As patients increasingly seek medical information online, artificial intelligence (AI) chatbots like NIPRGPT-the most widely available AI tool for Department of Defense (DOD) computer users-offer a novel resource for addressing queries about femoroacetabular impingement (FAI). To date, there have not been any studies evaluating NIPRGPT responses to orthopedic medical questions. The primary objective of this study was to evaluate the accuracy, comprehensiveness, and readability of NIPRGPT's responses to common FAI-related questions. Twelve frequently asked questions (FAQs) regarding FAI were selected from a curated list and posed to NIPRGPT. The accuracy and adequacy of the responses were graded by a panel of board-certified surgeons as excellent (not requiring clarification), satisfactory (requiring minimal clarification), satisfactory (requiring moderate clarification), or unsatisfactory (requiring substantial clarification). Additionally, readability was assessed using the Flesch-Kincaid readability score. Of the 12 responses, four (33.3%) were excellent, requiring no clarification, seven (58.3%) were satisfactory, requiring minimal clarification, and one (8.3%) was satisfactory, requiring moderate clarification. No responses were deemed unsatisfactory. The average quality score was 3.38/4.0. However, the average Flesch-Kincaid readability score was a 19.6 Grade Level, indicating a reading level suited for postgraduate or specialized academic backgrounds. Interobserver agreement was low, with a Krippendorff's alpha of 0.046. NIPRGPT provides answers to FAQs about FAI that are generally accurate and reliable. However, the responses are generated at a complexity level far exceeding the recommended reading level for patient education. While a potentially useful adjunct in military healthcare settings where access may be limited, clinicians must be aware of the high literacy demand placed on patients using this tool.
Despite the introduction of the 2017 periodontal disease classification system to enhance diagnostic accuracy, several concerns persist regarding its implementation in clinical situations. The prevalence of diagnostic errors in periodontics remains relatively high, with limited data available on the impact of different training levels and institutional approaches on the diagnostic accuracy and competency of students and practitioners. This study aims to explore the patterns of diagnostic accuracy and perceived confidence and familiarity with utilizing the 2017 periodontal classification system across various levels of clinical complexity, different educational levels, and two Canadian institutions METHODS: This prospective cross-sectional study included 104 participants from two universities, including third- and fourth-year dental students, dental hygiene degree students, periodontics residents from five programs, and clinical instructors in periodontics and dental hygiene. Participants were asked to diagnose five de-identified clinical cases along the spectrum of periodontal health and disease. Gold standard diagnoses were established by board-certified periodontists. Diagnostic accuracy, error patterns, and factors influencing diagnostic decisions were analyzed using chi-square tests, t-tests, and a content analysis approach. The overall diagnostic accuracy ranged from 18.3% to 53.8%. Clinical instructors achieved the highest accuracy (58.3%), followed by residents (52.9%), fourth-year dental students (45.2%), dental hygiene degree students (36.5%), and third-year dental students (26.4%). Statistically significant institutional differences were identified in Cases 1 (χ2  = 7.62, p = 0.01) and 4 (χ2 = 4.04, p = 0.05). Common errors included underdiagnosis (32.4%), incorrect periodontal status identification (28.7%), and wrong extent classification (21.3%). Qualitatively, participants frequently described the classification system as "ambiguous" with substantial "gray zones". Regardless of the training level, diagnostic accuracy with the 2017 classification system remains suboptimal. Institutional variations suggest that curricular approaches may significantly impact the development of diagnostic skills and their diagnostic competency. These findings highlight the need for calibration protocols, targeted teaching and learning interventions, and technology-supported learning tools to improve diagnostic skills in periodontal education. Dentists and dental students often experience challenges in diagnosing gum disease accurately using the updated classification system introduced in 2017. This study tested 104 dental professionals and students from two Canadian universities to see how accurate their diagnoses were of five different gum disease and health cases. The participants included dental students in their third and fourth years, dental hygiene students, specialists‐in‐training, and experienced teachers. Even the most experienced teachers only got diagnoses correct in about 58% of cases, while students had an accurate diagnosis for about 26% of the cases. The accuracy varied between the two universities and was found to be related with confidence and familiarity in using the system for individual participants. When asked about the diagnostic system, many participants described it as confusing and difficult to apply. These findings reveal that dental education needs significant improvements, with more exposure to different cases of gum disease and health, more consistent teaching methods, and possibly technology‐assisted learning tools to help students and clinicians become more accurate at diagnosing one of the most common diseases experienced by the population worldwide.
