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Incarcerated people suffer stigmatized conditions at higher rates than nonincarcerated people, making upholding privacy and confidentiality ethically essential in prisons and jails. Yet these health professional values are widely acknowledged to be challenging to maintain in carceral settings. Robust qualitative data on how physicians and nurses navigate and perceive limitations to privacy and confidentiality in U.S. prisons and jails is lacking. This study reports on 55 semistructured interviews with physicians and nurses who have worked in federal or state prisons and/or jails across the United States. Participants perceive multiple challenges to privacy and confidentiality in prisons and jails and yet differ in how important they think it is to protect these values in comparison with other pressing concerns.
Humanity is crossing multiple planetary boundaries while facing rising inequality, democratic fragility, and worsening mental health, exposing the incompatibility of unlimited gross domestic product-driven growth with a finite, socially interdependent planet. Only 17% of the Sustainable Development Goal targets are on track, indicating the need for a deeper transformation rather than faster implementation. Synthesising evidence across disciplines, we argue that human beings are evolutionarily wired for cooperation and relational wellbeing, and not perpetual consumption and status competition. This argument underpins a post-2030 shift in a global development paradigm that places multidimensional wellbeing, of people and the planet, at its core. We outline three mutually reinforcing systemic shifts: deliberative democracy that gives communities real power to shape collective futures; economic democracy that redirects finance, enterprise design, and fiscal policy towards equitable, regenerative outcomes; and transformed land and resource governance that recognises ecological limits and the rights of nature. By aligning institutions with the cooperative nature of humans and the Earth's regenerative capacity, societies can achieve flourishing lives for all within planetary boundaries, offering a scientifically grounded agenda for the decades beyond 2030.
Understanding how gene-flow and selection interact across environmental gradients is essential for assessing population resilience and evaluating the deep-refugia potential of mesophotic habitats under rapid climate change. In the context of depth, genetic connectivity patterns have been documented for broadcast-spawning species, but that of brooding marine invertebrates remains largely unexplored, leaving the role of mesophotic habitats as potential refugia uncertain. Here, we investigated the genetic structure of the brooder sponge Ircinia variabilis across shallow and mesophotic habitats in the Eastern Mediterranean and across shallow sites spanning multiple Mediterranean basins (i.e., Mallorca, Ionian-Sea and Israel). By quantifying depth and distance-related connectivity, and assessing the relative roles of neutral processes and temperature-driven selection, we evaluated the genetic connectivity of I. variabilis and the potential of mesophotic habitats to function as refugia. Using ddRADseq, we obtained 957 SNPs, to characterize gene-flow patterns, genetic structure, and environmental influences on differentiation. Ircinia variabilis exhibited pronounced vertical and geographic genetic structure, consistent with limited larval dispersal. Notably, Ionian-Sea populations were genetically closer to Mallorca than to the geographically closer Israeli populations, suggesting influence of oceanographic barriers. Analyses of selection-associated loci indicate that environmental variability contributes to population divergence, supporting local adaptation. Along the Israeli coast, pronounced differentiation between shallow and mesophotic populations highlights depth as a key axis of evolutionary divergence. Limited vertical connectivity challenges a central assumption of the deep refugia hypothesis, suggesting mesophotic populations may not sustain shallow populations under climate change.
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Around one in four people with stroke will have a recurrent stroke. The risk can be reduced through medication and lifestyle changes, but many have poor risk factor control post-stroke. There is no nationally recognised model of care for stroke secondary prevention, and inadequate secondary prevention may be a complex problem that cannot be effectively dealt with by addressing various contributing factors independently. We sought to understand implementation and research priorities to address gaps in stroke secondary prevention in Australia. An online roundtable and four follow-up small group discussions were conducted between March and April 2023. Participants were people with lived experience of stroke, researchers, health professionals and representatives from stroke advocacy organisations and the Australian federal government. Participants were given pre-discussion questions on stroke secondary prevention priorities, barriers and enablers. Moderated discussion invited reflection on system-level connections between priorities and shared understanding of diverse perspectives, rather than consensus-building. Discussions were recorded, transcribed and analysed following Braun and Clarke's thematic analysis methodology. In the roundtable and small-group discussions, 25 people participated (68% women). Most priorities related to the inductive theme, 'models of care', including programmes, interventions and health system settings. Perceived barriers and enablers related to the following inductive themes: 'coordination', 'resourcing', and the 'research translation pipeline'. Identified priorities were heterogeneous and extensive. Tensions existed between some priorities, but others were shared by participants. Our roundtable identified a range of priorities for stroke secondary prevention, coming from diverse perspectives. Stroke secondary prevention is a complex problem with interacting system elements that make improvement challenging. A model of care for stroke secondary prevention in Australia is needed that accounts for this complexity while building upon shared priorities. This project embedded people with lived experience of stroke. This included three people with lived experience of stroke, or of being a carer for a person with stroke, who took part in the initial roundtable and provided valuable contributions in discussions of implementation and research priorities for secondary stroke prevention. These participants also helped to prepare this manuscript, providing helpful feedback to ensure that priorities, barriers and enablers for secondary stroke prevention from a lived experience perspective were centred.
