Background Radiation oncology (RO) plays a critical role in the multidisciplinary care of cancer patients. As an integral component of comprehensive oncologic care, medical students should have meaningful exposure to the field to develop a foundational understanding of radiation medicine concepts. Because physicians across nearly all specialties encounter patients with cancer, a basic understanding of radiation therapy is essential for delivering high-quality, patient-centered care. Methods A single-institution open house was conducted for local medical students with the goal of increasing awareness and knowledge of RO. The event included lectures describing an overview of RO and residency training, as well as technical considerations such as common RO indications and radiation treatment planning and delivery modalities. This was followed by a department tour to see and learn about RO treatment machines, including linear accelerators, proton therapy gantries, a CT simulator, and a brachytherapy afterloader device, as well as an interactive question-and-answer session. Participants were invited to complete an anonymous post-event survey consisting of six pre-/post-comparison questions (Likert scale: 1 = Not at all familiar to 5 = Very familiar), five questions regarding the impact of the open house, and general feedback. Survey items evaluated baseline exposure to RO, familiarity with the role of the radiation oncologist and aspects of the field, comfort asking questions, and interest in further exposure. Results Fifteen students attended the open house, and 12 completed the survey: nine (75%) MS1, one (8.3%) MS2, and two (16.7%) MS3. Baseline familiarity with RO was low (mean 2.5), with seven (58.3%) reporting no or minimal familiarity and six (50%) indicating no prior exposure. Following the open house, understanding of the role of a radiation oncologist improved (mean 2.3-4.1), as did knowledge of clinical indications (2.1-3.5), treatment planning (2.0-3.9), the multidisciplinary nature of care (2.8-3.8), and radiation therapy delivery modalities (1.8-3.8). Participants reported increased understanding of the specialty (mean 4.7), awareness of technology (4.6), comfort asking questions (4.6), and interest in RO (4.3). All respondents expressed motivation to pursue additional exposure, with the highest interest in clinical shadowing (100%), research opportunities (91.6%), and mentorship or career advising (91.6%). Favorable highlights of the event were the departmental tour and question-and-answer session. Conclusions A structured open house notably improved medical students' understanding, awareness, and interest in RO. This event represents a feasible, scalable approach to early medical student engagement. This approach can be reproduced in other RO departments to enhance medical student engagement, knowledge, and continued engagement with the specialty.
To date, deaf children with deaf parents have been assumed to experience "typical" first language acquisition while deaf children from hearing families have often been excluded from research due to limited language exposure in early life. The present study eschews these assumptions and examines language development across these two populations asking whether the use of a signed language at home, the use of a signed language at school, and the family's socioeconomic status or education level can predict deaf children's fluency in American Sign Language (ASL) and English. Language and familial background data were collected from 96 preschoolers (age: 5 years) and 58 middle schoolers (age range: 11-15 years) in the United States. Deaf children of deaf parents reached higher proficiency in both ASL and English than those from hearing families when compared as groups, but there was considerable overlap in language proficiency between the two groups which was associated with the language environments in children's homes for preschoolers and children's schools for middle schoolers. Socioeconomic status and parent education were associated with English proficiency for deaf children of hearing parents, and with ASL proficiency for deaf children of deaf parents.
Acute musculoskeletal (MSK) pain remains a leading contributor to global disability, with little reduction in its burden over the past three decades. Despite increasing recognition of the prognostic role of psychological comorbidities such as anxiety, depression, and stress, clinical care for MSK pain continues to prioritize biomedical interventions, often at the expense of psychosocial considerations. This disconnect is particularly evident in emergency department (ED) settings, where care pathways focus on immediate physical assessment and discharge planning, with limited integration of mental health screening or support. Individuals presenting with acute MSK pain and comorbid mental health conditions may therefore experience fragmented care, increasing their risk of chronicity and suboptimal outcomes. This narrative review synthesizes current evidence on clinical care pathways for individuals presenting to EDs with acute MSK pain in the context of preexisting mental health disorders. It highlights the limitations of existing models of care, underscores the need for integrated biopsychosocial approaches, and identifies opportunities for improving patient-centered outcomes through more holistic and prognostically informed care strategies. People who come to emergency departments with sudden muscle or joint pain often also live with mental health conditions such as anxiety or depression.Emergency care usually focuses on the physical injury and may not fully consider mental health needs, which can affect recovery.This review looked at research from the past 10years to understand how emergency care manages people who have both physical pain and mental health conditions.We found that mental health concerns are common in these patients, but they are not always checked or included in care. This can lead to delays in diagnosis or repeated visits to the emergency department.Factors such as stigma, bias, and limited time during assessment may also affect care.Simple changes, such as asking a few questions about mental health and involving different healthcare providers, may help improve outcomes.Considering both physical and mental health early may reduce long-term pain and repeat visits as well as improve recovery.
