A clear understanding and ability to apply musculoskeletal (MSK) anatomy knowledge in a clinically relevant manner is an essential element of clinician training. Unfortunately, a critical review of the literature illustrates the lack of information available about the MSK anatomy learning environment that exists within allied health profession training programs around the world. The purpose of this investigation was to document the current state of MSK anatomy education within nationally accredited allied health profession training programs. A survey was sent to all Canadian accredited allied health profession programs in the fields of physical therapy, occupational therapy, athletic therapy, and physician assistant. Responses were received from 87% of programs. MSK curricular hours were highly variable both within and between professions: physical therapy ( x ¯ $$ \overline{x} $$  = 56.4 ± 31.2; 37.2, 75.6), occupational therapy ( x ¯ $$ \overline{x} $$  = 44.4 ± 26.2; 26.2, 62.5), athletic therapy ( x ¯ $$ \overline{x} $$  = 124.0 ± 88.4; 58.5, 189.5), and physician assistant ( x ¯ $$ \overline{x} $$  = 16.5 ± 12.0; 0.1, 33.1), with curricula being delivered in the 1st year of professional training for all but one program. Thirteen of the twenty-five programs integrated MSK anatomy instruction into the clinical learning environment. Content related to muscle, bone & joint, anatomical terminology and clinical correlates was consistently covered by all programs (regardless of profession). This study is the first-of-its-kind to document the current state of MSK anatomy education across nationally accredited allied health programs. Data provide important insight about the MSK anatomy learning environment within allied health profession training programs and serve as a reference point against which other medical and healthcare programming can be compared. Results are expected to assist in the refinement of MSK anatomy educational standards that can be used to guide curricular renewal and reform within nationally accredited allied health profession training programs.
Preeclampsia continues to be one of the main causes of maternal and fetal complications in the absence of any effective treatment apart from placental expulsion. The present review presents a systematic evaluation of the involvement of mammalian target of rapamycin (mTOR) and AMP-activated protein kinase (AMPK) in preeclampsia through a discussion of mechanisms, pathophysiology, and clinical features, and explores the possible role of metformin as a therapeutic agent. In normal pregnancy, the physiological interaction between mTORC1 and AMPK enables appropriate trophoblast invasion and nutrition. However, in preeclampsia, chronic placental hypoxia and oxidative stress affect this delicate balance, resulting in a pathological situation characterized by increased AMPK activation and reduced mTORC1 activity, which adversely affects the function of trophoblasts and leads to increased anti-angiogenic factor production. However, the interaction is mutual because, while low doses of AMPK activation might restore metabolic equilibrium, higher doses, especially in combination with metformin, may further inhibit mTORC1. Thus, identifying the mTOR/AMPK axis as a key mechanism offers a new paradigm for understanding preeclampsia, yet therapeutic targeting with metformin requires careful titration to avoid aggravating the very imbalance it aims to correct. This nuanced perspective supports the future development of safe, placenta-directed therapies for preeclampsia.
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Ethnic enclaves, as an area-level social determinant of health, have significant implications for understanding ethnic health disparities. While a growing body of literature examines the impacts of residing in ethnic enclaves on the health of co-ethnics, studies often map enclaves solely from population concentrations within individual census tract. This approach overlooks the spatial clustering of populations in adjacent census tracts and the presence of cultural resources like ethnic-specific businesses and organizations. We develop and assess a hybrid clustering enclave model (HCEM) that maps spatial clustering patterns of both ethnic populations and cultural resources. We apply this approach to identify Chinese, Japanese, and Korean enclaves in Los Angeles County and compare the resulting ethnic enclaves to those mapped only from thresholds of ethnic population concentrations in individual census tracts. Depending on the types of health disparities assessed and the specific ethnicity of the enclave being mapped, different approaches to mapping Asian ethnic enclaves yield areas with larger or smaller health disparities than tracts mapped from population thresholds. Our results highlight the importance of aligning ethnic enclave measures with its conceptualization and potential health mechanisms when examining enclaves' health impacts. We offer an approach to make and assess maps which may help researchers to capture the multidimensional features of enclaves and to distinguish diverse types of enclaves for answering a range of specific questions about the role of place in ethnic health disparities.
