Plant functional traits link environmental conditions to plant performance and adaptation. Growing evidence suggests that intraspecific trait variation can be as important as differences between species, yet large intraspecific studies of in-situ variation remain rare. While most studies have focused on plant morphological traits, the concentrations of elemental nutrients in seeds have received much less attention so far. We conducted a large-scale in-situ study of the widespread annual ruderal grass Hordeum murinum. We sampled 2070 individuals from 207 populations across a large part of its native range in Europe and North Africa. We measured seed ripening phenology and growth-related traits in-situ and analyzed concentrations of elemental nutrients in the seeds. We found that Hordeum murinum grew larger, produced seeds later, and had heavier seeds in colder and wetter regions. Plants growing in denser vegetation were taller and produced heavier seeds but formed fewer spikes. Concentrations of elemental nutrients in the seed generally declined with seed weight and were primarily driven by climatic variables, whereas soil conditions had only minor effects on plant traits and seed nutrients. Population identity explained a substantial proportion of trait variation, indicating a possible genetic component. Our findings provide a comprehensive view of how Hordeum murinum responds to environmental gradients across its European distribution. Climatic variables, particularly temperature, are key drivers of reproductive timing and concentrations of elemental nutrients in the seed, whereas local environmental conditions, such as biotic pressures, are more critical for growth-related traits. Together, these patterns indicate that Hordeum murinum modulates its growth and reproductive investment along environmental gradients, balancing phenology, stress tolerance, and limited competitive capacity.
Kidney bean is an important edible legume crop characterized by a short growth period, strong stress resistance, and wide adaptability. Straw return combined with rational nitrogen fertilizer application is a crucial agronomic measure for improving kidney bean yield and economic performance. However, quantitative analyses of their combined effects on the photosynthesis, biomass, yield, and economic benefits of kidney bean remain insufficient. This study investigated the effects of two straw return methods and four nitrogen fertilizer rates (0, 45, 90, and 135 kg ha⁻¹) on chlorophyll content, photosynthetic characteristics, agronomic traits, root length, biomass accumulation, yield, and planting profit in a kidney bean cropping system in Inner Mongolia over two growing seasons. The results showed that straw return combined with nitrogen fertilizer significantly improved growth and photosynthetic indicators, as well as increasing yield and profit. At the same nitrogen application rate, straw return showed superior performance compared with no straw return. The promoting effect increased with nitrogen rate within the tested range (0-135 kg ha⁻¹). Among all treatments, straw return with 135 kg N ha⁻¹ achieved the relatively highest yield of 3130.73 kg ha⁻¹, while straw return with 90 kg N ha⁻¹ produced the greatest economic benefit of 6312.05 yuan ha⁻¹, which was 16.77% higher than the control. Considering overall performance, straw return with 90 kg N ha⁻¹ is favorable for balancing yield and economic returns, whereas straw return with 135 kg N ha⁻¹ is appropriate for pursuing higher yield. These findings provide theoretical and practical references for rational straw return and nitrogen management in kidney bean production.
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are increasingly prescribed to adolescents for obesity and type 2 diabetes mellitus (T2DM), with growing interest in extending their use to conditions such as polyendocrine metabolic ovarian syndrome (PMOS, formerly known as polycystic ovary syndrome or PCOS). However, adolescence represents the critical window for peak bone mass acquisition, and the implications of pharmacologic weight loss during this developmental period have received limited attention. Furthermore, this commentary addresses potential concerns related to eating disorder risk and future reproductive outcomes in this population. This commentary examines the emerging concerns regarding bone health, reproductive safety, eating disorder risk and endocrine development when GLP-1 RAs are used in adolescent populations. Adult studies demonstrate improvements in weight loss, insulin resistance, and menstrual regularity with GLP-1 RA therapy. In adolescents with obesity, clinical trials of liraglutide and semaglutide show significant weight reduction without short-term effects on growth or pubertal development. However, adolescence represents a critical period for peak bone mass acquisition, and rapid pharmacologic weight loss may theoretically impair bone mineral accrual. Evidence from adult populations suggests modest reductions in bone mineral density associated with weight loss, while structured exercise may mitigate these effects. GLP-1 RAs are not recommended during pregnancy, and no data exist on reproductive outcomes following adolescent exposure. Additionally, the potent appetite-suppressing effects of these agents raise concerns about potential misuse or exacerbation of eating disorders in adolescents, a population uniquely vulnerable to body image pressures. GLP-1 RAs represent a promising adjunct therapy for adolescents with obesity, T2DM, and PMOS, but long-term skeletal, reproductive, psychological, and endocrine outcomes remain uncertain. Careful patient selection, bone health monitoring, incorporation of resistance exercise, contraceptive counseling, and screening for disordered eating may be essential when these therapies are considered in adolescent populations.
