This study explored the use of Appreciative Inquiry to engage speech-language pathologists in co-designing culturally and contextually responsive diagnostic practices for Developmental Language Disorder in the Northern Territory, Australia. Over 18 months, Appreciative Inquiry was delivered through online sessions with Northern Territory Health speech-language pathologists. Using the 4D cycle (Discovery, Dream, Design, Destiny) and a strategic "Detour" to connect local ideas to organisational priorities, participants engaged in collaborative visioning, resource development, and guided reflection on culturally responsive, linguistically appropriate practices. The process produced a context specific framework, including guiding principles, contextual considerations, diagnostic resources, and scripts to embed child and family voice. Participants reported increased confidence applying developmental language disorder criteria, improved clarity in diagnostic decision-making, and strengthened professional connections across locations and organisations. The approach fostered ownership, flattened hierarchies, and generated practical outputs adaptable to urban, rural, and remote contexts. Appreciative Inquiry is a cost-efficient, inclusive, and flexible methodology for improving rural and remote healthcare services. By aligning locally driven solutions with strategic priorities, Appreciative Inquiry promotes sustainable practice change, collaborative leadership, and culturally and contextually responsive developmental language disorder diagnosis in the Northern Territory.
Personal values shape health behaviors, yet the role of sleep value within broader value systems remains unknown. This study aimed to validate the Values Inventory, a novel measure assessing individual life values, and examine how sleep value fits into broader these value orientations. An online sample of U.S. adults (N = 455) completed the Values Inventory and the Sleep Valuation Item Bank 2.0 (SVIB-2.0), along with demographic and sleep-related surveys. Exploratory factor mixture modeling and confirmatory factor analysis supported a five-factor structure of the Values Inventory: Health/Wellbeing, Fundamental Human Values, Social Status, Personal Accomplishment/Global Advancement, and Community/Belonging. Internal consistency was high across factors (ω ≥ 0.88). Structural equation modeling revealed significant associations between demographic characteristics and value endorsements. Sleep health, along with mental and physical health, formed the core of the Health/Wellbeing factor, supporting the common belief that sleep is a pillar of health. Age was significantly associated with higher valuing of Health/Wellbeing and Fundamental Human Values. Multivariate analysis of variances comparing Values Inventory factors across previously established sleep value profiles (Unconcerned, Appreciative, Devalue, Ambivalent Priority, and Concerned) revealed distinct value patterns. The Appreciative profile showed the highest valuation of Health/Wellbeing. The Ambivalent Priority profile showed the highest valuation of Social Status and Community/Belonging. Findings support the Values Inventory as a psychometrically sound tool for assessing individual value systems and highlight the complex role of sleep. These results suggest the need for future research determining whether aligning sleep health interventions with individuals' broader values may enhance effectiveness and relevance.
Severe infectious keratitis is a leading cause of corneal transplants and vision loss, primarily caused by microorganisms such as the protozoan genus Acanthamoeba spp. and the yeast Candida species. Treating these infections poses significant challenges, particularly in cases of polymicrobial keratitis. Both Acanthamoeba spp. and Candida species can adhere to contact lenses and the patient cornea, forming complex polymicrobial biofilms. This is the first study to explore polymicrobial biofilm formation involving Acanthamoeba and Candida. This study to evaluate adhesion and the co-culture between Acanthamoeba spp. and Candida albicans, as well as to analyze the antibiofilm efficacy of natamycin, voriconazole, and chlorhexidine against these microorganisms. Adhesion capacity was assessed using crystal violet dye, while drug susceptibility was evaluated using Trypan Blue dye. The results indicated that the strain A. castellanii and the clinical isolate R40 displayed a high capacity for adhesion. All treatments tested showed promising antibiofilm activity and were effective in eradicating biofilms of C. albicans and Acanthamoeba spp. Therefore, gaining a deeper understanding of the adhesion behavior of Acanthamoeba spp.-both independently and in association with Candida species along with evaluating the antibiofilm efficacy of various treatments, could enhance the management of severe polymicrobial keratitis. This research also contributes to assessing the effectiveness of multipurpose solutions for cleaning and maintaining contact lenses and their cases.
