Early experiences shape how children understand food as part of their health, family, and culture. Pediatricians promote picture book reading to support developmental and relational health. We conducted a pediatric-informed content analysis of food and nutrition in US picture books. Using an interdisciplinary content analysis framework, we assessed food and nutrition content within a representative sample of US picture books (N = 159). Coders documented the presence and types of food, mealtimes, and social drivers of nutritional health. We assessed interrater reliability and summarized food-related content within the context of how the book depicted the role and function of food. The κ agreement ranged from 78% to 99% (strong reliability). Most books depicted food in text (67%) or pictures (68%). Fruit (39%) was the most depicted food group, milk the most depicted beverage (15%), and sweet the most depicted flavor (33%). Among books that included meals, snacks were most common (57%), followed by dinner (41%). Characters ate with their families in over half (53%) of books that depicted meals. Food often symbolized a role beyond satiating hunger (eg, rewarding behavior, fostering connection). Specific roles were associated with a higher appearance of certain foods (eg, fruits with pleasure). Picture books, which frequently portray food and reliably capture children's interest, are helpful tools to engage children in conversations about the social, cultural, and nutritional functions of food. Our findings suggest that picture books are a commercial-free early literacy tool that can support integrated interventions addressing both nutritional and relational health.
Children's picture books about dentistry can be used to prepare children for a dental visit and to familiarize them with oral care. Children's books play an important role in the social and emotional development of children and can thus have an influence on their perception of dental care. This study charted the representation of dentists and oral care providers in Dutch-language picture books. 29 books were analysed using a standardized questionnaire. The overall tone of most books was positive or neutral. Both the main character and the dentist were often depicted as animals. The dentist was usually presented as a friendly professional in a colourful practice, although the use of personal protective equipment was rare. Many books included educational elements, although the information did not always align with current professional guidelines and was sometimes inaccurate or outdated. Further research on the perspectives of parents, children, and oral care providers is needed to gain insight into actual usage and its impact, and to provide targeted recommendations. Kinderprentenboeken over tandheelkunde kunnen worden gebruikt om kinderen voor te bereiden op een tandartsbezoek en hen vertrouwd te maken met mondzorg. Kinderboeken spelen een belangrijke rol in de sociale en emotionele ontwikkeling van kinderen en kunnen het beeld van tandheelkundige zorg beïnvloeden. Dit onderzoek bracht de weergave van tandartsen en mondzorg in Nederlandstalige prentenboeken in kaart. Er werden 29 boeken geanalyseerd met een gestandaardiseerde vragenlijst. De meeste boeken hadden een positieve of neutrale toon. Zowel hoofdpersoon als tandarts werden regelmatig als dier afgebeeld. De tandarts werd meestal gepresenteerd als een vriendelijke professional in een kleurrijke praktijk, maar het gebruik van persoonlijke beschermingsmiddelen was zeldzaam. Verder bevatten veel boeken educatieve elementen, maar de informatie kwam niet altijd overeen met actuele professionele adviezen en was soms onjuist of achterhaald. Vervolgonderzoek naar perspectieven van ouders, kinderen en mondzorgverleners is nodig om inzicht te krijgen in daadwerkelijk gebruik en effect, en om gerichte aanbevelingen te kunnen doen.
Biographies of scientists are widely used to spark children's interest and broaden participation in science. In telling the stories of successful scientists, these books convey implicit "recipes for success"-yet no study has systematically examined whether these recipes align with what motivation research recommends. Here, we provide the first large-scale analysis of motivational messages in children's science biographies (422 best-selling books, 1,355 protagonists). Four main findings emerged. First, scientific ability was portrayed equally often as fixed and as malleable, a pattern unlikely to support motivation. Second, interest in science was overwhelmingly portrayed as fixed: Most scientists were said to be captivated by science from a young age. Third, scientists in physics, engineering, and computer science were portrayed as more reliant on fixed ability than scientists in other fields. Fourth, biographies of female scientists disproportionately emphasized effort even after adjusting for the obstacles they faced, consistent with stereotypes attributing women's success to hard work over talent. These findings suggest that well-intentioned efforts to diversify science through role model exposure in children's science biographies may fall short.
