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The use of measurement-based care (MBC) can significantly improve outcomes for patients, including symptom reduction, improved functioning, and quality of life. However, existing barriers can lead to low implementation rates, especially among first responders, military personnel, and Veterans (FRMV). Overcoming barriers and identifying ways to measure implementation using aggregate data is the next step in integrating MBC into mental health care. This article outlines the current state of MBC implementation at a mental health and addictions hospital in Canada. Aggregate data provided by an online MBC platform were used to review clinical outcomes (Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, PTSD Checklist for DSM-5, and Working Alliance Inventory-6) and implementation rates (patient adoption and continuous engagement) of a Guardians program tailored for FRMV and compare these outcomes with benchmarks of Canadian and U.S. organizations. Clinical outcomes and MBC implementation rates for the program exceeded national median benchmarks. Patient adoption and engagement increased between 2022 and 2023 and dropped in 2024. Results suggest that the program was aligned with patients' clinical needs and addressed hospital needs for a MBC system because patient adoption and engagement exceeded national benchmarks. The consistent rise in patient participation since the implementation of MBC reflects the system's relative success, although barriers such as limited familiarity and staff capacity likely persist. Future work addressing barriers through organizational training and MBC champions may enhance implementation. The complex treatment needs of FRMV underline the importance of evaluating the integration of MBC into programming for this population. During mental health treatment, it can be difficult to objectively determine whether an individual is doing better and whether the treatment is actually working. Measurement-based care (MBC) can support this. It allows the clinician to use the same survey tools at different points in treatment to measure how the patient is doing and whether they are feeling better as treatment progresses. The implementation of MBC can be challenging and comes with barriers. Furthermore, evaluating the implementation of MBC can also be difficult. This article describes how one organization implemented MBC and the outcomes seen across a program tailored to first responders, military personnel, and Veterans, who have unique mental health needs. Using outcomes produced by a MBC system, promising results were found, suggesting that the program was aligned with the clinical needs of this unique population and that patients were engaging well with the MBC system compared with other organizations in Canada and the United States. Finally, various challenges to implementing MBC and strategies to overcome these barriers at the organization were discussed. Le recours à des soins fondés sur des mesures (SFM) peut améliorer considérablement le pronostic des patient.e.s, y compris la réduction des symptômes, l’amélioration du fonctionnement et la qualité de vie. Cependant, les obstacles actuels peuvent être responsables d’un faible taux d’adoption, particulièrement chez les premiers.ères répondant.e.s, le personnel militaire et les vétéran.e.s (PRMV). La prochaine étape pour intégrer les SFM aux soins en santé mentale consistera à surmonter les obstacles et à déterminer les moyens d’en mesurer l’adoption à l’aide de données regroupées. Cet article expose l’état actuel d’adoption des SFM dans un hôpital canadien spécialisé en santé mentale et en toxicomanies. Des données regroupées fournies par une plateforme en ligne sur les SFM ont permis d’examiner les résultats cliniques (Questionnaire sur la santé du patient-9, Trouble anxieux généralisé-GAD 7, critères de TSPT du DSM-5 et questionnaire de l’alliance thérapeutique-6) et les taux d’adoption (adoption par les patient.e.s et participation continue des patient.e.s) d’un programme de tuteurs.rices adapté aux PRMV et de comparer les résultats aux normes des organisations canadiennes et américaines. Les résultats cliniques et les taux d’adoption des SFM du programme ont dépassé les normes médianes nationales. L’adoption par les patient.e.s et la participation des patient.e.s ont augmenté entre 2022 et 2023 et diminué en 2024. Selon les résultats, le programme répondait aux besoins cliniques des patient.e.s et aux besoins de l’hôpital à l’égard d’un système de SFM puisque l’adoption des patient.e.s et leur participation dépassaient les normes nationales. La hausse régulière de la participation des patient.e.s depuis l’adoption des SFM reflète la réussite relative du système, même si selon toute probabilité, des obstacles comme les connaissances limitées et les capacités du personnel se maintiennent. De futurs travaux pour vaincre les obstacles par des formations au sein de l’organisation et la présence de porte-parole des SFM pourraient améliorer l’adoption de ce programme. Les besoins thérapeutiques complexes des PRMV font ressortir l’importance d’évaluer l’intégration des SFM aux programmes offerts à cette population.