Traumatic brain injury (TBI) continues to be one of the world's top causes of mortality and long-term disability. It is a severe and frequently fatal disorder. Patients with traumatic brain injury (TBI) not only sustain neurological impairment but also undergo significant metabolic changes and psychological stress, which may affect their ability to recover. The purpose of this study was to investigate the nutritional determinants and epidemiological trends linked to outcomes in traumatic brain injury patients. This prospective cohort study was carried out at the Imam Reza Hospital's Trauma Department in Tabriz, Iran. Over the course of six months, 520 patients with moderate-to-severe traumatic brain injury were consecutively enrolled, and they were monitored for one month following their release from the hospital. Clinical findings, radiographic results, laboratory data, therapies, outcomes, mechanisms of injury, and demographics were all methodically documented. BMI and serum albumin levels were used at discharge and one-month follow-up to evaluate nutritional status. The Impact of Event Scale (IES) and the Hospital Anxiety and Depression Scale (HADS) were used to assess psychological status. Descriptive techniques, correlation analyses, paired comparisons, and receiver operating characteristic (ROC) curve analysis were among the statistical techniques used to evaluate the standalone discriminatory ability of psychological and nutritional variables. The mean age of the patients was 32.49 ± 13.78 years, and 71.7% were male. Nearly 75% of injuries were caused by falls, making them the most frequent cause. In total, 51.2% of patients passed away while in the hospital, whereas 48.8% of patients survived discharge. Discharge and one-month Glasgow Coma Scale (GCS) scores demonstrated a substantial correlation with outcome (p < 0.001), and neurological severity was strongly associated with survival. Survival, neurological improvement, and psychological distress did not significantly correlate with either discharge or follow-up BMI. Additionally, there was no significant correlation between serum albumin levels and survival, anxiety, depression, or symptoms of post-traumatic stress disorder. BMI, HADS, and IES all showed poor outcome discrimination, and ROC analyses supported their limited standalone discriminatory ability. In this cohort of patients with moderate-to-severe TBI, BMI and serum albumin were not associated with survival or psychological distress and showed limited standalone discriminatory ability for short-term outcomes. These findings suggest that recovery after TBI cannot be adequately characterized by simple nutritional indices alone and support the use of more comprehensive, multidimensional approaches to nutritional and prognostic assessment in TBI survivors.
How the public perceive the natural world matters because these emotions shape how society cares and values nature. Organisms that are perceived as useless, annoying, frightening or uncharismatic are less likely to benefit from conservation efforts. Here we review how parasitoids are perceived by the public in the wider context of insects; we identify aspects of their biology that could be used to effectively challenge negative perceptions, and discuss how outreach and citizen science activities can help achieve these shifts. Parasitoids are one of the least well-studied taxa on the planet, when taking into account the importance of their ecology and evolution, and that they are estimated to be the most speciose of insect Orders: they deserve to be noticed, identified and valued by both scientists and the public. Our review, therefore, provides a much-needed synthesis of reasons to appreciate parasitoids, and outlines promising avenues for public outreach and communication.
Health equity remains a central yet insufficiently integrated priority within lifestyle medicine (LM). Although LM offers evidence-based strategies to prevent and treat chronic disease, its impact is limited when interventions fail to account for the social determinants of health (SDOH) shaping patient behavior and access. Despite growing appreciation of the importance of screening for and addressing social drivers of health, knowledge, skills, and resource gaps remain for many LM practitioners. This innovation report synthesizes key insights from the LM2025 conference session and translates them into a practical, equity-centered framework. We propose a three-domain model emphasizing (1) prioritization of populations experiencing health disparities, (2) context-sensitive application of lifestyle interventions, and (3) delivery of culturally relevant, community-engaged care. We illustrate application through a pediatric case and highlight the Family Lifestyle Program Produce Prescription (FLiPRx) as a scalable model of health equity-driven LM. We further examine biological pathways linking social adversity to chronic disease and describe how lifestyle interventions mitigate these effects. Additionally, we highlight a multisector collaboration between a hospital, health department and churches as a model for achieving health equity. This framework offers clinicians and health systems a practical pathway to integrate equity into LM practice while advancing population health outcomes.