To evaluate whether a tactile-audio Chinese language book can function as an educational assistive technology for children with visual impairment by improving access to curriculum content, supporting comprehension, and enhancing user engagement. A mixed-methods case study was conducted across four phases: needs assessment, iterative product development, user testing, and implementation. Quantitative data included a questionnaire completed by 36 teachers from schools and organisations serving learners with visual impairment across nine Chinese provinces, and a repeated-measures comparison involving 12 visually impaired children (VIC) who used Braille-only materials, tactile graphics, and tactile-audio books. Qualitative data included field notes, design records, and semi-structured interviews with teachers, VIC, designers, and production partners. Teachers reported a substantial shortage of accessible graphic learning materials, with 97% identifying insufficient provision and 91.67% reporting inadequate standardisation. In student testing, the tactile-audio book outperformed Braille-only and tactile-only materials on learning cognition, graphic cognition, and learning interest. Qualitative findings showed that integrated tactile and audio cues improved recognisability, reduced uncertainty during exploration, and increased willingness to participate. Implementation data further indicated that product benefit depended on production quality, teacher mediation, audio access, and institutional support. The findings support the classification of tactile-audio curriculum books as educational assistive technology rather than supplementary teaching aids alone. Their value lies not only in the product itself, but also in the surrounding service system that enables selection, production, teacher use, and classroom integration. Educational tactile-audio books can be treated as assistive technology when they remove barriers to curriculum access for visually impaired children.Product effectiveness depends on the interaction between tactile design, audio support, production quality, and teacher-mediated implementation.Low-tech and mid-tech educational assistive products may offer scalable options in under-resourced contexts when service delivery is planned alongside product design.
Histology is a visually complex and cognitively demanding subject often perceived as abstract, memorization-heavy, and disconnected from clinical practice. Despite its foundational importance, histology is frequently under-emphasized relative to gross anatomy and lacks interactive, multimodal resources tailored to its unique challenges. This study explored student-identified barriers to learning histology and evaluated the perceived value of coloring as a supplemental learning strategy. An online mixed-methods survey was distributed to individuals with histology learning experience. Respondents answered questions about educational level, learning challenges and strategies, and prior use of coloring books. Quantitative data were analyzed descriptively, and open-ended responses were thematically coded. Findings were interpreted alongside cognitive learning theories and accessibility frameworks. Most participants were enrolled in professional (53.7%) or graduate (26.7%) programs. While 91.7% of respondents found histology enjoyable or somewhat enjoyable. Many respondents reported difficulties distinguishing connective, nervous, and epithelial tissues. Common challenges included abstract content, inconsistent staining, and poor structure-function integration. Some respondents had previously used educational coloring books in other disciplines and reported the act of coloring as moderately to extremely effective for their learning. Respondents valued labeled diagrams, repetition, and guided prompts, and suggested including quiz-style activities with closer alignment to course content. Survey results support coloring as an engaging, multimodal teaching strategy that accommodates diverse learning needs. At the time of this study, a histology coloring book was in the process of development. Future work will evaluate its effectiveness in improving comprehension, accessibility, and learner performance in histology education.
Female genital cosmetic surgery (FGCS) became popular in recent decades. Many patients worldwide consider these procedures for medical or esthetic reasons. Previous literature indicates a significant gap in public understanding of the risks, benefits, and recovery processes associated with FGCS. This study aims to assess the knowledge and attitudes of healthcare providers in Makkah clusters regarding FGCS. A cross-sectional study was conducted on 142 participants from Makkah cluster facilities, including general practitioners (GPs), gynecologists, surgeons, nurses, medical interns, and medical students, from July to September 2025. Data was analyzed using SPSS software. Descriptive statistics and Chi-square tests were used to measure knowledge and awareness levels, and to assess the associations between cultural beliefs and awareness. Most of the respondents were females and residents. Consultants and specialists showed a lower agreement on having adequate knowledge of FGCS. About 78.2% of workers felt they lacked adequate knowledge of FCGS. Only 26.8% felt confident about labiaplasty, and <10% in other procedures. Nearly half of the participants were not sufficiently aware of the procedures' risks. During GPs' consultations of FGCS, the most used information sources were anatomy books. Relationship difficulties and body dysmorphia were the most common identified psychological issues by GPs. Partners' comments were the most significant social factor influencing women's decisions in these procedures. Furthermore, GPs were often seen as educators. The study reveals a significant gap in knowledge and confidence among healthcare providers in FGCS. Creating accessible materials and educating healthcare providers can raise awareness and the quality of care.