Corporate entrepreneurship (CE) and work engagement (WE) are well-established topics in the literature; however, little is known about the psychological processes through which a CE ecosystem shapes employee engagement. Specifically, no prior studies have explained this relationship in terms of psychological need satisfaction. In addition, the millennial workforce, characterized by distinctive values and work preferences, has received limited attention in CE research. To address these gaps, this study applies self-determination theory (SDT) to examine how satisfaction of basic psychological needs accounts for the link between a CE ecosystem and millennials' WE. We employed a convergent parallel mixed-methods design, independently and concurrently collecting primary data through semi-structured interviews with HR professionals from ten organizations in India and survey responses from 233 millennial employees within these organizations. The qualitative data were analyzed using thematic analysis, while the quantitative data were examined using regression, path, and effects analyses to test the proposed conceptual framework. The findings indicate that a CE ecosystem is positively associated with millennials' WE. This relationship is fully mediated by satisfaction of the needs for autonomy and competence, two core dimensions of SDT. The results suggest that organizations seeking to improve engagement and retention among valued millennial employees may benefit from implementing CE ecosystems that are deliberately designed to satisfy these psychological needs, with positive implications for both individual and organizational performance. The study's theoretical, empirical, methodological, and practical contributions are discussed.

Despite targeted health reforms, differences in healthcare access, utilization, and mortality have persisted between American Indian and Alaska Native (AI/AN) and non-AI/AN people and within the AI/AN population. Using the 2015-2019 Medical Expenditure Panel Survey Household Component (MEPS-HC), we examined healthcare access, utilization, and care experiences for AI/AN people relative to non-AI/AN people and disaggregate the AI/AN population by race (ie, single race and one or more races) and ethnicity (ie, Hispanic and non-Hispanic). We found that AI/AN people had a lower probability of at least one dental and ambulatory visit annually than non-Hispanic White people. Conversely, non-Hispanic AI/AN people were more likely than non-Hispanic White people to have at least one emergency-department (ED) visit. Non-Hispanic AI/AN people who reported multiple races had higher rates of delayed or unmet needs due to cost than non-Hispanic White people. People solely identifying as AI/AN reported worse care experiences, and non-Hispanic AI/AN people rated their healthcare lower than non-Hispanic White people. Our findings highlight the importance of efforts to improve healthcare access and care experiences of AI/AN people and shed light on how decisions about disaggregating race and ethnicity may affect study results.

Adolescents today are undergoing physical, emotional, and social changes to grow up as healthy and productive individuals. They have very specific needs that must be met, chief among which is sexual reproductive health information. However, even when information is supplied to adolescents, much of the information can be incorrect or even be used to encourage adolescents to practice sexual health adversely. It is thus the aim of this study to assess the level of knowledge, attitudes, and perceptions that adolescents have with regard to sex education and to assess the impact of a specific sex education program in the rural and urban settings of Varanasi, India. The study was conducted using a single-group, pre-post interventional approach. A total of 370 adolescents (11-18 years) studying in schools and colleges of rural and urban areas of Varanasi, Uttar Pradesh, were selected as the study population. The present study assessed adolescents' baseline sexual health knowledge and their attitudes and perceptions regarding sex education and examined the immediate changes in these outcomes following a structured sex education session. A single session of sex education was conducted for the study participants after 60 minutes of baseline questionnaire, and the same questionnaire was administered to them immediately after the intervention.&#xa0;Paired comparisons were made using appropriate statistical tests. The findings were further summarized to reveal that 70.0% of the adolescents studied had low knowledge of sex education, 41.4% had a low attitude towards sex education, and 61.1% had a low perception of sex education. However, all these scores indicated significant improvement in the knowledge, attitude, and perception (KAP) of the adolescents towards sex education following the intervention. The mean knowledge scores on sex education increased from 1.75&#xb1;1.20 at the baseline to 4.53&#xb1;0.85 at the end line. Similarly, the mean scores for attitude towards sex education increased from 3.59&#xb1;1.60 at the baseline to 5.11&#xb1;0.90 at the end line. The mean scores for perception on sex education increased from 1.38&#xb1;1.01 at the baseline to 2.20&#xb1;0.86 at the end line. The overall mean KAP scores increased from 6.72&#xb1;2.61 at the baseline to 11.84&#xb1;1.85 at the end line, with a mean gain of 5.11 points (95% CI: 4.79-5.44; p<0.001). The awareness of the adolescents regarding issues such as awareness of the lesbian, gay, bisexual, and transgender (LGBT) community increased from 9.2% at the baseline to 84.1% at the end line. Thus, there was a significant change in KAP of adolescents with regard to sex education through the said intervention. The findings of the study would help in promoting and integrating into the school and college curriculum of the country, in general, and the state of Uttar Pradesh, in particular, sex education programs that are culturally appropriate to equip adolescents to make informed decisions regarding their sexual and reproductive health.