Lubrication is often applied at interfaces where friction occurs upon relative motion. In boundary lubrication regimes, amphiphilic lubricant additives spontaneously adsorb onto the solid/liquid interfaces, tailoring surface properties and decisively dictating macroscopic lubrication performance. This process is essential for the proper functioning of machinery and for prolonging its service life. The molecular structure of amphiphilic compounds is a key determinant of their interfacial adsorption behavior, which directly influences lubrication quality. Recent advances in characterization techniques, particularly neutron reflection (NR) and small-angle neutron scattering (SANS), have enabled more precise analysis of the nanostructure self-assembled at interfaces from the amphiphilic molecules. These developments have provided new insights into the relationship between molecular structure, interfacial adsorption, and lubrication behavior, stimulating the growing interest in the design of lubrication systems that are novel, efficient, cost-effective, and environmentally friendly. This review summarizes recent experimental progress on the role of amphiphilic molecular structure in interfacial adsorption in both oil-based and water-based lubrication systems and its impact on lubrication. First, we discuss the interactions of amphiphilic molecules with particle surfaces in oil-based systems, including over-based detergent/dispersants, nanoparticles, and emulsion droplets. Next, we review the packing and structure-function relationship of these molecules at solid-liquid interfaces under friction and at gas-liquid interfaces in lubricant foams within oil-based systems. We also describe the behavior of amphiphilic molecules in water-based lubrication systems, including various surfactants and their experimentally revealed lubrication mechanisms. Finally, we outline current challenges and future directions for the development of amphiphilic lubrication additives.
With growing attention to cognitive impairment screening, digital screening tools have become an important approach for early detection and intervention. However, considerable uncertainty remains regarding users' acceptance of such mini programs, particularly among middle-aged and older adults. Based on the Technology Acceptance Model (TAM) and the Theory of Planned Behavior (TPB), this study developed an extended model to investigate the key factors influencing users' intention to adopt a cognitive impairment screening mini program. The extended model incorporated perceived usefulness (PU), perceived ease of use (PEOU), attitude (ATT), trust (TRU), subjective norm (SN), perceived behavioral control (PBC), and perceived privacy risk(PVR), and was empirically tested using structural equation model (SEM). The analysis of 610 valid questionnaires showed that PU was significantly and positively associated with ATT, while PEOU significantly and positively predicted PU. Both TRU and ATT were significantly and positively associated with users' behavioral intention (BI). In addition, SN and PBC had significant indirect effects on BI through ATT and TRU. PVR was significantly and negatively associated with both TRU and ATT, and also had a negative indirect effect on BI. These findings offer practical implications for the design, privacy management, and promotion of digital health tools, particularly the cognitive impairment screening mini programs.