The development of electronic technologies capable of withstanding high-energy cosmic radiation is urgently needed to enable scientific exploration in increasingly extreme application scenarios, such as nuclear facilities, deep-space missions, and orbiting space stations. Conventional silicon-based integrated circuits (ICs) typically require additional radiation-hardening processes after design, resulting in structures that are more complex than standard devices. Moreover, many standard silicon-based ICs remain susceptible to total ionizing dose (TID)-induced degradation without dedicated hardening, leading to limited radiation tolerance. Consequently, the development of new materials, devices, and ICs with intrinsic radiation tolerance has emerged as a critical research frontier in recent years. Single-walled carbon nanotubes (SWCNTs) offer significant inherent advantages over conventional silicon-based technologies owing to their strong sp2 carbon-carbon bonds, one-dimensional quantum confinement, and minimal charge-trapping interfaces. This Review highlights the progress made at the Suzhou Institute of Nano-Tech and Nano-Bionics (SINANO), Chinese Academy of Sciences (CAS), in the development of semiconducting SWCNTs (sc-SWCNTs) as well as radiation-hardened SWCNT field-effect transistor (FET) devices and ICs. In this field, researchers at SINANO have also authored several books on carbon-based electronic materials, devices, and circuits, alongside publishing more than 200 papers and being granted more than 50 patents. Specifically, this Review covers the purification of sc-SWCNTs and single-chirality sc-SWCNTs by both commercial and self-designed conjugated organic compounds; the deposition of high-quality networked and aligned sc-SWCNT thin films on flexible and rigid substrates; and the design and fabrication of record-performance radiation-hardened SWCNT FET devices and ICs. Finally, the remaining challenges in sc-SWCNT materials, FET devices, and ICs for reliable radiation-hardened applications are discussed, followed by perspectives on future practical deployment in space and other nuclear extreme environments.
This essay synthesizes various articles and books published over five decades, a lapse in which the characteristics and attributes of what we now call genuine criticism were specified, which was the result of exerting it in questioning prevailing ideas and theories in different fields such as education in general, medical education, health research or human progress. With regard to the "dark times" of the title, they refer to our "diagnosis" of the current situation of the dominant western civilization, which we have characterized for a decade: "The human world immersed in unprecedented absolute degradation, is evidence of the exhaustion and civilizational ruin of the dominant culture that, under the relentless dominant interests of profit, has made the most sublime and despicable commodity of the human condition, and the worst atrocities and planetary devastation profitable." As for the subtitle, an update is presented to the proposals developed in the criticism of the above-mentioned fields, condensed in four tables explaining them: the way of criticism and its vicissitudes; techno-phetishism, a particular expression of civilizational collapse; attributes of criticism, and the reasons of being critical thought, in times that run. Este ensayo sintetiza diversos artículos y libros, publicados en el transcurso de cinco décadas, lapso en el cual se fueron especificando las características y los atributos de lo que ahora denominamos crítica genuina, que fue resultado de ejercerla al cuestionar las ideas y teorías prevalecientes en diferentes campos como la educación en general, la educación médica, la práctica médica, la investigación en salud o lo relativo al progreso humano. Con respecto a los «tiempos oscuros» del título, aluden a nuestro «diagnóstico» de la situación actual de la civilización occidental dominante, que hemos caracterizado desde hace una década: «El mundo humano inmerso en una degradación omnímoda sin precedentes, es evidencia del agotamiento y la ruina civilizatoria de la cultura dominante que, bajo el dominio implacable de los intereses de lucro sin límites, ha convertido en mercancía lo más sublime y vil de la condición humana, y en rentables las peores atrocidades y la devastación planetaria». En cuanto al subtítulo, se presenta una actualización de las propuestas desarrolladas a propósito de la crítica de los campos arriba mencionados, condensadas en cuatro tablas que los explicitan: el camino de la crítica y sus vicisitudes; el tecnofetichismo, expresión particularizada del colapso civilizatorio; atributos de la crítica, y las razones de ser del pensamiento crítico, en los tiempos que corren.
This article reviewed the relevant records of Choerospondiatis Fructus in historical literature on materia medica, medical books and prescriptions, and local chronicles, conducting comprehensive research from several aspects such as ancient name changes, origin descriptions, production area evolution, medicinal parts, and efficacy indications, in order to provide a theoretical basis for modern clinical application and development, and to provide ideas for future research on the value of Choerospondiatis Fructus in other applications. According to research, Choerospondiatis Fructus was mainly used in Tibetan and Mongolian medicine in ancient times, with Niang Xiao Xia and Ju Ri Hen Shao Sha as its official names. It gradually appeared in TCM literature during the Ming Dynasty, with Shan Zao as its official name. The original plant of Choerospondiatis Fructus in historical literature was Choerospondias axillaris(Roxb.) B. L. Burtt & A. W. Hill, which belonged to the family Anacardiaceae. Fruit was its main medicinal part, while the bark, stems, and roots were also used in areas of nations such as Yao, Miao, and Zhuang. The production areas of Choerospondiatis Fructus were concentrated in areas south of the Yangtze River basin and the Xizang area. Guangdong province and Fujian province were the main production areas of Choerospondiatis Fructus in ancient times, and Luoyu in Xizang was a high-quality production area. In addition to medicinal value, Choerospondiatis Fructus also has edible and daily application value, which is worth further development and utilization.
