Bacterial biofilms-structured communities of bacteria encased in self-produced polymeric matrices-present formidable challenges in clinical medicine. The resistance of biofilms to conventional antibiotics stems from multiple factors. These include limited drug penetration and the presence of metabolically dormant bacteria that survive treatments, despite their retaining sensitivity under standard laboratory conditions. Bacteriophages (phages), the viruses that infect and kill bacteria, have emerged as promising alternatives or adjuncts to antibiotic therapy, including against bacterial biofilms. Phages, nonetheless, likely evolved to optimize especially their dissemination between spatially separated bacteria, including spatially separated biofilms, rather than to become specialists at eradicating all targeted bacteria from biofilms. By contrast, complete bacterial elimination from the body is the standard goal of antibacterial therapies. Considered here is how an understanding of these competing goals-virion dissemination vs. complete bacterial eradication-can inform our development of phage-based anti-biofilm therapies.
Group therapies address the growing treatment demand-supply gap for depression. This study evaluated whether the novel WISE-Therapy (WISE-T; What's Important: Schedule and Engage) and Bouldering Psychotherapy (BPT) are more effective in reducing depressive symptoms in an outpatient group therapy setting than treatment as usual (TAU). This randomized, controlled, assessor-blinded, longitudinal, clinical trial was conducted in a naturalistic monocentric setting in Erlangen (Germany) between April 2022 and March 2023, with follow-up until July 2024. 128 adults were randomly assigned to WISE-T (44), BPT (40), or TAU (44). In 10 weekly 2-hour group sessions, WISE-T focused on identifying what is important, scheduling meaningful activities, and engaging in them for long-term mental health, and BPT combined psychotherapy with bouldering, while the control group received TAU. Depression severity was measured with the Montgomery-Asberg Depression Rating Scale at baseline, post-intervention, and one-year follow-up, and analyzed with a hybrid marginal model. Both intervention groups showed significantly greater reduction in depressive symptoms than controls at post-intervention (WISE-T: -5.5 points, 95%-CI [-9.5 to -1.5], P = .007, d = 0.62; BPT: -4.2 points, 95%-CI [-8.2 to -0.3], P = .037, d = 0.48). Response rates were 35.3% for WISE-T, 29.7% for BPT, and 21.1% for controls. Remission rates were significantly higher in WISE-T (17.6%) than in controls (2.6%, P = .047). Treatment adherence was good with minimal adverse events reported. The secondary outcomes showed significant results for anxiety, sense of coherence, self-efficacy, and mindfulness during physical activity. Both interventions demonstrated efficacy in reducing depressive symptoms compared with controls in this single-center setting. The study supports the integration of both therapies into outpatient care settings. Study procedures received approval from the Friedrich-Alexander-Universität Erlangen-Nürnberg Ethics Committee (Ref. 21-332-B) on December 13, 2021. The Trial was preregistered in March 2022 via ISRCTN12347878 .
Spin polarization, an intrinsic electronic degree of freedom, has emerged as a transformative lever in catalysis, offering new avenues to address challenges in environmental pollution control, renewable energy generation, and modern chemical manufacturing. Building on the inherent connection between electronic properties and catalytic activity, spin effects can enhance catalytic performance through mechanisms such as modification of the d-band center, regulation of eg electrons, and promotion of photogenerated carrier separation and transport. In this review, we introduce established mechanisms, representative evidence, and remaining limitations, and present an up-to-date overview of spin catalysis grounded in the fundamental roles of spin-resolved d-band levels, eg occupancy, spin-assisted carrier separation, and spin filtering, with emphasis on applications in hydrogen evolution, O2 evolution/reduction, CO2 conversion, ammonia synthesis, and CO oxidation. We next highlight effective strategies to improve catalytic performance by modulating spin polarization, including structural engineering and the application of external magnetic fields. Finally, we outline priorities for integrating spin effects into advanced catalytic systems through coordinated development in experimental technologies and theoretical approaches, thereby unlocking opportunities for sustainable chemical processes.
Kruglanski et al.'s love model rightly highlights motivation and meaning as core to love, aligning with current research. However, this commentary expands the view, emphasizing love's biological basis in brain systems and evolving different types of motivation. Love fulfills both individual and species-level needs, promoting health, connection, and generativity. True love transcends ego, growing into unconditional, spiritually rich connectedness over time.