Women are increasingly delaying childbearing and utilizing assisted reproductive technology to achieve pregnancy. As the demand for reproductive endocrinology and infertility (REI) care increases, there is potential for sharing responsibility for fertility counseling and care with generalist obstetrics and gynecology physicians (OB/GYNs). The American College of Obstetrics and Gynecology (ACOG) recommends discussing reproductive plans during annual visits; however there are concerns about the feasibility of guideline implementation due to the comprehensive nature of these visits. The purpose of this study was to explore whether OB/GYN generalists at our outpatient clinic are addressing patients' needs for fertility counseling. An Institutional Review Board (IRB)-approved electronic survey was distributed by Quick Response (QR) code on exam room posters at our clinic between April 1 and August 30, 2024 with a $5.00 gift card incentive. Of the 166 patients who met inclusion criteria, the minority of patients (33%) responded "yes" when asked, "In the last two years, did you discuss your fertility with an OB/GYN at an annual/routine visit?" Those who had not discussed their fertility with their OB/GYN were significantly more likely to be under age 32 than 32 or older (80% vs. 20%). The majority of patients (64%) who had not discussed fertility responded "yes" when asked "Would you like to discuss fertility at annual visits?" These findings suggest that generalist OB/GYNs may not be meeting the needs of patients, particularly younger patients, who desire fertility counseling. Concerningly many patients are obtaining information on fertility from sources other than their clinicians.

Black adolescents differ from adolescents of other racial/ethnic groups in prevalence, patterns, risk and protective factors, and consequences of substance use, underscoring the need for culturally tailored interventions. Black adolescents also experience unique barriers in access to interventions that may be amenable to digital interventions. However, based on available literature, no systematic review has examined the efficacy of culturally tailored digital interventions for substance use prevention among Black adolescents. Here, existing culturally tailored digital interventions for substance use prevention among Black adolescents were systematically reviewed, and their efficacy in preventing substance use was examined. A systematic search of biomedical research databases was conducted. Search terms included controlled vocabulary terms and free text terms for concepts of digital interventions, substance use, and clinical trials. Randomized controlled trials comparing a culturally tailored intervention for Black adolescents with a control intervention were included. The level of cultural tailoring (surface- vs deep-level tailoring) was determined, and the impact of interventions on substance use outcomes was assessed. The quality of studies was evaluated using the National Institutes of Health tool for quality assessment of controlled intervention studies. A narrative synthesis summarizing results by study characteristics, intervention characteristics, and study outcomes/findings was also conducted. Eleven articles comprising 6 studies testing 6 interventions met inclusion criteria. The proportion of Black adolescents varied among studies from 41% to 100% (n = 109-421). Four interventions significantly improved overall substance use outcomes with effect sizes ranging from 0.002 to 1.5 for alcohol use, 0.11 to 1.57 for marijuana use, 0.002 to 0.64 for tobacco use, and 0.009 to 0.35 for other drugs. Five interventions also improved antecedents to substance use (eg, self-efficacy, intentions to use drugs, parental monitoring). Effects persisted at long-term follow-up (&#x2265;12 months) among 75% of interventions that examined these outcomes. Cultural tailoring varied widely among interventions, with 4 studies reporting surface-level adaptations, 1 study reporting deep-level adaptations, and 1 study reporting both surface- and deep-level adaptations. Cultural tailoring largely focused on intervention content, with only 2 studies describing additional tailoring at the implementation level. One study assessed the impact of cultural tailoring on intervention outcomes. Interventions were tested in various settings, including community (2 studies), home (1 study), school (1 study), emergency department (1 study), and primary care (1 study); were delivered using a CD-ROM/computer (5 studies) or videotape (1 study); and comprised different types of interventions, including universal (4 studies), selective (1 study), and indicated (1 study). Although the number of available studies is limited, culturally tailored digital interventions appear to be effective at improving substance use outcomes among Black adolescents and have been tested across various settings. However, the impact of cultural tailoring is challenging to isolate, given the wide variability in the description of culturally tailored content, the lack of homogeneity in the study samples, and the lack of evaluation of the effect of cultural tailoring on intervention outcomes. Given rapid advances in digital technologies and the pressing need to curtail the rise in substance use among Black adolescents, it is imperative to design, test, and implement digital interventions that meet the needs of Black adolescents. Culturally adapted digital substance use interventions for black adolescents: a systematic review; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023452522. This systematic review examined studies that tested whether digital interventions (eg, online, computer, or mobile phone apps) designed for Black adolescents were effective in improving substance use outcomes. It also examined ways in which each of these interventions were tailored for Black adolescents. Despite the limited number of available studies, the results show that culturally tailored digital interventions may be effective at improving substance use outcomes in Black adolescents across various settings.