Pavement management decisions shape how road quality is distributed across communities, yet equity is rarely evaluated as an outcome of standard prioritization practices. This study introduces a framework for assessing whether equity improvements can be a co-benefit of routine pavement maintenance without requiring equity-specific optimization. We propose two methodological advances. First, a community-based Gini coefficient computed at the census block group level, rather than at individual road segments, to meaningfully capture horizontal equity. Second, the Wasserstein distance to quantify vertical equity through distributional comparisons between Environmental Justice and non-Environmental Justice communities rather than relying on centrality measures. Four prioritization strategies combining pavement condition, traffic volume, and nearby population exposure are evaluated using Massachusetts Highway District 3 data (3000 lane-miles, 905 block groups). All strategies improve both equity metrics compared to baseline conditions, achieving up to 75% reduction in vertical disparity and 30% in horizontal inequality under a 150 lane-mile scenario. Crucially, for this case study, sensitivity analysis reveals that population-weighted strategies can widen rural-urban gaps at higher budget levels, while condition-only prioritization may sustain equity gains. These findings demonstrate that better road conditions for all communities can be achieved as a co-benefit of maintenance through careful selection of prioritization factors.
Teamwork and communication are critical to reducing medical error, particularly in complex surgical procedures such as vascularized composite allotransplantation (VCA). Although cadaveric rehearsals are used to prepare for VCA, their effect on team development and operative outcomes remains unstudied. We therefore sought to evaluate the evolution of teamwork and its impact on operative outcomes in preparation for the first successful combined full-face and bilateral hand transplant. Cadaveric rehearsals were conducted in preparation for a combined full-face and bilateral hand transplant. As a quality improvement effort, teams followed surgical checklists and were assessed for teamwork using the Clinical Teamwork Scale (CTS) and the Oxford Non-Technical Skills (NOTECHS) tool. Face- and hand-specific scores and dissection times were recorded at each rehearsal to guide debriefings and refine subsequent sessions until transplantation. Eleven cadaveric rehearsals were conducted with 9 surgical teams, each including at least 3 surgeons, 2 nurses, and 1 research fellow. Overall mean CTS scores improved significantly from baseline to transplantation for both face and hand teams, with notable gains in teamwork, communication, situational awareness, and decision-making. Linear regression showed significant positive associations between rehearsal number and scores in most CTS and NOTECHS domains. Total dissection time significantly decreased from 411 minutes at baseline to 273 minutes at the final rehearsal (P = 0.004). Teamwork and dissection time significantly improved during 11 cadaveric rehearsals, culminating in the first successful face and bilateral hand transplant. A comprehensive, team-based approach is essential to the success of VCA.
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Anterior cruciate ligament reconstruction is a constantly evolving procedure, and we continue to push the limits to improve outcomes for our patients. As rates of reinjury continue to be higher than we desire, we have consistently sought methods to improve postoperative outcomes and reduce the rates of revision surgeries. The rebirth of lateral extra-articular augmentation procedures has given us a strong tool to leverage to achieve these goals. It is essential that we continue to appreciate the price of this progress and fully understand the risks of augmenting our existing surgical techniques. Finding the optimal patients on whom to utilize these techniques is the key to balancing our success in this challenging patient population.