The morphological appearance of zona pellucida (ZP) is considered to be predictive of the quality of the oocytes and embryos. Agar-like ZP represents a common type of ZP abnormality, which is usually associated with significant defects in oocyte maturation and typically leads to unfavorable assisted reproductive technology (ART) outcomes. Currently, the intrinsic properties of agar-like ZP oocytes remain unclear, and effective strategies to improve the ART outcomes for such patients are still lacking. We explored the intrinsic characteristics of metaphase I (MI)-arrest oocytes with agar-like ZP through RNA sequencing, immunofluorescence, and polarization microscope. Preemptive intracytoplasmic sperm injection (Pre-ICSI), i.e., performing ICSI on MI-arrest oocytes with agar-like ZP, was attempted, and its clinical outcomes were evaluated. What's more, we analyzed the potential mechanism of the effectiveness of Pre-ICSI. We uncovered the intrinsic nature of MI-arrest oocytes with agar-like ZP, revealing that these oocytes have inherently achieved nuclear and cytoplasmic maturation and should not be abandoned. Based on the fertilization and developmental potential of MI-arrest oocytes with agar-like ZP, we proposed Pre-ICSI as a targeted therapeutic strategy for such oocytes. Clinical results confirmed Pre-ICSI enabled the successful fertilization and development of these oocytes into available embryos, significantly improving the ART outcomes for patients with agar-like ZP. Further mechanical properties detection showed that the stiffness of agar-like ZP and narrow perivitelline space mechanically restrained the first polar body (PB) separating from the cytoplasm in space during the first meiosis. The mechanical intervention of Pre-ICSI, along with the dynamic changes in the cytoplasm post-insemination, provided space for the extrusion of PBs, thus facilitating the fertilization process. MI-arrest oocytes with agar-like ZP possess intact nuclear and cytoplasmic maturation, representing a highly viable and valuable gamete pool rather than inherently defective discards. When managed with the targeted Pre-ICSI strategy, these oocytes can be successfully rescued, significantly improving the yield of available embryos and the overall success rate of IVF for these patients.
It is well established that a complete package of photoprotection includes staying in the shade, wearing photoprotective clothing, hat, and sunglasses, and on otherwise exposed sites, applying sunscreen. Recent advances have modified photoprotection through new active ingredients, innovative formulations, complementary oral strategies, and personalized approaches. This review aims to summarize the latest new developments in photoprotection. A narrative review of the literature was conducted from January 2010 to October 2025 using terms related to photoprotection, sunscreen innovation, visible light, oral photoprotection, microbiome interaction, climate change, and personalized approaches. Articles in English and Spanish were selected based on scientific relevance. Advances in photoprotection include the development of new topical filters targeting UVA1 and visible light, as well as the incorporation of iron oxides and, in some formulations, pigmentary titanium dioxide in tinted sunscreens to enhance protection against visible light. In addition, the use of antioxidants and DNA repair enzymes has been explored to mitigate oxidative stress and address field cancerization. Natural and eco-friendly bioactive ingredients derived from botanical and marine sources show growing potential as photoprotective agents. Additional considerations such as the role of skin microbiome, and personalized photoprotection strategies tailored to skin phototype, lifestyle, diseases, and high-exposure conditions further refine preventive practice. Photoprotection is evolving into a multidimensional approach that integrates advanced topical formulations, oral agents, and individualized recommendations. This paradigm offers improved prevention of photoaging, pigmentary disorders, and photocarcinogenesis while promoting safer and more sustainable photoprotection practices.
Malalignment in student versus service objectives may contribute to barriers in teaching and learning, occasionally resulting in conflict or perceived mistreatment. Expectation setting between the medical students and the residents at the start of each service during the surgery core clerkship was mandated and guided. This was done at 1 tertiary academic center. One historic class did not undergo mandatory expectation setting and therefore were identified as the control group. The subsequent 2 class years were utilized as the intervention group. The 3 classes were surveyed, assessing markers representative of comfort, success, and confidence in the surgical clerkship. Responses were compared between control and intervention groups. Formal mistreatment reports were also utilized to examine if expectation setting and mistreatment discussions affected rates in these 3 years. The overall response rate was 25%. Students who set expectations felt more comfortable asking questions in the operating room and advocating for themselves and their education during the clerkship. In the qualitative analysis, students most frequently credited the impact of expectation setting on their performance in the clerkship to increased direction, role clarity, and concrete goals for the clerkship. The number of mistreatment reports declined in the 2 years after expectation setting was initiated. Reports of rude or belittling language and public humiliation steadily declined. Expectation setting at the beginning of the surgical core clerkship may enhance the students' sense of psychological safety to improve the learning environment for nontechnical skills development.