Information seeking is widely understood as a curiosity-driven exploration behavior similar to resource foraging. However, it remains unclear whether specific exploration decision mechanisms, such as reward generalization and directed exploration, extend beyond physical consumption domains to the semantic spaces of knowledge and information. How do people choose what to read when navigating vast and unfamiliar content landscapes? We study sequential book selection to investigate this question. At times, readers exploit familiar books they expect to enjoy; at other times, they explore novel options to discover potential rewards. Using a large-scale real-world dataset and a controlled behavioral experiment, we show that book selection is guided by structured generalization across a semantic embedding space and by directed exploration toward options with high uncertainty. Moreover, individual differences in curiosity modulate this exploration-exploitation tradeoff, promoting exploratory reading and increasing enjoyment. These findings demonstrate that core computational mechanisms underlying foraging generalize to epistemic domains and shape real-world media selection.
Socioeconomic disadvantage in childhood is linked to cognitive ageing, but the extent to which adult socioeconomic factors modify these associations remains unclear. We examined whether childhood socioeconomic status relates to later-life episodic memory and whether education and adult social class modify this relationship. Observational longitudinal secondary analysis of the English Longitudinal Study of Ageing, waves 1-11 (2002-2024). The sample comprised 6939 participants aged ≥50 years, contributing 52 742 observations. Childhood socioeconomic status was derived using latent class analysis from four indicators (main carer's occupation, household overcrowding, availability of household facilities and number of books in the house). Total episodic memory (0-20) combined immediate and delayed 10-word recall at each wave. Linear mixed-effects models with repeated measures estimated associations between childhood socioeconomic status and episodic memory and tested interactions with education and adult occupational social class, adjusting for sociodemographic, behavioural, health and psychosocial covariates. A two-class (poor vs non-poor) childhood socioeconomic status solution fit best. Non-poor childhood socioeconomic status was associated with higher episodic memory across models (β=0.53-0.99; p<0.001). The advantage of non-poor childhood socioeconomic status was smaller among those in higher adult occupational classes (interaction β=-0.40; p<0.001), whereas the interaction with education was not significant. Findings were robust in imputed analyses. Poor childhood socioeconomic status is associated with lower episodic memory in later life. Adult occupational social class modestly attenuates this association, whereas education shows no evidence of effect modification. These longitudinal associations suggest that future public health research should evaluate structural frameworks that consider both early-life conditions and sustained socioeconomic support across the life course to address cognitive ageing.
Gastric ulcer (GU), characterized by complex and multifactorial etiology, remains a prevalent gastrointestinal disease globally. The traditional Chinese medicine Astragalus membranaceus (Fisch.) Bunge is recorded in numerous ancient books such as "Shennong Bencao Jing", "Bencao Gangmu", "Yao Lei Fa Xiang", and "Zhenzhu Nang" to have the functions of tonifying qi, strengthening the spleen, harmonizing the stomach, and promoting ulcer healing. Astragalus membranaceus, a classical Chinese medicinal plant embodying the concept of "medicine-food homology," prominently features astragaloside IV (AS-IV) among its active pharmacological constituents. Accumulating evidence suggests AS-IV confers gastroprotective benefits in various experimental gastric injury models through mechanisms likely involving antioxidant, and anti-apoptotic effects. However, the specific molecular nodes through which AS-IV modulates its gastroprotective effects have not been fully defined. This experiment combined network pharmacology and transcriptomics to elucidate the underlying mechanisms of AS-IV in alleviating acute ethanol-induced GU in a rat and cell model. This investigation employed Sprague-Dawley (SD) rats subjected to ethanol-induced gastric injury and human gastric epithelial GES-1 cells to establish robust in vivo and in vitro GU models, respectively. Initially, we comprehensively assessed the protective efficacy of AS-IV on gastric mucosal lesions using diverse analytical techniques such as Hematoxylin and Eosin (H&E) staining, Alcian Blue-Periodic Acid-Schiff (AB-PAS) staining, Enzyme-Linked Immunosorbent Assays (ELISA), real-time quantitative PCR (RT-qPCR), immunohistochemical (IHC) analysis, and immunofluorescence (IF). Next, we identified essential molecular targets and signaling cascades influenced by AS-IV through integrated analyses encompassing network pharmacology predictions and transcriptomic profiling. Furthermore, the transcriptome further