Mental images of threat are common in social anxiety disorder and could impede exposure to fear-relevant situations. Landkroon et al. (2022) found that imagery rescripting of anticipated future threat, compared to no-task, increases willingness of non-clinical individuals to conduct a social anxiety-related behavioral experiment. The aim of this two-day preregistered extended replication study was to examine whether the effects persist beyond the intervention session by scheduling the behavioral experiment 1-7 days after the intervention. On Day 1, 60 pre-screened participants were asked to design a behavioral experiment to test an idiosyncratic negative belief about a feared social situation. They were then randomly assigned to imagery rescripting (focused on their worst feared outcome of the behavioral experiment) or no-task. Participants' willingness to do the behavioral experiment and their threat beliefs was measured. On Day 2, they were asked to carry out the behavioral experiment. The imagery rescripting group, compared to the control group, did not show increased willingness or compliance to do the behavioral experiment on Day 1 or 2. Furthermore, the imagery rescripting did not lead to greater reductions in threat beliefs on either day. The quality of the imagery rescripting intervention was not assessed, and given the brief nature of the intervention, any effects may have dissipated before participants decided whether to carry out the behavioral experiment. There was no evidence that imagery rescripting leads to changes in willingness or compliance to do a fear-relevant behavioral experiment. More research is needed to examine interventions that can enhance exposure in socially anxious people.
Large language models (LLMs), a form of artificial intelligence, are increasingly being utilized in healthcare to support patient education and information delivery. The aim of this study was to perform a comparative analysis of five different LLMs (i.e., ChatGPT-4o, Claude 3.7 Sonnet, Gemini 2.5 Pro Preview, DeepSeek-V3, and Microsoft Copilot) in terms of accuracy, completeness, and readability, based on their responses to frequently asked questions in preoperative patient education for mitral valve surgery (MVS). A standardized questionnaire comprising seven frequently asked questions by patients prior to MVS was developed. Prompting procedures and model parameters were fully reported to support reproducibility. These questions were presented to each LLM in an identical manner. The responses were evaluated by two academic experts in cardiac surgery using structured assessment criteria across three main dimensions: accuracy, completeness, and readability. For the readability analysis, the Simplified Measure of Gobbledygook (SMOG) Index and the Flesch-Kincaid Grade Level (FKGL) scale were utilized. The ChatGPT-4o and Gemini 2.5 Pro Preview models received statistically significantly higher scores than Claude 3.7 Sonnet and Microsoft Copilot for both accuracy (median 5 for ChatGPT-4o and Gemini 2.5 Pro Preview vs. 4 for Claude 3.7 Sonnet and Microsoft Copilot, p < 0.001) and completeness (median 5 for Gemini 2.5 Pro Preview vs. 3 for Claude 3.7 Sonnet, p < 0.001). Claude 3.7 Sonnet achieved the highest readability scores, with significantly lower SMOG (10.90 for Claude 3.7 Sonnet vs. 12.24 for ChatGPT-4o, p = 0.006) and FKGL (8.0 for Claude 3.7 Sonnet vs. 9.04 for ChatGPT-4o, p = 0.004) scores, indicating simpler and more comprehensible sentence structures. Significant differences were observed among the evaluated models across all three assessment dimensions (p < 0.001 for all comparisons). The LLMs represent valuable supplementary tools in patient education processes. However, their implementation in clinical practice must be carefully evaluated, particularly with regard to accuracy and completeness. This study highlights the potential applicability of ChatGPT-4o and Claude 3.7 Sonnet models for preoperative patient education in MVS, while emphasizing that all LLMs should be used under the supervision and guidance of healthcare professionals. For LLMs to be reliably utilized in the medical field, improvement in medical accuracy and standardization are essential.