The integration of large language models (LLMs) into orthopedic surgical decision-making represents a growing area of research. This study aimed to compare the surgical recommendation capabilities of ChatGPT-4.0, ChatGPT-4o, and ChatGPT-5 models in simulated cases of hallux valgus deformity. A total of 50 simulated cases were constructed using fundamental clinical data related to hallux valgus pathology and were individually submitted to 3 models. For each case, a surgical recommendation and a brief rationale were obtained. The responses were compared based on content alignment, adequacy of justification, and consistency with established surgical algorithms. Additionally, textual outputs were evaluated using DISCERN and multiple readability indices. All 3 models demonstrated overall algorithmic consistency. However, the ChatGPT-5 model provided the most context-aware and clinically consistent recommendations, followed by ChatGPT-4o and ChatGPT-4.0. Concordance rates with surgical algorithms were 70% for ChatGPT-4.0, 82% for ChatGPT-4o, and 90% for ChatGPT-5. DISCERN scores were 51, 56, and 62, respectively. ChatGPT-5 also achieved superior performance across readability metrics, including Flesch Reading Ease Score, Simple Measure of Gobbledygook, and Gunning-Fog Index, indicating improved textual clarity and reduced complexity. The ChatGPT-5 model demonstrated the highest contextual accuracy, consistency, and readability in surgical decision support for hallux valgus surgery, highlighting the progressive improvements of newer LLMs. Nonetheless, ChatGPT-4.0 and ChatGPT-4o also exhibited compatibility with surgical algorithms, indicating potential utility in generating patient education and informational content.   Cite this article as: Karadamar ÖL, Aydilek A. Evaluation of surgical recommendation algorithms in hallux valgus cases using ChatGPT models: an artificial intelligence approach based on 50 simulated scenarios. Acta Orthop Traumatol Turc. 2026; 60(2), 0580, doi: 10.5152/j.aott.2026.25580.
The global surge in cosmetic procedures has been accompanied by a rise in medical malpractice litigation. Cosmetic services differ fundamentally from therapeutic medicine in their elective nature, heightened patient expectations, and the growing participation of unlicensed providers, each contributing to distinct patterns of adverse outcomes and varying levels of judicial accountability. Therefore, clarifying the distinct risk patterns and legal consequences between medically qualified professionals and unauthorized providers is of critical importance; this research gap has been addressed in the present study. This retrospective cross-sectional study reviewed 525 medical malpractice complaint records registered at the Shahid Ghodosi Judicial Complex in Shiraz, Iran, between 2021 and 2023. Records were screened according to predefined inclusion and exclusion criteria. Data were extracted from judicial case files using a structured checklist including demographic, clinical, forensic, and legal variables. Descriptive statistics and the Fisher-Freeman-Halton Exact Test were performed using SPSS version 25. Of the 525 medical malpractice records reviewed, 253 (48.1%) met the eligibility criteria and were included in the final analysis. Statistically significant differences were observed between licensed and unlicensed providers across clinical outcomes, service settings, and judicial penalties (p < 0.001). Licensed providers were involved in 74.3% of cases and were primarily associated with technical complications in surgical procedures, particularly rhinoplasty (27.1%), leading mainly to structural deformities (86.4%) and dissatisfaction with aesthetic outcomes. In these cases, "Diyah" (financial compensation) alone was the predominant judicial outcome (96.8%). In contrast, unlicensed providers (25.7%) were significantly associated with minimally invasive procedures such as fillers and Botox (40.0%), frequently performed in informal settings including private homes (53.8%). These interventions were mainly linked to infections and tissue necrosis (62.2%) and resulted in significantly harsher judicial penalties, including imprisonment (52.3%) (p < 0.001). Licensed and unlicensed providers exhibited distinct malpractice patterns and judicial outcomes. Licensed providers were primarily associated with technical complications resulting in Diyah penalties, whereas unlicensed providers were linked to severe adverse events in informal settings and harsher sanctions, including imprisonment. These findings highlight the need for targeted regulatory and patient-safety interventions. Not applicable.