revealed five key molecular nodes (Ereg, Tnfsf11, Nr1d1, Socs3, IL-6), from which we proposed the "triple imbalance - triple repair" model. Finally, in vitro and in vivo experiments verified the inhibitory effect of AS-IV on the EGFR-mediated PI3K/Akt/NF-κB signaling axis. Our in vivo findings revealed that AS-IV substantially ameliorated pathological manifestations in gastric tissues, markedly reduced inflammatory markers, alleviate oxidative stress, and decreased apoptotic cell death. Network pharmacology and molecular docking predicted EGFR as the key target. MD simulation and CETSA confirmed that there was a stable direct binding between AS-IV and EGFR. Transcriptomics analysis further identified five key molecular nodes on the EGFR/PI3K/Akt/NF-κB signaling axis - Ereg, Tnfsf11, Nr1d1, Socs3 and IL-6. Both in vitro and in vivo experiments confirmed that AS-IV exerted a protective effect against ethanol-induced gastric injury by inhibiting the abnormal activation of the PI3K/Akt/NF-κB signaling pathway mediated by EGFR. AS-IV has a significant gastric protective effect against acute gastric injury induced by ethanol. Transcriptomics screening identified five key molecular nodes on the EGFR/PI3K/Akt/NF-κB signaling axis - Ereg, Tnfsf11, Nr1d1, Socs3 and IL-6. Based on this, the "triple imbalance - triple repair" model was proposed. Experimental verification confirmed that AS-IV exerts anti-inflammatory and anti-apoptotic effects by inhibiting the EGFR-driven PI3K/Akt/NF-κB pathway. These findings provide valuable scientific basis for the development of new therapeutic strategies for gastric mucosal protection.
Non-destructively reading text on a sheet of paper with characters on both sides, when those characters might be obscured, unreadable visually, and the paper cannot be turned over, remains an open problem in document analysis. This problem has practical relevance to archival characterisation, fragmentology, and forgery detection. Terahertz (THz) time-of-flight tomography (TOFT) offers the ability to penetrate paper and parchment as well as sensitivity to the composition of inks. However, progress in data-driven THz analysis has been hindered by the absence of publicly available, labelled reference datasets. While a range of historical materials have been employed in manuscripts and printed books, it is favorable to phrase the problem in a way that is accessible to numerous laboratories to develop techniques to extract such texts. In view of this aim, we introduce a curated THz-TOFT dataset comprising raster-scan measurements of four distinct print/writing media (henceforth ink), namely toner, inkjet, iron gall ink, and graphite, deposited on standard copy paper. Samples were prepared from contemporary materials consisting of one sheet of standard copy paper with overlapping test patterns or characters on each side. THz-TOFT data were acquired in reflection mode under controlled, nitrogen-purged conditions, yielding per-pixel time-domain waveforms. Multiple checkerboard-style test patterns are provided per ink type, each covering four ink configuration classes: no ink, ink on the front, back, and on both surfaces. Raw data is distributed as CSV files encoding spatial coordinates, full time-domain waveforms (reflected THz electric field), and manually validated class labels. To demonstrate the suitability of the dataset for machine-learning applications, a convolutional neural network baseline is provided together with a PyTorch-compatible dataloader. This baseline is trained and tested separately for each of the ink datasets, and the predictions on unknown data are qualitatively evaluated to compare the characteristic media properties.
Hybrid technologies enable the blending of physical and digital elements, creating new ways to experience and interact with the world. Such technologies can transform engagement with relics-both secular and sacred-but they present challenges for capturing faith, belief, and representation responsibly. Given the complexities of digital representation and the ethical challenges inherent in digitising culturally significant objects, a transdisciplinary understanding of these issues is needed. To inform this discussion from a linguistic perspective, we examined the representation of relics in historical and contemporary texts. Using a corpus linguistic approach to extract modifiers of the word 'relic' in corpora of Early Modern English books and contemporary web-sourced texts from 2021, we examined the multifaceted ways in which relics have been perceived and evaluated over time. Early texts consider relics as both objects of moral and spiritual significance, and tools of religious and political control, while they are more often framed as heritage symbols, reflecting past events, places, and traditions in contemporary texts. We discuss how hybrid, sometimes AI-based technologies can enhance accessibility and engagement, whilst also challenging traditional sensitivities around authenticity and sensory experience, which are integral to the meaning and significance of relics. The online version contains supplementary material available at 10.1007/s42803-026-00120-4.