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Cancer rehabilitation and exercise services (CaRES) improve physical function and survival. Yet, CaRES remain underutilized by survivors, despite the availability of ≥2000 CaRES nationwide. To date, CaRES referrals have originated primarily from oncologists. Primary care providers (PCPs) are an untapped potential referral source, particularly for older cancer survivors (≥65 years) who often have long-term PCP relationships. This study aimed to explore multi-level perspectives on primary care referrals to CaRES and co-create a prototype referral process. Individual semi-structured interviews were conducted with three groups: (1) older cancer survivors (≥65 years), (2) PCPs, and (3) CaRES directors. Semi-structured interview guides were developed with guidance from the Pragmatic Robust Implementation and Sustainability Model (PRISM) to understand factors that could influence PCP referrals to CaRES. Two rounds of iterative feedback on a prototype CaRES referral process were obtained. Interviews were recorded, transcribed, and deidentified. Transcripts were analyzed using rapid matrix analysis with domains mapped onto PRISM. After the completion of all interviews, the final prototype referral process was distributed to all participants for member-checking. PCP-initiated CaRES referrals were viewed as appropriate by survivors (n = 5), PCPs (n = 6), and CaRES directors (n = 7). However, PCPs were not aware of CaRES, "…you'd have to make sure that providers are aware of it… I wasn't aware of it," (3-PCP). Two key needs for the referral process were: (1) initial PCP education about CaRES and (2) embedding the referral process into existing workflows. CaRES directors stated that successful referral processes to date have required tailoring to individual clinics, "We…discuss what their referral process is internally, and how we can fit this referral with what's already going on in their workflow" (11-Director). Iterative feedback on the referral process resulted in a wireframe prototype of a clinical decision support tool for CaRES referrals. The PCP-initiated CaRES referral process was of interest to cancer survivors, PCPs, and CaRES directors, but will require tailoring to individual clinic workflows. PCP-initiated CaRES referrals may expand the reach of CaRES by providing another opportunity, in addition to the oncology care team, for patients to learn about and connect with CaRES.
A client-centred approach ensures that individuals can express what's most important to them, with therapists providing collaborative support. This study examined factors influencing the quality of collaborative relationships between clients and occupational therapists and explored how the strength of these relationships affects therapy outcomes. A prospective longitudinal observational study was conducted at day care centres across Japan, with participants followed for 1 year. Occupational therapists delivered occupational therapy guided by a client-centred approach. Outcomes, including daily activities and health-related quality of life, were measured before and after the intervention. The Collaborative Relationship Scale (CRS) was used to assess baseline relationship quality. Among 101 participants (aged 47-93 years), CRS scores categorised them into good, neutral, and poor relationship groups. Logistic regression revealed that goal achievement and clients' understanding of occupational therapy were associated with relationship quality. Over 50% of participants in the good relationship group had activities of daily living goals, whereas more than 50% in the poor relationship group had mobility goals. Strong collaborative relationships may positively influence occupational therapy processes and outcomes. These findings highlight the importance of goal setting within occupational therapy guided by a client-centred approach in enhancing therapeutic relationships.