There is growing awareness into the challenges experienced by LGBT+ older adults when accessing aged care in Australia. However, the perspectives of Australian LGBT+ older adults accessing aged care have not been well documented. This study answered the question: What are the views and perspectives of LGBT+ older adults about their experiences of using aged care in Australia? This qualitative study utilised an interpretive descriptive methodology. Between December 2024 to March 2025, semi-structured interviews were conducted with LGBT+ older adults accessing aged care either in a community or residential setting. Interview data were analysed using reflexive thematic analysis. 19 LGBT+ older adults were interviewed. Findings are presented in 4 themes that explore participants perceptions of the impact of their LGBT+ identity on their interactions with aged care (theme 1). Participants described their ideals of aged care (theme 2), the processes of getting started in aged care (theme 3), and their experiences when engaging with the care system (theme 4). Whilst there are shared experiences in aged care between LGBT+ older adults and the general population, the impact of minority stress is highly evident in the liminal phases between being assessed for, seeking and making decisions about receiving care.
Extracellular vesicles (EVs) are membrane-enclosed structures secreted by virtually all living cells, serving as essential mediators of intercellular communication in both physiological and pathological processes. There is growing interest in their potential applications as biomarkers, therapeutic targets, and drug delivery systems, which entails the need for a detailed understanding of their molecular composition. The functional cargo of EVs includes all types of biological macromolecules, among which proteins are of particular importance. As the vesicular proteome becomes increasingly mapped, research attention is gradually shifting toward post-translational modifications (PTMs), which fundamentally influence protein function and play key roles in all aspects of vesicular activity, including biogenesis, cargo sorting, recognition, and uptake. In this review, we outline recent advances in the application of mass spectrometry (MS)-based analysis of PTMs in EVs. In this context, we provide an overview of the roles of various PTMs in EV biology, discuss the impact of EV isolation methods on downstream PTM analyses, and address current challenges and approaches related to MS-based investigations. We further highlight key findings concerning specific PTMs, including glycosylation, phosphorylation, acetylation, methylation, lipidation, and small ubiquitin-like modifier (SUMOylation). Finally, we discuss studies focusing on the simultaneous analysis of multiple PTMs, as well as efforts toward multiomic data integration and single-EV characterization to resolve vesicular heterogeneity, highlighting these approaches as cutting-edge directions in the field.
Neurodegenerative disorders constitute a growing global health concern, with oxidative stress, cholinergic dysfunction, and compromised neuroplasticity identified as key pathological contributors. Zingerone, a bioactive phenolic compound from ginger (Zingiber officinale), possesses antioxidant and anti-inflammatory properties, but its neuroprotective capacity against combined aluminum chloride (AlCl₃) and D-galactose (D-Gal)-induced hippocampal neurotoxicity remains poorly characterized. This study evaluated the neuroprotective effects of zingerone (100 mg/kg) on spatial memory, brain antioxidant enzyme activities, acetylcholinesterase (AChE) activity, ATP hydrolysis and nitric oxide levels, together with hippocampal neuronal integrity, astrocytic reactivity, and brain-derived neurotrophic factor (BDNF) expression, in mice co-exposed to AlCl₃ and D-Gal, with donepezil (10 mg/kg) as the standard reference drug. Twenty male Swiss mice were randomly assigned to four groups (n = 5): Control, AlCl₃/D-Gal, AlCl₃/D-Gal + Zingerone, and AlCl₃/D-Gal + Donepezil. AlCl₃/D-Gal co-exposure significantly impaired Y-maze and Morris water maze performance, depleted catalase and superoxide dismutase activities, elevated AChE activity, ATP hydrolysis, and nitric oxide levels, reduced Nissl substance staining, increased glial fibrillary acidic protein (GFAP) immunoreactivity, and suppressed BDNF expression. Zingerone significantly reversed these deficits, producing significantly greater restoration of superoxide dismutase activity than donepezil (p < 0.01) and numerically greater catalase and BDNF responses, whereas donepezil produced greater AChE inhibition and a greater reduction in nitric oxide. These contrasting profiles indicate complementary mechanisms rather than therapeutic superiority of either agent, and provide a rationale for evaluating a zingerone-donepezil combination in future studies. These findings position zingerone as a promising multi-target neuroprotective agent.