Fragility hip fractures are associated with high morbidity, mortality, and complex care needs that extend beyond acute management. Despite this, palliative care remains underutilised in this population. Consequently, palliative care needs in people with fragility hip fractures remain insufficiently recognised, assessed and integrated into care pathways. To identify, synthesise, and analyse key concepts emerging from the literature on palliative care in fragility hip fractures, with a focus on their interrelationships and implications for care. An empirical narrative review with a structured search was conducted in MEDLINE, Scopus, CINAHL and Google Scholar for articles addressing palliative care and patients with fragility hip fractures, between 15 January and 10 February 2026. Eligible studies included meta-analyses, systematic reviews, observational studies, case series, books and case reports, published in Portuguese, English and Spanish within the last 5 years. Of the 876 studies screened, 4 were included, adhering to the PRISMA flow diagram. The results suggests that patients with fragility hip fractures may have substantial palliative care needs, particularly in relation to symptom management, functional decline, and psychosocial support. However, timely identification of these needs and referral to palliative care services appears to remain limited. In light of the limited evidence in integration of palliative care in the management of fragility hip fractures, an interdisciplinary approach embedding palliative care principles within orthogeriatric and fracture care pathways appears necessary. This should include adequately trained nurses to ensure comprehensive care and to support the quality of life of patients and their families.
Rural small and micro enterprises (RSMEs) struggle to borrow, and the reason is rarely a shortage of willing lenders. It is that the information a lender would normally rely on is missing, informal, or simply not written down. Conventional scorecards, built for firms with clean books, tend to falter here, where the data are heterogeneous, riddled with gaps, and shaped by nonlinear risk. We build a credit-risk model that pairs a convolutional network, a bidirectional LSTM, and an attention layer, and we ask it to read three things at once: structured financial indicators, temporal behavioural sequences, and softer signals that stand in for social capital. On 8,647 real loan applications the model reaches an AUC-ROC of 0.943, an AUC-PR of 0.867, an F1-score of 0.849, and 87.4% recall. We report raw accuracy (91.8%) only for completeness, since the 7.3% base default rate makes accuracy a weak guide to minority-class performance. Because oversampling distorts predicted probabilities, we recalibrate the outputs and check them against the observed default rate, and we probe generalization through temporal, province-level, and institution-level holdouts alongside an ablation study and a subgroup fairness probe. The attention weights give case-level explanations that, to our reading, fit a decision-support role rather than fully automated lending. The model code, the full preprocessing and evaluation pipeline, and an anonymized synthetic dataset are provided in the Related files. We frame the contribution as a rural-finance application of established methods, and we read the gains cautiously in light of the limitations set out below.
Robert "Bob" Henley Woody was born on October 4, 1936, in Bridgeport, Alabama, and died in Omaha, Nebraska on November 11, 2024. Bob was an attorney, practicing psychologist, psychology professor, dean, and accomplished musician. Bob was a prolific scholar, publishing 39 books, hundreds of articles, and an uncountable number of professional writings, such as widely read legal-advice columns in psychology newsletters. In his later years, his primary focus was on ethical, legal, and professional concerns within psychology. He was intensely involved in multiple state and national-level professional leadership activities. He was a unique blend of tough-minded attorney and compassionate psychologist, as well as a superb academician and scholar. His last book, titled Confronting Dishonesty and Lying, was emblematic of Bob's professional stance: unwavering commitment to professional integrity. He diligently strove to reconcile soft-hearted compassion with tough-nosed justice by promoting the highest quality professional values in an amazing career. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