Preconception health improvement is vital for maternal and child health, yet societal perceptions about who holds responsibility for this remain underexplored. We conducted a hybrid workshop at the 2024 UK Preconception Early-Mid Career Researcher (EMCR) Network conference, attended by academics, health professionals and members of the public (N = 60). Small-group discussions on responsibility for preconception health improvement were audio-recorded and transcribed alongside notes from online whiteboards and paper-based flipcharts. Using framework analysis, we applied a deductive coding framework derived from the workshop questions. Attendees felt a disproportionate burden of responsibility for preconception health improvement was placed on women, reflecting deeply entrenched gendered norms within research, healthcare and broader societal structures. Attendees' recommendations centred around (i) society, community and culture, (ii) education and early awareness, (iii) considerations for future research, and (iv) systems-level and policy solutions. These findings provide valuable insights for developing equitable public health strategies and research agendas relating to preconception health. Being healthy before pregnancy and parenthood is important. It affects pregnancy outcomes and lifelong wellbeing. But there are mixed views on who should be responsible for improving health before pregnancy. We held a workshop with 60 people, including health workers, researchers, and members of the public. We asked who is responsible for health before pregnancy and how this shows up in different contexts. We also asked for suggestions for how to make sure this responsibility is shared evenly.Attendees felt that women carry most of the burden. This happens in health care, research, and everyday life. Men are often left out of conversations about health around pregnancy. Current approaches to improving health before pregnancy focus on women’s choices and actions such as diet and smoking rather than wider issues like poverty, education, and health care access.Attendees felt that health before pregnancy should be a shared responsibility between partners, health workers, government, and society. They suggested including men equally in health care, research, and campaigns around health before pregnancy. They also said that education about this should start early, in schools. They called for changes in communities to support health before pregnancy, so that people don’t need to do this alone.These suggestions can help create fairer approaches to improving health before pregnancy and parenthood that support everyone. They reflect that this requires support from the whole of society.
Diagnostic reference levels (DRLs) have been proven to be a useful tool for optimizing patient radiation exposure. National DRLs (NDRLs) are defined based on data from a representative sample of the healthcare facilities in a particular country. This project presents the survey to update the NDRLs for cardiac interventional procedures in Switzerland. Healthcare facilities performing cardiac procedures in Switzerland were asked to provide radiation dose data for adult cardiac interventional procedures performed over the course of one year. The dataset included the procedure name and the corresponding air kerma area product, air kerma at the reference point, fluoroscopy time and number of cine acquisitions. Thirty-five healthcare facilities (95% of the total) provided data. The procedures were grouped into 11 electrophysiology procedures, 4 cardiac catheterization procedures, and 3 structural heart procedures. For each healthcare facility and radiation quantity, the median values were calculated. Updated NDRLs were determined as the 75th percentile of the distribution of these median values. For example, the updated NDRL for air kerma area product was set at 24 Gy∙cm2 for coronary angiography and at 2 Gy∙cm2 for pacemaker implantation, reflecting a substantial reduction from the prior NDRL values of 50 and 30 Gy∙cm2, respectively. These new NDRL values are substantially lower than the previous ones, highlighting the importance of conducting regular updates to accommodate continuous patient dose optimization of and technological advancements.
V-safe is an active surveillance system developed during the pandemic to monitor COVID-19 vaccine safety. After vaccination, US residents could enroll to receive text messages linked to health check-in surveys. Questions about symptoms and health impacts, including inability to complete daily activities, attend work or school, or receipt of medical care were asked at daily, weekly, and monthly intervals after vaccination. We describe demographics of participants compared to the vaccinated population, trends in enrollment, participation over time, and self-reported health impacts in the V-safe population during the COVID-19 pandemic. During December 14, 2020 - June 30, 2023, 9,609,282 persons completed at least one V-safe survey. Most were female (62.2%), aged 25-64 years (69.2%), and received an mRNA vaccine (95.0%). Compared to the US vaccinated population, a higher proportion of participants were non-Hispanic White or Asian and ≥ 75 years. Most registered for V-safe within the first few months after vaccination was recommended for their age group. Most completed an initial health survey within the first week after vaccination. Participation decreased for successive doses, especially among persons aged <18 years. Health impacts were reported more frequently during the first week post-vaccination, after dose 2 compared to dose 1, and among recipients of mRNA-1273 vaccine compared to recipients of BNT162b2 vaccine. Health impacts among children <12 years were reported slightly less frequently compared to adults. Seeking medical care was reported in the first week after vaccination by 0.8-1.2% of adults after doses 1-6 of an mRNA vaccine. Findings were similar to those in previous V-safe analyses and data from clinical trials. Rapidly decreasing participation during the course of the pandemic suggests that incentives encouraging survey completion in V-safe could be useful for improving safety monitoring for future emergency vaccines. V-safe continues to collect data about COVID-19 vaccines, with an emphasis on new products.
