Individuals experiencing structural vulnerabilities experience greater rates of serious illness and face barriers to accessing healthcare, including advance care planning. However, evidence to understand relevant barriers, facilitators, and effective interventions for advance care planning engagement among different structurally vulnerable populations remains fragmented. To inform advance care planning interventions for structurally vulnerable patients by reviewing: barriers and facilitators to advance care planning; and advance care planning interventions. Scoping review. We searched MEDLINE, Embase, CINAHL, and PsycINFO for studies published between January 2003 and October 2024. Eligible studies examined advance care planning for those experiencing housing instability, poverty, racialization of Black or Indigenous race, serious mental illness, or substance use disorders. From 70 included articles, 13 barriers, 13 facilitators, and 6 targets of intervention were identified. Barriers and facilitators were commonly experienced between multiple structurally vulnerable populations. The most common barriers include low advance care planning literacy, discomfort with conversations around mortality, personal, cultural and/or spiritual beliefs, and familial and social isolation. Common facilitators include trusted provider relationships, provider training and empowerment, social support, and tailored advance care planning content and delivery. We identified 27 interventions, most commonly involving advance care planning education and outreach or guided advance care planning. Structurally vulnerable patients share many barriers and facilitators to advance care planning, which can inform interventions for underserved populations. Interventions targeting advance care planning education and outreach or guided advance care planning show promise if providers can incorporate advance care planning facilitators.
This pilot study evaluated the feasibility of hospital-based identification and preparation for a personalised, multidisciplinary tapering programme for long-term hypnosedative use in older adults with insomnia, focusing on implementation processes and patient-reported barriers rather than clinical efficacy. This single-centre, prospective, interventional pilot study was conducted at Ghent University Hospital (Belgium). Patients aged ≥70 years using ≥1 hypnosedative for insomnia for ≥90 consecutive days were screened. Eligible participants received either a reimbursed tapering scheme or an individual tapering plan which was initiated after discharge. Both were developed collaboratively with the patient, hospital physicians, clinical pharmacist, general practitioner, and community pharmacist. Follow-up telephone interviews at four and twelve weeks assessed tapering adherence, self-reported barriers, fall incidents, and sleep quality. Among 2860 screened patients, 30 were included (median age 77 years; 50% Male; 93.3% polypharmacy). At 12 weeks, 23.1% were actively tapering, and 19.2% had fully discontinued hypnosedatives. The most frequently reported barriers involved reflective motivation (62.9%), including (fear of) worsening sleep and deterioration in physical or mental health. Social opportunity barriers (22.8%) included limited support from healthcare professionals. Structural barriers included missing prescriptions and incomplete discharge instructions. Deprescribing hypnosedatives in older patients within a hospital setting is complex and challenged by low recruitment, motivational, social, and structural barriers. Multidisciplinary strategies, education, and integrated care pathways are essential to enhance implementation. Policy measures, including broader reimbursement and shared electronic medication records could further facilitate safe deprescribing interventions.
