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In 2022, the Basic Healthcare Services (BHS) primary care physiotherapy program was embedded at three rural primary clinics in southern Rajasthan. The intent was to address critical rehabilitation needs in underserved rural communities, strengthen primary care teams, and improve functional outcomes. The aim of the paper is to share systematic insights from our practice on the burden of musculoskeletal, neurological, and respiratory conditions in a rural, underserved population, while also documenting the role and outcomes of community-based physiotherapy. BHS operates in deeply underserved tribal regions of southern Rajasthan through a network of rural primary care centers (AMRIT Clinics). Within this model, physiotherapy services are designed to emphasize accessibility, continuity, and collaboration, with care provided across clinic, community, and home settings. To systematically document service delivery and outcomes, a prospective clinical registry was maintained from July 2022 to July 2024 in two phases across three rural clinics-Manpur, Ghated, and Bedawal. Service delivery challenges were analyzed using the three-delays framework, which considers barriers in recognizing the need for care, reaching care, and receiving adequate care. This approach highlights both obstacles to rehabilitation access and the solutions emerging from a community-anchored physiotherapy model. Between June 2024 and July 2025, over 1000 physiotherapy encounters were documented. The program served a diverse age range from children under 10 years to elders over 70, with the majority being working-age adults between 20 and 50 years (45%) and older adults >50 years (50%). Patients predominantly presented with musculoskeletal disorders (~70%), followed by respiratory sequelae such as post-tuberculosis lung disease and chronic obstructive pulmonary disease (~15%), and neurological impairments (~10%). Autoimmune conditions, particularly rheumatoid arthritis, were most prevalent among women aged 20-50 years. Seventy six percent of patients were new and 24% were follow-up visits. Occupational analysis indicated that 32% of patients were unemployed and reported disability or functional limitations. The program employed a holistic, low-cost approach integrating pain relief, mobility enhancement, and progressive strengthening tailored to individual needs. Evidence-based interventions-including hot packs, strengthening exercises, breathing routines, and functional rehabilitation-were the most common modalities used. Analysis of 2 years of registry data from a rural physiotherapy program offers a snapshot of the clinical scope, utilization patterns, and major syndromes encountered in primary care. Three key insights emerge: physiotherapy functions as a core component rather than an ancillary service, clinical data serve as a powerful learning and improvement tool, and the physiotherapist's role must remain flexible and context-sensitive. A matrix of key individual and interprofessional competencies emerged for members of the primary care teams. For health systems and practitioners aiming to replicate or scale such models, we recommend investing in integrated primary care teams, ensuring continuity of care, and developing adaptive systems responsive to local realities.

Stem cell-based therapies for movement disorders show inconsistent translation due to variations in product characterisation, delivery, endpoints, safety, and follow-up. Regulatory guidance provides principles but lacks a unified trial framework. The objective was to create a practical framework that translates scientific, regulatory, manufacturing, ethical, and clinical expectations into an auditable pre-First Patient In (FPI) checklist for stem cell trials. A structured review of the literature, clinical trials, and guidance documents was conducted. Searches were performed in PubMed/MEDLINE, Embase, Google Scholar, and clinical trial registries, including ClinicalTrials.gov, Japan Registry, European Union Register, and Clinical Trials Registry-India, until January 2026. Key guidance documents from the FDA, EMA, ICH, ISSCR, and selected PMDA sources were reviewed. Recurring requirements related to nonclinical evidence, manufacturing quality, ethics, trial design, safety, and follow-up were identified and translated into auditable pre-FPI checklist items. A framework was developed, structured as a universal Core Gate plus three risk-proportionate modules: Module A for pluripotent-derived neural grafts, Module B for somatic neural grafts, and Module C for mesenchymal stromal cell/secretome approaches. The Core Gate outlines the minimum pre-FPI requirements across preclinical justification, GMP release documentation, regulatory and ethics readiness, patient selection, trial design, safety oversight, trial conduct, long-term follow-up, and transparency. The modules add platform-specific requirements according to biological and procedural risks, including tumourigenicity and genomic stability assessment, immunologic monitoring, and route-appropriate biodistribution and persistence expectations. Movement disorder-specific operational elements not defined in general guidance were also incorporated, including harmonised baseline phenotyping, disease-specific endpoint menus, practical imaging and biomarker options. This framework turns fragmented guidance into a practical, auditable pre-FPI roadmap for stem cell trials in movement disorders. By combining a universal Core Gate with risk-proportionate modules, it aims to reduce protocol heterogeneity, improve cross-trial comparability, strengthen regulatory planning, and support safer, interpretable clinical translation.