People with hearing loss may have difficulty communicating with health care providers if not properly supported. Hearing loss is common among people with kidney failure. Outpatient hemodialysis centers may present communication barriers due to noisy machines and overlapping conversations. Tools, such as assistive listening devices, exist to help people with hearing loss communicate. If and how they should be used in the outpatient hemodialysis setting is unclear. Understanding the patient perspective is an important first step before implementing such solutions. Describe the communication-related experiences of patients with hearing loss when conversing with health care providers during hemodialysis treatment, focusing on perceptions about communication tools. Qualitative descriptive. Outpatient hemodialysis centers in Calgary and Edmonton, Alberta, Canada. Adults with kidney failure receiving maintenance hemodialysis with self-reported hearing loss. Semi-structured individual interviews. Interviews were audio-recorded, transcribed, and abductively coded using a validated communication framework, a strategy to guide communication access in practice, and participants' experiences. Fourteen patients participated between October 2023 and January 2024. Patient perceptions about communication tools varied. We identified three themes that describe these differences: (1) communication tools may be needed in transitional or clinically complex situations, (2) patients with their own resources may rely less on center-provided tools, and (3) awareness and self-advocacy for support varies across patients. The major limitation of this study is the lack of representation from patients with language barriers and those belonging to the Deaf community or with overlooked hearing difficulties. Consequently, results may not be transferable to all patients with hearing loss in Alberta or elsewhere. Communication support needs are both person-specific and context-dependent, varying across and within patients. Not all patients that may benefit from communication tools will be comfortable asking or accepting help. Clinicians should routinely check in with patients about their communication needs and offer a variety of tools to accommodate as needed. La perte auditive, fréquente chez les personnes atteintes d’insuffisance rénale, peut compliquer la communication avec les prestataires de soins en l’absence d’un soutien adapté. Les unités d’hémodialyse ambulatoires constituent des environnements propices aux difficultés de communication en raison du bruit des machines et du chevauchement des conversations. Des outils d’aide à la communication, comme les aides de suppléance à l’audition, peuvent contribuer à améliorer la communication. L’indication et les modalités d’utilisation de ces outils en hémodialyse ambulatoire demeurent mal définies. La prise en compte de la perspective des patients constitue une étape fondamentale avant leur déploiement. Décrire les expériences de communication des patients présentant une perte auditive pendant les traitements d’hémodialyse, en mettant l’accent sur leurs perceptions des outils d’aide à la communication. Étude qualitative descriptive. Centres d’hémodialyse ambulatoire à Calgary et Edmonton, en Alberta (Canada). Des adultes atteints d’insuffisance rénale et traités par hémodialyse, présentant une déficience auditive autodéclarée. Les entretiens individuels semi-structurés ont été enregistrés, transcrits et analysés par codage abductif à l’aide d’un cadre de communication validé, d’une stratégie guidant l’accès à la communication en pratique et des expériences rapportées par les participants. Quatorze patients ont participé à l’étude entre octobre 2023 et janvier 2024. Les perceptions des patients à l’égard des outils d’aide à la communication variaient. Nous avons dégagé trois éléments permettant de décrire ces différences : (1) des outils d’aide à la communication peuvent s’avérer nécessaires dans les situations de transition ou présentant une complexité clinique, (2) les patients ayant leurs propres ressources dépendent moins des outils fournis par le centre, et (3) le degré de sensibilisation aux outils disponibles et la capacité à demander du soutien varient d’un patient à l’autre. La principale limite de cette étude est le manque de représentation des patients présentant des barrières linguistiques, ainsi que de ceux appartenant à la communauté sourde ou ayant des troubles auditifs non reconnus. Par conséquent, les résultats peuvent ne pas être transférables à tous les patients atteints de perte auditive en Alberta ou ailleurs. Les besoins en matière d’aides à la communication dépendent à la fois de chaque individu et du contexte, et varient d’un patient à l’autre, voire chez une même personne. Tous les patients susceptibles d’en bénéficier ne seront pas nécessairement à l’aise pour demander ou accepter de l’aide. Les cliniciens devraient évaluer régulièrement les besoins des patients et offrir divers outils pour y répondre.