Non-communicable diseases (NCDs) disproportionately affect rural South Africans due to limited healthcare access and delayed diagnoses. Biokineticists, experts in clinical exercise therapy, can aid in the early detection and prevention of NCDs, but their integration into primary healthcare remains limited. To explore Biokineticists' perspectives on their role in early NCD detection and prevention in rural South Africa, along with health-system factors affecting their integration into public primary healthcare. An interpretivist qualitative study using semi-structured interviews was conducted with 10 purposively selected Health Professions Council of South Africa (HPCSA)-registered Biokineticists (6 female, 4 male; median age 34; median 10 years' practice experience). Interviews explored screening, health promotion, referrals, interprofessional collaboration, and systemic barriers. Sessions were recorded, transcribed, and analysed using Braun and Clarke's thematic analysis. Four interconnected domains were identified: (1) professional identity and recognition, (2) screening and early-detection practices, (3) community-based prevention and management, and (4) structural barriers and integration opportunities. Participants conducted screenings, exercise-based interventions, and health promotion activities, but faced fragmented referral pathways, low awareness of Biokinetics, limited visibility, and financial and geographic barriers affecting rural access. While participants viewed Biokineticists as capable contributors to NCD prevention and early detection, systemic issues, including weak integration into primary healthcare and the National Health Insurance framework (NHI), hindered continuity of care. Conclusion: Biokineticists are an underused allied-health resource with the potential to strengthen early detection and prevention of NCDs in rural primary care settings; addressing structural and policy barriers is crucial for their integration into primary care. Main findings: Biokineticists demonstrate capacity for early detection of NCD risk factors, but their contribution is constrained by fragmented health system structures that limit continuity of care.Added knowledge: This study provides qualitative evidence on how structural, professional, and financing barriers shape the limited integration of Biokinetics within primary healthcare in rural South Africa.Global health impact for policy and action: Addressing structural and financing barriers to integrating prevention-oriented allied health professionals within primary healthcare systems may enhance early detection and continuity of care for NCDs in low- and middle-income settings.
This systematic review and meta-analysis evaluated the impact of probiotics on postoperative complications and intestinal barrier integrity markers in patients with colorectal cancer (CRC) undergoing surgery. Postoperative complications pose a substantial challenge in CRC. Probiotics have been shown to alleviate these complications through various mechanisms, including improving intestinal barrier integrity. Following PRISMA guidelines, a systematic search was conducted in MEDLINE, Web of Science, Cochrane Library, and Scopus up to February 1, 2026, to identify randomized controlled trials (RCTs) investigating the effects of probiotics on post-surgical complications, recovery parameters, and functional intestinal barrier biomarkers (lactulose/mannitol [L/M] ratio and transepithelial electrical resistance [TER]). Statistical analysis was performed using random-effects models in R. Effect sizes were expressed as risk differences (RD) for binary outcomes and standardized mean differences (SMD) for continuous outcomes. Heterogeneity was assessed using Cochran's Q and I² statistics (PROSPERO: CRD420251172153). Eleven RCTs involving 1,234 CRC patients were included. Probiotic supplementation significantly reduced the risk of septicemia (RD=-0.158, p=0.029), surgical site infection (RD=-0.060, p=0.024), respiratory tract infection (RD=-0.079, p<0.001), central line infection (RD=-0.096, p=0.007), diarrhea (RD=-0.137, p=0.005), and abdominal distension (RD=-0.172, p=0.005). Functional intestinal barrier markers were significantly improved, evidenced by a decreased L/M ratio (SMD=-1.78, p=0.018) and increased TER (SMD=1.10, p<0.001). Furthermore, the duration of postoperative antibiotic use was significantly shortened (SMD=-0.45, p=0.001). No significant differences were observed for bacteremia, abscess, urinary infection, ileus, anastomotic leak, pyrexia, or hospital stay (p>0.05). Sensitivity analyses showed outcome variability, and substantial heterogeneity existed for pyrexia, septicemia, ileus, and the L/M ratio. Probiotics reduced the risk of specific infectious and gastrointestinal complications and enhanced intestinal barrier function after CRC surgery, highlighting their potential as a safe and effective adjunct to improve postoperative outcomes.