Conduction disturbances are common after transcatheter aortic valve implantation (TAVI), yet the clinical implications of junctional rhythm (JR) remain poorly characterized. We aimed to assess the incidence, temporal characteristics, and clinical outcomes associated with JR occurring after TAVI. We conducted a prospective study including all TAVI patients at Clermont-Ferrand University Hospital between December 2023 and April 2025. Patients who developed JR were identified, and a propensity score was used to match them in a 1:3 ratio with patients without JR. Among 616 TAVI procedures, JR was identified in 26 patients (4.2%). The mean time to onset was 41 ± 22 hours after TAVI, with a mean junctional rate of 71 ± 12 beats per minute. At baseline, no significant differences were present in clinical, electrocardiographic, or procedural characteristics between patients with vs without JR. The incidence of in-hospital high-grade atrioventricular block did not differ significantly between groups (11.5% vs 10.3%, P = 0.48). Permanent pacemaker implantation occurred in 38.5% of JR patients (10 of 26) vs 16.7% of controls (13 of 78; P = 0.02). JR was consistently asymptomatic and transient, and its morphology suggested either Hisian or infra-Hisian origin. JR after TAVI appeared to be an infrequent and transient phenomenon. Although pacemaker implantation was more frequent among JR patients, no excess of documented high-grade atrioventricular block was observed. The higher pacemaker rate appeared to be related primarily to precautionary management decisions. These findings require confirmation in larger multicentre cohorts. Les troubles de la conduction sont fréquents après une implantation valvulaire aortique par cathéter (IVAC), mais les implications cliniques du rythme jonctionnel (RJ) restent mal caractérisées. Notre objectif était d'évaluer l'incidence, les caractéristiques temporelles et les résultats cliniques associés au RJ survenant après une IVAC. Nous avons mené une étude prospective incluant tous les patients ayant subi une IVAC au Centre Hospitalier Universitaire de Clermont-Ferrand entre décembre 2023 et avril 2025. Les patients ayant développé un RJ ont été identifiés, et un score de propension a été utilisé pour les apparier selon un rapport de 1:3 avec des patients ne présentant pas de RJ. Sur 616 procédures d'IVAC, un RJ a été identifié chez 26 patients (4,2 %). Le délai moyen de survenue était de 41 ± 22 heures après l'IVAC, avec une fréquence jonctionnelle moyenne de 71 ± 12 battements par minute. Au départ, il n'y avait pas de différences significatives concernant les caractéristiques cliniques, électrocardiographiques ou procédurales entre les patients avec ou sans RJ. L'incidence du bloc auriculo-ventriculaire de haut degré en milieu hospitalier ne différait pas de manière significative entre les groupes (11,5 % vs 10,3 %, p = 0,48). L'implantation d'un stimulateur cardiaque permanent a été réalisée chez 38,5 % (10/26) des patients présentant un RJ contre 16,7 % (13/78) des témoins (p = 0,02). Le RJ était systématiquement asymptomatique et transitoire, et sa morphologie suggérait une origine hissienne ou infra-hissienne. Un RJ après IVAC semble être un phénomène rare et transitoire. Bien que l'implantation d'un stimulateur cardiaque ait été plus fréquente chez les patients présentant un RJ, aucun excès de bloc auriculo-ventriculaire de haut degré documenté n'a été observé. Le taux plus élevé d'implantation de stimulateurs cardiaques semblait principalement lié à des décisions de prise en charge par précaution. Ces résultats doivent être confirmés dans des cohortes multicentriques plus importantes.

The provision of nursing care is at risk, especially in rural areas. For ensuring nursing care there is a need for innovative care provision concepts that consider the specific conditions and specific needs of care in rural areas. The aim of the study is to determine how innovative care provision concepts can strengthen/ensure local care provision in rural areas. For the analysis three care provision concepts based on seven criteria were selected. A document analysis with selected studies, professional articles and authority documents was conducted for the three care provision concepts. Key factors for the provision of nursing care in rural areas were identified. Innovative care provision concepts have to comply with three key prerequisites to ensure care provision:  1. the parallel practice of case management and care management in one local service concept,  2. the local arrangement of care provision concepts,  3. the link at regional level (municipality) of care provision concepts. The parallel practice of case and care management in one care provision concept, the local arrangement and the link at regional level (municipality) of care provision concepts enable a continuing interdigitation of the analysis and targeted development of the local care provision infrastructure and strengthen the access to professional support for older persons (in need of care) and relatives respectively caregivers in rural areas. HINTERGRUND: Die Sicherstellung der pflegerischen Versorgung ist in ländlichen Räumen gefährdet. Um die pflegerische Versorgung sicherstellen zu können, werden innovative pflegerische Versorgungskonzepte benötigt, die die besonderen Bedingungen sowie pflegerischen Bedarfe in ländlichen Räumen berücksichtigen. ZIEL: Das Ziel der Studie ist es, zu bestimmen, wie innovative pflegerische Versorgungskonzepte zur lokalen Stärkung/Sicherstellung der pflegerischen Versorgung in ländlichen Räumen beitragen können. Für die Analyse wurden drei pflegerische Versorgungskonzepte ausgewählt. Die Auswahl der Konzepte erfolgte auf Basis von sieben Kriterien. Es wurden eine Dokumentenanalyse mit ausgewählten Studien, Fachartikeln und Behördendokumenten zu den drei Versorgungskonzepten durchgeführt und zentrale Gelingensfaktoren für die Sicherstellung der pflegerischen Versorgung in ländlichen Räumen identifiziert. Innovative Pflegeversorgungskonzepte müssen drei Voraussetzungen erfüllen, um zur Sicherstellung der pflegerischen Versorgung beizutragen: 1. paralleles Ausüben von Case-Management und Care-Management im Rahmen eines Versorgungskonzepts, 2. die dezentrale Gestaltung von Versorgungskonzepten, 3. die kommunale Anbindung von Versorgungskonzepten. Das parallele Ausüben von Case-Management und Care-Management, die dezentrale Gestaltung und die kommunale Anbindung von Pflegeversorgungskonzepten ermöglichen eine kontinuierliche Verzahnung der Analyse und gezielten Weiterentwicklung der Pflegeinfrastruktur vor Ort und stärken den Zugang zu professioneller Unterstützung für ältere (pflegebedürftige) Menschen und (pflegende) Angehörige in ländlichen Räumen.