The Community Engagement (CE) Studio is an established approach for integrating community and patient perspectives into research. Despite its widespread implementation, little information is available about how this model has been adapted across institutions to accommodate varying resources and capacities. The Patient and Community Engagement in Research (PaCER) Program at UNC-Chapel Hill modified the CE Studio model - with adaptations to recruitment, onboarding, virtual delivery, compensation, and session planning - resulting in the development of a new Community Feedback Session (CFS) service. This adaptation yielded a scalable model that requires fewer resources, supports capacity-building within research teams, and leverages technology. We then evaluated the CFS approach via surveys distributed to CFS attendees and researchers. Between January 2022 and August 2025, we conducted 46 CFSs across 19 projects engaging 302 attendees; 149 attendees and 34 researchers completed evaluation surveys. Of these, 99% of attendees indicated they would participate again, and 97% of researchers rated the CFS service as Good or Excellent and recommended it to colleagues. Respondents appreciated the structure, facilitation, composition, and size of the sessions, and many had no suggestions for improvement. Researchers described changes they made to projects based on feedback received during CFSs, including amending study protocols, altering intervention content and delivery modalities, and revising a variety of study-related materials. Evaluation data support the acceptability, feasibility, and utility of the CFS approach, indicating that this modified and scalable service accomplishes researcher goals, informs research in an impactful way, and provides value to partners.
Martial arts involve cutting, jumping and landing movements known to increase injury risk. Martial artists frequently sustain injuries. Recreational martial arts have yet to implement an evidence-informed prehabilitation programme to prevent these injuries. Here, we evaluate the Martial Arts Striking Sports prehabilitation programme (MASS-12) in a recreational setting. Three traditional martial arts warm-ups and two MASS-12 warm-ups were delivered over 2 weeks as a recreational Jiu Jitsu club hall. A coach and seven athletes (five male, two female), ranging in experience from white belt to brown belt, participated. Main Outcome Measures were the Frontal plane projection angle (FPPA), a measure of dynamic knee valgus and Single leg vertical hops (SLVH), a measure of performance. Over half of recreational athletes reported previous, serious lower limb injuries. Athlete FFPA and SLVH significantly improved (-11.9° to -1.93°, 25.2 vs 27.5 cm, respectively) after the MASS-12. Athletes appreciated the increased feedback and sense of preparedness. The coach found it easy to teach and perceived improvements in performance. The MASS-12 is easy for coaches to implement; improves lower limb alignment; and is accepted by athletes. A significant improvement on current practices, the MASS-12 should be widely implemented in recreational martial arts.
Platelets are anucleate blood cells traditionally recognized for their central role in hemostasis but are now appreciated as active sentinels of innate immunity. During bacterial infection, platelets sense pathogen-associated molecular patterns and immune complexes through Toll-like receptors (TLRs), FcγRIIA, complement receptors, and adhesive integrins. This recognition enables platelets to interact with leukocytes and endothelial cells and to release pro-inflammatory and pro-coagulant mediators. While these responses contribute to pathogen containment, they also promote thromboinflammation and microvascular thrombosis, a process collectively referred to as immunothrombosis. This review synthesizes knowledge on platelet interactions with Gram-positive and Gram-negative bacteria and delineates how these pathways converge on immunothrombosis in clinical settings such as infective endocarditis and sepsis. Gram-positive bacteria, including Staphylococcus aureus and Streptococcus spp, activate platelets through FcγRIIA signaling following IgG opsonization and through αIIbβ3 engagement via plasma protein bridges. In contrast, Gram-negative bacteria such as Escherichia coli, Pseudomonas aeruginosa, and Neisseria meningitidis predominantly trigger inflammatory platelet activation through TLR4-dependent recognition of lipopolysaccharide. Activated platelets form aggregates with neutrophils and monocytes, promote neutrophil extracellular trap formation, and support tissue factor-dependent coagulation. Although localized immunothrombosis may be host-protective by restricting bacterial dissemination, dysregulated systemic platelet activation contributes to disseminated intravascular coagulation and organ failure. We discuss mechanistic and translational implications, argue for selective modulation of platelet immune signaling rather than global platelet inhibition. We outline priorities for biomarker-guided interventions, including circulating markers of platelet activation such as soluble P-selectin, soluble GPVI and NETosis markers, aimed at preserving antimicrobial defense while limiting pathological thrombosis.