Head and neck cancer (HNC) presents a significant challenge in oncology. It has high prevalence rates, especially in India, where 30-40% of cancer cases are attributed to HNC. While chemotherapy and radiation therapy are essential components of treatment, they often lead to significant sleep disturbances that negatively impact patients' quality of life and the effectiveness of their treatment. These sleep disturbances are frequently associated with disruptions in the circadian rhythm, which are commonly seen in cancer survivors. This study aimed to evaluate the effect of an exercise oncology program on sleep quality and circadian rhythm in patients with HNC undergoing chemo-radiation therapy. Patients with HNC (stage III, IVa, or IVb) undergoing chemo-radiation therapy, aged 18 years or above, of any gender, and with an Eastern Cooperative Oncology Group score < 2 were included. Patients with severe orthopedic or neurological conditions, hemoglobin < 8 g/dL, platelet count < 30,000/µL, or unfit for exercise were excluded. Seventy HNC patients were randomized to exercise oncology and control group. The exercise oncology group received 15-20-minute sessions of aerobic (brisk walking) and resistance training (upper and lower limb exercises). Participants in the control group were asked to follow the walking protocol recommended by National Comprehensive Cancer Network guidelines, five days a week for seven weeks. Pittsburgh Sleep Quality Index (PSQI) was used to assess overall sleep quality, while melatonin excretion in urine, quantified using ELISA, was used to evaluate the circadian rhythm. Between-group comparisons were analyzed using mixed analysis of variance for PSQI and analysis of covariance for urinary melatonin. Receiver operating characteristic (ROC) curve analysis was used to evaluate the diagnostic accuracy of PSQI scores and melatonin levels. PSQI significantly improved in the exercise group (13.97 ± 2.29 to 7.09 ± 1.15), and significantly worsened in controls, (13.06 ± 1.73 to 14.14 ± 2.64) (both p < 0.001). Although urinary melatonin levels increased in the exercise group (284.16 ± 85.29 ng/L to 369.75 ± 91.61 ng/L) and decreased in controls (368.00 ± 100.62 ng/L to 304.39 ± 99.50 ng/L), the between-group difference was not significant after adjusting for baseline values (p = 0.372). Furthermore, ROC curve analysis demonstrated that post-intervention PSQI exhibited excellent diagnostic accuracy for distinguishing between good and poor sleep quality. An exercise oncology program has potential benefits in improving quality of sleep and regulating the circadian rhythm in HNC patients undergoing chemo-radiation therapy.
A patient complained of left-sided low back pain that radiated to her left ankle and, upon examination, was found to have right hip internal rotation weakness. She was classified by this author as having a directional preference for lumbar rotation in flexion per the McKenzie Method of Mechanical Diagnosis and Therapy (MDT, or the McKenzie Method). At the patient's eighth visit, she reported that she had been performing approximately 160 repetitions of left lumbar side gliding against a wall per day and, of her own volition, having an untrained family member give this movement a push. At this visit, manual correction of a lateral lumbar shift, also known as a shift correction, slightly improved her lumbar active range of motion (AROM). The clinician then asked the patient to perform left lumbar side gliding against a wall in the clinic during which a "pop" was heard, and the patient reported intense right hip pain as well as displayed an antalgic gait. Despite numerous limitations including inadequate documentation of subjective and objective baselines, such as numeric pain rating scale, strength, and AROM immediately after this critical event as well as multiple confounding factors, it is possible that future clinicians may wish to utilize the shift correction manual technique, instead of additional repetitions of lumbar side gliding, to more accurately determine directional preference.