Antimicrobial resistance (AMR) is a rapidly growing global public health problem. There is growing evidence that the emergence and dissemination of AMR genes and antimicrobial-resistant bacteria are linked to antibiotic use in animals raised primarily for food. The use of antibiotics in livestock and poultry farming in India has led to the emergence of multidrug-resistant organisms (MDROs) and their impact on human health. Resistant bacteria can be transmitted via the food chain, direct contact with animals and the environment. Recent surveillance studies in India have shown that AMR exists in humans and in animal production systems as well as in the environment, making it evident that AMR are interdependent in human, animal and environmental production systems. Governmental efforts such as the National Action Plan (NAP) on AMR and the ban on colistin use in livestock for food production are important measures, but there is still work to be done. While these are positive measures, there are still gaps in monitoring, antimicrobial stewardship and knowledge among stakeholders. This brief communication highlights the public health issues posed by livestock-associated AMR in India and the need for robust One Health surveillance, judicious antibiotic use, and coordinated government initiatives to prevent the emergence of resistance.
Periprosthetic fractures following total hip arthroplasty and total knee arthroplasty are complications associated with substantial morbidity and mortality. As the volume of primary arthroplasty continues to increase in the United States, the incidence and overall burden of periprosthetic fractures are expected to rise accordingly. However, contemporary trends and future projections in emergency department (ED) visits and operative management for these injuries remain incompletely characterized. There were three national databases that were queried to identify the national volume of ED visits for periprosthetic hip and knee fractures between 2017 and 2022, as well as to capture inpatient and outpatient surgical management for these fractures during the same period, including fixation, arthroplasty, or combination procedures. Patients who presented with periprosthetic joint infections were excluded. National surgical volumes were calculated, and future projections through 2035 were modeled using linear and Poisson regression. Between 2017 and 2022, 224,456 patients presented to the ED with periprosthetic hip and knee fractures, of whom 155,335 underwent surgical treatment. Based on regression modeling, annual ED visits are projected to increase substantially by 2035, reaching 43,324 to 53,128 visits for periprosthetic hip fractures and 40,952 to 108,301 visits for periprosthetic knee fractures. Surgical volume is similarly expected to rise, with 22,750 to 29,017 procedures for periprosthetic hip fractures and 23,743 to 31,400 procedures for periprosthetic knee fractures annually. The mean hospital costs are projected to increase to $50,919 to $81,194 per case, with charges exceeding $300,000 for complex surgical procedures. Periprosthetic hip and knee fractures constitute a rapidly growing source of healthcare utilization in the United States. The increasing volume, high acuity, and projected growth of these injuries highlight the need for targeted prevention strategies, system-level resource planning, and optimization of multidisciplinary care pathways to mitigate their expanding clinical and economic impact.
Hematopoietic stem cell transplantation (HSCT) offers curative potential for hematologic malignancies and immune disorders, yet pulmonary complications remain major contributors to non-relapse morbidity and mortality. Traditionally attributed to immune suppression and graft-versus-host disease (GvHD), these complications are increasingly recognized to involve disruption of pulmonary microbial communities. A growing body of clinical and experimental evidence indicates that HSCT-associated perturbations in the lung microbiome, driven by conditioning, antimicrobials, immune injury, and infection, are associated with distinct post-transplant pulmonary phenotypes and, in some cohorts, with mortality risk. Whether these microbial shifts represent causal contributors to lung injury or contextual biomarkers of immune vulnerability remains unresolved, and this distinction carries direct implications for microbiome-targeted intervention. Dysbiotic shifts in the lung have been associated with both infectious and non-infectious complications, including idiopathic pneumonia syndrome, bronchiolitis obliterans syndrome, and fibrotic lung disease. Gut-lung microbial crosstalk may amplify or reflect systemic immune dysfunction, though the directionality of this relationship remains incompletely characterized. Multi-omics approaches, integrating metagenomics, metatranscriptomics, and metabolomics, are beginning to define the host-microbiome interaction signatures that distinguish injury subtypes and predict outcomes. This review synthesizes mechanistic insights into lung microbiome-immune interactions after HSCT, critically appraises the methodological constraints on the current evidence base, and evaluates microbiome-based interventions, including fecal microbiota transplantation, inhaled postbiotics, and precision antimicrobials, as candidate strategies for respiratory protection in transplant recipients, while acknowledging that prospective interventional evidence in this population remains limited.