As a consequence of the "graying prison population," the number of older people leaving prison and on parole has grown. Because older people on parole are a growing proportion of the paroled population, there is a greater need to understand their reentry experiences. Therefore, the aim of this study was to understand what role age played in perceptions of stigma and reintegration. Surveys were conducted with people (n = 74) who left prison within a year to understand their perceptions of stigma and reintegration. Fisher's exact tests were conducted to determine the relationship between personal characteristics and perceptions of reintegration and stigma. Results indicated that age was only significant on one of several measures. Variables including sex, race, living situation and employment since release were consistently associated with perceptions of stigma or reintegration regardless of age. Implications for future research will be discussed.
Gestational diabetes mellitus (GDM) is one of the most common metabolic disorders in pregnancy and is associated with significant maternal and fetal risks. The study aims to investigate lipid metabolism profiles associated with GDM to identify independent risk factors. Clinical data from 17,452 women with singleton pregnancies who received regular prenatal care and nutritional assessment at Fujian Maternity and Child Health Hospital between December 2011 and December 2019 were analyzed. Participants were divided into GDM and control groups based on diagnosis. Gestational age was confirmed by first-trimester ultrasound, and lipid profiles were measured in early (10-13 weeks) and late pregnancy (28-32 weeks). GDM was diagnosed using either a two-step approach (2011-2014) or the International Association of Diabetes and Pregnancy Study Groups (IADPSG) one-step 75-g oral glucose tolerance test. Maternal characteristics, pregnancy outcomes, and lipid indicators-including total cholesterol (TC), triglycerides (TG), LDL-C, HDL-C, and apolipoproteins (Apo-A1, Apo-B)-were extracted. Feature selection was performed using LASSO regression and the Boruta algorithm. Age, TG/HDL-C ratio, TG, pre-pregnancy BMI, and HDL-C were identified as independent risk factors for GDM. Levels of ALT, HGB, Apo-B, TC, TG, and TG/HDL-C ratio were significantly higher in the GDM group, while HDL-C was lower (P < 0.05). Threshold analysis indicated that first-trimester HDL-C and TG/HDL-C ratio critical cut-off points were 2.37 and 1.33, respectively. Abnormal lipid metabolism is a hallmark of GDM and may serve as a predictive biomarker. Assessment of TG/HDL-C ratio and HDL-C in early pregnancy could improve risk stratification and facilitate early interventions.
Bangladesh's coastal socio-ecological systems are increasingly threatened by climate hazards and human pressures, yet system-specific risk assessments remain limited. This study applies an adapted Global Delta Risk Index to evaluate risks across five systems, including irrigated agriculture, rain-fed agriculture, freshwater prawn farming, saltwater shrimp farming, and mangrove-dependent livelihoods. Using 48 quantitative and qualitative indicators, we employ a mixed-methods approach combining spatial datasets, socioeconomic statistics, interviews, and focus group discussions to construct composite indices of exposure, susceptibility, adaptive capacity, and ecosystem condition. Results show that mangrove-dependent systems exhibit the highest risk due to extreme hazard exposure, weak adaptive capacity, and ecosystem degradation, while shrimp-based systems show comparatively lower risk. All systems are affected by freshwater scarcity, salinity, and pollution. Findings highlight cross-system trade-offs and governance challenges. Co-developed stewardship strategies with stakeholders emphasize community empowerment, institutional strengthening, resilient agroecosystems, hybrid infrastructure, and integrated resource management.
Caffeine intake may be influenced by both genetic and environmental factors. This study aimed to examine the genetic contribution to variation in coffee and tea drinking, as well as total caffeine intake. A total of 1,106 Korean twins, comprising 456 monozygotic and 97 dizygotic twin pairs aged 30 years or older, from the Healthy Twin Study were included. Structural equation models were used to assess heritability estimates and their 95% confidence intervals (CIs). Heritability (95% CI) was estimated at 0.29 (0.21, 0.37) for coffee drinking, 0.11 (0.02, 0.20) for tea drinking, and 0.27 (0.16, 0.38) for total caffeine intake, with the remaining variance in each trait attributed to unique environmental factors. The unique environmental factors contributed more substantially to coffee drinking than genetic factors during early adulthood, while the genetic contribution to tea drinking remained consistently low across all ages. In conclusion, coffee drinking, tea drinking, and total caffeine intake were partly heritable, with unique environmental factors playing a predominant role.