Organoids provide a useful model system to study interactions between gut microbes and the activity of host tissues, including gastrointestinal (GI) barrier function. However, most organoid models have limited capacity to mimic the physiological hypoxia experienced by the colonic epithelium in vivo. While oxygen is required to support respiration in the host cells, many gut microbes are anaerobes that require anoxic conditions to grow. Using an innovative anaerobe co-culture system that maintains constant oxygen concentrations on the basolateral side of colonic epithelial monolayers and anoxic conditions on the luminal side, we demonstrate that colonic monolayers derived from a primary human cell line behaved more like in vivo epithelia when cultivated in the co-culture system than when cultured under ambient oxygen concentrations. We then identified interactions between the colonic epithelium and a strain of Bifidobacterium adolescentis-an oxygen-sensitive species that is prevalent and abundant in the adult gut microbiome. Co-culturing colonic monolayers with Bifidobacterium adolescentis U269-1 in the anoxic apical chamber mitigated loss of the barrier function in monolayers exposed to inflammatory cytokines. We identified indole lactic acid (ILA) as one metabolite from B. adolescentis that provides dose-dependent protection against inflammatory cytokines. Oral administration of ILA was well tolerated in mice and provided protection against immunotherapy-induced (anti-CTLA4) colitis in female, but not male mice. Together, we demonstrated the utility of the co-culture system for screening microbes and their metabolites for interactions with the colonic epithelium, as well as advancing our understanding of interactions between bifidobacteria and host barrier function.IMPORTANCEThe present study yielded strong evidence for the beneficial effects of B. adolescentis on the maintenance of colonic barrier function in an asymmetric oxygen system that mimics the colonic environment. The bifidobacterial metabolite indole lactic acid was implicated in this protection both in vitro and in a mouse model. We also refined and scaled the co-culture system to a 96-well plate format to provide the capacity for higher-throughput screening of microbes and microbial metabolites under physiologically relevant conditions.
Tobacco use among people living with HIV (PLWH) in Sub-Saharan Africa (SSA) is prevalent, compounding health risks. Tobacco cessation interventions (TCIs) have shown promise but are not widely tested in HIV care settings. In this study, we applied the Consolidated Framework for Implementation Research (CFIR) to examine barriers and facilitators to implementing the adapted tobacco cessation intervention Quit4life+ for PLWH in Uganda and Zambia. Guided by the CFIR determinant framework, Quit4life+ trial implementation challenges were evaluated across 16 HIV clinics in Uganda and Zambia between July 2021 and October 2025. Qualitative data were drawn from multiple sources, including 22 quarterly site visit reports, 4 health systems assessments completed by study coordinators and health facility personnel in-charge, key informant interviews with 14 clinic healthcare providers (nurses, nursing officers, and midwives), and focus group discussions with 55 PLWH (aged ≥18 years and receiving HIV care at participating clinics). Qualitative data were mapped to relevant domains and constructs. Within the innovation domain, evidence for TCIs, nicotine replacement therapy (NRT), and culturally adapted message libraries enhanced acceptability, while costs challenged adoption. Outer setting challenges, including seasonal labor demands, civil unrest, poor road access, and restrictive procurement and regulatory processes, influenced delivery. Inner setting barriers included overcrowded clinics, limited counseling space, inconsistent network connectivity, and staff turnover. Providers were motivated to support cessation but reported limited skills and faced intersecting stigma among patients. The implementation process relied on external resources, raising concerns about sustainability. Findings identify multilevel barriers and facilitators to delivering cessation support within HIV care clinics in Uganda and Zambia. Further research is needed to determine how determinants can be effectively addressed and to build the evidence base for the sustainable integration of services into HIV care across SSA.
