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The operating room (OR) is a complex, high-stress environment in which crisis situations place considerable demands on staff and compromise patient care. Despite the availability of crisis management training, existing research has predominantly relied on objective measures of effectiveness rather than examining nurses' perceived preparedness to manage crises. This study aims to explore nurses' perceptions of crisis management in the OR, specifically what they perceive as a crisis situation, and which crises they consider important but feel insufficiently prepared to manage. Examining these dimensions allows for the identification of crisis situations representing priority areas for OR nurses' training. This exploratory qualitative study used focus group interviews with certified nurse anaesthetists, perioperative nurses, and nurse educators from anaesthesia and perioperative nursing programmes. Seven focus groups were analysed using qualitative content analysis, using an inductive approach with limited quantification. Five categories of crisis situations were identified: (1) interpersonal dynamics; (2) staffing and equipment constraints; (3) errors or incidents during the care process; (4) unexpected external events; and (5) deterioration in the patient's condition. Participants reported feeling least prepared to manage interpersonal conflicts, emotional demands, and unexpected external events. This study identifies two critical training gaps. First, while nurses receive substantial training in procedural and technical crisis management, they perceive a significant lack of nontechnical skills training, particularly regarding interpersonal dynamics. Second, training related to low-frequency, high-impact crises appears insufficient.

The opioid crisis is a major public health issue in Canada, with prairie provinces such as Saskatchewan experiencing particularly high rates of opioid-related harms. Factors contributing to this crisis include an unstable drug supply, limited access to harm reduction services, and structural challenges such as poverty and housing instability. The rise of fentanyl has further exacerbated overdose risks, particularly among people who use drugs. Harm reduction programs, such as opioid overdose education and naloxone distribution, have proven effective in reducing overdose fatalities and improving community health. While geospatial analysis has shown promise in identifying areas of high need for targeted harm reduction interventions, its integration into harm reduction strategies remains underexplored. This study utilized data from 44 participants who completed pop-up naloxone training sessions in Regina, Saskatchewan, between August 2023 and September 2024. Data sources include geospatial information on discarded needles from the ReportNeedles.ca platform and survey responses evaluating opioid overdose and naloxone administration using a modified Opioid Overdose Knowledge Scale. Naloxone training sessions were targeted to areas with a high number of discarded needles determined by the ReportNeedles.ca platform. Geospatial analyses were conducted using ArcGIS to map needle prevalence and assess the accessibility of harm reduction services based on walk-time buffers. Between August 2023 and August 2024, 315 reports on ReportNeedles.ca led to the disposal of 2,836 needles. Geospatial analysis revealed clustering of discarded needles in Regina's city center, with some seasonal variation. Pop-up training sites expanded the accessibility of naloxone services, with 70% of participants reporting living within a 15-minute walk to pop-up Naloxone trainings. However, geospatial analysis revealed gaps in service accessibility specifically in suburban areas. Participants in pop-up naloxone trainings demonstrated strong knowledge of overdose recognition and naloxone administration. This study demonstrates potential benefit in integrating geospatial analysis with harm reduction interventions to address the opioid crisis. By identifying needle prevalence hotspots and utilizing pop-up naloxone training, service providers can improve service accessibility.

Loss of p53 and Rb enables continued cell division despite progressive telomere erosion, ultimately triggering telomere crisis. While recent work has clarified mechanisms of chromatin bridge resolution, the longitudinal dynamics of structural damage through crisis remain incompletely understood. We transduced normal human astrocyte (NHA) cells with HPV18 E6/E7 and tracked them across extended population doublings. NHA E6/E7 cells showed progressive telomere shortening, anaphase bridges, and a growth plateau consistent with crisis. Multicolor FISH revealed subclonal chromosomal abnormalities largely invisible to short-read sequencing, with acrocentric chromosomes disproportionately affected: chromosome 13 was abnormal in over 92% of metaphases, and chromosomes 21 and 22 were similarly enriched. Translocations involving chromosome 13 were transient, replaced at later passages, while numerical aberrations persisted. Immunofluorescence revealed compact spherical nucleoli replaced by dispersed necklace-like structures, indicating a large-scale reorganization of nucleolar structure in response to telomere dysfunction. To determine whether these changes reflected altered chromosomal organization in the nucleus, we performed Hi-C and deployed KaryoScope, our alignment-free k-mer-based approach that recovers trans-chromosomal signal from repetitive acrocentric short arms. Inter-chromosomal contacts among nucleolar organizing region-bearing acrocentric chromosomes were markedly and persistently depleted in E6/E7 cells. Together, cytogenetic, imaging, and chromatin-contact data identify the nucleolus as a structural nexus linking telomere dysfunction to large-scale genomic rearrangement.