Although the associations between cerebrovascular dysfunctions and Alzheimer's disease are increasingly appreciated, the relationship of cerebral blood flow and white matter hyperintensities with tau and amyloid-β pathology remains unclear, particularly in the longitudinal context. This study investigated cross-sectional and longitudinal associations of cerebral blood flow and white matter hyperintensities with tau and amyloid-β pathology using multimodal imaging and blood biomarkers in 179 participants from the ADNI3 cohort. Participants underwent structural (T1-weighted, T2-weighted FLAIR) and arterial spin labelling perfusion MRI, tau and amyloid-β PET, and plasma assay tests for amyloid-β 42, amyloid-β 40, and phosphorylated tau-217. Tau from PET was negatively associated with cerebral blood flow both cross-sectionally and longitudinally in the posterior brain, independent of amyloid-β quantified from PET. Higher white matter hyperintensities volumes were associated with higher levels of tau and amyloid-β at baseline, but the associations were significantly attenuated after further adjusting for amyloid-β and tau, respectively. Plasma amyloid-β 42/40 ratio was negatively associated with white matter hyperintensity volumes both cross-sectionally and longitudinally. In conclusion, tau pathology showed spatially specific associations with cerebral hypoperfusion, independent of amyloid-β, particularly in posterior regions. The attenuation of associations of white matter hyperintensities with amyloid-β and tau after adjustment may reflect shared disease-related variance rather than distinct independent effects.
Mistreatment in healthcare is widespread in low- and middle-income countries (LMICs) especially as obstetric violence in and around motherhood amid paucity of evidence. Respectful maternity care is a woman-centered care by discharge of soft skills from the healthcare workers (HCWs) that befriends and allays anxiety among mothers regarding their unborn child. To assess the perception of mothers on their care during childbirth by feedback analysis. This hospital-based study was conducted in a teaching rural institute from January 15 to July 14, 2024. The predesigned pretested semi-structured questionnaire collected feedback of mothers who delivered their children in the past 1 year containing 26 questions in 5 domains, namely, Friendly care (9), Non-confidential and non-dignified care (11), Negative experience (2), Neglect (2), and Discrimination (2). An array of untold truths on 'Obstetric violence' was elicited by candid feedback from 58 respondent mothers on their positive and negative, subjective and objective internalization discharged by the HCWs. Mothers appreciated positively on the care received ranging from 58 (100) to 22 (37.93%) on different issues. Overall, our mothers felt positive on service provision during childbirth at our center. Disrespect and abuse, though infrequent findings, underscore the need for continuing education on holistic maternity care. This paper will significantly impact on Family Medicine and Primary Care on LMICs including India to boost respectful maternity care.