Adequate fruit and vegetable (FV) intake is the foundation of a healthy diet; however, intake is especially low among stroke survivors. This study explores barriers and motivators to FV intake in female stroke survivors and informs strategies to improve well-being. Female stroke survivors completed questionnaires and attended either a focus group or an interview, with the resulting transcripts analysed using reflexive thematic analysis. Ten female stroke survivors aged (mean [SD]) 66.3 [17.1] years completed the study. Across the focus groups (n = 3) and interviews (n = 2), three themes emerged: (1) "Navigating alone," reported that survivors felt left to fend for themselves for dietary support and education. (2) "If it's good for me" identified a willingness to improve FV intake and nutrition literacy. (3) "Make it easy" highlighted the need for compensatory strategies to raise FV intake. Barriers to FV intake included physical impairments, fatigue, and memory loss. These barriers impacted food shopping, preparation, and consumption, necessitating reliance on family and compensatory strategies. Motivators included education, simplified recipes, reminders, and pre-prepared options. Female stroke survivors wanted more dietary education, FV knowledge, support, and practical stroke-appropriate resources. Incorporating these findings into rehabilitation planning may improve the well-being of female stroke survivors. Female stroke survivors participating in this study reported inconsistent (suboptimal or absent) delivery of dietary education, post-stroke support, and dietary and stroke-related resources to optimise their rehabilitation.Participants were heavily reliant on family for ongoing dietary, emotional, and physical support.Participants reported that the lack of clear, relevant, and timely dietary and stroke-related resources negatively impacted their quality of life.Improved strategies for the delivery of dietary education, support, and practical stroke-appropriate resources will likely improve the quality of life of female stroke survivors, with likely repercussive benefits to overall health and wellbeing and recovery.
Aortic dissection (AD) is a life-threatening cardiovascular disease with exceedingly high mortality, particularly during the acute phase. Ubiquitination modification is implicated in the pathogenesis of cardiovascular diseases through diverse biological processes. However, the role of TRIM9, an E3 ubiquitin ligase, in AD remains unexplored. In this study, the expression profiles of TRIM9 and SMAD4 were analyzed using clinical samples, as well as Angiotensin II (Ang II)-induced mouse and human aortic endothelial cell (HAEC) models. Endothelial barrier function in AD was assessed through CCK-8 assays, vascular permeability measurements, immunofluorescence staining, hematoxylin-eosin and Verhoeff's van Gieson staining, and Western blot analysis. The underlying molecular mechanisms were elucidated using quantitative real-time PCR, immunoprecipitation (IP), co-immunoprecipitation (Co-IP), and enzyme-linked immunosorbent assay (ELISA). TRIM9 was markedly overexpressed, whereas SMAD4 was significantly downregulated in AD. Knockdown of TRIM9 attenuated endothelial permeability, preserved the endothelial barrier integrity, and inhibited pyroptosis both in vivo and in vitro. Mechanistically, TRIM9 promoted the ubiquitination and subsequent proteasomal degradation of SMAD4, thereby exacerbating AD progression. Collectively, these findings demonstrate that elevated TRIM9 expression aggravates AD progression through SMAD4 destabilization, offering novel therapeutic insights for AD management.
This study investigates how social networks transcend professional barriers to facilitate knowledge sharing in China's medical organizations, examining the mediating roles of positive emotions and relationship quality and exploring configurational paths to successful sharing. A mixed-methods design combining Structural Equation Modeling (SEM) and Qualitative Comparative Analysis (QCA) was employed using data from 2,300 employees across 23 Tertiary Grade A hospitals in Beijing. SEM tested linear paths and mediation effects, while QCA identified equifinal configurations for high knowledge sharing. SEM confirms social networks positively correlate with knowledge sharing. Positive emotions and relationship quality act as significant mediators, with relationship quality showing the strongest effect. QCA reveals three equifinal configurations: (1) professional synergy (high special heterogeneity, network density and positive emotion); (2) relational cohesion (high relationship quality, network density, low general heterogeneity and positive emotion) and (3) diversity-catalyst (high general and special heterogeneity with positive emotion, even when relationship quality is low). Positive emotion is a necessary condition across all successful paths. This study provides organization-level evidence from real-world medical settings, integrates structural, cognitive and relational dimensions of social capital and combines SEM with QCA to uncover equifinality and compensatory mechanisms unattainable through linear methods alone. Identifying positive emotion as a non-negotiable catalyst reconfigures knowledge governance theory in professional complex systems.