Preparing students for the increasingly complex emergency management profession necessitates fostering interpersonal and higher-order thinking skills, alongside adaptability to navigate ethical situations. Embedding experiential learning opportunities into course design is one option to link theoretical and practical skills in shared decision-making. This longitudinal study focuses on the design and implementation of a tabletop exercise to integrate high-efficacy strategies by challenging students with ethical decision-making under conditions of uncertainty. This study extends the emergency management literature by asking the following: How did the embedded instructional design elements influence the ethical dilemma discussions? An analysis of data collected over three semesters resulted in three dominant themes: public health mandates versus individual freedoms; authority versus consensus building; and bureaucratic resistance and political pressures. The manuscript concludes with recommendations based on lessons learned and suggestions for future research.
Inguinal hernia repair is one of the most commonly performed procedures worldwide. Several different methods for repair exist, where the preferred surgical procedure for a non-complicated unilateral inguinal hernia is still up for debate. Originally described as a tissue repair, the introduction of prostheses have led many surgeons to move away from this type of repairs. However, recently updated guidelines still recommend non-mesh treatment, in a subgroup of patients, with a preference for the Shouldice technique. Therefore, we set out to map the incidence and knowledge about tissue-based repair of a primary inguinal hernia in Belgium. We designed a voluntary, open web-based survey for both surgeons and trainees asking about their knowledge, experience and indication for tissue-based suture repair, using a Google-forms document. The survey included level of experience and surgical preference, practice of tissue-based inguinal repair, indications for tissue-based repair, and technique and knowledge about tissue-based repair. Data was collected between 1st of December 2023 and 31st of January 2024 and analyzed using Microsoft Excel (version 16.77.01). A total of 122 respondents filled out the questionnaire, 47 trainees and 75 surgeons, of which 4 were discarded due to inaccurate data. Only 15 out of 71 surgical respondents still performed a non-mesh based repair in an elective setting., where the Shouldice repair was the preferred technique (n = 12, 80%).Knowledge about tissue-based mesh was rated mainly moderate (43.7%) and a non-mesh based repair was still considered an option when faced with fecal contamination (54.9%). Upon patient's request, 67.7% respondents would convince patients of mesh superiority.Among surgical trainees eighteen respondents (38.3%) had never seen a tissue based repair before and 36.1% respondents said tissue-based repair was not taught in their current or previous hospital(s).Most surgical trainees (48.9%) had basic knowledge and know a single technique. Considering indications for primary tissue repair, 57.4% mentioned a contaminated field as a valid indication. Comparable to the surgeon's response, 66% of surgical trainees would convince the patient of mesh superiority when asked for a pure tissue-based repair. Our survey confirms the declining rate of tissue based repairs, with only 7% of surgical respondents performing sufficient procedures to allow for equivocal result compared to mesh-based repairs. Centralizing these procedures into specific hernia centers might allow for an increased case-load and dedicated training pathways giving trainees and future surgeons proper training.
We often avoid talking to people who disagree with us, missing potentially valuable learning opportunities. Across four preregistered studies, we examined children's (6-11 years) and adults' interest in learning from disagreement and whether it can be increased. In Study 1, we confirmed that children (6-11 years, N = 99, Canada) and adults (N = 100, USA and Canada) preferred to learn from those who agreed rather than disagreed with them across belief domains. In contrast, when asked what others should do, children (7-11 years, N = 83) and adults (N = 100) more often endorsed disagreement to increase learning, revealing a self-other gap. Studies 3 and 4 tested two interventions aimed at increasing interest in learning from disagreement. In Study 3, explicitly teaching participants (96 children, 6-11 years; 100 adults) about the benefits of disagreement for learning reduced agreement seeking, particularly among older children and adults. In Study 4, asking participants (31 children, 10-11 years; 72 adults) to consider what others should do before making their own choices also reduced agreement seeking. To learn from disagreement, we cannot avoid it. We provide two means of increasing children's and adults' interest in learning from disagreement by making epistemic benefits more salient. SUMMARY: Children and adults prefer learning from people who agree with them, despite recommending that others seek disagreement. Explicitly teaching about the benefits of disagreement increased interest in seeking out opposing viewpoints. Considering what others should do before making their own choice, increased participants' engagement with disagreement. Self-distancing through third-person reasoning helped both adults and children aged 10-11 prioritize epistemic benefits over social costs.