Perinatal loss is a significant global health issue that affects millions of families worldwide and represents a profound emotional challenge for both parents and healthcare professionals. Nurses and midwives play a key role in providing care and support to parents during this difficult period. However, many report feeling underprepared and inadequately supported when delivering perinatal bereavement care. We sought to explore the experiences of nurses and midwives of supporting parents following perinatal loss, to examine the personal and professional impact of providing bereavement care on nurses and midwives, and to identify the key facilitators and challenges they encounter in this role. A qualitative systematic review of the literature. PubMed, CINAHL, Embase, PsycINFO, Web of Science, Medline, Scopus. We conducted a systematic literature search, limited to English language publications, in the above databases from January 2015 to November 2025. Two reviewers independently performed study selection and data extraction and assessed methodological quality using the JBI Critical Appraisal Tool. The extracted data were then analyzed and synthesized using a thematic synthesis approach to identify patterns and generate comprehensive insights into the experiences of nurses and midwives providing bereavement care. A total of 15 studies met the inclusion criteria. From these, we identified three major themes: (1) a caring role in supporting bereaved parents; (2) the impact of bereavement care on nurses and midwives; and (3) facilitators and barriers to providing bereavement care. Each main theme included several sub-themes. Perinatal loss had a profound impact on the psychological and physical well-being of nurses and midwives; a variety of coping strategies were used to navigate these challenges. Both bereavement care training and organisation support were seen as essential for them to prepare themselves. There appears to be an urgent need for an effective bereavement care training program created for nurses and midwives, as well as open discussion, informal debriefing sessions among colleagues working in maternity units. What's more, institutional support and managerial support may be important as well.
In recent years, millions of adolescents have joined school strikes to demand climate action from governments and industries, standing in solidarity with young people from future generations and from vulnerable geographical regions (i.e., the Global South). The goal of the present study is to explore adolescents' climate activism from a developmental science perspective, analyzing how climate activism may be rooted in adolescents' developing identity and developmentally salient motives. Eleven 14-18-year-old Dutch adolescent climate activists (six female, two male, one non-binary, two not disclosed) participated in an online semi-structured interview between September 2022 and 2023. Data were analyzed in NVivo through theoretical reflexive thematic analysis, exploring patterns of meaning across the dataset while embracing researchers' active, subjective, and reflective role in data analysis. We constructed three themes: "Activism is motivated by the desire to make contributions to a just world;" "Activism is an autonomous choice that helps explore and express who I am;" and "Activism makes me feel connected to (some but not all) others." Taken together, the present analysis suggests that adolescents' climate activism-and pro-environmental engagement more generally-is driven by and satisfies their developmentally salient motives to contribute to a socially just world, to make autonomous choices, to explore and express their identity, and to feel connected to others. As such, our work sheds light on how we may promote and support adolescents' engagement in acts of solidarity to contribute to today's societal challenges, and suggests avenues for further research.
The transition away from animal experimentation is gaining momentum across scientific disciplines, driven by technological advancements, ethical imperatives and policy support. At the forefront of this movement is the development of New Approach Methodologies (NAMs). Rather than serving as mere substitutes for animal testing, NAMs represent a paradigm shift. Their growing acceptance has been reinforced by recent policy advancements, such as the US Food and Drug Administration Modernization Act 2.0 and the European Chemicals Agency's commitment to transitioning toward an animal-free regulatory system, both of which promote the adoption of NAMs. However, the term NAMs has become increasingly ambiguous, leading to confusion and potential misuse. To address this, we propose a unified definition: NAMs are species-specific methodologies, not including the use of living animals. NAMs prioritize the use of the target species in some form or another, eliminating the need for interspecies extrapolation. If the target species is human, this simple definition implies that working with experimental animals as a model never qualifies as a NAM. This distinction positions NAMs as a fundamentally different approach to the 3Rs framework of Replacement, Reduction and Refinement, and practical examples are discussed. Critically, this definition extends beyond toxicology and regulatory science, encompassing basic, applied and translational research. By leveraging cutting-edge technologies, including organoids, organ-on-chip, microfluidics, 3D bioprinting, bioinformatics, artificial intelligence and machine learning, NAMs provide novel biological insights that differ from those obtained through animal models while enhancing species-relevant data accuracy. Although challenges remain, particularly in their validation and widespread adoption, continued innovation, policy support and interdisciplinary collaboration will be key to unlocking their full potential, fostering more sustainable, humane and human-relevant approaches in biomedical research.