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Transhumant pastoralist communities in the Kashmir Himalayas represent a marginalized and understudied population, particularly vulnerable to health risks due to their mobility and isolation. This study examines their healthcare practices, knowledge, and attitudes (KAP), with a focus on zoonotic disease exposure. Data from 384 respondents revealed that only 15% were aware of zoonotic diseases, despite 80% reporting frequent disease outbreaks. Access to health care was limited for 71% of participants, hindered by geographic isolation, poor transportation, and financial constraints. A significant positive correlation (r = 0.641, p < 0.05) was found between knowledge, attitudes, and practices, suggesting that greater awareness can lead to improved health behaviors. Traditional healing systems, including herbal and spiritual remedies, were used by 75% of respondents. However, poor hygiene and livestock care practices, such as infrequent handwashing (60%) and low vaccination rates (90%), further increased health vulnerabilities. The findings urge the adoption of integrated, culturally responsive healthcare methods based on the One Health concept. Mobile health and veterinary units, community-driven health education, and participatory disease surveillance should all be implemented to successfully minimize zoonotic hazards and enhance the overall well-being of transhumant communities.
Traditional microbiology education is fundamentally constrained by the requirement for sterile laboratory conditions, which limits the implementation of practical activities in school settings. This limitation can be overcome by using Halobacterium salinarum, a halophilic archaeon that grows readily on media containing up to 5 mol·l⁻¹ (290 g·l⁻¹) sodium chloride, effectively preventing contamination. Moreover, this micro-organism is non-pathogenic and well suited for educational use. This article presents two simple hands-on activities that can be easily carried out in a standard school science laboratory using common consumer products with the aim of reducing operational costs. The first activity introduces basic microbiological techniques by highlighting characteristic features of H. salinarum colonies, including their pink pigmentation and violet fluorescence under UV light. The second activity involves microscopic observation of cells stained with crystal violet, using microscope slides prepared according to a protocol adapted for halophilic microorganisms. Well-stained, flexible rod-shaped cells are observed, reflecting the absence of a rigid cell wall. Following these activities, a short questionnaire is proposed to encourage reflection on the experimental work performed. Instructors are also invited to discuss with students the role of extremophiles in the evolution of life forms.
Perspectives of families from historically marginalized groups regarding pediatric oncology clinical trial participation are not well-represented in the literature. To describe clinician- and parent-perceived facilitators and barriers to clinical trial participation. This single-center cross-sectional study with an explanatory sequential mixed-methods design enrolled parents of Black and Hispanic children with cancer as well as pediatric oncology clinicians from a large pediatric cancer center in Boston, Massachusetts. Parent participants completed single-time point surveys, and a subset, purposively sampled based on self-identified race and ethnicity, language, and household material hardship (HMH; ie, food, housing, transportation, or utility insecurity), completed semistructured interviews from September to December 2021. Clinicians completed semistructured interviews from February to March 2022. Data were analyzed from April 2022 to October 2025. Key factors influencing clinical trial participation in pediatric oncology among parents from historically marginalized groups. Quantitative data were summarized descriptively. Interview transcripts were analyzed using thematic analysis and integrated along key domains. A total of 60 parents completed the questionnaire; self-identified race and ethnicity included 5 Hispanic Black (8%), 10 Hispanic White (17%), 21 Hispanic other (35%), 21 non-Hispanic Black (35%), and 3 non-Hispanic White (5%) parents; most were mothers (51 [85%]). Twenty parents participated in interviews. Fifteen clinicians (10 [67%] female participants; 10 [67%] with ≥10 years caring for children with cancer) were interviewed, including 12 (80%) attendings and 3 (20%) advanced practice practitioners; most identified as non-Hispanic White (14 [93%]). Most families experienced HMH (44 [73%]) and reported high trust in their oncology team (mean [SD] score, 4.63 [0.65] of 5.00). Qualitatively, parents and clinicians aligned in identifying altruism and trustworthiness as facilitators to trial participation, while the informed consent discussion, non-English language preference, trial materials, and study requirements were participation barriers. Unlike clinicians, parents did not identify HMH or the experimental nature of trials as significant barriers to participation. Parents identified the desire for representation as a facilitator to participation, and clinicians identified gatekeeping as a barrier. In this cross-sectional study of pediatric oncology families from historically marginalized groups and clinicians, clinician- and parent-perceived barriers identified opportunities to increase equitable trial participation. Next steps include standardization of trial eligibility screening and systematic HMH screening and support to reduce gatekeeping.