Patient satisfaction and dissatisfaction are critical indicator of healthcare quality. This study assessed satisfaction levels and identified factors associated with outpatient dissatisfaction among adult outpatient attendees in public hospitals in Addis Ababa, Ethiopia. A multicenter, institution-based cross-sectional study was conducted in August 2023 among 421 outpatients. Data were collected using a standardized questionnaire, processed in EpiData, and analyzed via SPSS version 27. Multivariable logistic regression was used to identify factors associated with patient dissatisfaction. A total of 421 patients participated, with an overall satisfaction was 67% (95% CI [62.5, 71.5%]). Patients with repeated visits for the second (adjusted odds ratio (AOR): 0.023; 95% CI [0.003, 0.192]) and third visits (AOR: 0.098; 95% CI [0.016-0.603]) were significantly less likely to be dissatisfied compared to first-time visitors. Conversely, partial (AOR: 4.126; 95% CI [1.589, 10.72]) or complete non-availability (AOR: 6.668; 95% CI [2.14, 20.753]) of ordered procedures, unclean waiting areas (AOR: 12.48; 95% CI [3.96, 39.37]) or consultation rooms (AOR: 0.168; 95% CI [0.041, 0.68]), and poor patient-provider interactions, including not feeling comfortable asking questions (AOR: 30.28; 95% CI [13.52, 67.85]), and perceived impoliteness: (AOR: 7.204; 95% CI [1.305, 39.78]) were significantly associated with higher odds of dissatisfaction. Patient satisfaction was sub-optimal. Outpatient dissatisfaction was strongly associated with first-time visits, structural limitations in procedure availability, unclean waiting environments, and poor interpersonal interactions. Strengthening nurses' roles in patient communication and coordination represents a vital pathway to mitigate dissatisfaction and optimize healthcare quality.
Snakebite envenomation remains a critical health challenge across the culturally and ecologically diverse sub-Saharan Africa (SSA). This study examined healthcare providers' (HCPs') knowledge, attitudes, and practices (KAP), and their determinants towards snakebite envenomation. A cross-sectional study was conducted across nine SSA countries using the validated Knowledge, Attitudes, and Practices of Snake Envenomation - Healthcare Providers Questionnaire (KAPSE-HCPQ). The fractional logistic regression was conducted to identify the factors associated with KAP. A total of 3,544 HCPs were enrolled through professional and digital networks. General practitioners represented approximately half of the participants (50.1%), whereas toxicologists were 3.2%. Considerable variations were reported across sub-Saharan countries. Uganda and Sierra Leone attained perfect median knowledge scores (100%, range: 93-100, 73-100, respectively) yet both demonstrated marked deficiencies in practice (range: 0-25% and 0-75%, respectively). Attitude scores ranged from the lowest in Ethiopia (79%, range: 75-85%) to the highest in Uganda (91%, range: 87-95%). Higher knowledge was significantly associated with advanced training, antivenom availability, curricular inclusion of toxicology, and self-study. Positive attitudes were significantly associated with prior clinical exposure, faculty-based education, informal information sources, and participants' countries. HCPs demonstrated incorrect practices, such as applying a tourniquet above the bite site, attempting to suck out the venom, incising the bite wound, and asking to run to the nearest health facility, which may accelerate the systemic venom spread. In contrast, pharmacists and HCPs unaware of management guidelines demonstrated poorer practices. The study identifies a substantial gap between theoretical knowledge and clinical practice among HCPs across SSA, with variations by country, profession, training, and resource availability. Urgent interventions training, protocol standardization, and reliable antivenom supply are required to improve snakebite outcomes. Although healthcare providers across sub-Saharan Africa generally have good knowledge and favorable attitudes towards snakebite management, their actual practices remain persistently inadequate, irrespective of their country’s income level.Systemic barriers - limited formal training, absent institutional protocols, unreliable antivenom supply, and weak referral systems- are highly associated with inadequate clinical practice.Urgent standardization of training protocols and reliable antivenom supply are needed to improve snakebite outcomes across the SSA region.