The "Cone of Gaze" (CoG), a measure of the range of gaze angles that one perceives to be looking at them, has been proposed as a biobehavioural marker of psychiatric disorders characterised by symptoms in the social domain, such as social anxiety disorder. However, the evidence remains inconsistent and its mechanisms unclear. Here, we combine meta-analysis and well-powered experimental replications to investigate: 1) individual differences in the CoG between those with and without social anxiety; 2) within-subjects differences in the CoG in response to faces with angry versus neutral expressions; and 3) the interaction between these factors. The meta-analyses revealed significantly wider CoG for socially anxious versus non-anxious individuals (representing 10 studies and 403 participants), and wider CoG for angry versus neutral expressions (9 studies, 523 participants). However, the existing evidence was sparse, highly heterogeneous and often involved small samples. Our experiments (N = 514) did not replicate the effect of social anxiety or emotional expression on CoG. Our integrated approach, combining meta-analyses with experimental replications and extensions, provides a rigorous framework for assessing the robustness and clinical relevance of gaze perception effects. We highlight the need for larger, more transparent datasets to accurately estimate CoG effects and other putative markers to assess their translational potential.
Correctional climate-the perceptions staff and incarcerated people hold about their institution-can influence well-being for everyone living and working in prison. This study explores differences in perceptions of safety, quality of sleep, psychological and emotional wellness, physical health, and overall life outlook among 1,148 security staff, non-security staff, and incarcerated individuals across five Minnesota Department of Corrections facilities. Results indicate that both staff groups report significantly greater safety and sleep quality outcomes than incarcerated people, while security staff also reported better emotional wellness than the incarcerated population. No differences emerged across groups regarding perceived psychological wellness, physical health, or life outlook. These findings highlight both shared experiences and key disparities within correctional environments, underscoring opportunities to improve conditions, support workforce well-being, and advance institutional policies that benefit all people in prison settings. How Prison Staff and Incarcerated People View Safety, Health, and Life in PrisonPrisons are environments where both staff and incarcerated people live or work every day. How people feel about safety, health, and well-being in these settings, often called the correctional climate, can affect everyone inside the facility. Understanding these perceptions can help improve conditions for both staff and incarcerated individuals. This study examined how people in five prisons in Minnesota view their safety, sleep quality, emotional and psychological well-being, physical health, and overall outlook on life. The study included responses from 1,148 people: correctional security staff, non-security staff, and incarcerated individuals. The results showed some important differences. Both security staff and non-security staff reported feeling safer and said they slept better than incarcerated people. Security staff also reported better emotional well-being than incarcerated individuals. However, the three groups reported similar levels of psychological well-being, physical health, and general outlook on life. These findings suggest that people in prisons share some similar experiences but also face different challenges. Understanding these similarities and differences can help correctional leaders develop policies and programs that improve safety, well-being, and working and living conditions for everyone in prison facilities.
BackgroundCurrent theoretical models emphasize sadness as a functional and multifaceted emotion, yet research often neglects the heterogeneity of children's co-occurring emotional responses to sad events.AimThis study investigated the heterogeneity in children's emotional responses to sad events, moving beyond variable-centered approaches that assume uniform emotionality.MethodUsing a person-centered approach grounded in the core affect framework, the primary aim was to identify distinct configurations of sadness, anger, fear, and confusion in middle childhood. A secondary aim explored whether mother's and father's attachment security and loneliness predicted membership in emotional profiles. A total of 174 children (age range: 7-11 years-old; M = 8.79, SD = 1.03; 55.9% female) participated.ResultsLatent Profile Analysis identified four distinct profiles: Sadness-Focused Response, Anxious Sadness, Emotional Overwhelming, and Externalized Sadness. ANOVAs revealed that sadness-focused profile showed higher loneliness than Emotional Overwhelming. Furthermore, Externalized Sadness showed lower attachment security for both mother and father than Sadness-Focused Response and Anxious Sadness.ConclusionThese findings underscore that sad events elicit qualitatively different emotional configurations, highlighting the need for tailored assessment and intervention strategies based on distinct emotional response patterns. Sadness is a normal part of growing up, but not every child experiences it the same way. While many think of sadness as a single feeling, it often mixes with other emotions like anger or fear. Researchers wanted to understand these different emotional “mixtures” in children because traditional studies often assume everyone reacts similarly. The research involved 174 children between the ages of 7 and 11 from schools in Italy. Each child was asked to describe a recent event that made them feel very sad. They then rated how much sadness, anger, fear, and confusion they felt during that event. The children also completed surveys about their relationships with their parents and how often they felt lonely. The study discovered four distinct ways children react to sad events: sadness-focused, the most common and “balanced” response, where children felt mostly sad but did not feel much anger, fear, or confusion; anxious sadness, in which children felt both sad and very fearful, seeing the event as threatening; emotional overwhelming, in which children felt high levels of anger, fear, and confusion all at once, making it hard for them to even identify their sadness; externalized sadness, in which instead of feeling sad, children reacted primarily with anger. The study also found that the type of sad event (like an injury or a fight with a friend) didn’t determine which group a child fell into. Instead, their personal relationships mattered more. For example, children who felt lonelier were more likely to feel “overwhelmed” rather than just “sad.” Children who felt very secure with their parents were much less likely to react with anger. These results show that sadness is not the same for everyone. A child’s emotional reaction depends heavily on their personal sense of security and social connection rather than just the event itself.