Transcriptomic studies of liver preservation and ischemia-reperfusion injury (IRI) often report large gene lists that are difficult to translate into deployable diagnostic tools. Genome-wide profiling remains impractical within organ procurement timelines, where decisions must be made rapidly and assay infrastructure is limited. A compact, interpretable gene panel deployable via targeted platforms such as NanoString or RT-qPCR could bridge this gap between transcriptomic discovery and clinical utility. We asked whether full transcriptomes from human liver cohorts can be compressed into such panels without loss of classification performance. Seven GEO datasets covering static cold storage, hypothermic/normothermic machine perfusion, ischemic preconditioning, and peri-transplant biopsies (GSE112713, GSE276531, GSE12720, GSE14951, GSE15480, GSE151648_TIME, GSE151648_IRI) were re-processed into ML-ready expression and phenotype matrices. All gene identifiers were harmonized to HGNC symbols before any modelling step. For each dataset, elastic net (EN) logistic regression and XGBoost were trained and evaluated within a repeated nested cross-validation framework (fivefold × 3-repeat; 15 outer folds), with feature selection performed exclusively on the outer training partition. The union of the top-30 EN coefficient and top-30 XGBoost gain importance genes (EN ∪ XGB) was evaluated on the held-out outer test fold. Nested CV yielded AUCs of 0.842-0.965 across four datasets with reliable sample sizes (n ≥ 30). The two largest cohorts, GSE151648_TIME (n = 80) and GSE12720 (n = 42) achieved AUC = 0.959 ± 0.052 and 0.965 ± 0.059 respectively, with specificity and PPV > 0.90. GSE276531 (n = 32) did not yield reliable transcriptomic signal in either label orientation and is reported as a negative result. Cross-dataset transferability assessed by Leave-One-Dataset-Out validation was consistently poor, with balanced accuracy of 0.500 and macro F1 ≤ 0.333 in five of seven test sets, indicating majority-class collapse rather than genuine cross-dataset signal, suggesting that panels are largely context-specific. An exception was observed among the three reperfusion-focused cohorts (GSE12720, GSE15480, GSE151648_TIME), where high bidirectional panel transfer within this subset (AUC = 0.99-1.00) coincided with convergent selection of inflammatory, proteotoxic stress, and AP-1 axis genes across independently derived panels. Explainable ML models can compress liver transplant transcriptomes into compact, context-specific gene panels with strong within-cohort diagnostic accuracy. The convergence of biologically coherent gene signatures across reperfusion-focused cohorts lends biological support to these panels, while consistently poor LODO transfer underscores the need for cohort-tailored assay development and prospective validation.
Osteoarthritis (OA) affects millions of Canadians with substantial healthcare costs, yet education and exercise can improve outcomes. This study explored the perceived benefits, facilitators, and barriers influencing perceived access and adherence to an 8-week physiotherapist-supervised exercise and education program in a private clinic. Adults with hip and/or knee OA enrolled in the program were invited to complete a cross-sectional online survey. Descriptive statistics and qualitative content analyses were used to describe participant demographics, clinical features, and perceptions. Of 102 participants, 61 completed the survey (60% response rate). Perceived benefits identified by participants included physical improvements, socialization, increased confidence, expert support, and improved self-efficacy. Perceived facilitators supporting adherence were physical ability, financial support, transportation, and provider expertise. While most participants reported no major barriers, some noted financial constraints, physical limitations, inconvenient class times, and work demands. A group-based hip and knee OA program delivered by physiotherapists can provide substantial perceived physical, psychological, and social benefits, though self-reported adherence may be influenced by financial, physical, and social factors. Why did we do this study? Osteoarthritis (OA) can cause pain and make daily activities difficult. While supervised exercise and education programs can help, we wanted to understand the patient experience. We wanted to understand directly from patients with hip and knee arthritis what they felt were the benefits of a physiotherapist-led group program, as well as what made it easier to attend and what challenges got in the way. How did we do this study? We invited adults with hip or knee OA who were enrolled in an 8-week group program at a private-practice clinic to complete an online survey about their experiences. We asked about the positive changes they noticed and what helped or hindered their ability to stick with the program. What did we find? Participants reported benefits beyond just physical improvements. While they felt stronger and moved more easily, they also highlighted the value of social connection with others in the group. Many felt more confident and less afraid of their pain. The expert guidance from physiotherapists was crucial for helping them feel safe and motivated. Facilitators included physical ability, financial support from health insurance, and reliable transportation. The most common challenges were the program’s cost, especially after insurance benefits ran out. Other barriers included pain and class times conflicting with work schedules. What does this mean? Group exercise programs led by physiotherapists can provide whole-person care, helping patients physically, socially, and emotionally. For these programs to help more people, our findings show we must address practical challenges like program cost and scheduling flexibility.
The magnitude of contraceptive non-use attributed to side effects globally merits concerted attention to ensure women receive quality side effect counseling and support in line with their goals. Evidence shows comprehensive contraceptive counseling can help women navigate side effects, yet survey data reveal consistent gaps in side effect counseling quality. To elucidate women's lived experiences with side effect counseling and management, we examined how women in Kenya and Ethiopia manage contraceptive side effects with and without help from healthcare providers, and what their preferences are for support. We conducted in-depth interviews with sexually active women of childbearing age (N = 83) in Nairobi and Kisumu, Kenya, and Addis Ababa and Amhara region, Ethiopia. Participants were asked about their contraceptive experiences, including side effects, how they managed side effects, what support they received, and their preferred approaches for receiving support when experiencing side effects. We utilized a modified grounded theory approach for data collection and analysis. We found gaps in reported counseling quality among women in our sample, and a desire for more comprehensive counseling on side effects during initial and follow-up visits. After experiencing side effects, most participants described enduring and self-managing with over-the-counter remedies, and seeking clinical advice only when they worried about how their contraceptive method was affecting their overall health. Follow-up services often addressed participants' immediate needs, but rarely offered additional information or comprehensive counseling. A few participants were denied a desired contraceptive device removal or shamed for not using contraception. We identified a need to improve anticipatory contraceptive side effects counseling and proactive follow-up approaches that support women to choose methods they prefer and then navigate their use or switching. Such counseling would help health systems become more responsive to patient needs in contexts where women's suffering is often considered acceptable, rather than cause for intervention.