Magic tricks provide a uniquely powerful window onto the boundaries of what people consider possible, and the ways in which those boundaries can be challenged. Although there exists an effectively infinite variety of magic tricks, relatively little is known about how different magical effects relate to one another at a psychological level. Previous attempts to classify magic have largely relied on the judgments of a small number of expert magicians, rather than capturing people's intuitive understanding of magical phenomena. Here, we introduce a new multi-dimensional taxonomy of magic that treats the observable effect (e.g., an object vanishing) and the attributed cause (e.g., a magic wand) as independent dimensions. This framework allows a wide range of magic tricks to be systematically described and captures the vast majority of known magical effects. We evaluated the psychological validity of this taxonomy by asking participants to judge the perceived similarity between magic tricks drawn from each category. These similarity judgments were used to construct a dendrogram, revealing a hierarchical structure that reflects how people cognitively organize magical effects. The results corroborate several key distinctions traditionally made by magicians, such as the separation between mental and physical effects, while also revealing more subtle patterns in the perception of magic that have not previously been documented. Together, these findings provide a psychologically grounded framework for understanding how people categorize and experience magical impossibilities.
Type 2 diabetes (T2D) impairs antiviral immunity; however, the causal link between T2D and interferon-α2 (IFN-α2) deficiency remains unclear. This study used genome-wide association study-based Mendelian randomization (MR) to investigate this relationship and validated the findings in an H1N1-infected diabetic mouse model. MR analysis of 26 single nucleotide polymorphisms showed a significant negative association between T2D and IFN-α2 levels (inverse variance weighted odds ratio 0.667; P = 0.000116) without heterogeneity or pleiotropy. In vivo experiments confirmed that db/db mice exhibited more severe H1N1-induced lung injury, higher viral loads, and lower survival rates compared with nondiabetic controls. However, exogenous IFN-α2 treatment significantly reversed these pathologic outcomes. Inflammatory cytokine profiling showed that IFN-α2 downregulated 21 elevated cytokines and restored Fas ligand levels in lung tissue. Mechanistically, Western blotting demonstrated that IFN-α2 inhibited the phosphorylation of JAK1/2 and STAT3, thereby suppressing excessive inflammation. In conclusion, our findings indicate that T2D leads to IFN-α2 deficiency, contributing to susceptibility to viral infection. Supplementation with IFN-α2 effectively attenuated virus-induced lung injury by inhibiting JAK/STAT3 signaling and cytokine storms, positioning IFN-α2 supplementation as a promising therapeutic strategy for managing influenza complications in patients with diabetes. Type 2 diabetes (T2D) is linked to impaired antiviral immunity, but whether it drives interferon-α2 (IFN-α2) deficiency remains unknown. We asked whether T2D causally suppresses IFN-α2 levels and whether exogenous supplementation could rescue host defense mechanisms against influenza infection. By integrating genetic analysis with an H1N1-infected diabetic mouse model, we show that T2D genetically lowers IFN-α2 and that treatment reverses lung injury by inhibiting JAK/STAT3-mediated hyperinflammation. Our study positions IFN-α2 supplementation as a promising therapeutic strategy to prevent severe viral pneumonia in patients with T2D.
While non-invasive electrical stimulation is used clinically to enhance motor performance, its efficacy and mechanisms remain unclear. Studies show that personal factors, such as beliefs and expectations of stimulation, can impact how much a person benefits from the stimulation itself. Furthermore, beliefs related to the "closeness is strength of effect" have been observed outside of electrical stimulation contexts, suggesting that the location of stimulation (eg, head and neck) for improving motor performance may impact how much they believe the stimulation will work. This exploratory study investigated beliefs about the optimal target region of stimulation for maximizing the effect of stimulation itself. Eighty participants (39 females; 46.9 ± 12.6 years) completed an online spatial mapping task in which they were asked to indicate where they would place the electrodes for electrical stimulation to hypothetically enhance specific functions: "hand movement," "arm movement," "leg movement," and "attention/concentration." Participants selected their placement by clicking a blank human figure in anatomical position. Information about prior use/knowledge of non-invasive stimulation was also collected. Optimal target region of stimulation was significantly associated with the body movement/function to be enhanced (P < .001). This association was independent of prior non-invasive stimulation knowledge (P = .242) and sex (P = .923). These findings suggest a pre-existing belief of spatial proximity for electrical stimulation in which placing electrodes closer to the body region of interest would maximize improvement hypothetically.