Despite longstanding recognition of sex as a biological variable, its integration into biomedical research remains inconsistent. Numerous publishers have introduced policies to improve reporting and inclusion of sex and gender, including Nature, which requires authors to complete a Life Science Reporting Summary documenting sex inclusion. Here, we evaluated the effectiveness of these policies by examining sex inclusion and reporting practices in all original research articles involving humans, vertebrates, or cell lines published in Nature in 2025 (N = 513). Nearly two-thirds of articles included both sexes (62.7%); however, inclusion was often nominal. Of these articles reporting inclusion of both sexes, 33% did not maintain inclusion across experiments, used markedly unbalanced sex ratios (≥ 2:1), or alternated between male- and female-only experiments. Another 45.5% of these articles reporting inclusion of both sexes did not report sample size by sex, so it cannot be ascertained whether sex inclusion was maintained across experiments or balanced by sex. Single-sex studies accounted for approximately one-fifth of articles. While male-only and female-only studies occurred at similar overall rates, male-only studies were more than four times more likely to address conditions affecting both sexes while female-only studies were more likely to address sex-specific conditions (e.g., ovarian cancer). Notably, the policies aimed at improving reporting and inclusion also did not increase analysis by sex; only 7% of articles explicitly analyzed sex as a discovery variable for at least some analyses. These findings suggest that transparency-focused reporting summaries alone are insufficient to ensure sex inclusion and/or meaningful analytical integration of sex (i.e., direct comparison of sexes, rather than using sex as a covariate). As a leading biomedical journal, Nature plays a central role in shaping research norms; without stronger editorial expectations, reporting requirements risk reinforcing male-default assumptions rather than advancing rigor and generalizability. Biological sex can influence how diseases develop and how treatments work. For this reason, researchers are increasingly encouraged to include both males and females in their studies. Many scientific journals now have policies to improve how sex is considered and reported. In this study, we looked at whether these policies are working by reviewing all research articles published in Nature in 2025. We found that nearly two-thirds of studies said they included males and females. However, this inclusion was often incomplete or unclear. In many cases, researchers did not consistently include both sexes throughout all experiments, used uneven numbers of males and females, or switched between studying only males or only females. Nearly half of the studies that claimed to include both sexes did not provide enough detail to confirm how many males and females were used. About one in five studies used only one sex. Studies using only males were much more likely to focus on conditions that affect everyone, while studies using only females were more likely to focus on female-specific conditions. Importantly, very few studies (7%) compared results between males and females to see if there were meaningful differences. Overall, our findings suggest that current reporting requirements are not enough to ensure that sex is properly included, reported, and analyzed in research. Stronger expectations are needed to improve the quality and usefulness of scientific findings for everyone.