To investigate the current implementation of and key barriers to perioperative comfort therapy in pediatric anesthesia in China, and to provide evidence-based support for optimizing the perioperative anesthesia experience of children. A cross-sectional online survey was conducted from March 21 to May 21, 2025. Using convenience sampling, an anonymous electronic questionnaire was distributed to anesthesiologists nationwide via the WeChat group of the Pediatric Anesthesia Branch of the Chinese Society of Cardiothoracic and Vascular Anesthesia. Participants were invited to complete the survey anonymously and were requested to provide objective institutional data as completely and accurately as possible. The questionnaire comprised 22 closed-ended questions and 3 open-ended questions, covering preoperative and postoperative anesthesia management, parental presence rates, and other relevant indicators. Data analysis and visualization were performed using SPSS version 27.0 and GraphPad Prism 10. A total of 150 valid responses were collected. Participating hospitals were predominantly tertiary A-grade facilities, accounting for 79.3% of the sample. Preoperative visits were universally implemented (100%) and preoperative education, fasting instructions, and explanations of anesthesia plans were provided in 95.3%, 94.0%, and 92.7% of hospitals, respectively, non-routine premedication remained the most common anxiolytic strategy, reported by 59.3% of hospitals. When premedication was used, dexmedetomidine, midazolam, and ketamine or esketamine were the main agents, reported by 29.3%, 25.3%, and 20.0% of hospitals, respectively. Non-pharmacological interventions were widely adopted, including comfort toys or picture books in 84.4%, play therapy in 44.2%, and educational videos in 36.1% of hospitals, whereas virtual reality was rarely used, with a utilization rate of 9.5%. Parental presence was permitted during anesthesia induction in 30.0% of hospitals and in the post-anesthesia care unit (PACU) in 20.7%. Only 12.7% of hospitals had dedicated induction rooms. The main barriers to parental presence were concerns regarding parental emotional distress, reported by 75.3% of respondents, and increased workload, reported by 73.3%. Notably, only 34.0% of hospitals used standardized scales to assess emergence delirium. Propofol was the most commonly used intervention for emergence delirium, accounting for 48.0%, while early parental comforting accounted for 21.3%. In China, current pediatric perioperative anesthesia management remains insufficient in addressing children's psychological well-being, and interventions aimed at reducing perioperative anxiety are suboptimal. These shortcomings are mainly reflected in three areas: first, inadequate assessment of children's anxiety during preoperative education and insufficient preoperative anxiolytic measures; second, a substantial discrepancy between recognition of the importance of parental presence during anesthesia induction and recovery and its limited implementation in clinical practice; and third, underuse of standardized assessment scales for emergence delirium, together with limited diversity in management strategies. These limitations are likely attributable to constraints in medical resources and insufficient staffing.
Nurse-physician dual leadership (NPDL) has gained attention in healthcare as a model particularly suited to innovation-driven environments, where the complex demands of leadership may outpace the capacities of a single leader. By combining the distinct yet complementary expertise of nurses and physicians, NPDL offers a hybrid structure that balances the clarity of single leadership with the breadth of shared leadership. Despite its growing presence in healthcare, the concept remains insufficiently defined in the literature. To clarify the concept of NPDL in acute hospital settings, ensuring consistent terminology and providing a solid foundation for further research, education and practice. Concept analysis guided by the Walker and Avant 8-step method. A systematic literature search was conducted through PubMed, ScienceDirect and Embase. Keywords included co-leadership, dual leadership and dyad leadership, with and without the prefix 'nurse-physician' and combined with healthcare-related terms. Peer-reviewed articles, books and grey literature, including definitions, attributes, antecedents, consequences and empirical referents, were identified and managed using EndNote. Of 247 identified articles, 23 were included, with eight additional sources retrieved through manual reference list searching. A definition of NPDL in acute hospital settings is proposed. Four defining attributes were identified: formalised dual leadership structure, joint responsibility, joint decision-making and role complementarity. The analysis also identified five antecedents that were categorised into organisational and relational factors. The consequences of NPDL include stronger leadership, enhanced interprofessional collaboration, improved decision-making and the presentation of a united leadership front. NPDL can be defined as a collaborative leadership model in which two formal leaders, a nurse and a physician leader, work together as co-leaders, with different skill sets and without a power difference, and they are jointly accountable and responsible for the organisational or unit results. Clarifying the concept of NPDL enhances future research. It could inform policymakers and support both educators, who provide formal leadership training, and facilitators, who guide professional development through coaching and mentoring, in fostering effective collaboration between nurse and physician leaders. This study did not include patient or public involvement in its design, conduct, or reporting.