Intelligent reflecting surface (IRS) has emerged as a promising technique for achieving high-transmission rate and low-power consumption transmission to meet the requirements of future beyond 5G and 6G communication. In this paper, we optimize and compare the energy-efficiency (EE) of IRS-assisted bidirectional relay transmission (BRT) and bidirectional direct transmission (BDT). In specific, we firstly consider and give the IRS-assisted BRT and BDT models. Then, we give the analyses of signal transmission models and EE for both IRS-assisted BRT and BDT. In addition, to optimize the EE, we give the joint optimization problems for both IRS-assisted BRT and BDT, which incorporate phase shift (PS) and transmit power (TP) optimizations. What's more, to solve the joint optimization problems and obtain the optimal PS, we design complex circle gradient descent algorithm and apply successive convex approximation for both IRS-assisted BRT and BDT, respectively. After that, we introduce Lagrange factors and Karush-Kuhn-Tucker conditions to obtain the close-form expressions of each node's optimal TP for both IRS-assisted BRT and BDT, respectively. Furthermore, with the optimal PS and TP, we provide the analysis of EE comparison between the IRS-assisted BRT and BDT. Simulation results illustrate that when total TP exceeds approximately -5 dBm, the IRS-assisted BRT will consistently outperform IRS-assisted BDT. Meanwhile, when compared with individual optimization, our IRS-assisted BRT and BDT with joint optimization achieve 61.36% and 65.51% improvements in EE, respectively.
Plants face significant threats from pathogens while chemical pesticides remain the primary method for disease control. However, excessive use of chemical pesticides has led to increased pathogen resistance and environmental hazards, highlighting the urgent need for sustainable alternatives such as plant immune priming agents. Among these, levan have shown great potential compared to commercial priming agents, but their high degree of polymerization (DP) results in low solubility. To address this, we synthesized levan-derived oligosaccharides (LOS) with reduced DP. However, if LOS could induce plant immunity and what's the priming mechanism remain unclear. This study evaluated the effects in foliar applications on melon (Cucumis melo L.) and watermelon (Citrullus lanatus Thunb.), focusing on two pathogens, Botrytis cinerea (B. cinerea) and Phytophthora capsica (P. capsica). While LOS did not significantly reduce lesion area caused by B. cinerea in either crop, it reduced the lesion area caused by P. capsica by more than 65% in melons and watermelons. LOS also decreased disease severity by increasing the proportion of mild lesions (grades 1-2) and reducing the proportion of severe lesions (grades 3-4). Compared to CK, foliar application of LOS to single-leaf melons and watermelons did not significantly alter lesion area of untreated leaves, but it did significantly reduce the proportion of severe disease symptoms. Besides, LOS showed efficacy across multiple melon and watermelon cultivars while also demonstrated better immune effects compared to commercially available elicitors. Although LOS did not significantly improve melon quality compared to CK, it significantly increased the soluble solids content in watermelon fruit by 16%. LOS spraying promoted reactive oxygen species production, with H₂O₂ levels increasing 4.8-fold in melons and 44.5% in watermelons at 72 h. Physiological analysis revealed significant enhancement in the activity of antioxidant enzymes, such as catalase, peroxidase, and polyphenol oxidase in both crops. Besides, lignin content remained elevated in both melon types compared to CK, enhancing the plant's physical defense capabilities. Furthermore, gene expression analysis showed upregulation of several immunity-related genes (RBOHD, PR1, PAL, NPR1), indicating activation of the salicylic acid and jasmonic acid signaling pathways. These results suggest that LOS, as a broad-spectrum priming agent, enhances disease resistance in watermelons and melons, making it a promising sustainable solution for plant disease management.
Historically, coercive and distrustful relations between police and people who use drugs have contributed to profound and enduring health harms. British Columbia's drug decriminalization policy, introduced in 2023, aimed to shift these dynamics and promote health and wellbeing by reducing criminalization and improving interactions with police. Drawing on qualitative interviews with 38 people who use drugs with diverse and intersecting structural vulnerabilities, including Indigeneity, racialization, and economic and housing precarity, we examine perceptions and experiences of policing and policy during the first year of decriminalization. Participants described a persistent legacy of police violence, including physical, psychological, and symbolic harms, that shaped enduring mistrust toward both policing and the policy itself. This mistrust constrained the perceived legitimacy of decriminalization, with participants questioning whether the policy meaningfully altered entrenched institutional practices, culture, or power relations. Past and present policing also remained a structuring force of social marginalization, shaping the everyday realities of people who use drugs. Rather than a departure from previous enforcement regimes, the legacies of policing overshadowed the potential benefits of decriminalization. These findings demonstrate how historical harms and institutional legacies mediate health-oriented policy reforms through fear, mistrust, and constrained legitimacy. Drug decriminalization is not implemented in a vacuum; its capacity to improve health and wellbeing depends on the sociohistorical contexts and legacies that structure how people engage with police, institutions, and health policy.