Hand osteoarthritis (HOA) is a prevalent degenerative joint disorder that causes pain, functional disability, and considerable socioeconomic burden. China's rapid population aging and widespread engagement in repetitive manual labor may have accelerated to the rise of HOA. However, long-term trends and future projections of its disease burden remain insufficiently characterized. To describe trends in HOA incidence, prevalence, and DALYs from 1990 to 2021, examine differences across age and sex, and project future disease burden. A population-based descriptive study using GBD 2021 data to examine trends and project the burden of hand osteoarthritis in Chinese adults aged 30 years and older across national and subnational regions. Age-standardized incidence rate (ASIR), prevalence rate (ASPR), and disability-adjusted life year rate (ASDR) were analyzed by sex and age group. Temporal trends were quantified using Joinpoint regression to calculate annual and average annual percent changes (APC, AAPC), and future trends were projected to 2036 using an autoregressive integrated moving average (ARIMA) model. Between 1990 and 2021, the burden of HOA increased substantially worldwide, with China showing a faster rise than the global average. In China, ASIR rose from 59.12 to 92.70 per 100,000, ASPR from 988.51 to 1603.85, and ASDR from 31.57 to 51.26, corresponding to AAPCs of 1.46%-1.58%. Females experienced consistently higher rates than males and faster growth. The disease burden rose sharply after age 50 and peaked between 65 and 79 years. Joinpoint analysis revealed multiple inflection points, with the steepest acceleration occurring from 2015 to 2019 (APC >5%). ARIMA projections indicate that male rates will plateau or slightly decline by 2035, whereas female rates will continue rising, potentially exceeding 150 per 100,000 for incidence and 3000 per 100,000 for prevalence. The burden of HOA in China is increasing rapidly and is likely associated with population aging, sex-specific biological vulnerability, and occupational exposure. Women and elderly adults are disproportionately affected, with widening sex and age disparities. Targeted interventions-including ergonomic protection, menopausal health management, and early rehabilitation-are essential to mitigate the projected rise in disease burden and to improve musculoskeletal health in an aging population. Temporal trends and future projections of hand osteoarthritis burden in China from 1990 to 2021 Hand osteoarthritis is a common condition where the joints in the fingers and thumbs break down, causing pain and stiffness that can make daily tasks difficult. As China’s population gets older and people use their hands intensively for both manual jobs and digital devices like smartphones, this problem is getting much worse. A new study looked at data from 1990 to 2021 to understand how widespread and severe hand osteoarthritis has become in China. The findings show a fast and significant increase. The number of new cases, the total number of people living with the condition, and its overall impact on people’s lives and health have all nearly doubled over those 30 years. This rise in China has been faster than the global average. The burden of this disease is not shared equally. Women are affected more often and more severely than men, and the gap is widening. For everyone, the risk increases sharply after age 50, with the highest rates seen in adults aged 65 to 79. The fastest period of increase happened very recently, between 2015 and 2019. Using this data, researchers forecast trends to 2036. They predict that while the rate for men may level off, the number of women developing and living with hand osteoarthritis will continue to climb significantly. The main drivers behind this rising trend are the aging population, hormonal changes after menopause in women, repetitive hand use in certain jobs, and the widespread use of digital technology. To address this growing public health challenge, the study suggests that targeted steps are needed. These include promoting hand-friendly work tools and habits, providing better health support for women around menopause, and offering early rehabilitation programs. Taking action is crucial to reduce future pain and disability and improve the quality of life for China’s aging population.
For many health conditions, there are highly efficacious treatment and prevention products. Maximizing their impact requires strategies that improve the reach of health screening in order to establish who could benefit. For example, HIV prevention strategies aim to expand risk screening and to improve uptake of pre-exposure prophylaxis (PrEP) among those experiencing risk. Often, these strategies induce changes at the group-level (e.g., health clinics or communities) and are evaluated through cluster randomized trials. This scenario creates a complex, multilevel-mediation-missing data problem for the following reasons: First, the strategy is delivered at the cluster-level, while health screening and outcomes are at the individual-level. Second, the strategy improves health outcomes directly and indirectly through improved health screening. Third, everyone has an "underlying" status, which is only observed among those screened. To formally define the total effect in such settings, we use Counterfactual Strata Effects: causal estimands where the outcome is only relevant for a group whose membership is subject to missingness and/or impacted by the exposure of interest. To identify and estimate the corresponding statistical estimand, we propose a novel extension of Two-Stage targeted minimum loss-based estimation (TMLE). Simulations demonstrate the practical performance of our approach as well as the limitations of existing approaches.