The Community Access Support Team is an initiative aimed at improving crisis response for people facing mental health challenges or trauma. It brings together policing, health and social care in a co-response team that offers compassionate, timely support, reducing the need for risk and emergency department visits. Co-responding has three core elements namely specialised call handling, a joint police mental health team, and a community support hub for follow-up care. This scoping review, which follows the JBI Methodological Framework, aims to explore and map the extent, range and nature of research related to co-responding and to identify gaps in existing literature. Following a search of various online databases, two independent reviewers underwent a two-step screening process on Covidence; a total of 29 papers were included for data extraction. The mapping included a review of the various models and regulatory frameworks underpinning service providers, type of interventions, outcomes and stakeholder experiences (providers, person, family). Co-response teams improved interagency collaboration and service co-ordination; they reduced jail bookings and emergency department transport. Service users felt better understood and communicated with compared to police-only responses. Police gained confidence and received more crisis training. Co-response teams help to improve service user care and access to community mental health services. However, there is limited evidence of the long-term cost-effectiveness, and some challenges included role conflict, staffing and data sharing issues.

Poor diet is a leading risk factor of non-communicable diseases. Product placement strategies in retail outlets can influence customers' food preferences. The United Kingdom government introduced legislation in October 2022 restricting chain retailers from using location promotions on unhealthy food and drinks. High-quality scientific evidence is needed to inform the inclusion of healthier product placement approaches into these regulations. In the context of Brexit, COVID-19 and the cost-of-living crisis, this study assessed whether positioning an expanded fresh fruit and vegetable section near store entrances in discount supermarkets, which do not routinely market produce this way, improved store sales, household purchasing and diet. This natural experiment had a prospective matched controlled cluster design, involving 36 stores (18 intervention and 18 control) across England. The intervention was implemented continuously for 6 months. Control stores were matched on store sales, customer profiles and neighbourhood deprivation. Participants were women, aged 18-60 years, with loyalty cards and were assigned to their primary store (n = 280 intervention and n = 300 control). Weekly store sales and household data from loyalty cards were provided by the collaborating supermarket chain. Dietary quality, household food waste and demographic characteristics were collected through questionnaires. A process evaluation and economic evaluation were completed. Store-level sales of fruit and vegetables were greater in intervention stores than predicted at intervention implementation and 3 and 6 months' follow-up, equivalent to ≈ 2525, ≈ 1940 and ≈ 1450 extra portions per store per week, respectively. Effect sizes were somewhat stronger in stores where the produce section moved forwards more than 14 m. The proportion of households purchasing fruit and vegetables were somewhat protected among intervention compared to control participants after 3 and 6 months. Changes in dietary quality were small but generally in the expected direction for health benefit. Changes in frequency of household fruit and vegetable waste were negligible at 3 months' follow-up but increased at 6 months. The intervention was implemented according to the study protocol, with marked differences in the positioning of fresh fruit and vegetables between intervention and control stores post-intervention implementation. Fresh fruit and vegetable availability increased post intervention in intervention compared with control stores. Interviews with store staff demonstrated that changes in staff attitudes had a positive reinforcing effect on intervention implementation. Assessment of the policy context showed that stakeholders across the food system largely support the United Kingdom government's unhealthy placement ban; some felt it does not go far enough. This study shows that positioning produce sections near supermarket entrances can improve the nutrition profile of store sales and may improve household purchasing and diet. The United Kingdom Food (Promotion and Placement) Regulations could be refined to require a produce section near supermarket entrances to increase its health impact. Future research should continue to build the evidence for which healthy eating interventions are effective in retail outlets. Further evaluations of real-world supermarket intervention studies using robust scientific study designs are required, alongside process and economic evaluations, to provide evidence for policy intervention to improve retail food environments in the United Kingdom and internationally. This synopsis presents independent research funded by the National Institute for Health and Care Research (NIHR) Public Health Research programme as award number 17/44/46. Supermarkets are a major source of food for families. Discount supermarkets have less-healthy environments than other supermarkets and are used more by families living on lower incomes. We worked with a United Kingdom discount supermarket chain to assess if moving a bigger fresh fruit and vegetable section near store entrances improves what people buy. A total of 580 women aged 18–60 years who regularly shopped at one of 36 stores (18 with changes and 18 with no changes) across England took part. Women did a survey over the phone four times (once before the change in layout and 1, 3 and 6 months after). The survey asked about the foods they and their young children (aged 2–6 years) usually ate, where they shopped for food and how much they spent each week, as well as their age, number of children and highest educational qualification. Information about the food each woman bought from loyalty card data and the total sales of fruit and vegetables for each store in the study was given by the supermarket. We found that the sales of fruit and vegetables were higher in stores where they had been moved to the front when compared to stores where they remained at the back of the store, though the size of the impact decreased over time. We found that during the time of Brexit, COVID-19 and the cost-of-living crisis, all families bought fewer fruit and vegetables over time. Families who shopped mostly at study stores with fruit and vegetables near the front entrance had a smaller decline in fruit and vegetable purchases than families who shopped at stores with fruit and vegetables towards the back. Our study provides new information that governments could use to make all supermarkets place fruit and vegetables near the front of their stores so people buy and eat more fresh produce.