The COVID-19 pandemic catalyzed unprecedented global expansion of telehealth services, with utilization increasing exponentially from pre-pandemic baselines. While digital health technologies promise to democratize healthcare access, they have simultaneously created and amplified new forms of healthcare disparity. This review distinguishes between health equity - the absence of avoidable, unjust differences in health outcomes across population groups, and health equality- the provision of identical services regardless of differing needs. These concepts, while related, require distinct policy responses. Our aim was to synthesize global evidence on equity challenges in telehealth implementation, identify key barriers to equitable access, and analyze strategies for promoting inclusive digital health delivery, with Israel examined as an in-depth case study illustrating broader themes. A narrative review methodology was employed, searching PubMed/MEDLINE and Google Scholar (January 2020-June 2025) using Boolean search strings combining telehealth-related terms with equity, access, and barrier keywords. Initial searches yielded 847 articles; 623 underwent title/abstract screening after deduplication; 156 met criteria for full-text review; 49 high-quality studies formed the final evidence base. Israel was integrated as an in-depth case study within this global synthesis. Significant telehealth utilization disparities persist globally across age, race/ethnicity, geography, and language groups. Technology access alone is insufficient to ensure equity: cultural barriers, digital literacy gaps, provider readiness, and systemic policy failures produce compound digital disadvantage. Israel's experience demonstrates that even in technologically advanced universal-coverage systems, Arab-Jewish and center-periphery disparities persist despite high smartphone ownership and internet access. Achieving telehealth equity requires multi-layered interventions addressing digital divides, cultural and linguistic barriers, and systemic inequalities. Success depends on equity-first design, multi-modal service delivery, provider training encompassing all available modalities, infrastructure investment, and continuous monitoring of disparate impacts.
Staphylococcus aureus forms biofilms on biotic and abiotic surfaces, enabling persistent infections that evade immune clearance. Although many S. aureus strains can produce the biofilm-associated exopolysaccharide, poly-β-1,6-N-acetyl-D-glucosamine (PNAG), they often form protein-dominated biofilm matrices in vitro, leaving a role for PNAG unclear. Using intravital imaging in a foreign-body infection model, we found that PNAG in biofilms hinders neutrophil access and delays bacterial clearance. Neutrophil elastase was crucial for eventual biofilm clearance. In vivo PNAG labeling revealed that the exopolysaccharide forms a physical barrier that prevents neutrophils from reaching bacterial clusters. In contrast, PNAG-deficient strains permitted greater neutrophil infiltration and were cleared more rapidly than wild-type bacteria. Enzymatic degradation of PNAG with the glycoside hydrolases PgaB or dispersin B (DspB) disrupted the biofilm, restored neutrophil access, and enhanced bacterial clearance. Together, these findings identify PNAG as a key structural barrier protecting S. aureus from innate immunity and suggest that targeting PNAG with glycoside hydrolases may offer a promising therapeutic strategy for biofilm-associated S. aureus infections.IMPORTANCEThe biofilm-associated exopolysaccharide PNAG is frequently expressed in Staphylococcus aureus clinical isolates but is often reduced during laboratory passage, with expression highly dependent on growth conditions. While in vitro analyses have revealed that PNAG is not a dominant matrix component, our intravital imaging of community-acquired methicillin-resistant S. aureus (CA-MRSA) skin infections demonstrates that PNAG is robustly produced in vivo and plays a central role in immune evasion. These findings highlight how PNAG function in tissue environments may be non-obvious in vitro and underscore the need for in vivo models to understand biofilm pathogenesis. By revealing PNAG as a key barrier to neutrophil-mediated clearance, this work positions PNAG and PNAG-targeting glycoside hydrolases as compelling therapeutic candidates for treating antibiotic-resistant S. aureus biofilm infections, a major cause of morbidity in both healthcare and community settings.