Community Engagement and Outreach (CEO) Cores are a key component of the IDeA Clinical and Translational Research (IDeA-CTR) Program, serving to develop and implement capacity-building initiatives that empower communities to engage and collaborate with investigators in community-engaged research. To strengthen collaboration and shared learning across sites, a CEO Special Interest Group was established. In 2022, the group conducted a landscape analysis to systematically characterize and categorize CEO Core activities across the IDeA-CTR network, with a focus on capacity-building efforts related to knowledge transfer, co-learning, and infrastructure development. The analysis revealed several common approaches to community engagement and capacity building across sites, as well as distinctive strategies tailored to the specific needs and communities served. Multiple innovative practices were identified and disseminated across the network, highlighting opportunities to enhance collective impact and inform future community-engaged efforts.

The experiences foster caregivers have while providing care are linked to important outcomes including placement stability for the child and foster caregiver retention within the child welfare system. Understanding the expectations prospective caregivers have about fostering, and how this compares to their lived experience while fostering, is important for building realistic expectations and addressing unmet needs. The current study used a phenomenological approach through semi-structured qualitative interviews with 45 foster parents (71% female) to assess their recollections of what they had expected fostering to be like, and their thoughts about their fostering experiences to date. Inductive coding revealed positive, negative and neutral expectation and experience themes, as well as a "no expectations" theme, with several subcodes within each. Participants were mixed in terms of whether they agreed their experience had matched their expectations. While a subset of foster caregivers felt their expectations were in alignment with what their lived experience fostering has been, many felt that there were multiple experiences they had not expected, both positive and negative. The themes revealing unmet expectations as well as unforeseen negative experiences have implications for foster care licensing agencies, who can work to assess and develop appropriate expectations for prospective caregivers.

Successful and responsible innovation in neurotechnology requires clear ethical priorities and a deep understanding of individual and societal needs as well as public concerns. Recent cases of consumer exploitation, misleading claims, and inadequate patient aftercare reveal critical gaps in current practices and underscore the urgent need for more ethical, transparent, and user-centered engagement in this rapidly developing field. This study focuses on four complementary domains: (1) neuroethics and embodiment; (2) the cultural embedding of neurotechnologies; (3) art and culture in relation to neurotechnology; and (4) human enhancement, technovisions, and sociotechnical imaginaries. Across these domains, the manuscript explores user and societal perceptions, highlighting often overlooked asymmetries in communication between scientists and entrepreneurs and those who ultimately receive research outcomes in the form of products. Drawing on the authors' multidisciplinary expertise and a synthesis of the relevant literature, the manuscript outlines a possible foundation for developing more balanced, inclusive and symmetric communication formats that empower stakeholders regardless of status or expertise. Integrating insights from neurotechnology with applied ethics, the humanities, social sciences, technology assessment and the arts, this work seeks to contribute to a broader understanding of the societal and individual impacts of emerging neurotechnologies and to support the protection and empowerment of users by prioritizing their needs.