Chiroptera species (hereafter bats) exhibit extraordinarily long lifespans compared to non-flying mammals of similar body size, yet the underlying ecological drivers and molecular mechanisms remain poorly understood. In this study, we employed phylogenetic regression models to explain maximum longevity (MLg) variation using 24 life-history traits from 101 bat species. In parallel, we conducted comprehensive comparative genomics analyses on 39 high-quality bat genomes to identify candidate genes and biological processes involved in longevity regulation. Our results revealed that female age at sexual maturity and maximum latitude explain the greatest proportion of MLg variation within bats, and genes involved in DNA damage repair, inflammation, immunity and mitochondrial function may play critical roles in various extremely long-lived bat species. We also identified the potential importance of lipid metabolism, specifically the cholesterol metabolism pathway and APO gene family, as a previously under-appreciated mechanism in bat longevity regulation. Given the distinct ecological and physiological features, our family-specific analyses on Vespertilionidae and Pteropodidae uncovered divergent life-history predictors and genetic strategies for extended longevity. In Vespertilionidae, MLg is most strongly associated with latitude and may be regulated primarily through the maintenance of DNA stability, while MLg in Pteropodidae is best predicted by body mass and is linked to tumour suppression and immune response. Overall, our study elucidates the complex interplay between life-history factors and genomic adaptations underlying extended lifespans in bats, providing valuable insights into mammalian longevity evolution and potential targets for improving human healthspan.
Spinal angiolipomas are rare benign epidural tumors accounting for 0.14-1.2% of all spinal neoplasms. Pathologically, these lesions are composed of mature adipose tissue and contain proliferative vascular elements. Here, a 44-year-old female presented with a thoracic epidural angiolipoma causing progressive myelopathy, which was diagnosed and effectively managed, resulting in a good clinical outcome. A 44-year-old female presented with a 7-month history of progressive thoracolumbar pain radiating into the lower extremities, accompanied by bilateral paraparesis (Medical Research Council scale [MRC] 4/5), symmetric hyperreflexia, and a T8-T9 sensory level to pin appreciation, along with impaired vibration/proprioception (Nurick Grade 3; Modified Japanese Orthopaedic Association scale [mJOA] score 11/18). The magnetic resonance imaging demonstrated a T7-T8 epidural mass with heterogeneous T1 signal and T2 hyperintensity that homogeneously enhanced with contrast, causing significant spinal cord compression and intramedullary high signal. Through a T7-T8 decompressive laminectomy, gross total tumor resection from T6 to T9 was accomplished; additionally, a T6-T9 posterior instrumented fusion was performed. Histopathology confirmed a non-infiltrating epidural angiolipoma. Three months postoperatively, the patient's ability to ambulate continued to improve. Spinal angiolipomas should be considered amongst the differential diagnoses of spinal epidural masses, particularly in middle-aged women presenting with progressive myelopathy. Notably, early surgical decompression with gross total tumor resection offers an excellent prognosis.
Fibularis brevis tendon (FBT) variants are under-recognised and may alter both imaging interpretation and operative strategy. The purpose of this review was to synthesise the available anatomical, radiological, and surgical literature on distal FBT variants and to frame this evidence through a classification-based approach. This study was designed as a narrative review. Anatomical/cadaveric, imaging, and surgical publications relevant to distal FBT morphology and clinical interpretation were synthesised using the Olewnik classification as the organising framework. No formal systematic-review protocol or meta-analysis was undertaken. The available literature describes two main distal attachment types of the FBT: Type I and Type II, the latter further subdivided into subtypes IIa-IIc. The most consistent findings concern recognition of accessory slips and fused components, differentiation of variants from longitudinal split tears or pseudomass-like findings, and appreciation of how atypical insertions may influence distal operative exposure. The strongest evidence remains anatomical and imaging-based, whereas direct validation of classification-guided treatment is still limited. The Olewnik classification provides a useful anatomical framework for radiological reporting and preoperative planning, but it should presently be regarded as clinically promising rather than fully validated. A structured, variant-aware interpretation can improve communication and operative preparation in patients with lateral ankle pain, tendon pathology, or instability.