This perspective describes a cross-institutional collaboration designed to expand access to authentic translational science training between the University of Connecticut Health Center (UConn Health), part of the R1 research university of UConn, and the University of Hartford (UHart), a private university with a strong undergraduate teaching mission located in close proximity. The collaboration integrates selected UHart undergraduates into federally funded biomedical translational laboratories at UConn Health through co-mentorship and shared research activities, providing exposure to clinically relevant research environments that are often unavailable at undergraduate-focused institutions. The partnership has already produced student-authored publications, successful matriculation into graduate programs, and preparation for STEM careers. For UConn Health, the collaboration has expanded research capacity, broadened the trainee pipeline, and improved external funding competitiveness. We believe this collaboration represents a scalable, low-barrier model for developing the next generation of translational scientists and propose it as a scalable strategy to reduce barriers to research training and strengthen the US biomedical workforce.
Microplastics and nanoplastics (MNPLs) are known to enter the human body and accumulate within different tissues. As MNPLs have been shown to exert toxic effects in vivo, we aimed to evaluate the link between MNPLs and colorectal cancer tumorigenesis. A literature review was conducted, using Ovid MEDLINE and PubMed databases. MeSH terms "colorectal carcinoma" and "microplastic" were the foundations for the search strategy. Forty-one studies were initially identified, of which fourteen were ultimately selected for analysis. MNPLs are found within human colorectal tumors and are present at higher levels in the feces of colorectal cancer patients. The tissue sample studies however are limited by small sample sizes (n = 10 or 25), and are representative of mainly Chinese populations (five of the six human studies conducted in China). The mouse studies observed increased tumor loads and dysbiosis in mice exposed to MNPLs, and the in vitro studies observed increased reactive oxygen species (ROS) when cells were exposed to MNPLs in culture. Although the direct link between MNPLs and de novo development of colorectal cancer remains to be elucidated, these findings suggest that MNPLs can induce the molecular changes involved in tumorigenesis, and tumorigenesis itself when combined with a compromised gastrointestinal barrier. Given that barrier disruption occurs with inflammatory bowel disease, smoking, alcohol, stress, and infections, these populations may be most vulnerable to the effects of MNPLs.
Implementation of Food Service Guidelines (FSG) can improve nutritious offerings and individual health behaviors. This case study demonstrates how a state health department supported hospitals to improve their nutrition environments. The Colorado Healthy Hospital Compact (the Compact) is a statewide initiative designed to implement FSG to improve hospital nutrition environments by increasing the availability of healthier foods and beverages and reducing or eliminating unhealthy items. Developed and implemented by the Colorado Department of Public Health and Environment (CDPHE), hospitals voluntarily participated and completed assessments to monitor changes in the cafeteria nutrition and marketing environments. Of the n = 10 participating hospitals that submitted quantitative data in 2021 and 2023, one staff member (eg, food service directors, registered dietitians, wellness coordinators) from 8 of these hospitals completed interviews with CDPHE staff in March 2023 on facilitators and barriers, attitudes and feedback on changes by implementers and clients, maintenance, and experiences with implementation of the Compact. From 2021 to 2023, hospitals showed improvements in meeting standards for healthy sides, entrees, snacks, desserts, and beverages. Hospitals also showed improvements in their pricing strategies and healthy product offerings. The primary barrier to implementation was customer desire for specific foods; facilitators included existing priorities around healthy food environments and buy-in from staff. Common themes of intervention maintenance included having a nutrition policy or contracts, good communication/culture about the Compact, leadership support, and using food service vendor healthy food program(s). The Compact appears to be a feasible approach for implementing healthier nutrition standards in the hospital setting and spreading implementation across hospital settings.