While Canada is rich in databases useful to support healthcare research, they are widely distributed, often poorly documented, and it is challenging to identify relevant databases, apply for access, and eventually use, link or harmonise the data. Even if the databases needed to address specific questions are known, it is difficult and time-consuming to find the metadata, the "data about the data" required to understand the characteristics and data content of these resources. A solution to these challenges is creation of metadata catalogues, which detail metadata for multiple databases, not the actual data. Describe a new catalogue including metadata about Canadian medical and non-medical databases' characteristics and variables, and information to assist catalogue users in seeking data access. Starting with a list of 385 national, provincial and regional databases, a group of physician-investigators, epidemiologists, data scientists and patient partners prioritised databases for inclusion. Metadata cataloguing occurred in steps: (i) description of the database with listing of its characteristics, and when available, (ii) addition of information about collected variables. 83 individual databases are documented in the Metadata Catalogue of the Sepsis Canada Network (https://www.maelstrom-research.org/network/sepsis). 57 are registries, 13 are cohort and 13 cross-sectional databases. 16 cover all of Canada, while another 13 cover most of the country; 45 focus on a single province. For 33 databases (38%) the catalogue includes detailed information about variables collected. This metadata catalogue includes databases collecting information spanning the continuum of medical care, non-medical data, and determinants of health. It is freely available online and extensively searchable. It can facilitate implementation of a wide range of research initiatives into medical conditions, medical care, and outcomes.

Cardiac arrhythmias are heterogeneous conditions that may limit physical activity (PA) and impair quality of life (QoL). To describe levels of PA and perceived barriers as well as to assess their associations with arrhythmia phenotype and QoL in tertiary care outpatients with preserved left ventricular (LV) function. This pilot cross-sectional study enrolled adults with documented arrhythmias and LV ejection fraction (LVEF) ≥ 50%. PA was assessed using the International Physical Activity Questionnaire (IPAQ) short form, and QoL using the 12- Item Short Form Survey (SF-12). Arrhythmias were classified as supraventricular tachycardia (SVT), atrial fibrillation (AF) and/or atrial tachycardia (AT) (including atrial flutter when applicable), ventricular, inherited, or multiple. Associations were analyzed using chi-square tests, multinomial regression, and linear regression models. Among 202 participants (mean age 50.5 ± 15.3 years; 58.9% men), 20.3% were sedentary and 45.6% were active or very active. The prevalence of sedentary behavior was higher among patients with ventricular arrhythmias (25.9%), inherited arrhythmias (35.1%), and multiple arrhythmias (25.0%) compared with those with SVT (3.8%) and AF/AT (8.0%) (p = 0.043). In adjusted models, active or very active PA showed a trend toward higher SF-12 physical component scores (p = 0.08), whereas mental component scores were primarily influenced by symptom status and sex. In this tertiary outpatient cohort with arrhythmias and preserved LVEF, physical inactivity clustered among higher-risk phenotypes and was frequently associated with potentially modifiable barriers, including medical advice and lack of time. Higher levels of PA tended to be associated with better physical health status, supporting individualized, risk-based counseling and supervised strategies to safely promote PA in patients with arrhythmias. As arritmias cardíacas são condições heterogêneas, que podem limitar a atividade física (AF) e prejudicar a qualidade de vida (QV). Descrever os níveis de AF e as barreiras percebidas, bem como avaliar suas associações com o fenótipo de arritmia e a QV em pacientes ambulatoriais de nível terciário com função do ventrículo esquerdo (VE) preservada, se faz necessário. Este é um estudo piloto, transversal, que incluiu adultos com arritmias documentadas e fração de ejeção do VE (FEVE) ≥ 50%. A AF foi avaliada por meio da versão curta do International Physical Activity Questionnaire (IPAQ), e a QV pelo 12-Item Short Form Survey (SF-12). As arritmias foram classificadas como taquicardia supraventricular (TSV), fibrilação atrial (FA) e/ou taquicardia atrial (TA) (incluindo flutter atrial quando aplicável), ventricular, hereditária ou múltipla. As associações foram analisadas por meio de testes do qui-quadrado, regressão multinomial e modelos de regressão linear. Entre 202 participantes (idade média 50,5 ± 15,3 anos; 58,9% homens), 20,3% eram sedentários e 45,6% eram ativos ou muito ativos. A prevalência de comportamento sedentário foi maior entre pacientes com arritmias ventriculares (25,9%), arritmias hereditárias (35,1%) e arritmias múltiplas (25,0%) em comparação com aqueles com TSV (3,8%) e FA/TA (8,0%) (p = 0,043). Nos modelos ajustados, níveis de AF ativos ou muito ativos mostraram uma tendência a escores mais elevados no componente físico do SF-12 (p = 0,08), enquanto os escores do componente mental foram principalmente influenciados pelo status dos sintomas e pelo sexo. Nesta coorte ambulatorial terciária com arritmias e FEVE preservada, a inatividade física concentrou-se em fenótipos de maior risco e esteve frequentemente associada a barreiras potencialmente modificáveis, incluindo orientação médica e falta de tempo. Níveis mais elevados de AF tenderam a estar associados a melhor estado de saúde física, sustentando a necessidade de aconselhamento individualizado baseado no risco e de estratégias supervisionadas para promover de forma segura a AF em pacientes com arritmias.