Urban waterways are reservoirs and vectors of antimicrobial resistance (AMR), yet AMR is not routinely measured alongside faecal indicator bacteria. Using 2 years of data on Escherichia coli and AMR in a New Zealand urban river, we tested how AMR quantification could improve water quality risk assessment. Persistently high frequencies of AMR and pathogenic E. coli sequence types were detected near homes and places of recreation. We measured AMR phenotypes and gene mobilisation by conjugation. We compared phenotyping with genotyping by whole-genome sequencing to assess whether phenotyping could serve as a proxy for costly sequencing methods. Results suggest that one AMR phenotype could act as a sentinel for less common but problematic resistances, potentially due to plasmid-based linkage of antibiotic resistance genes or enrichment of clinically relevant sequence types. The study offers a low-cost water quality monitoring strategy to meet community needs. Widespread adoption of AMR hazard reporting could support the World Health Organization's Sustainable Development Goals and Global Action Plan on AMR.

Programmed cell death (PCD) encompasses multiple regulated processes, including apoptosis, pyroptosis, ferroptosis, and necroptosis. These pathways form an interconnected network that contributes to the pathogenesis of cardiovascular diseases (CVDs), including atherosclerosis and myocardial ischemia-reperfusion injury. This review highlights cell-type-specific PCD signatures, showing that endothelial cells predominantly undergo pyroptosis and ferroptosis, whereas macrophages exhibit multiple PCD modalities and complex pathological crosstalk. Moreover, the review systematically summarizes key regulatory pathways (e.g., Piezo1 [Piezo-type mechanosensitive ion channel component 1]/NLRP3 [NOD-like receptor family pyrin domain containing 3], and Nrf2 [nuclear factor erythroid 2-related factor 2]/HO-1 [heme oxygenase 1]/GPX4 [glutathione peroxidase 4]), as well as multi-target natural compounds (e.g., melatonin and Guizhitongluo Tablet) that show translational promise and advantages in modulating PCD networks. The review also provides critical insights into major bottlenecks in clinical translation, including nonspecific tissue distribution and the lack of pathway-specific biomarkers. Novel solutions, such as cardiomyocyte-specific delivery systems (e.g., CD47-targeted lipid nanoparticles) and validated biomarkers (prostaglandin-endoperoxide synthase 2 [PTGS2] for ferroptosis), are also proposed. Overall, this review advances our understanding of PCD network regulation in CVDs and proposes innovative precision therapeutic strategies that align with the evolving needs of cardiovascular translational medicine.

In recent years, there have been significant advances in both theoretical knowledge and technological applications in cardiac intensive care, a crucial area of cardiovascular medicine. This study methodically outlines the most recent developments in the field's research, including new understandings of pathophysiological mechanisms, advancements in monitoring technology, improvements to prognostic evaluation systems, and optimization of therapeutic approaches. The article emphasizes cutting-edge advancements like artificial intelligence-assisted decision-making systems, microcirculation monitoring tools, and precision medicine approaches, which are customized to individual patient needs by combining evidence from basic research and clinical practice. Precision medicine in the cardiac intensive care unit (CICU) is described in this review as a reactive, patient-centered approach that uses real-time clinical, molecular, imaging, and hemodynamic data to customize acute therapeutic and monitoring interventions for critically ill cardiac patients with complicated, frequently multi-organ pathophysiology. Despite tremendous advancements, there are still difficulties in ensuring individualized care and converting these developments into standardized clinical procedures. In order to promote the development of standardized therapy and customized medical practice in this developing field, this thorough overview attempts to provide researchers and doctors with up-to-date information on cardiac intensive care.

There is growing focus on community-engaged research (CEnR) in the clinical and translational sciences, supportive policies, environments, and processes within academic medical centers. The purpose of this evaluation was to gather academic and community member perspectives on key actionable strategies for supporting CEnR in an academic medical center. We used a sequential mixed method design by first conducting qualitative in-depth interviews with academic leaders, investigators, and staff (total, n = 54) and focus group discussions with community members (n = 33). Themes from these qualitative data informed the adaptation of an institutional survey that gathered perspectives from a broader group of academic and community members affiliated with the institution (n = 85). Both qualitative and quantitative data were integrated to inform actionable strategies. Survey findings revealed that the institution was perceived as committed to health equity and CEnR, but institutional respondents expressed more concerns than community members about instrumental support of the work. Interviews and focus groups highlighted the opportunity to better align research efforts with community needs through more robust CEnR infrastructure and through interface with the clinical practice to promote patient access. Academic and community members emphasized the need for authentic, sustained engagement beyond federal mandates, including financial investment, capacity-building, and fostering trust. Leaders acknowledged structural challenges, siloed efforts, and the necessity for stronger coordination to increase integration of community engagement into the institutional mission. Findings suggest that aligning academic leaders, researchers, staff perspectives, and community members is essential to support and promote CEnR at an institutional level.