A 1997 survey assessed United States poison center medical directors' recommendations for serum alkalinization in tricyclic antidepressant poisoning. This study aims to assess current recommendations for all sodium channel blocking drug poisonings. This was a cross-sectional survey utilizing anonymous responses from United States poison center medical directors. Participants were asked about initial treatments of varying features of sodium channel blocking drug poisoning, criteria and thresholds to recommend sodium bicarbonate, including a patient with baseline pre-poisoning QRS prolongation; and how specific drug exposures influenced treatment recommendations. The QRS duration thresholds to recommend sodium bicarbonate were compared to those from the prior survey and to the case with pre-poisoning QRS prolongation. Of 55 recipients, 30 (60%) surveys were completed. Sodium bicarbonate was the most frequently recommended initial treatment (23 participants, 78%) for isolated electrocardiogram changes. Vasopressors and supportive care alone were the most frequent initial recommendations for isolated hypotension (17, 57%) and isolated central nervous system toxicity (28, 93%), respectively. In the presence of electrocardiogram changes, shock, and central nervous system toxicity, 28 (93%) recommended sodium bicarbonate as initial treatment. The most frequent second- and third-line treatments were vasopressors (21, 70%) and hypertonic saline (11, 37%). Twenty-nine (97%) participants considered QRS duration when recommending sodium bicarbonate. The median QRS threshold utilized was 120 (IQR 100-160) milliseconds, compared to the previous survey's median threshold of 100 milliseconds (P = 0.002). In the case with pre-poisoning QRS duration 130 milliseconds, this threshold increased to 140 (IQR 130-160) milliseconds (P <0.001). Thirteen (43.3%) respondents were less likely to recommend sodium bicarbonate in bupropion poisoning. The threshold QRS duration for recommending sodium bicarbonate was greater in 2024 compared to 1997, likely due to practice changes and increased variety of sodium channel blocking drugs. Sodium bicarbonate recommendations continue to focus heavily on electrocardiogram changes, with exact thresholds depending on patient and drug exposure factors. Further studies are needed to evaluate the optimal approach to sodium channel blocking drug poisoning.
Background and Aims As part of an effort to streamline our institutional process for referral and scheduling of interventional endoscopy procedures; facilitate ease of referral for these procedures; and standardize documentation of critical steps in the chain of referral, review, and scheduling, we devised and implemented an eConsult service for interventional endoscopy and analyzed its performance by uptake and provider satisfaction. Methods An eConsult electronic order template was designed and implemented for outpatient referrals for interventional endoscopic procedures. Following 12 months of operation of this eConsult platform, referring providers were asked to rate their satisfaction with eConsult referrals. Results In all, 129 eConsults were completed within a 12-month period, with steady monthly growth throughout. About 89.5% of referring providers indicated that "eConsult has made it easier for me to refer patients for endoscopic retrograde cholangiopancreatography/endoscopic ultrasound," while 84% indicated "I would like to see eConsult expanded to other service lines." Conclusion eConsults appear to be an efficient and effective mechanism for referral, clinically documented review, and scheduling of outpatient interventional endoscopy procedures.
Language production often occurs under time pressure, leading speakers to initiate speech before fully formulating their message. Speakers can then continue planning their utterance incrementally, as more message information becomes available. We investigated how speakers use incremental planning to describe events under message uncertainty, and how planning strategies vary cross-linguistically. In Experiment 1, English speakers described animations of motion events (e.g., the butterfly moves to the slide), and we manipulated whether the target location was known from the trial onset or only disambiguated toward the end. When the target was initially uncertain, participants delayed speech onset but still began speaking before target disambiguation, starting with the available message information. Speakers also produced longer utterance durations and more pauses in uncertain trials, indicating incremental planning after speech began. In Experiment 2 we found that Spanish speakers planned more incrementally than English speakers, as Spanish word order allowed delaying production of the uncertain element - providing speakers with more time to incorporate it into their ongoing utterance after disambiguation. In Experiment 3 we asked whether Spanish speakers would pre-plan the gender-marked article of an uncertain target, if all potential targets matched in grammatical gender. There was no evidence that the gender-marked article was planned prior to target disambiguation, despite being shared across target options. Together, findings suggest that the balance between advance planning and incrementality depends on both message properties and language-specific grammatical affordances. These interactions highlight speakers' flexibility in adapting planning strategies to the production context, including in situations of message uncertainty.