The growing global environmental crisis, such as resource depletion and climate change risks, poses a serious threat to the achievement of the Sustainable Development Goals. As the core strategy to alleviate environmental crisis, pro-environment behaviors (PEBs) can significantly reduce carbon emissions and support sustainable development of the environment. However, the influencing factors and underlying mechanisms of PEBs have not yet been fully elucidated. A total of 620 undergraduate students from Nanjing, Hefei and Wuhan were selected as the research objects. Correlation analysis, structural equation model, and mediating effect test were employed to delve into the inductive mechanism of environmental events concerns (EEC) of undergraduate students on their PEBs to test the hypothesized paths. The EEC of undergraduate students directly and positively affected their climate risk awareness, environmental responsibility, and PEBs. Further analysis results demonstrated that EEC also could indirectly strengthened PEBs by the chained mediating pathway of EEC → climate risk awareness → environmental responsibility → PEBs. This uncovered the critical underlying mechanism through which the EEC of undergraduate students influenced PEBs via a dual mediating chain of cognition → emotion → behavior. Additionally, the core bridging role of environmental responsibility and synergy among variables was clarified, which verified the logical chain in Value-belief-norm (VBN) theory. This study is based on the VBN theory and constructs a chained mediating theoretical framework of cognition-emotion-behavior. It clarifies the chained mediating mechanism between EEC and PEBs, supplements the dynamic activation path of the VBN theory, and provides targeted theoretical basis and practical references for promoting the formation of PEBs among college students. Diverse publicity and practical measures should be adopted to enhance the climate risk awareness and environmental responsibility of college students, thereby motivating them to take the initiative to protect the environment.

The youth mental health crisis in the United States has garnered increasing attention, stimulating calls for urgent, evidence-based action. To inform the development of effective solutions, this literature review synthesized current data on youth mental health challenges, youth perspectives on needs and priorities, and existing resources and gaps. Findings reveal significant increases in mental health concerns among youth; disparities in outcomes and access to care, particularly among marginalized populations; and the critical importance of youth engagement and leadership in co-developing solutions. Youth perspectives emphasized the need for mental health education, school- and community-based resources, and arts-based activities as key avenues for fostering social connection and engagement. The review describes three categories of existing resources (community-based services, national nonprofits, and government initiatives), notes the potential value of creative engagement, and identifies gaps and challenges-such as inadequate funding and barriers to access. Findings underscore the urgent need for equity-oriented, culturally responsive approaches, including modalities informed by the arts, to address the youth mental health crisis. Importantly, they indicate the value of co-learning and co-strategizing with youth to promote mental health and flourishing. Despite some limitations, this review offers a timely synthesis of key themes and priorities, providing actionable insights for intervention and research efforts that support the mental health and well-being of youth in the United States.