A significant proportion of healthcare costs is incurred in hospitals at the end of life (EoL), with a small group of patients accounting for most of the costs. Scarce resources should be allocated based on cost-effectiveness. High costs and low satisfaction with care suggest low-value care at EoL; however, there is little evidence regarding which patients receive such care. To identify the characteristics of older patients who experience high-cost care but report low satisfaction with care at EoL. Secondary data analysis of mortality follow-back surveys: International Access, Rights, and Empowerment (IARE) studies. We surveyed the next of kin of older patients who received palliative care or died in hospital in England. Satisfaction with care at EoL and cost of hospital care calculated with quantity of services and unit costs. We used multinomial logistic regression to analyse factors associated with potentially low-value care. 404 patients were included (mean [SD] age: 80.4 [8.5] years). During the last three months of life, 53.8% of the total hospital care costs were incurred by 20% of the patients. 36.6% of the respondents reported low satisfaction. Compared to patients with low-cost care and reporting satisfaction, patients who were 65-74 years old (relative risk ratio [RRR] = 3.2, 95% CI: 1.09 to 9.42), had low income (RRR = 4.12, 95% CI: 1.29 to 13.15) and with an illness duration of 1-12 months (RRR = 3.93, 95% CI: 1.37 to 11.21) were more likely to receive high-cost hospital care and report low satisfaction. Being younger, on low incomes and with short illness duration are associated with high-cost, low-satisfaction hospital care at EoL. Identifying underlying mechanisms may enable targeted interventions to reduce high-cost, low-value care. Further investigation is needed to change the care trajectories of patients with these risk factors. Most healthcare costs at the end of life go toward hospital care, and a small group of patients accounts for the largest share of these costs. However, receiving high-cost care does not necessarily mean better outcomes. When patients experience both high costs and low satisfaction, it suggests care that is not good value and should be avoided if possible. But there has been little evidence about which patients tend to receive this type of care. The research team analyzed data from two surveys of bereaved family members or carers of older patients who potentially had palliative care needs or died in hospitals in England. They aimed to identify the characteristics of older patients who were most likely to receive high-cost, low-satisfaction hospital care at the end of life. The study included 404 older patients. Those who were aged 65 to 74 years, had lower incomes, or had an illness lasting between one month and one year were more likely to receive high-cost hospital care and to have low satisfaction with that care. The findings suggest that the oldest patients, those with higher incomes, and those with longer-term chronic illnesses may be more likely to receive better-value hospital care. These differences point to possible inequities in healthcare, which can also affect how efficiently hospital resources are used. Having realistic expectations about care may also play a role. The study highlights specific targets that could be the focus of future efforts to improve trajectories of care.

Research in child and adolescent mental health stands at an inflection point: the burden of psychiatric illness is global, heterogeneous, and dynamic, whereas our evidence base often remains limited and insufficiently responsive to patient needs. To meaningfully improve outcomes for youth and families globally and at scale, innovation in child and adolescent mental health research must extend beyond developing new treatments to encompass how we design, measure, and disseminate research. Continued innovation is essential to build on the existing corpus of knowledge and to ensure that research keeps pace with real-world clinical and public health priorities.