To explore what works for whom, how and why when implementing women's sexual and reproductive health interventions in prisons to understand the barriers and facilitators to implementation and to generate recommendations for policymakers. Realist review using the Realist And Meta-narrative Evidence Synthesis: Evolving Standards guidelines. We systematically searched Ovid MEDLINE, Global Health, Embase, the Cumulative Index to Nursing and Allied Health Literature (CINAHL) and the American Psychological Association (APA) PsycINFO databases and hand-searched unpublished literature and reference lists, January-June 2025. Primary studies of implementing women's sexual and/or reproductive health interventions, including those addressing sexually transmitted infections, cervical health, breast screening, contraception and women's health holistically. Study populations included people in prisons that detain women in high-income countries. We extracted and analysed data relating to implementation processes using a grounded theory approach and retroductive inference to articulate cross-case Intervention-Context-Actor-Mechanism-Outcome configurations (ICAMOCs) and refine programme theory. We discussed findings in relation to existing theories from the literature to elicit recommendations for policymakers. Of 4617 deduplicated records, 26 met the inclusion criteria. Ten ICAMOCs were constructed from cross-case analyses, grouped into three themes: (1) planning (teaming, team leadership, assessing needs and capacity, tailoring and planning), (2) doing (piloting, standardisation and support, trauma-informed engagement and peer advocacy) and (3) sustaining (evaluation-adaptation cycles). The ICAMOCs indicated three overarching mechanisms as being key to effective implementation, namely, perceived utility of the intervention, motivation and empowerment. For women's sexual and reproductive health interventions to be effective in prisons, everyone involved in implementation needs to perceive the intervention's benefit and be both motivated and empowered to take action. We recommend policymakers build a resilient and empowered delivery workforce, invest in research partnerships to increase awareness and understanding and promote trauma-informed approaches to women's healthcare in prisons.
To examine the relationship between resident-level (intrinsic) and facility-level (extrinsic) factors associated with pressure injury development among nursing home residents. Exploratory, retrospective cohort design using secondary data from the Turn Everyone and Move for Pressure Ulcer Prevention study. Data from a convenience sample of 998 residents across nine nursing homes were analysed. Resident-level factors included demographics, body mass index, comorbidities, Braden Scale scores, and clinical severity. Facility-level factors included staffing hours and location. Multivariable logistic regression identified factors associated with pressure injury development. Of 998 residents, 61 (6.1%) developed new pressure injuries. Four significant predictors were: higher clinical severity laboratory values, underweight, fewer licensed practical nurse staffing hours, and lower Braden Scale Mobility subscale scores. This study highlights the importance of considering both intrinsic resident-level and extrinsic facility-level factors when assessing pressure injury risk in nursing home residents. Clinical severity measures capturing individualized physiological status may provide valuable information beyond traditional risk assessment tools. Pressure injury prevention benefits from incorporating physiological markers with traditional risk factors, enhancing early identification of high-risk residents. Effective prevention strategies address both resident vulnerability and care environment factors, particularly staffing levels. Clinical mobility assessments remain essential but gain value when integrated with physiological markers. As electronic health record use increases in nursing homes, future research can leverage these data to develop targeted interventions. Elevated pressure injury rates in nursing homes are a persistent problem. Main findings reveal that intrinsic resident-level and extrinsic facility-level factors influence pressure injury risk. These findings enable a shift in assessment focus from primarily mobility-based to more comprehensive risk profile evaluations. Vulnerable residents will benefit from earlier risk identification that leads to targeted interventions. For healthcare systems and administrators, it highlights the importance of adequate staffing models in pressure injury prevention efforts. Data were from resident participants in the implementation of the parent study.