Phonological biases in word recognition vary across languages, however, most work has examined consonant and vowel information, with little attention to how lexical tones contribute to word recognition in tone-language learners. The present study asked how consonants, vowels, and tones are weighted using a familiar-wordform recognition task in 11-month-old Cantonese-learning infants. In a baseline experiment (Experiment 1), infants listened longer to familiar wordforms than to pseudowords, confirming successful recognition of familiar wordforms. In Experiment 2, infants were tested on consonant and vowel mispronunciations of the same familiar words. Infants listened longer to vowel than to consonant mispronunciations, indicating that vowel changes were more disruptive to recognition than consonant changes, a V-bias. In Experiment 3, we compared vowel and tone mispronunciations and found no difference in infants' listening behaviour, suggesting comparable weighting of vowel and tone information at this age. These findings provide the earliest developmental evidence of phonological asymmetries in a tone language: vowels are more critical than consonants for recognizing familiar wordforms by 11 months, whereas vowels and tones appear to contribute similarly. Considered together with prior findings that older Cantonese-learning children rely less on tone contrasts during word learning, the present results suggest that the relative weighting of phonological cues reorganizes over development in tone-language learners.
Gambling-related harm affects not only the individual who gambles, but also their families, friends, and the wider community, referred to as affected others (AOs). AOs experience substantial harms across financial, relational, and psychological domains, yet remain underrepresented in treatment settings. Emerging evidence indicates that AOs have dual needs: support to manage their own gambling-related harm and guidance on how to support the person who gambles. However, these needs are underexplored, particularly beyond intimate partners. To address these gaps, this study asked two research questions: (1) what strategies do AOs use to reduce gambling-related harm, and (2) do these strategies differ by relationship type. A secondary analysis of 44 in-depth, semi-structured interviews with partners, family members, friends, and colleagues was conducted using reflexive thematic analysis. Three themes described how AOs navigated gambling-related harm within this dual-needs framework: Holding it together (protecting wellbeing by talking to others, seeking professional support, setting boundaries, and creating distance); Pushing for change (trying to influence gambling behaviour by restricting access to shared finances, setting spending limits, and encouraging help-seeking); and Different needs, limited options (a desire for practical, skill-based supports alongside barriers to access). Across themes, partners tended to use more direct strategies such as ultimatums and financial controls, whereas non-partners more often adopted indirect, advisory or supportive roles. These relational differences suggest that interventions should be tailored to relationship type and explicitly build AO-focused support, so that available resources align with how AOs are actually managing gambling-related harm rather than treating AOs as a uniform group.
Informed consent is a fundamental aspect of surgical care, ensuring that patients comprehend the nature, risks, and benefits of their procedures. With the growing adoption of digital healthcare solutions, electronic consent (eConsent) has emerged as an alternative to traditional paper-based consent. This study evaluates patient experiences with eConsent in the context of paediatric scoliosis surgery at our institution. A prospective review of 46 patient responses to eConsent surveys was conducted. Data collected included the likelihood of recommending eConsent, the perceived ease of the process (rated 0-10, with 0 being the easiest), preferred method of consent (paper vs. eConsent), adequacy of information provided (yes/no), and overall satisfaction with the consent process (rated 1-10). Descriptive statistical analysis was performed. Among the 46 respondents, 97.8% preferred eConsent over traditional paper-based consent, while none explicitly favored paper. Most patients selected "Extremely Likely" or "Likely" when asked if they would recommend eConsent. The quality and quantity of information provided were deemed adequate by 97.8% of patients. The average overall process rating was 9.0/10, indicating a high level of patient satisfaction. Notably, the difficulty rating averaged 0.76/10, indicating greater ease, demonstrating that patients found the digital process highly user-friendly. This study highlights a possible preference for eConsent in spinal surgery, with high satisfaction ratings and widespread agreement on information adequacy. The low difficulty scores (indicating a smooth and simple process) suggest that eConsent is well-received and accessible to patients. However, the lack of strong recommendations in survey responses warrants further investigation into potential areas of improvement, including how patient satisfaction metrics are assessed and interpreted. Future work should explore strategies to further optimize digital consent workflows and address any remaining barriers to adoption.