Mental health professionals (MHPs) play important roles in providing expert opinions in courts; however, dated studies indicate that legal professionals prefer psychiatrists as mental health expert witnesses as well as mental health testimony on ultimate opinions, clinical diagnosis, and interpreting the legal standard for mental conditions. This mixed-methods study surveyed 132 judges and lawyers in the United States and Canada to examine their preferences for mental health testimony elements and MHPs as expert witnesses. Updating previous research conducted between the 1980s to 2010s, respondents were presented with 11 questions describing different elements of mental health testimonies and were asked to rate the importance of these testimonies and rank their preference for psychiatrists, psychologists or social work experts. Legal professionals preferred expert testimony on clinical diagnosis, psychological testing, and descriptive testimonies. American legal professionals considered testimony on crime statistical data related to diagnosis as more essential than did Canadians, and Canadians ranked testimony on measure of dangerousness higher. Overall, American legal professionals preferred having psychologists as expert witnesses, whereas Canadian legal professionals preferred psychiatrists. Using a qualitative reflexive thematic analysis of participants' comments on factors that contribute to a useful testimony, four themes summarized the indicators of useful expert testimony: Qualified and Engaged Experts, Relevant and Useful Information, Empirical Rigor in Testimony, and Clarity and Accessibility. Results reveal that American legal professionals are increasingly understanding the value of forensic psychologists as expert witnesses, whereas Canadians hold preferences for psychiatrists.
Germline pathogenic variants in the RUNX1 gene lead to the condition RUNX1-familial platelet disorder (RUNX1-FPD). This condition is associated with a 30%-50% lifetime risk of hematologic malignancies, including acute myeloid leukemia. In addition to physical manifestations including prolonged bleeding and easy bruising, individuals with RUNX1-FPD face profound psychosocial challenges. Individuals 18-39 years old may particularly struggle in their experiences with RUNX-FPD as they navigate developmental milestones. This descriptive, cross-sectional study includes participants aged 18-39, enrolled in the NIH RUNX1 Natural History Study (19-HG-0059). Each participant completed a structured psychosocial self-report assessment that included demographic factors, patient-reported outcomes on mental health symptomatology, psychiatric treatment history, and traumatic stress symptomatology. Open-ended questions asked participants to identify the most difficult part of living with RUNX1-FPD and how RUNX1-FPD has impacted their lives. Twenty-two participants completed the measures and were included in the analyses. Participants' mean age was 31 years (SD = 5.1). Fifty percent of participants reported higher than average anxiety scores, 59% reported they had been treated by a mental health professional, and 64% reported traumatic stress symptomatology. Living with the chronic uncertainty of cancer development and overall distress from recommended lifelong monitoring processes emerged as themes from the illustrative exemplar quotes. With this study, we describe the significant psychosocial and mental health challenges that emerging adults with RUNX1-FPD face. Access to psychological counseling, peer support groups, and genetic counseling can help individuals process their risk, manage anxiety, and make informed decisions. More research is needed to explore effective coping strategies, resilience-building techniques, and patient-centered resources to improve quality of life for those living with a hereditary predisposition to hematologic malignancies. RUNX1‐FPD is a rare inherited condition caused by changes in the RUNX1 gene that can lead to bleeding problems and an increased risk of blood cancers like leukemia. Along with these physical health risks, individuals may experience significant anxiety and emotional distress related to lifelong cancer monitoring and uncertainty about their health.