Antiplatelet medications remain essential in managing atherosclerotic cardiovascular disease. We assessed the adequacy of female representation in the antiplatelet medication literature, which informed the 2023 Canadian Antiplatelet Guidelines. Literature cited in the 2023 Canadian Antiplatelet Guidelines was systematically reviewed. Randomized controlled trials were included. Observational studies, systematic reviews, guidelines, consensus documents, studies missing demographic data, and research protocols were excluded. Extracted data included study titles, author, year, design, sample size, mean participant age, and proportion of female participants. Of 138 identified unique citations, 109 studies met the inclusion criteria. From the included evidence informing the 7 antiplatelet PICO (population, intervention, comparison, outcome) topics, the total sample size was 570,217 participants, with a mean age of 65.4 years. The mean percentage of female participants included across trials was 28.5%, and 21% of the included studies had a participation-to-prevalence ratio of 0.8-1.2 for female participants. Female patients were not adequately represented in nearly two-thirds of the evidence informing antiplatelet medication trials. Thus, the 2023 Canadian Antiplatelet Guidelines PICO topics are informed largely by evidence with inadequate female representation. A need remains for greater attention to adequately representing female patients in clinical trials for antiplatelet medications, which in turn inform clinical guidelines. Les antiplaquettaires demeurent essentiels pour la prise en charge des maladies cardiovasculaires athéroscléreuses. Nous avons évalué l’adéquation de la représentation des femmes dans les données publiées sur les antiplaquettaires et sur lesquelles reposent les lignes directrices canadiennes de 2023 sur le traitement antiplaquettaire. Nous avons procédé à un examen systématique des publications mentionnées dans les lignes directrices canadiennes de 2023 sur le traitement antiplaquettaire. Les essais contrôlés randomisés ont été inclus. Les études observationnelles, les revues systématiques, les lignes directrices, les documents consensuels, les études pour lesquelles il manquait des données démographiques et les protocoles de recherche ont été exclus. Les données extraites sont les suivantes : titre de l’étude, auteur, année, plan, taille de l’échantillon, âge moyen des participants et proportion de femmes. Parmi les 138 études mentionnées, 109 satisfaisaient aux critères d’inclusion. D’après les données incluses pour éclairer les sept sujets PICO sur les antiplaquettaires, la taille totale de l’échantillon était de 570 217 participants, dont l’âge moyen était de 65,4 ans. Le pourcentage moyen de femmes incluses dans les essais était de 28,5 %, et le rapport participation/prévalence pour les femmes était compris entre 0,8 et 1,2 dans 21 % desessais. Les femmes n’étaient pas suffisamment représentées dans près des deux tiers des données utilisées à l’appui des essais sur les antiplaquettaires. Les sujets PICO abordés dans les lignes directrices canadiennes de 2023 sur les antiplaquettaires reposent donc en grande partie sur des données dans lesquelles les femmes ne sont pas adéquatement représentées. Il convient d’accorder une plus grande attention à la représentation des femmes dans les essais cliniques sur les antiplaquettaires, elles-mêmes utilisées pour éclairer les lignes directrices cliniques.