Post-stroke dysphagia (PSD) is a common and serious complication. Traditional rehabilitation for PSD is often hampered by low patient adherence due to its unengaging nature. This study aimed to evaluate the efficacy and safety of an immersive, surface electromyography (sEMG)-triggered virtual reality (VR) game training as an adjunctive therapy for patients with PSD. In this prospective, randomized, single-blind, controlled trial, 60 patients with PSD were randomly assigned to an experimental group (n = 30) or a control group (n = 30). The control group received conventional swallowing therapy, while the experimental group received the same therapy plus sEMG-triggered immersive VR game training. Treatment was provided 5 times per week for 3 weeks. Outcomes included the Kubota Water Swallowing Test (WST), Standardized Swallowing Assessment (SSA), Functional Oral Intake Scale (FOIS), and sEMG root mean square (RMS) values. After 3 weeks, both groups showed significant improvement, with lower WST grades and SSA scores and higher FOIS levels and sEMG RMS values (all P < 0.05). The experimental group achieved significantly greater gains in WST, SSA, FOIS, and RMS values than the control group (all P < 0.05). The total effective rate was 86.67% in the experimental group and 73.33% in the control group, and the distribution of clinical efficacy categories differed significantly between the two groups (Z = 3.15, P = 0.002). No serious training-related adverse events occurred. Immersive, sEMG-triggered VR game training may be a safe and effective adjunct to conventional swallowing therapy for improving short-term swallowing-related outcomes in patients with PSD.
Managing ecosystems effectively requires managing the ways in which people interact with them, as opposed to managing ecosystems in isolation. However, management decisions often rely predominantly on biophysical data, leaving socio-economic data on the periphery. The absence of centralised socio-economic data collected systematically and purposefully makes their inclusion in decision-making challenging and often impractical. Drawing on the aggregation of a variety of data from heterogeneous stakeholders, we present and test the Ecosystem Service Value Chain (ESVC), a decision-oriented data structuring framework for visualising, organising, and prioritising socio-economic data for ecosystem management decision-making. The ESVC represents the stages and processes involved in delivering ecosystem services, from ecosystems to beneficiaries (government, industries, households, and First Nations Peoples). It reframes ecosystems as traceable value flows, linking ecosystem condition to service use, realised benefits and, where possible, valuation across distinct beneficiary groups. We demonstrate that this data structuring framework enhances transparency around data quality and gaps, providing a practical pathway for prioritising socio-economic information in management.
The Lan antigen is a high-prevalence red blood cell antigen encoded by the ATP binding cassette subfamily B member 6 (ABCB6) gene. Variants in this gene are responsible for Lan null and variant phenotypes. Individuals lacking the Lan antigen may develop anti-Lan antibodies following sensitizing events such as transfusion or pregnancy. Hemolytic disease of the fetus and newborn (HDFN) caused by anti-Lan antibodies is extremely rare. We report a case of a Chinese pregnant woman carrying a novel homozygous variant in exon 17 of the ABCB6 gene (NM_005689.4:c.2312_2313del), resulting in a Lan null phenotype. Anti-Lan antibodies were detected in maternal plasma, neonatal plasma, and cord blood eluate. The newborn developed mild HDFN, which resolved spontaneously without intervention, leading to a favorable outcome. This represents the first documented case of anti-Lan-mediated HDFN in an Asian population and the fifth case worldwide. Our findings expand the genetic diversity and geographic spectrum of this rare condition and provide important insights for clinical management.