Motivated by their potential use as a photosensitizer in photodynamic therapy, we report an electrostatic embedding quantum mechanics/molecular mechanics (QM/MM) study of 6-selenoguanine and 6-thioguanine in water. We analyzed triplet-state nonradiative decay within quasi-Marcus theory and assessed the influence of solvation by comparing QM/MM with previous microsolvation and PCM models. Both molecules follow similar deactivation pathways, involving torsional distortion around the chalcogen center and decay through a T₁/S₀ crossing point. Experimental studies show that triplet decay of 6-selenoguanine (6SeGua) is 835 times faster than 6-thioguanine (6tGua) in water. The shorter T₁ lifetime of 6SeGua is due to its higher spin-orbit coupling (SOC) and lower activation barrier to reach the T1/S0 crossing point. Stronger hydrogen bonding in 6tGua stabilizes the T₁ minimum relative to the T₁/S₀ crossing point, thereby increasing the activation barrier for triplet decay. The decay rates obtained from QM/MM are in good agreement with the previous microsolvation model, indicating that both approaches capture the essential solvent effects. The findings underscore the role of solvent effects and hydrogen bonding in modulating the photophysical properties of chalcogen-substituted nucleobases. All molecular dynamics simulations of 6SeGua and 6tGua were performed using AMBER 2023 with GAFF2 and the TIP3P water model. Representative equilibrated structures were used for QM/MM calculations within the COBRAMM framework using electrostatic embedding. The QM region was treated using TD-DFT within the Tamm-Dancoff approximation (TDA) at the CAM-B3LYP/6-311G* level, with electronic structure calculations performed using Gaussian 16. T₁/S₀ crossing points were optimized using an in-house CIOpt program. Spin-orbit coupling (SOC) matrix elements were calculated using the PySOC program based on the Breit-Pauli spin-orbit Hamiltonian with the effective charge approximation. Nonradiative ISC rates were estimated using a quasi-Marcus approach, and noncovalent interactions were analyzed using QTAIM and IGMH methods with Multiwfn.
The presence of naturally occurring radionuclides in coastal groundwater constitutes a significant public health risk, especially in areas susceptible to hydrological variability. This research applies multivariate statistical methods, including principal component analysis and hierarchical cluster analysis, alongside the PHREEQC thermodynamic model to elucidate the mechanisms governing the mobility of naturally occurring radioactive materials (NORM), specifically gross alpha and beta activity, in a tropical coastal aquifer. Examination of 44 groundwater samples collected over two seasons indicated that more than half exceeded the national guideline for gross alpha activity (0.1 Bq/L). The results indicate that mildly acidic and reducing (anaerobic) conditions facilitate the reductive dissolution of iron and manganese hydroxides. The reductive dissolution of Fe/Mn oxides destabilizes the mineral structures that previously acted as sorptive barriers, thereby releasing trapped radionuclides directly into the groundwater. Additionally, this mobilization is synergistically influenced by competitive ion exchange mechanisms. PHREEQC modeling further identifies a potential iron "lock/release" mechanism: at mildly acidic conditions (mean pH 5.36-5.39), ferrihydrite precipitation is inhibited, maintaining elevated radionuclide mobility. Conversely, as pH increases (up to 7.32), the system approaches supersaturation (saturation index, SI > 0), promoting co-precipitation and resulting in a more than 31-fold decrease in alpha activity during the rainy season (from 0.405 to 0.013 Bq/L). In contrast, beta-emitting radionuclides are less affected by iron-related processes and are predominantly influenced by dilution, with a reduction of approximately threefold (from 0.358 to 0.109 Bq/L). These findings establish a scientific basis for developing cost-effective water treatment approaches, such as aeration combined with pH adjustment, to simultaneously remove heavy metals and alpha radioactivity from tropical coastal aquifer systems.