Advance Directives have been available in Catalonia since 2000, and medical social workers are responsible for assisting individuals who wish to draft these documents. For this study, the hypothesis was that proactive intervention by medical social workers working with people diagnosed with complex chronic illnesses would increase the number of Advanced Directives. Forty-eight individuals completed the study. The results showed low initial knowledge about Advance Directives but a high level of interest in drafting them once informed. There was high satisfaction with the process and model provided, and with the support provided by the medical social workers. The study confirms that the support provided by medical social workers in drafting Advance Directives was valued by the patients and that proactive involvement facilitates the drafting of the document. Social workers can work with health professionals and administrators to secure a place in this important process.

Patients with Wolff-Parkinson-White (WPW) syndrome frequently develop atrial fibrillation (AF); however, the factors associated with the occurrence of AF remain incompletely defined. To evaluate the prevalence and associated factors of clinical AF and electrophysiological study (EPS)-induced AF in a large consecutive cohort of patients with WPW undergoing accessory pathway (AP) ablation. This retrospective analysis included 845 consecutive patients with WPW who underwent AP ablation at a single tertiary referral center. A standardized EPS protocol was applied throughout the study period. Study outcomes included clinical AF (documented by medical history or monitoring before EPS), EPS-induced AF, and any AF (composite outcome). Multivariable logistic regression models were used to estimate adjusted odds ratio (ORa) with 95% CIs. Statistical significance was set at p < 0.05. Mean age was 33.2 &#xb1; 15.9 years, and 486 of 845 patients (57.5%) were male. Multiple APs were identified in 31 patients (3.7%). The most common AP locations were left lateral (327/845, 38.7%) and posterior (323/845, 38.2%). Clinical AF was present in 109 patients (12.9%), EPS-induced AF in 77 (9.1%), and any AF in 168 (19.9%). In multivariable analyses, a left lateral AP was independently associated with clinical AF (ORa, 2.31; 95% CI, 1.53-3.49; p < 0.001), whereas a posterior AP was associated with EPS-induced AF (ORa, 1.78; 95% CI, 1.07-2.91; p = 0.025). Female sex was associated with lower odds of EPS-induced AF (ORa, 0.56; 95% CI, 0.34-0.93; p = 0.025). Increasing age was independently associated with clinical AF (per-year ORa, 1.018; p = 0.007) and any AF (per-year ORa, 1.014; p = 0.009). In this large cohort of patients with WPW undergoing AP ablation, left lateral AP location and older age were independently associated with a higher prevalence of clinical AF. In contrast, posterior AP location and male sex were associated with a greater likelihood of EPS-induced AF. Pacientes com s&#xed;ndrome de Wolff-Parkinson-White (WPW) frequentemente desenvolvem fibrila&#xe7;&#xe3;o atrial (FA); no entanto, os fatores associados &#xe0; ocorr&#xea;ncia de FA permanecem incompletamente definidos. Avaliar a preval&#xea;ncia e os fatores associados &#xe0; FA cl&#xed;nica e &#xe0; FA induzida durante o estudo eletrofisiol&#xf3;gico (EEF) em uma grande coorte consecutiva de pacientes com WPW submetidos &#xe0; abla&#xe7;&#xe3;o de via acess&#xf3;ria (VA). Esta an&#xe1;lise retrospectiva incluiu 845 pacientes consecutivos com WPW submetidos &#xe0; abla&#xe7;&#xe3;o de VA em um &#xfa;nico centro terci&#xe1;rio de refer&#xea;ncia. Um protocolo padronizado de EEF foi aplicado durante todo o per&#xed;odo do estudo. Os desfechos inclu&#xed;ram FA cl&#xed;nica (documentada por hist&#xf3;rico m&#xe9;dico ou monitoriza&#xe7;&#xe3;o antes do EEF), FA induzida no EEF e qualquer FA (desfecho composto). Modelos de regress&#xe3;o log&#xed;stica multivari&#xe1;vel foram utilizados para estimar odds ratios ajustados (ORa) com intervalo de confian&#xe7;a de 95% (IC 95%). A signific&#xe2;ncia estat&#xed;stica foi definida como p < 0,05. A m&#xe9;dia de idade foi de 33,2 &#xb1; 15,9 anos, e 486 dos 845 pacientes (57,5%) eram do sexo masculino. M&#xfa;ltiplas VAs foram identificadas em 31 pacientes (3,7%). As localiza&#xe7;&#xf5;es mais comuns das VAs foram lateral esquerda (327/845, 38,7%) e posterior (323/845, 38,2%). FA cl&#xed;nica esteve presente em 109 pacientes (12,9%), FA induzida no EEF em 77 (9,1%) e qualquer FA em 168 (19,9%). Nas an&#xe1;lises multivari&#xe1;veis, uma VA lateral esquerda esteve independentemente associada &#xe0; FA cl&#xed;nica (ORa, 2,31; intervalo de confian&#xe7;a de 95% [IC 95%], 1,53-3,49; p < 0,001), enquanto uma VA posterior esteve associada &#xe0; FA induzida no EEF (ORa, 1,78; IC 95%, 1,07-2,91; p = 0,025). O sexo feminino esteve associado a menores chances de FA induzida no EEF (ORa, 0,56; IC 95%, 0,34-0,93; p = 0,025). O aumento da idade esteve independentemente associado &#xe0; FA cl&#xed;nica (ORa por ano, 1,018; p = 0,007) e a qualquer FA (ORa por ano, 1,014; p = 0,009). Nesta grande coorte de pacientes com WPW submetidos &#xe0; abla&#xe7;&#xe3;o de VA, a localiza&#xe7;&#xe3;o lateral esquerda da VA e a maior idade estiveram independentemente associadas a maior preval&#xea;ncia de FA cl&#xed;nica. Em contraste, a localiza&#xe7;&#xe3;o posterior da VA e o sexo masculino estiveram associados a maior probabilidade de FA induzida no EEF.