Pathogenic bacteria adapt to distinct disease environments, but whether these adaptations create therapeutic vulnerabilities remains unclear. Fusobacterium nucleatum has emerged as a key microbial player in colorectal cancer (CRC), yet its strain-specific virulence mechanisms remain poorly defined. In this pilot study of 16 clinical F. nucleatum isolates from CRC patients (n=6), Crohn's disease patients (n=6), colon of healthy individuals (n=3) and an oral lesion (n=1), a subset of CRC-derived strains produced three- to fourfold higher levels of endogenous indole. Exogenous indole treatment differentially affected growth and biofilm formation, with some strains increasing biofilm despite growth inhibition. Notably, sensitivity to exogenous indole was independent of endogenous production and revealed that isolate 7-1 (EAVG002), a member of the tumourigenic Fna C2 clade, was uniquely hypersensitive to I3CA- and IPA-mediated stress. Invasion assays further showed that indole and its derivatives (I3A, I3CA) reduced the invasion of a highly indole-tolerant CRC-derived isolate (SB-CTX3Tcol3) into CRC cells by ~50%, comparable to antibiotic treatment. Furthermore, in two CRC cell lines, exposure to indole or indole derivatives resulted in substantial variability in adherens junction and tight junction transcript levels, with I3A having the strongest effect on tight junction (CLDN1, CLDN7) transcripts. Collectively, these findings reveal profound strain-level heterogeneity and indole derivative effects, highlighting vulnerabilities that could enable precision therapeutic targeting of pathogenic F. nucleatum populations within the host environment while preserving beneficial commensals.
Integrating polar bimetallic active sites on the metal nanocatalysts for advanced cross-coupling reactions holds great promise, yet is challenging. Here, we report the successful synthesis of Lewis acid/base bimetallic nanocluster Au20Mn2 and demonstrate its catalytic potential in visible-light-driven direct C(sp2)-H arylation of aryl halides. The cluster comprises two Au11 incomplete icosahedra fused into an Au20 kernel, which features four uncoordinated gold atoms in a rhombic pattern and is protected by two bridged Mn(CO)5 moieties. Experimental and computational studies disclose that the Mn sites function as electron donors, facilitating polarized Au(δ+)-Mn(δ-) bonds with pronounced [Mn(CO)5]-→Au20 σ donation interactions. The Lewis acid/base pair bestows Au20Mn2 with exceptional photocatalytic performance in C(sp2)-H arylation of various substituted (hetero)aryl bromides and chlorides with electron-rich-to-deficient arenes under mild conditions. This protocol boasts high functional group tolerance, supports gram-scale synthesis, and is applicable to both the late-stage functionalization of complex molecules and the targeted synthesis of bioactive products. Mechanism analyses uncover that the collaboration between the gold-involved single electron transfer activation of aryl halides and Mn π-base activation of arenes accounts for the remarkable efficiency of this system.
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Mounjaro (tirzepatide) is a recently approved medication for type 2 diabetes that is increasingly used off-label for weight loss, in part due to extensive promotion on social media. X has emerged as a major venue for discussions about weight-loss medications, yet limited research has examined public discourse surrounding Mounjaro. Identifying key influencers and mapping conversation dynamics are critical for understanding how social media may shape public awareness and adoption of emerging pharmacotherapies. This study examined Mounjaro-related discourse on X to identify influential information sources, dominant discussion topics, and public sentiment. A quantitative, exploratory observational design was employed using social network analysis and automated sentiment analysis of publicly available tweets. The dataset included 5,566 tweets generated by 5,641 unique users collected between January 9 and February 24, 2025. Using NodeXL, betweenness and in-degree centrality measures were used to identify influential users and content sources, and cluster analysis identified dominant discussion topics within the network. Sentiment analysis assessed the overall tone of Mounjaro-related tweets. Results indicated that the most influential users were predominantly non-medical individuals, including public figures and patients sharing personal experiences. Overall sentiment toward Mounjaro was largely positive, with 62.6% of tweets expressing favorable attitudes. Network clusters centered on weight loss, comparisons with Ozempic and Wegovy, pharmaceutical branding, and diabetes treatment. These findings highlight the prominent role of non-expert voices in shaping online discourse and underscore the need for evidence-based health communication strategies on social media.