Charles Darwin's theory of evolution was seriously deficient. Although his concept of natural selection was an important contribution - highlighting the fundamental fact that life on Earth is a contingent, always at-risk enterprise - he failed to acknowledge the fact that all living systems - from the smallest single-celled bacteria to humankind - are also shaped by their evolved purposiveness (teleonomy). Their initiatives and activities - their "agency" - has exercised an important influence over the trajectory of life on Earth, as one of Darwin's predecessors, Jean-Baptiste de Lamarck, appreciated. Lamarck proposed that changes in an animal's "habits", stimulated by environmental changes, have been a primary source of evolutionary change over time. Darwin also portrayed evolution as a fundamentally competitive process (the "struggle for existence" in Darwin's term), as did many of his contemporaries. Today we know that life has also been a multi-faceted cooperative (synergistic) enterprise and that this has been of overriding importance in the evolution of complexity over time. Teleonomy and cooperative functional effects (synergy) have shaped natural selection in many different ways. Indeed, we now know that there have been many influences in evolution. My proposed Inclusive Synthesis is also open-ended, because it is expected that still more has yet to be learned about biological evolution; it is an ongoing work-in-progress rather than a completed theoretical edifice. "Teleonomic Selection" (after Corning) and "Synergistic Selection" (after John Maynard Smith) have played important parts in evolution. It's time for a more inclusive theory.
Boarding of patients in the Emergency Department (ED) impedes patient flow through the department and deprives medical students of valuable educational opportunities. We designed a curriculum for medical students during their required Emergency Medicine (EM) clerkships aimed to circumvent lost educational opportunities. Participants should gain increased appreciation of interprofessional collaboration, procedural competency, and ED flow. Students learned of the optional curriculum as they began their required EM clerkship. From August 2023 through January 2024, 120 students were contacted for recruitment into the optional curriculum. Students were provided with an ED-BINGO card with 25 pre-identified patient care activities deemed relevant to EM across 5 different categories. Participants were surveyed regarding educational value and enjoyment on a 5-point Likert scale. The 32 fully completed surveys were evaluated (26.7%), and 16 students (13.4%) reported using the ED-BINGO card during their EM clerkships. Participants reported that the ED-BINGO card tasks were appropriate for their level of training (median: 5, interquartile range (IQR): 1, mean 4.56, standard deviation (STD) 0.68), enhanced their understanding of flow/throughput of the ED (median: 4, IQR: 1.75, mean 3.94, STD 1.22), improved their knowledge/skills (median: 4, IQR: 2, mean 4, STD 1.06), helped them feel more valuable to the team (median score: 5, IQR: 2, mean 3.89, STD 1.49), and should remain a permanent fixture of the rotation (median: 4.5, IQR: 1, mean 4.5, STD 1.01). The ED-BINGO activity for the EM clerkship was perceived by medical students as educationally beneficial and enjoyable. While the limited number of participant respondents precludes any definitive conclusions about its broader effectiveness or its suitability for formal incorporation into the clerkship, the warm reception, especially noted in our student narrative responses, shows promising opportunities for other clerkships to adopt similar activity-driven gamification for self-driven adult learners. Further study with greater response rates would determine whether gamified interventions can meaningfully mitigate the educational challenges posed by ED boarding.
Pregnancy involves profound physical and psychological changes that may increase the risk of lumbopelvic pain and affect body image. Body surveillance and functionality appreciation are key constructs in this context, yet little is known about interventions targeting them in pregnant women experiencing pregnancy-related pain. This study examined whether standard prenatal education alone or combined with pain neuroscience education could improve functionality appreciation and reduce body surveillance in women with pregnancy-related lumbopelvic pain. A total of 211 third-trimester pregnant women with pregnancy-related lumbopelvic pain were randomly assigned to standard prenatal education or a combined program with pain neuroscience education. Both programs included twelve online lessons delivered over four weeks. Functionality appreciation and body surveillance were measured at baseline and post-intervention using validated questionnaires. Linear mixed models were used for analysis under an intention-to-treat approach. Functionality appreciation improved significantly over time in both groups (p = .018), but no between-group differences were observed (Cohen's d = 0.056). Body surveillance scores remained unchanged in both groups (Cohen's d = 0.00). Adherence was higher in the SPE group (88%) compared to SPE+PNE (77.5%, p = .011). Brief online educational programs, especially standard prenatal education, can enhance functionality appreciation during pregnancy, shifting focus from appearance to bodily capacities.