To investigate the relationship between clinical pain and functional mobility, especially gait performance, in individuals with Parkinson's Disease (PD). Pain was evaluated using the Brief Pain Inventory (BPI), while functional mobility was measured through the Timed Up and Go (TUG), Six-Minute Walk Test (6MWT) distance and Freezing of Gait Questionnaire (FOGQ) total score. Thirty-four individuals with PD were assessed during the "ON" medication state. While reported pain intensity was low, pain interference was moderate and significantly correlated with reduced walking performance and greater freezing of gait severity (p < 0.05, ρ=0.37). Notably, higher pain interference, but not intensity, was associated with shorter 6MWT distances (p < 0.01, ρ=-0.48) and more frequent freezing episodes (p < 0.001, ρ=0.64). Another test, the TUG was not affected by pain. Assessing pain interference, rather than pain intensity alone, is essential when addressing functional mobility in PD. Pain interference is significantly related to reduced gait performance and increased freezing, highlighting the importance of rehabilitation strategies that focus on minimizing disruptive impact of pain on movement. Why was this study done? Walking difficulties and pain are major challenges for people living with Parkinson’s Disease. While doctors often ask “how much it hurts,” they may overlook “how much pain stops movement.” This study investigated if the way pain interferes with daily life is more critical for walking ability than the actual intensity of the pain itself.What did the researchers do? We evaluated 34 individuals with Parkinson’s using specific walking tests and questionnaires. We measured how far they could walk in six minutes, their risk of falling, and “freezing of gait” (the feeling that feet are glued to the floor). We also asked them to rate both their pain intensity and how much that pain disrupted daily activities, such as walking and working.What were the main findings? Even when patients reported low pain intensity, the way pain interfered with their lives significantly impacted their movement. People who felt pain disrupted their activities walked shorter distances and had more frequent and severe “freezing” episodes. Interestingly, the simple “level of hurt” did not predict these walking problems, but the “level of interference” did.What do these results mean? When talking to healthcare professionals, patients should describe not just the intensity of their pain, but specifically how it prevents them from staying active. For therapists and doctors, this highlights that treatment should focus on reducing the disruptive impact of pain on movement. By managing how pain interferes with daily life, we can help people with Parkinson’s walk better and remain independent for longer.
Empathy, the ability to understand and communicate another's experience to them, positively affects genetic counseling processes and outcomes. Genetic counseling, a specialty healthcare profession, provides education and support for those impacted by genetic disease; thus, empathy is critical. Limited studies have explored patients' perceptions of genetic counselor (GC) empathy responses. This study investigated the types of GC responses proxy patients perceived as most empathic and why. Female MTurk workers (n = 198) completed a survey containing two hypothetical genetic counseling scenarios (Fabry disease; postnatal diagnosis of cleft lip and palate) that ended with a patient statement followed by five different GC responses. Participants were asked to identify the GC response that best conveyed empathy and explain their choice. Every GC response was selected by at least one participant. Inductive content analysis of participants' rationales yielded six categories: Understanding, Problem Solving, Sympathizing, Focusing on the Patient, Validating, and Miscellaneous. Understanding was the most prevalent rationale for both scenarios (~ 50% each). While GC responses containing the words "I'm sorry…" were chosen most often for both scenarios (~ 45% each), Sympathizing was the rationale for only ~ 20% of these GC responses. Logistic regression analyses showed significant predictors varied across scenarios and between rationales, with few significant demographic predictors. Participants differed in preferences for empathy statements and rationales, signaling context and tailoring are important when considering empathy. Patient demographics are not recommended in predicting the type of GC patients may find empathic. Ongoing assessment of patients' feelings and needs (empathic resonance) will allow genetic counselors to tailor their empathy communication (expressed empathy) accordingly.
Visual narrative comprehension is essential for navigating modern society, where information, rules, and news are frequently communicated through images, diagrams, and visual stories. Encoding a coherent narrative from disparate elements is critical for all age groups. Although recent studies report a significant rise in stress and anxiety levels, driven by factors such as the COVID-19 pandemic and recent geopolitical conflicts, the impact of stress on visual narrative comprehension remains largely underexplored. This study explored how acute stress affects narrative comprehension in younger (N = 203, 18-57 years; M = 23 years; Experiment 1) and older adults (N = 212, 60-85 years; M = 67 years; Experiment 2). Participants were assessed under both acute stress and neutral conditions. A tool for inducing acute stress online employed mathematical and logical tasks under time pressure, along with elements that simulate social stress. Participants were presented with pictorial stories consisting of three panels, with the second panel intentionally left blank. Their task was to comprehend the storyline despite the missing information. On the following page, an image representing a possible bridging event was shown, either depicting the correct or an incorrect inference. Participants were asked to judge whether or not the presented image accurately reflected the missing event in the story. Results revealed that acute stress negatively impacted narrative comprehension in younger adults, while the older adults' comprehension remained unaffected by acute stress. Similarly, younger adults demonstrated reduced confidence in their responses under stress, whereas older adults' confidence levels remained unaffected. These findings highlight the relationship between visual narrative comprehension, stress, and aging, suggesting that, with age and experience, comprehenders may develop more differentiated event schemas, which makes their comprehension processes more resilient to stress. Understanding how cognitive and perceptional processes function under stress is crucial for daily life across all age groups. Our research demonstrates that younger adults exhibit poorer visual narrative comprehension under acute stress, whereas older adults' performance remains stable. This finding suggests that older adults may employ more differentiated event schemas, which help maintain their narrative comprehension in the face of stress. Consequently, narrative comprehension appears to be more resilient compared to other fundamental cognitive skills. These insights could inform interventions and strategies to support cognitive health across different age groups.