Contact lens (CL) wear may induce changes to the tear film, leading to sensations of ocular dryness and CL discomfort, key reasons for CL discontinuation. CL care solutions can help address underlying mechanisms of CL discomfort, improving wear experience. We report outcomes of an in-home use test of Biotrue® Hydration Plus Multi-Purpose Solution (BHP MPS; Bausch + Lomb, Rochester, NY, USA), which is formulated to maintain ocular surface homeostasis and improve CL comfort. In this IRB-approved, real-world survey study, adult soft CL users used BHP MPS for 7 days before completing a survey rating their experience (agreement/disagreement for attributes including CL cleanliness, comfort [including during extended screen use], prevention of CL dryness, perception of CL hydration, gentleness on eyes, and likelihood to recommend to others). A power analysis estimated sample size for 80% statistical power. Responses were analyzed with 2-sided exact binomial tests for agreement in >50% of responses (significance level α=0.05). Participants (N=435) were demographically balanced (mean age 42.5 years; 52.9% female). Over 60% of participants reported baseline CL dryness and tired eyes; 8.0% were likely to discontinue CL wear. At the end of the trial period, 98.9% were satisfied with how their CLs felt. Individual responses were significantly >50% for all attributes (p<0.05), including 91.7% agreeing that BHP MPS positively impacted CL comfort (and helped to keep CLs feeling clean [96.8%], keep CLs comfortable so that eyes do not feel tired [93.1%], maintain CL comfort [94.7%], prevent CL dryness [93.6%], maintain comfort with extended screen use [92.0%], and maintain hydration [94.7%] while being gentle on eyes [96.6%]); 94.0% would recommend BHP MPS to other CL wearers. No adverse events were reported. BHP MPS demonstrated strong performance across all key criteria evaluated in this real-world cohort of soft CL wearers for improved CL wear experience. Comfort is important to keep people wearing their contact lenses, but some people stop wearing them because their eyes feel uncomfortable and dry over time. For reusable contact lenses especially, the choice of lens cleaning and care solution is important to help keep lenses feeling comfortable. Biotrue® Hydration Plus Multi-Purpose Solution (BHP MPS; Bausch + Lomb, Rochester, NY, USA) is a unique contact lens solution with ingredients that help clean and remove spots off the lenses, which may help keep the eye healthy and help the contact lenses feel more comfortable. The BHP MPS ingredients were chosen based on scientific research and advice from experts. This study looked at how using BHP MPS in daily life made people feel. The study included 435 people who regularly wore reusable contact lenses. Overall, these people agreed that BHP MPS helped keep their contact lenses clean and comfortable, was gentle on their eyes, and stopped their lenses from feeling dry, even if they were using a screen, like a computer, for a long time. Nearly everyone in the study agreed they would recommend BHP MPS to others who wear contact lenses. This study showed that BHP MPS can help reusable contact lens wearers, improving the way people’s eyes feel. This real-life study is important because it builds on what we already know about BHP MPS from other studies and helps people who wear contact lenses and their eye care doctors choose the right contact lens solution to use.
The integration of artificial intelligence in medical image classification for screening has the potential to enhance efficiency, diagnostic accuracy and accessibility. However, ethical concerns such as accountability, bias, transparency and the impact on healthcare professionals remain critical. This review synthesises qualitative evidence on the ethical considerations surrounding artificial intelligence adoption in screening programmes. A systematic search of qualitative studies, from June 2020 to September 2024, was conducted across multiple databases: MEDLINE, EMBASE, PsycInfo® (American Psychological Association, Washington, DC, USA) and Cumulative Index to Nursing and Allied Health Literature. Primary qualitative studies exploring healthcare professionals', patients' and other stakeholders' perspectives on artificial intelligence in screening were included. Thematic analysis was performed, and findings were assessed using the Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative Research approach to evaluate confidence in the evidence. Fourteen qualitative studies were included, covering perspectives from clinicians, radiologists, artificial intelligence developers, policy-makers and patients. Key ethical concerns identified included: (1) the necessity of human oversight to ensure that artificial intelligences diagnostic recommendations are appropriate; (2) challenges in assigning liability when artificial intelligence errors occur; (3) risks of algorithmic bias due to discrepancies between training data sets and real-world populations; (4) concerns over data privacy, cybersecurity and informed consent in artificial intelligence-driven decision-making; (5) the need for transparency in artificial intelligence decision-making processes to build trust and (6) potential deskilling of healthcare professionals and shifts in professional responsibilities. While artificial intelligence was seen as a valuable tool to augment clinical decision-making, stakeholders emphasised that ethical frameworks must guide its implementation to maintain public trust and patient safety. This review highlights the critical considerations that must be addressed to ensure the responsible integration of artificial intelligence in medical screening. Policy-makers, healthcare institutions and developers should