Habitat fragmentation is one of the main threats to biodiversity. Studying biodiversity is also useful for evaluating the impacts of anthropogenic activities and guiding conservation decisions. We evaluated the effects of habitat fragmentation on reptile diversity in the Tandilia Mountains, a landscape of isolated grassland patches embedded in an agricultural matrix. Seven isolated patches of native grassland were characterized in terms of their spatial characteristics, land use, and diversity. Then a SIMPER analysis and rank-abundance curves were performed to estimate dissimilarity between patches. A Canonical Correspondence Analysis was conducted to understand how the characteristics of the grassland patches influence reptile species presence. A total of 20 species were found in the selected patches. Amphisbaena kingii, Epictia munoai, and Liolaemus tandiliensis were the most abundant and dominant species. The highest reptile diversity was found in the patches more connected, with low border effect and more native grassland. This study highlights the need to prevent further fragmentation of the remaining grasslands to conserve reptile diversity of Tandilia Mountains. Protecting their habitats could provide umbrella protection to other less-documented or cryptic taxa within the same ecosystems.

Traditional spica casting is the standard treatment for pediatric femoral fractures in children under five years of age, but it carries well-documented limitations, including the need for general anesthesia, increased caregiver burden, and high rates of skin complications. Prefabricated functional bracing, such as the Dynamic Femur Fracture (DF2) brace (OrthoPediatrics, Warsaw, IN), has emerged as an alternative that eliminates anesthesia exposure and improves patient mobility. However, clinical data regarding the practical limitations, complication profiles, and patient selection boundaries during early adoption remain limited. This case series describes our institution's early experience with the DF2 brace to provide practical insights into patient selection and brace management. Following Institutional Review Board (IRB) approval, a case series was conducted at a single tertiary care pediatric institution. Records were reviewed for patients aged under 18 years diagnosed with a fracture requiring functional bracing treatment between January 1, 2020, and October 17, 2025. Patients were excluded if they had inadequate clinical and radiographic follow-up of less than six weeks. Demographic variables, injury characteristics, treatment parameters, radiographic time to union, and soft-tissue complications were extracted from electronic medical records into a secure database. Five pediatric patients were evaluated (four traumatic fractures and one elective postoperative reconstruction). Successful fracture healing and a return to age-appropriate activity were achieved in all four traumatic fracture cases. Open, superficial pressure injuries of the proximal lateral calf occurred in two patients, with both successfully managed in the outpatient clinic setting with local wound care. In an elective hip reconstruction case involving a 12-year-old nonambulatory patient with advanced cerebral palsy, the brace dug deeply into the groin and impinged on a pre-existing vesicostomy site, necessitating discontinuation on postoperative day 1 in favor of a straight knee immobilizer. Ultimately, the DF2 brace serves as an alternative to spica casting for acute, isolated femoral fractures in young children, providing reliable bone healing with simplified hygiene access. However, it did not eliminate the risk of pressure injuries in this series, highlighting the need for vigilant stockinette hygiene and proactive padding.

Both type II (consumer/client-on-worker) and type III (worker-on-worker) workplace violence and mistreatment exist within the sign language interpreting field, however type III (also known as horizontal violence or lateral aggression) is more commonly reported. Between 22 to 90% of sign language interpreters have witnessed and/or experienced forms of horizontal violence or behaviors associated with it and 0 to 8% have knowingly perpetrated horizontal violence against another interpreter. This perspective article aims to provide a cross-industry approach by sharing general practices and previous strategies used within the mental and general healthcare settings. We describe how these tools have been adapted to other industries and model how to apply them to the sign language interpreting field. Available regulatory guidance emphasizes employer responsibility for identifying workplace violence hazards and implementing evidence-informed prevention strategies. Safety and Violence Education (SAVE) was designed for front-line healthcare professionals who are exposed to multiple, well-documented risk factors for workplace violence. The original SAVE curriculum primarily emphasized the perceived predominance of consumer/client-on-worker violence in community mental health settings. Critical steps in adapting SAVE for sign language interpreters involved organizational/administrative exposure control strategies, like cultivating awareness of how organizational culture intersects with emotional and psychological safety and emphasized behavioral/interpersonal approaches by recognizing, preventing, and mitigating worker-on-worker aggression, bullying, and relational-based conflict. The adapted SAVE sought to "break the cycle" of horizontal violence and establish a sustainable culture of safety, respect, and professional resilience among sign language interpreters.