Patient narratives are foundational to diagnosis, yet clinicians frequently and unintentionally distort, minimize, or reinterpret these narratives during clinical encounters. These distortions - termed patient narrative distortion - are unmeasured contributors to diagnostic error [G.D. Schiff, O. Hasan, S. Kim, R. Abrams, K. Cosby, B.L. Lambert et al., Diagnostic error in medicine: analysis of 583 physician-reported errors, Arch Intern Med 169 (2009) 1881-1887; P. Croskerry, The importance of cognitive errors in diagnosis and strategies to minimize them, Acad Med 78 (2003) 775-780; H. Singh, A.N.D. Meyer, E.J. Thomas, The frequency of diagnostic errors in outpatient care, BMJ Qual Saf 23 (2014) 727-731; and M.L. Graber, N. Franklin, R. Gordon, Diagnostic error in internal medicine, Arch Intern Med 165 (2005) 1493-1499], emotional harm [J. Conway, F. Federico, K. Stewart, M.J. Campbell, Respectful Management of Serious Clinical Adverse Events, IHI Innovation Series White Paper, IHI, Cambridge, MA, 2011], and inequity [E.N. Chapman, A. Kaatz, M. Carnes, Physicians and implicit bias: how it affects clinical decision making, Acad Med 88 (2013) 354-360; and M. Marmot, R.G. Wilkinson (Eds.), Social Determinants of Health, 2nd ed., Oxford University Press, Oxford, 2005]. No existing safety tool captures the fidelity with which clinicians preserve patient stories [T. Greenhalgh, B. Hurwitz (Eds.), Narrative Based Medicine: Dialogue and Discourse in Clinical Practice, BMJ Books, London, 1998; and W. Levinson, D.L. Roter, J.P. Mullooly, V.T. Dull, R.M. Frankel, Physician-patient communication: the relationship with malpractice claims, JAMA 277 (1997) 553-559]. The stages at which narrative distortion emerges are illustrated in Figure 1. The objective of this article was to define patient narrative distortion as a measurable construct, develop a five-domain taxonomy, propose a scoring system (PNDI), and outline a workflow and validation strategy for clinical use. We conducted iterative conceptual modeling and structured synthesis of the diagnostic-safety and narrative-medicine literatures [G.D. Schiff, O. Hasan, S. Kim, R. Abrams, K. Cosby, B.L. Lambert et al., Diagnostic error in medicine: analysis of 583 physician-reported errors, Arch Intern Med 169 (2009) 1881-1887; P. Croskerry, The importance of cognitive errors in diagnosis and strategies to minimize them, Acad Med 78 (2003) 775-780; H. Singh, A.N.D. Meyer, E.J. Thomas, The frequency of diagnostic errors in outpatient care, BMJ Qual Saf 23 (2014) 727-731; and M.L. Graber, N. Franklin, R. Gordon, Diagnostic error in internal medicine, Arch Intern Med 165 (2005) 1493-1499] to identify core distortion modes, develop domain definitions, item-level anchors, and scoring thresholds. We propose a multi-phase validation plan including content validity, inter-rater reliability, construct validity, criterion validity, and responsiveness. The PNDI taxonomy includes five domains: Narrative Completeness Distortion, Meaning Substitution Distortion, Salience Distortion, Context Stripping Distortion, and Bias-Driven Distortion [E.N. Chapman, A. Kaatz, M. Carnes, Physicians and implicit bias: how it affects clinical decision making, Acad Med 88 (2013) 354-360]. Each domain includes 0-3 severity anchors and real-world clinical examples. The total PNDI score ranges from 0-15, with interpretation bands for narrative integrity and safety risk. Encounter-level, unit-level, and organizational-level workflows for implementation are outlined. The five-domain PNDI taxonomy is shown in Figure 2. PNDI operationalizes narrative integrity as a measurable dimension of diagnostic safety [The Joint Commission, National Patient Safety Goals: Improving Diagnosis in Health Care 2024-2026, The Joint Commission, Oakbrook Terrace, IL, 2024]. It provides clinicians, educators, and safety teams with a practical tool to detect narrative loss, reduce diagnostic error [G.D. Schiff, O. Hasan, S. Kim, R. Abrams, K. Cosby, B.L. Lambert et al., Diagnostic error in medicine: analysis of 583 physician-reported errors, Arch Intern Med 169 (2009) 1881-1887; P. Croskerry, The importance of cognitive errors in diagnosis and strategies to minimize them, Acad Med 78 (2003) 775-780; H. Singh, A.N.D. Meyer, E.J. Thomas, The frequency of diagnostic errors in outpatient care, BMJ Qual Saf 23 (2014) 727-731; and M.L. Graber, N. Franklin, R. Gordon, Diagnostic error in internal medicine, Arch Intern Med 165 (2005) 1493-1499], and strengthen patient trust [W. Levinson, D.L. Roter, J.P. Mullooly, V.T. Dull, R.M. Frankel, Physician-patient communication: the relationship with malpractice claims, JAMA 277 (1997) 553-559].