Overweight and obesity in adolescents have become significant public health issues, with traditional interventions showing limited effectiveness. Cognitive behavioral therapy (CBT) offers a novel approach to adolescent health promotion by altering individuals' cognitive and behavioral patterns. This study was designed to construct a health behavior promotion model for overweight adolescents integrating CBT theory and to empirically validate it based on multidimensional behavioral scoring. A cross-sectional study was conducted among 294 adolescents aged 13-16 from three secondary schools. Participants were classified into overweight/obese (n = 86) and normal weight (n = 208) groups based on BMI criteria. Data were collected using the Body Appreciation Scale-2, Weight Control Practices Questionnaire, and Comprehensive Lifestyle Assessment Scale. Statistical analyses included independent t-tests, Pearson correlation, structural equation modeling (SEM), and multiple regression. Overweight adolescents scored significantly lower in body appreciation cognition (t = 4.32, p < 0.001) and healthy weight control behaviors (t = 3.87, p < 0.001), and higher in unhealthy weight control behaviors (t = 4.96, p < 0.001). SEM revealed that body appreciation cognition had a direct negative effect on BMI (β = -0.18, p < 0.01) and an indirect effect through healthy weight control behaviors (β = -0.12, p < 0.05). The model demonstrated good fit (χ2/df = 2.36, CFI = 0.94, RMSEA = 0.06). The findings support the applicability of a CBT-based health behavior promotion model for overweight adolescents. The model, encompassing cognitive restructuring, behavioral activation, self-monitoring, and relapse prevention, provides a theoretical foundation for school- and community-based interventions.
Alcohol has been appreciated by civilizations for thousands of years. Nonetheless, alcohol has recently been linked to serious cardiovascular diseases. Therefore, this review summarizes the effects of alcohol on the heart based on the most current literature available. This review covers the effects of alcohol on blood pressure (BP), heart rate (HR), autonomic dysfunction, coronary artery disease (CAD), cardiomyopathy, and cardiac arrhythmias. Evidence supports the harmful effects of both acute (binge) and chronic heavy alcohol consumption on BP, HR, autonomic dysfunction, and the risk of CAD, cardiomyopathy, and various arrhythmias. Some studies suggest that mild to moderate drinking may reduce the risk of CAD and arrhythmias, consistent with a potential J-shaped relationship. However, other evidence contradicts this, thereby indicating that alcohol use may increase the risk of developing hypertension, CAD, and atrial fibrillation. At the time of this review, evidence supports the harmful effects of acute and chronic heavy alcohol consumption on the heart. Findings are mixed for mild to moderate drinking and may be influenced by confounding factors, underscoring the need for further research. Given the inconclusive benefits, the authors recommend that no level of alcohol consumption be promoted as beneficial for cardiac health.
To explore the acceptability of the Community Outpatient Psychotherapy Engagement Service for Self-harm (COPESS) intervention and trial procedures for participants. A mixed-method approach and a single-blind randomised controlled trial design with 1:1 allocation to either COPESS plus treatment as usual or treatment as usual alone. Primary care. Fifteen semistructured interviews were conducted with participants in the COPESS trial; eight were randomised to the intervention arm, and seven were randomised to the treatment-as-usual arm. Interviews lasted 30-60 min. COPESS is a brief, relational psychotherapy delivered over 4 weekly sessions plus a follow-up, focusing on understanding difficult emotional states and their links to self-harm through here-and-now relational and emotional processes. Thematic analysis allowed exploration of themes important to participants in their experiences in the COPESS trial and their experiences of care for self-harm more generally. Five themes were identified as associated with the acceptability of the COPESS intervention and trial: self-harm as a primary problem, what I needed when I needed it, being heard and understood, online delivery of the intervention and lasting impacts. Participants generally expressed positive views about the intervention, citing a need for services that specifically target self-harm and an appreciation of the rapid access to help. Strong relationships with the therapist were highly valued and not diminished by online delivery of the intervention. Positive impacts continued post therapy sessions. These results support the acceptability of the COPESS intervention, the need for self-harm specific services and support moving forward to a full trial. Pre-registered on clinicaltrials.gov (NCT04191122) on 9 December 2019.