prioritise human oversight, robust regulatory frameworks and strategies to mitigate bias and ensure transparency. Future research should focus on disease-specific artificial intelligence applications and long-term ethical implications. The protocol for this study is registered on PROSPERO as CRD42024599536. This award was funded by the National Institute for Health and Care Research (NIHR) Evidence Synthesis programme (NIHR award ref: NIHR172233) and is published in full in Health Technology Assessment; Vol. 30, No. 51. See the NIHR Funding and Awards website for further award information. Research is exploring if artificial Intelligence could help doctors find cancer by looking at medical images like X-rays and scans. Artificial intelligence could spot tiny signs of cancer that people might miss. This could help detect cancer and other diseases earlier and more accurately, for example in breast cancer and diabetic eye screening. Artificial intelligence can also speed up the process, so patients get results faster. However, ethical questions arise with using artificial intelligence in this way. While there are not yet specific national or international guidelines for artificial intelligence in screening, general healthcare guidance highlights the following key issues: transparency: being clear about how artificial intelligence makes decisions fairness: ensuring artificial intelligence treats everyone equally and does not discriminate against certain groups accountability: making sure someone is responsible for artificial intelligence’s actions reducing risks: ensuring artificial Intelligence systems are safe to use and do not cause harm governance and oversight: having strong systems in place to make sure artificial intelligence is used responsibly and ethically. This study examined ethical concerns of artificial intelligence in screening by reviewing research involving the general public, clinicians and patients. Initially focusing on diabetic retinopathy and breast cancer, it expanded to other conditions due to limited evidence. The study highlighted several ethical concerns raised in the literature, such as accountability for artificial intelligence mistakes, bias, data privacy, transparency and artificial intelligence’s impact on doctors’ professional roles. In addition, people in the studies included in the literature expressed worries about related issues, particularly keeping humans in control of decisions, who is responsible when errors occur and whether artificial intelligence systems can be trusted to act fairly. Ethical challenges related to the implementation of artificial intelligence in clinical screening were also highlighted. These included healthcare inequality (with resource-limited hospitals potentially not benefiting equally), risks to patient safety from delays or errors in artificial intelligence-generated reports, the need for trust through rigorous testing and the importance of clear governance guidelines to ensure that artificial intelligence remains an assistive tool rather than replacing human judgement. This study provides useful information by identifying recurring ethical concerns that can inform the development of governance frameworks, guide safe implementation of artificial intelligence in screening and highlight priorities for future research and policy. Despite providing useful information, this study has some limitations due to incomplete research available. Future studies could focus on specific diseases and ethical issues, reassessing ethical considerations as new evidence becomes available.
The 2007 United Nations Declaration on the Rights of Indigenous Peoples affirms Indigenous Peoples' right to maintain, control, protect and develop their knowledge systems, including knowledges of sciences and technologies of medicine and health. It could, however, be argued that this right is typically not upheld in health professions education (HPE), as the broader HPE community perceives dominant colonial ideologies as supreme. Yet, Indigenous Peoples' knowledges promote futurity. They can protect communities and promote healing for everyone from colonising harms. However, engaging with Indigenous Peoples' knowledges in HPE is not straightforward, as a contested cultural interface exists between knowledge systems. This article shares how Arts Informed Indigenous Research (AIIR) can illuminate ways to grow Indigenous knowledges into HPE. We outline the context and problem, describe AIIR's conceptual frame and praxis and share a praxis example. Informed by arts-based research paradigms, AIIR embeds and embodies an Indigenist research agenda. AIIR also incorporates storywork drawing attention to storying complexity. Indigenous Peoples engage AIIR to deeply investigate research questions and solve complex issues often caused by colonisation. Importantly, AIIR is Indigenous Peoples led and engages knowledge holder diversity through sensory and symbolic forms that create reflection. For many research methods, researchers perform data analysis. However, in AIIR knowledge holders make meaning through creativity, searching for ideas and interrelated understanding. Researchers revere created knowledges with honour and show reciprocity by strengthening story impact. Incorporating Indigenous knowledge within HPE is not straightforward, as colonial ideologies continue to dominate the field. However, AIIR can support engagement between divergent western and Indigenous knowledge systems by creating ethical, critically reflective and relational spaces that promote anti-colonial listening. Additionally, AIIR offers methods to generate insights into ways the broader HPE community can relinquish colonial power to make space in HPE for Indigenous Peoples' knowledges of futurity.