Baduanjin, a traditional Chinese mind-body exercise, is widely practiced to improve overall health in both elderly individuals and a growing number of young enthusiasts. Appropriate thermoregulation has been proposed as a potential physiological mechanism underlying the multiple health benefits of Baduanjin. Infrared thermography is a noninvasive functional imaging technique that provides a visual and noninvasive means of reflecting local metabolic activity and blood perfusion. However, comprehensive evidence regarding the effect of Baduanjin training on human body temperature, an objective and visual metric, remains limited. Therefore, this meta-analysis systematically evaluated the effects of Baduanjin exercise on human temperature, as quantified by infrared thermal imaging. A comprehensive search was performed in 5 databases, including PubMed, Web of Science, China National Knowledge Infrastructure, Wanfang Database, and VIP Information Chinese Journal Service Platform, using PICO-based search terms until October 2025. Primary outcomes were mean skin temperature at trunk acupoints, mean skin temperature over visceral projection areas, and mean skin temperature of the trunk and limbs. Study quality was assessed using the modified Jadad scale, and meta-analysis was conducted with RevMan 5.4. A total of 8 randomized controlled trials were included, published between 2017 and 2024. These articles involved a total of 377 participants from mainland China, including 194 in the Baduanjin group and 183 in the control group, with mean ages ranging from 19.8 to 32.2 years across studies. Compared with the control groups (routine lifestyle or traditional calisthenics exercise), Baduanjin training significantly increased the average skin temperature at trunk acupoints (mean difference [MD] = 0.74°C, 95% confidence interval [CI] [0.32, 1.16], P < .01, I2 = 74%), improved the mean skin temperature over the visceral projection areas (MD = 1.01°C, 95% CI [0.62, 1.41], P < .001, I2 = 0%), and improved skin temperature of the trunk and limbs (MD = 0.44°C, 95% CI [0.29, 0.59], P < .0001, I2 = 68%). This meta-analysis found that Baduanjin training may have a beneficial effect on improving body temperature measured by infrared thermography. However, these findings should be interpreted with caution due to the limited number of included studies and nearly exclusive research in mainland China. Further large-scale, high-quality randomized controlled trials are essential to verify these preliminary observations.
Type 1 diabetes (T1DM) is an autoimmune disorder marked by a characteristic dysfunction of insulin-secreting beta-cells in the pancreatic islets. This destructive process is not a single event but a chronic inflammatory cascade, propelled by immune cells-including T-lymphocytes and macrophages-that release potent pro-inflammatory cytokines. This review delves into the growing body of evidence implicating specific inflammation-promoting mediators-including Interleukin-1β (IL-1β), Tumor Necrosis Factor-α (TNF-α) and Interferon-γ (IFN-γ) -as master regulators of beta-cell death. We also explore how modern analytical techniques enable precise mapping of cytokine patterns in the blood, revealing a dynamic and ongoing disease process long that precedes clinical symptoms onset. By weaving together findings from clinical and preclinical studies, this article argues that profiling these inflammatory signals provides a crucial real-time, functional readout of autoimmune activity that complements traditional, static autoantibody measurements. We conclude by discussing the significant potential of integrating cytokine data into existing models to create more robust risk stratification tools and to pave the way for interventions that could intercept the disease pathway before critical beta-cell mass is lost.