Oncological Total Knee Replacements(TKR) are complex surgeries compared to Conventional TKR's as they involve morbid resections of bone and soft tissues with reconstructions. Literature on TKR for osteoarthritis, have reported around 10-34% incidence of moderate to severe Chronic post surgical pain(CPSP) which is documented to impact quality of life. We therefore, conducted a prospective observational study of 139 patients over a 38 month period undergoing oncologic TKR to assess the severity of postoperative pain, incidence of CPSP at 4th and 6th months in this subset, identify any neuropathic pain component at 4 and 6th months and its impact on daily function. Adult patients undergoing primary oncological TKR surgeries were included in the study. The mean average and worst pain scores were 3.17 (SD&#xb1; 1.25) and 4.85 (SD&#xb1;1.60) on the first postoperative day and decreased subsequently over the next 3 days. At 4th month 64 patients (46%) and at 6th month 30 patients (21.6%) continued to have pain, chiefly of mild and some with moderate intensity. The Pain Interference score deduced from Brief Pain Interference(BPI) questionnaire at 4th and 6th month was 1 (0-2.14) and 0 (0-1.29) respectively. At 4 th month, the main aspects which were found to be affected were walking ability and normal work (both outside the home and housework). At 6th month, 10 patients (7.19%) had pain suggestive of neuropathic character as per the pain descriptors used to describe the pain, however on applying the neuropathic questionnaire pain DETECT, all patients had a score below 12 which makes neuropathic pain highly unlikely. The median Musculoskeletal scoring system(MSTS) score was found to be 25 (IQR:24-26) and indicates a good functional outcome at 6 months following oncologic TKR. Hence, following oncologic TKR's, the pain was mild in intensity in majority patients. Around 1/5th of the patients had pain of mild intensity at 6 months which was not likely to be neuropathic. Pain did not interfere significantly with daily activities and the functionality as deduced from the MSTS score was good at 6 months.

Excessive body weight stands out as a major, well-documented risk factor for rheumatic and musculoskeletal diseases (RMDs). Indeed, high body mass index (BMI) affects disease severity, treatment response, and long-term outcomes. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) were first developed for type 2 diabetes and obesity, but there is growing evidence that they may also have anti-inflammatory and immunomodulatory properties [1-3]. This narrative review examines the available evidence on the role of GLP-1 RAs in two conditions that are strongly associated with metabolic and mechanical factors but sit on almost opposite ends of the inflammatory spectrum: osteoarthritis (OA), a predominantly mechanically driven disease, and psoriatic disease (PsD), an immune-mediated inflammatory disease. A comprehensive narrative review of the literature was conducted to evaluate preclinical and clinical evidence regarding the effects of GLP-1 signaling in both OA and PsD. Preclinical data suggest that GLP-1 signaling may protect cartilage, reduce inflammation, and alleviate pain in OA. Early clinical evidence is encouraging, showing reductions in both joint pain and body weight. In PsD, obesity and psoriatic inflammation share several common pathways, particularly through the IL-17/IL-23 axis, which provides a theoretical biological rationale for GLP-1 RAs use in this setting, although direct clinical evidence remains limited and largely derived from studies in obese patients. Dedicated randomized controlled trials are necessary to clarify the direct immunomodulatory mechanisms involved and to define the precise position of GLP-1 RAs in rheumatological practice.

Background Osteoporotic fractures impose a substantial economic burden in the United States. Although multiple pharmacologic therapies reduce fracture risk, variation exists in prescribing patterns. Internal organizational data from our institution demonstrated disproportionate utilization of denosumab compared with zoledronic acid despite substantial cost differences. This study evaluated prescribing attitudes, cost awareness, and determinants influencing primary care providers' osteoporosis medication selection. Methods A cross-sectional survey of primary care providers in New Mexico was conducted from April 18 to May 16, 2022. A convenience and snowball sampling strategy was used. Descriptive statistics, 95% confidence intervals, and chi-square testing were performed for subgroup analysis. An internal document review to determine relative acquisition costs of denosumab and zoledronic acid, and a limited literature review on this topic, were also conducted. Results Seventy-two providers responded (36% response rate). Although 75% reported prescribing denosumab more frequently, 48.6% incorrectly believed denosumab was similarly priced or less expensive than zoledronic acid. Only 26% correctly identified denosumab as much more expensive. Advanced practice clinicians underestimated costs more frequently than physicians (71% vs. 38%, &#x3c7;&#xb2;=6.36, p=0.012). Providers practicing >10 years also demonstrated significant underestimation (51.9%). Conclusion Primary care providers frequently underestimate the cost of denosumab despite reporting that cost influences prescribing decisions. Even long-practicing physicians demonstrated substantial misperception of drug pricing. Improved access to real-time cost information may promote more cost-effective osteoporosis management.