Bacterial antimicrobial resistance (AMR) is a defining global health crisis, projected to cause 1.91 million annual deaths globally by 2050. These alarming statistics call for a holistic, dual-lens approach that examines the molecular strategies bacteria use to develop antibiotic resistance, as well as the socio-economic drivers and structural inequities that remain critically overlooked in AMR governance. This review delves into two seemingly unrelated but critical aspects of bacterial AMR: biological mechanisms of bacterial resistance and the social norms and structural inequities that play significant roles in the development and spread of antibiotic resistance. Bacterial resistance mechanisms operate at the genotypic and phenotypic levels, inducing inheritable changes or temporary structural adaptations. A deeper understanding of these diverse mechanisms can help identify new drug targets and develop new antibiotics. We advocate that while discovering new classes of antibiotics and averting resistance mechanisms is paramount, prioritising technical solutions without a socially informed framework cannot yield the results required. Examining how occupational exposures, economic equities and gendered roles drive informal antibiotic usage and increase exposure to resistant pathogens is equally crucial. Hence, by combining the biological mechanisms of resistance with the social norms that facilitate its occurrence and spread, a comprehensive roadmap for socially grounded interventions should be developed.

Manikin-based high-fidelity simulation (HFS) is critical in anesthesia for teaching crisis resource management skills in a safe environment. However, HFS is known to result in significant stress, potentially affecting learning. Virtual reality (VR) has emerged as a promising alternative to HFS, but the impact on stress remains unknown. This study compares perceived and physiological stress in anesthesia trainees during VR and HFS, and in high- and low-performing subjects after HFS. This secondary analysis from a prospective, sequential, randomized controlled trial compares anesthesia trainee volunteers who undergo either VR or HFS scenarios. Perceived stress was measured using the State-Trait Anxiety Inventory (STAI), the Medical Emotion Scale (MES), and the NASA Task Load Index (NASA-TLX). Physiological stress was assessed via heart rate variability standard deviation between successive N-N intervals (SDNN) and the low-frequency/high-frequency (LF/HF) ratio. Trainees' performance was assessed with the Ottawa Global Rating Scale. Among the 34 volunteers enrolled, both the VR and HFS groups demonstrated similar STAI, MES, and NASA-TLX scores following the scenarios. However, VR elicited lower SDNN values (mean difference, -12, 95% CI, -23 to -1.0, P=0.034), but not the LF/HF ratio. No difference was observed in stress indicators between high-performing and low-performing trainees. Anesthesia trainees experience comparable levels of perceived stress in the form of anxiety, emotional responses, and task load in VR and HFS scenarios. A lower heart rate variability during VR scenarios may indicate greater physiological stress. The relevance and implications of these findings in simulation require further clarification. ClinicalTrials.gov (NCT05041049).

The competition for nursing faculty has reached a crisis point, with over 2000 schools of nursing vying for a shrinking pool of qualified candidates. This shortage hits research-intensive institutions hardest because nurses may delay entry into academic research careers following extended clinical practice. Although strategic faculty recruitment and development in research-intensive institutions is critical for advancing science, little is known about successful organizational strategies implemented within research-intensive schools of nursing. This article presents organizational strategies for recruiting and developing research-intensive nursing faculty through a mission-driven, human-centered approach at the Nell Hodgson Woodruff School of Nursing at Emory University. The authors highlight three key approaches: mission-aligned recruitment practices, human-centered approaches to creating supportive environments, and the integration of individual- and organization-centered approaches to faculty development. Success requires recruiting faculty with diverse disciplinary expertise, implementing transparent processes, and achieving a balance between individual career aspirations and institutional research, education, and service priorities. As federal research priorities rapidly evolve and the shortage of research-intensive nursing faculty deepens, institutions must invest in adaptive recruitment strategies, robust mentoring programs, and equitable resource allocation to build sustainable research capacity and leadership pipelines.