The medial longitudinal arch (MLA) height is an important clinical indicator of foot posture, linked to injury risk and rehabilitation targets. Assessment of navicular height (NH) in standing position is commonly used as a marker of MLA height. Methods such as palpation and imaging face limitations with operator variability, accessibility, and radiation exposure. Ultrasonography may be a practical alternative, but its reliability compared to established methods needs further evaluation. The research objective was to assess the reliability and validity of plantar ultrasonographic navicular height measures (US-NH) in standing position using a novel ultrasonography platform. A test-retest study design was adopted across 2 cohorts: cohort study 1 (CS1, 2023; n&#x2009;=&#x2009;16) and cohort study 2 (CS2, 2024; n&#x2009;=&#x2009;30), using the standing ultrasonography platform. Intra- and inter-rater intraclass correlation coefficients (ICCs) were assessed to evaluate method reliability. Validity was assessed using cadaveric dissection as a gold standard. US-NH demonstrated excellent intra-rater reliability (ICC 0.956, 95% CI: 0.934-0.971), improving from good reliability in CS1 (ICC 0.827, 95% CI: 0.675-0.912) to excellent in CS2 (ICC 0.981, 95% CI: 0.969-0.989) after methodologic refinements. Inter-rater reliability also increased markedly, from poor in CS1 (ICC 0.459, 95% CI: 0.240-0.819) to excellent in CS2 (ICC 0.964, 95% CI: 0.940-0.978), indicating reduced operator-dependent variability. Dissection confirmed the bone visualised with weight-bearing ultrasonography corresponded accurately to the plantar navicular surface. Ultrasonography is a reliable, valid, and radiation-free method for measuring navicular height, in a physically active population. Dissections demonstrated the high validity of ultrasonographic assessment when compared to direct anatomical measurement. Level V, mechanism-based reasoning.

Despite lacking evidence, homeopathy continues to enjoy high levels of usage and general acceptance. Particularly concerning the treatment of cancer, this can pose risks, especially when it leads to delay or replacement of evidence-based treatments. The goal was to assess informed decision-making and analyze outcomes. The decision aid summarized key aspects of homeopathy, including its definition, distinction from naturopathy, production, approval, scientific evidence, placebo effects, use in cancer, side effects, and insurance coverage. Therefore, we conducted a single arm,&#xa0;pre-post observational survey. A questionnaire assessed knowledge, attitudes, and use of homeopathy before and after reading the aid. It included demographic data, topic-specific knowledge, use for certain medical conditions, and an evaluation section. A total of 123 adult cancer patients were recruited from oncology centers across Germany (2022), with no age restrictions. Changes in knowledge and attitudes were analyzed. Participants significantly revised their views on homeopathy for most medical conditions; beliefs about its use for psychological stress remained unchanged. Knowledge about placebo effects and potentization improved significantly, whereas understanding of side effects did not. Prior use of homeopathy influenced post-intervention decisions. Educational background and socioeconomic status showed no significant effects, demonstrating broad applicability of the intervention. Ordinal regression analyzes indicated that participants with lower prior knowledge benefited more, particularly regarding "potentization" and "placebo difference." Post-intervention knowledge gains varied by prior knowledge and gender, with less-informed participants and male respondents benefiting more. Most participants felt well informed, gained new insights, and would recommend the material. The decision aid demonstrated potential to support evidence-based decision-making among oncology patients.However, heterogeneity in outcomes indicates the influence of unmeasured factors, such as belief systems or emotional needs.Future research should explore tailoring decision aids to gender- and knowledge-levels. Integrating such tools into patient communication could enhance informed choice where alternative healing methods remain prevalent.

Doula support is increasingly recognized as a promising strategy to address racial inequities in maternal health. The New York City Health Department launched the Citywide Doula Initiative (CDI) in March 2022 to expand access to free, community-based doula support in disinvested neighborhoods. To evaluate the program's first year of implementation, we conducted semi-structured interviews with 44 clients, doulas, doula-organization staff, and Health Department staff between November 2022 and April 2023. We coded interview notes using template analysis (a thematic analysis approach) and grouped barriers and facilitators according to the Practical Robust Implementation and Sustainability Model. Facilitators included high perceived value of the CDI, a shared commitment to community, open communication, and policymaker support for doula work. Barriers included insufficient time for planning, cumbersome bureaucratic processes, and cultural and capacity differences between the Health Department and community partners. Additional factors, such as-variation in hospital treatment of doulas, doula-organization capacity, doula skills and experiences, and client needs and circumstances-had mixed effects on program implementation. Findings indicate that community-based doula models, which have been shown to improve birth outcomes in disinvested communities, can be successfully scaled in an urban setting. Programs seeking to expand access to doula support should prioritize time for planning, allocate sufficient resources for administrative support, and work to establish efficient and responsive payment and contracting processes. Having mission-driven staff at all levels of the program and prioritizing relationships with community-based organizations and doulas are vital for success.