Congenital shortening of the fourth metacarpal (brachydactyly type E) is an uncommon anatomical variant that may occur in isolation or with syndromic conditions. Prior case reports have documented this finding in adults, but none have assessed functional outcomes in the context of high-level athletic participation. A 67-year-old woman presented to the emergency department on two separate occasions after falling on her left and right wrists. Radiography and computed tomography revealed a non-displaced triquetral fracture (left) and a non-displaced scaphoid fracture (right), with incidental bilateral symmetric shortening of the fourth metacarpals. Radiographic archives spanning more than a decade have confirmed stable morphology, thereby supporting a congenital etiology. The patient reported no history of hand dysfunction and had competed in softball at the high school level and internationally as part of her national team. Following conservative management, the patient regained a full, pain-free range of motion bilaterally. This case is the first report of bilateral congenital shortening of the fourth metacarpal in a lifelong competitive athlete, demonstrating that this variant is compatible with high-level athletic participation without self-reported functional limitations. Radiographic stability for more than a decade and preserved function into late adulthood extend the evidence base for the long-term benignity of this condition. Formal grip dynamometry and validated functional scores were not available, which is acknowledged as a limitation of this study. Conservative management with reassurance is appropriate for asymptomatic patients. Recognition of this radiographic appearance can prevent misinterpretation as traumatic shortening or growth plate injury.

Peripartum depression (PPD) is a serious public health issue associated with adverse maternal and infant outcomes. Healthcare providers (HCPs)-including pediatricians, family medicine physicians (FMPs), and obstetricians-are well-placed to screen for and manage PPD. This study aims to investigate the knowledge, attitudes, and experience regarding PPD among pediatricians and compare them with those of FMPs and obstetricians in Turkey. This cross-sectional study included HCPs from multiple cities across Turkey. Data were gathered through an online structured questionnaire designed by the researchers.&#xa0;The sample comprised 200 pediatricians, 158 FMPs, and 76 obstetricians. Pediatricians exhibited the lowest level of awareness regarding PPD screening tools (p&#x2009;<&#x2009;0.001), the lowest utilization rate of standardized PPD screening tools (2%), and the lowest rate of prior PPD training (1.5%). Although the majority of pediatricians agreed that PPD should be assessed, only 39% perceived postnatal PPD assessment as part of their professional responsibility (p&#x2009;<&#x2009;0.001). After adjusting for confounders, being a pediatrician was independently associated with lower awareness of PPD screening scales (aOR&#x2009;=&#x2009;0.50; 95% CI:0.30-0.83; p&#x2009;=&#x2009;0.007) and a higher likelihood of strongly disagreeing with PPD screening responsibility (aOR&#x2009;=&#x2009;5.82; 95% CI:1.31-25.84; p&#x2009;=&#x2009;0.021). Pediatricians demonstrated the lowest levels of knowledge, experience, and unfavorable attitudes toward managing PPD. A clear discrepancy exists between recognizing the importance of PPD management and acting on PPD. Incorporating PPD training into medical education and pediatric residency programs, as well as developing standardized PPD guidelines that include pediatricians, could enhance PPD screening and management in Turkey. &#x2022; Although a growing body of literature has documented a rise in peripartum depression (PPD) screening by pediatricians, current PPD screening rates remain profoundly inadequate. &#x2022; Healthcare providers have limited knowledge, negative attitudes, and insufficient clinical experience regarding PPD. &#x2022; This study is the first in Turkey to highlight the significant gaps in postpartum PPD awareness among pediatricians, revealing limited knowledge, negative attitudes, and insufficient clinical experience. &#x2022; Pediatricians had the lowest rate of prior training among healthcare professionals, despite expressing a strong need for education.

Plant species interactions in woodlands help maintain the coexistence of trees and groundcover, contributing to high plant diversity. Interactions can be either positive or negative and take place both above and below ground. Both competitive and facilitative interactions have been documented in longleaf pine woodlands, but the dynamics of these interactions and their effects on plant physiology are poorly understood. Our objective was to quantify the impact of tree root exclusion on physiology and growth of understory plant functional types (PFTs) that represent the diversity of longleaf pine woodlands. We used trenching to isolate understory plants from tree roots and compared soil moisture, leaf water potential (&#x3a8;), leaf-level gas exchange, and plant growth for four understory species representing different PFTs in trenched root exclusion plots and untrenched control plots. We hypothesized that root exclusion would reduce understory plant performance compared to untrenched control plots by isolating plants from facilitative effects of canopy trees, but our hypothesis was not supported. We observed better plant performance in trenched plots for some PFTs, and no differences in plant growth for any PFT. These data suggest competitive effects of tree root presence, but results varied among PFT. The study period was unusually wet, with rainfall 53% above normal. In the context of previous studies, these results suggest that belowground competition is more important than facilitation during a wet year, and the relationship between longleaf pines and understory plants shifts from facilitation to competition depending on rainfall.