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Immediate patient access to cancer-related results through digital portals has transformed the timing and nature of cancer communication. Although open records promote transparency, autonomy and engagement, they may expose patients to complex terminology before clinical interpretation is available. This creates a gap between information access and meaningful understanding, particularly when radiology, pathology or genomic reports contain terms such as "possible malignancy", "suspicious", "progression" or "cannot exclude". This article argues for digital result literacy as an essential component of cancer education. Patients require calibrated support to interpret results safely, avoid panic or false reassurance, and understand who is responsible for next steps. Clinicians also need training to respond when patients have already formed interpretations before consultation. Educational safeguards should include anticipatory guidance, plain-language summaries, safety-netting, named responsibility, equitable non-digital communication routes and preparation for AI-assisted result explanations. Immediate access should therefore become informed access, not isolated access.
Adolescence is characterized by increased risk-related decision-making, yet how depressive symptoms relate to adolescents' adaptation to uncertain environments remains unclear. The present study examined how depressive symptoms, risk level, and task stage were associated with performance on the Balloon Analogue Risk Task (BART) in junior high school students aged 12 to 13 years (N = 214). Across groups, adolescents demonstrated sensitivity to the risk level, showing higher pumping, fewer explosions, and greater accumulated rewards in low-risk relative to moderate- and high-risk conditions. Participants also exhibited improved performance from early to later trials. Depressive symptoms were not associated with overt risk-taking behavior, as indexed by pumping frequency or explosion rates. However, adolescents with elevated depressive symptoms consistently earned lower permanent scores and showed less differentiation between moderate- and high-risk conditions, suggesting reduced efficiency in adapting to task demands. These findings suggest that depressive symptoms in adolescence may be associated with reduced decision efficiency rather than global differences in risk-taking. More broadly, the results support a multi-process account of adolescent decision-making, in which emotional vulnerability interacts with task structure and learning processes to shape behavioral outcomes.
Conventional frameworks often attribute migrant health disparities to language barriers, legal exclusion, or socioeconomic deprivation. However, it remains unclear whether health inequities persist when these structural barriers are removed. Isolating the impact of historical and intergenerational trauma requires examining a unique minoritized population that shares full citizenship and linguistic heritage with the host society. To quantify the explanatory power of conventional demographic, socioeconomic, and family determinants on health disparities in a fully integrated refugee group and to estimate the magnitude of the unexplained residual disparity attributed to nonsocioeconomic factors. This cross-sectional study analyzed data from the Korea Youth Risk Behavior Survey (2011 to 2024), a nationally representative survey. The study used North Korean refugee-origin youths (NKRY) as a strategic case study of a population sharing ethnicity and citizenship with the host country (South Korean-origin youth, SKY), compared alongside international-origin youths (IOY). Self-reported mental health outcomes and health risk behaviors. Fairlie decomposition analysis was performed to calculate the percentage of the disparity explained by observed conventional determinants vs the unexplained residual component. Among 876 693 participants, SKY (n = 785 462; 392 731 [51.0%] male; median age, 14.97 years), NKRY (n = 547; 317 [58.25%] male; 15.61 years), and IOY (n = 13 800; 6675 [49.45%] male; 14.55 years) were included. NKRY had substantially poorer outcomes compared with SKY. Adjusted odds ratios for suicide planning (aOR, 4.35; 95% CI, 2.97-6.35), suicide attempts (aOR, 4.27; 95% CI, 2.78-6.56), and drug use (aOR, 14.09; 95% CI, 7.48-26.51) remained high. Decomposition analyses revealed that conventional socioeconomic factors explained less than 10% of these disparities. For suicide-related outcomes, observed factors accounted for less than 5% of the gap, leaving more than 95% unexplained. Conversely, disparities in the IOY group were largely explained by these conventional factors. In this cross-sectional study, substantial health inequities persisted even in a minoritized population granted full legal and linguistic integration, with the vast majority of disparities remaining unexplained by conventional socioeconomic metrics. These findings challenge the sufficiency of standard social determinant frameworks and suggest that for displaced populations worldwide, policies must address unmeasured structural drivers such as historical trauma and intergenerational instability.