global Index Medicus. An initial search was performed in December 2021 and updated in December 2025. A total of 91 articles were included, comprising qualitative (n = 48), quantitative (n = 13), mixed-methods (n = 6), others (n = 23) and one book chapter. Multiple definitions of workplace integration were found, and 23 tools were identified. Workplace integration, a multidimensional, time-dependent process, requires collaboration among stakeholders. A standard definition will help to clarify their responsibilities. Key factors ensuring successful integration include promoting effective communication, supporting knowledge advancement, facilitating career development and skill utilisation. The development of standardised interventions with flexibility for local adaptation will support successful workplace integration. Findings highlight the need for policy developers to support migrant nurses and midwives with interventions focused on linguistic challenges, cultural competence and differing care models, that are key to successful integration. Future research must include host stakeholders' perspectives to fully understand the dynamics of workplace integration.
Candida auris is a widely distributed yeast that is considered a dangerous pathogen, with reported mortality rates ranging from 30% to 60%. This yeast shows a high level of resistance to several antifungal agents commonly used to treat systemic infections. The pathogen persists on contaminated surfaces, tolerates hospital-grade disinfectants, survives desiccation and spreads easily through direct or indirect contact. It has been reported on all five continents and is increasingly prevalent in Europe. To determine the distribution and antifungal susceptibility/resistance of Candida auris isolates identified in Europe until January 2025. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Searches were conducted in EBSCOhost, MEDLINE/PubMed, Scopus and SciELO databases using the terms 'Candida auris' and 'Candidozyma auris', combined with the name of each European country. It was limited to English or Spanish articles published until 31 January 2025, excluding reviews, meta-analyses and book chapters. Ninety-one articles reporting antifungal susceptibility were retrieved, covering 2191 clinical isolates of C. auris from 16 countries. Most isolates were from Spain (n = 886, 40.44%), Italy (n = 553, 25.24%), Greece (n = 214, 9.77%), the United Kingdom (n = 182, 8.31%) and Russia (n = 108, 4.93%), accounting for 88.68% of cases. The remaining 248 isolates (11.32%) were reported across 11 other countries. Fluconazole resistance was found in 90.51% (1555/1718), while resistance to amphotericin B and echinocandins was 13.17% (223/1693) and 4.57% (76/1693), respectively. Candida auris has been predominantly detected in Southern Europe, where the majority of clinical isolates exhibit resistance to fluconazole. Consensus is essential for timely diagnosis, targeted treatment and infection control to prevent its spread. New therapeutic options must be explored to manage Candida auris.
Chronic low back pain (cLBP) is a leading cause of disability worldwide and is frequently refractory to pharmacological treatment. Mindfulness meditation has been shown to reduce pain through modulation of self-referential, cognitive and affective mechanisms. However, the neural mechanisms supporting the direct and immediate modulation of movement-evoked cLBP by mindfulness meditation as compared to an appropriate placebo-control remain poorly characterized. This single-center, sham-mindfulness meditation-controlled mechanistic clinical trial randomized 120 meditation naïve adults with cLBP to a six-session (20 min/session) mindfulness meditation, sham-mindfulness meditation, or book-listening control intervention delivered over two weeks. Perfusion fMRI was acquired at pre- and post-intervention timepoints during pain evocation with the leg raise test (LRT), a standardized orthopedic maneuver used to evoke low back and/or radiating leg pain in individuals with lumbar pathology. The primary outcome was change in whole-brain cerebral blood flow. Secondary outcomes included change in numerical pain ratings (0 = no pain; 10 = worst pain imaginable) corresponding to the LRT. Planned analyses include mixed-effects models examining group-by-time effects on behavioral and neuroimaging outcomes. By integrating a clinically relevant movement-evoked pain paradigm with perfusion-based neuroimaging and a matched sham meditation control, this trial will isolate mindfulness-specific neural mechanisms underlying pain modulation to inform the design of future efficacy-focused clinical trials. The study (ClinicalTrials.gov identifier: NCT03354585) was approved by the University of California, San Diego Institutional Review Board (IRB#181814). Written informed consent was obtained from all participants. At the time of manuscript submission, recruitment and intervention delivery were complete and data analyses ongoing. Study findings will be disseminated through peer-reviewed publications and scientific conferences.
Gender equity has become an important issue in academic medicine, but data on gender distribution in subspecialty medical societies remain limited. We analyzed gender distribution in membership, leadership positions, and conference participation in the Japanese Society for Hypothalamic and Pituitary Tumors (JSHPT). Membership data as of March 2025 (n = 860) were examined, and gender distribution among speakers and session chairs at the 36th Annual Meeting of the JSHPT was evaluated using the publicly available abstract book. Among all members, 128 (14.9%) were women. Women accounted for 6.6% of councilors and 5.6% of board members and auditors, and only one woman has served as Annual Meeting president among the first 36 annual meetings. At the 36th Annual Meeting, women represented 18.6% of presenters in general oral sessions, but only 5.0% of session chairs in general oral sessions and 3.7% of chairs in other sessions. Women also accounted for 36.4% of members with less than 1 year of membership. These findings suggest that, although women remain underrepresented in leadership positions within the society, female participation may be increasing among newer members, and women are actively participating as conference presenters. Continued efforts to increase opportunities for women to serve as session chairs and to encourage qualified women to apply for councilor positions may contribute not only to a more equitable academic environment, but also to the vitality and future leadership of the field.