Autosomal Recessive Spastic Ataxia of Charlevoix-Saguenay (ARSACS) is a neurodegenerative disease caused by pathogenic variants in SACS. ARSACS is characterized by mitochondrial abnormalities and disruptions of the neurofilament cytoskeleton. In other conditions, these features have been linked to activation of Sterile Alpha and TIR Motif Containing 1 (SARM1), an enzyme that can trigger axon degeneration and neuronal death. Inhibition of SARM1 is an attractive therapeutic strategy because SARM1 is inactive in healthy cells and knockout of SARM1 has little or no deleterious effects. We therefore asked whether SARM1 activity contributed to Purkinje cell degeneration and motor defects present in a Sacs -/- mouse model of ARSACS. We studied 4 cohorts of mice: (1) Sacs -/- ; Sarm1 +/+ ; (2) Sacs +/+ ; Sarm1 +/- ; (3) Sacs -/- ; Sarm1 +/- ; and (4) Sacs -/- ; Sarm1 -/- . In 9-month-old mice, we analyzed protein markers of Purkinje cells (n = 3-4 mice per genotype) and counted surviving Purkinje cells in folia III, IV, and VIII of cerebellar sections (n = 3 mice per genotype, 6 sections per mouse), and tested motor function at 3, 6, and 9 months by quantifying parameters of gait (Digigait) and coordination and balance (Rotarod) (8 male, 8 female mice of each genotype). Probing of cerebellar extracts showed that the Purkinje cell protein markers Calbindin-1, RGS8, and PCP2 were decreased in Sacs -/- mice but restored to normal levels in Sacs -/- ; Sarm1 -/- mice. Purkinje cell loss in Sacs -/- mice was most prominent in anterior folia, as previously noted. Sarm1 loss partially mitigated the Purkinje cell death in folium III of 9-month-old Sacs -/- mice. Similarly, longitudinal behavioral assessment of motor functions showed that disturbances in gait pattern (slower cadence, prolonged swing, and stance phases) were partially alleviated. Rotarod tests gave more ambivalent results, as the homozygous loss of Sarm1 was less effective than heterozygous loss in ameliorating the Sacs -/- phenotype. We conclude that SARM1 contributes to neurodegeneration in ARSACS, and its downregulation or inhibition could constitute a significant therapeutical strategy in the treatment of the disease.
Large language models (LLMs) are increasingly used by patients and caregivers as sources of health information. However, their performance in addressing attention-deficit/hyperactivity disorder (ADHD)-related questions has not been systematically compared. This study aimed to evaluate and compare the accuracy, reproducibility, quality, usefulness, and reliability of responses generated by ChatGPT (GPT-4o), Gemini, and DeepSeek R1. In this cross-sectional comparative study, 22 commonly asked ADHD-related questions identified from publicly available digital sources were categorized into four domains: basic knowledge, diagnosis and assessment, treatment and medication, and long-term outcomes. Each question was presented to all three models using the same standardized prompts in separate chat sessions. The generated responses were independently evaluated by two specialists in child and adolescent psychiatry. Reproducibility was examined by repeating the same queries on different days. Descriptive statistics and non-parametric repeated-measures analyses were used to compare model performance. All models showed high overall accuracy, with mean scores of 91% for ChatGPT (GPT-4o), 89% for Gemini, and 87% for DeepSeek R1. Reproducibility followed a similar pattern (89%, 86%, and 84%, respectively). Gemini and DeepSeek performed relatively better in basic knowledge and diagnostic domains, whereas ChatGPT (GPT-4o) showed stronger performance in treatment and long-term outcome-related questions. Significant differences were observed in quality, usefulness, and reliability across models, with ChatGPT (GPT-4o) achieving the highest overall expert-rated scores. Although large language models generally provided accurate responses to ADHD-related questions, notable differences were observed in the depth, clarity, and clinical usefulness of the information across models. These systems may serve as supportive sources of information for patients and caregivers; however, their responses should be interpreted with caution and should not replace professional clinical evaluation or medical advice.