The EQ Health and Wellbeing (EQ-HWB) is a new, generic instrument designed to evaluate quality-of-life across health, public health, and social care settings. The short form comprises nine items (EQ-HWB-9) and validation across diverse populations and contexts is required. We aimed to investigate the validity of the EQ-HWB-9 in an international sample of adults experiencing poor mental health who downloaded a meditation app. We further examined the impact of four item-level modifications on psychometric performance, including investigating a potential ordering effect for the 'activities' item (hypothesised in prior studies) and three minor changes to response options. The current study was embedded in a larger trial examining engagement with meditation via a free, downloadable app. Participants were randomised to complete the original (2022) and modified (2024) experimental version of the EQ-HWB-9. Psychometric evaluation included analyses of item distribution, known group and convergent validity, and responsiveness to change. There were no differences in demographic characteristics between the EQ-HWB original and modified versions at baseline (n = 865) or follow-up (n = 130). All psychometric tests supported the validity of the EQ-HWB-9 in this population. We found an ordering effect for the activities item, where the activities item showed a greater level of difficulty and a wider distribution over response options when asked before the mobility item, rather than after. There were no observable differences between versions for the other modifications. These findings add to growing literature supporting the EQ-HWB-9 as a suitable instrument for measuring quality-of-life across a range of settings. When the 'activities' item was presented first, as in the modified version, participants appeared to interpret the item more broadly, in line with the developers' intentions. Accordingly, our results support changing the item order of the first two items. Other modifications had little impact on outcomes, suggesting that further qualitative research will be required to inform decisions about their inclusion. Results from this study provide support towards finalisation of the instrument. The development of country-specific value-sets is now critical to support its application in economic evaluation.
What is this summary about? This is a summary of the results from a study that looked at the treatment preferences of people with hemophilia and caregivers of children with hemophilia in the US and UK. The study was published in a research journal called Haemophilia. People with hemophilia need regular treatments to help their blood clot properly and to prevent bleeding. Treatments to prevent bleeding are often injected into a vein. For some people, the injections can be painful or hard to use. If treatments are hard to use, people may be less likely to stick to their treatment plan. This can make it harder for them to manage their hemophilia. New treatments that work in a different way can be given as an injection under the skin instead of into a vein. These treatments may be easier for people to use. Newer treatments have different benefits and risks compared with earlier types of treatment, so researchers wanted to understand what features of treatments are most important to people with hemophilia and caregivers What were the results of the study? Adults with hemophilia and caregivers of children with hemophilia in the US and UK took an online survey. They were asked to choose between made-up (hypothetical) treatments with different benefits, risks, and ways of administration (how the treatment is delivered into the body). The study showed that people with hemophilia and caregivers had mostly the same preferences for treatments to prevent bleeds. People cared most about having a treatment they can take less often. People were willing to accept some additional risks or lower treatment benefits if they could have injections under the skin instead of into a vein. What do the results mean? People with hemophilia and caregivers found some treatment features more important than others. It is important for healthcare teams to know which treatment features are most important to people. If treatments match people's preferences, they are more likely to be satisfied. For example, if people prefer injections under the skin, they may be more likely to stick to their treatment plan if they use a treatment delivered under the skin instead of into a vein. People who stick to their treatment plan are likely to have better health outcomes.
Alzheimer's disease (AD) is a progressive neurodegenerative disorder characterized by cognitive decline, neuroinflammation, oxidative stress, and amyloid pathology, yet effective disease-modifying therapies remain limited. This study asked whether combined targeting of inflammatory and oxidative stress pathways could offer enhanced neuroprotection in an Aβ1-42-induced rat model of AD. Tenoxicam, an oxicam-class non-steroidal anti-inflammatory drug with COX-linked anti-inflammatory activity, and phenethyl isothiocyanate (PEITC), a natural compound known for antioxidant and Nrf2-activating properties, were selected on the basis of their complementary mechanisms; however, their combined potential in this model has not been sufficiently explored, providing the rationale for this hypothesis-driven investigation. Male Wistar rats were assigned to control, disease, standard, tenoxicam, PEITC, and combination treatment groups. Cognitive performance was evaluated using the Morris Water Maze, Y-maze, and Novel Object Recognition tests, while neuroinflammatory and oxidative stress markers, including NF-κB, NLRP3, IL-1β, Nrf2, catalase, and malondialdehyde, were assessed alongside histopathological examination of hippocampal integrity and molecular docking against COX-2, NF-κB, and NLRP3. Aβ1-42 administration induced significant cognitive impairment, neuroinflammation, oxidative stress, and neuronal damage. Tenoxicam and PEITC improved behavioral performance, reduced inflammatory signaling, restored antioxidant defenses, and preserved hippocampal architecture, with the combination showing the most pronounced effects. These findings provide preclinical evidence that dual modulation of inflammatory and redox pathways may represent a promising multi-target approach for AD and support further evaluation of this combinatorial strategy.