The proposal to involve patients and the public (Patient and Public Involvement; PPI) in research is increasingly recognised as important in research concerning speech, language, and hearing and communication difficulties. Whilst there is extensive guidance about PPI involvement by national agencies such as the National Institute of Health Research in the UK, little information is currently available concerning whether these expectations are met in any area of healthcare provision. This systematic review aimed to identify, describe and evaluate how PPI has been implemented and reported in research concerning childhood speech, language, hearing and communication difficulties. Six electronic databases were systematically searched for eligible studies reporting PPI in these fields. Records were screened against predefined eligibility criteria. Data were extracted on study characteristics, PPI contributors, stages and methods of involvement, reported impacts, and quality of PPI reporting. The methodological and PPI quality were assessed using MMAT and GRIPP2 Short Form, and findings were synthesised narratively. Twenty-one studies were included. PPI was reported variously across speech, language, hearing and communication topics, the implementations varied considerably. Parents, carers and professionals were more commonly involved than children and young people themselves. Most studies used consultation-based approaches, often during early stages (e.g., study design or material development), while fewer reported involvement in later stages (e.g., dissemination, implementation or evaluation). Reporting was inconsistent, particularly regarding contributor characteristics, accessibility adaptations, decision-making influence, and the impact of PPI. The systematic review showed that PPI in childhood speech, language, and hearing difficulties has advanced significantly, with the growing interest and number of publications, particularly in the past five years. The review also highlighted challenges such as confusion and heterogeneity of PPI concepts, representativeness issues, tokenistic practices, lack of support given to lay contributors, and limited impact evaluation. Future research should distinguish PPI from research participation, involve children and young people more directly where appropriate, report contributors' roles and influence more transparently, and consider accessibility and communication support throughout the involvement process. What is already known on the subject Health service providers and research funders now require attention to Patients and Public Involvement (PPI) in healthcare research. PPI highlights the need to work jointly with stakeholders at all steps involved in research to allow them to take governance over their health conditions. Whilst emphasis on PPI applies to health issues in general, there is no specific review of PPI considerations in research on health factors that affect hearing and communication difficulties. This omission is particularly noteworthy when considering issues that arise in early development. What this study adds to existing knowledge A systematic review was conducted to assess current progress with respect to PPI for hearing and communication research in childhood and adolescence. The review identified research involving PPI that met quality requirements. Challenges related to PPI were highlighted in further analyses that revealed confusion and heterogeneity in PPI concepts, representativeness issues, tokenistic practices, a lack of support given to lay contributors, and a limited evaluation of the impacts of PPI. What are the clinical implications of this work? PPI involvement in clinical research for communication and hearing difficulties should have a positive impact on the well-being of children and adolescents. Four challenges were highlighted when considering the current state of research on PPI in this domain: shallow involvement of the public and patients, conflicting expectations between groups participating in research, lack of clarity of research outcomes as they relate to PPI and variable standards of reporting PPI findings across studies. Tentative recommendations concerning how each of these matters could be addressed are offered.
Rare disorders contribute significant collective health system costs; individuals living with rare disorders frequently encounter diagnostic, treatment, and management barriers. Despite international recognition of these challenges, there remains limited research addressing systemic health service delivery and access barriers for those with rare disorders, or identification of how such research impacts policymaking. Dimensions, PubMed, Scopus, ProQuest, CINAHL, and Ovid platform databases were employed in a search of qualitative research documenting the health service experiences of people living with rare disorders and their primary support networks. A total of 4,615 studies were screened by title, keywords, and abstract. Seventy-eight studies met the inclusion criteria after full text screening, these were then reviewed. Policy impact in the form of citations was determined by whether an Overton search identified a link between the reviewed studies and policy documents. Two primary findings were identified. (1) Health service access and delivery barriers are pervasive. People living with rare disorders and their support networks manage emotional, financial, and social challenges. There is an urgent need for improved service delivery, including better access, education, psychological, and peer support. (2) Reviewed studies, covering only a small subset of the over 10,000 identified rare disorders, are published by specialised rare disorders journals often failed to adopt inclusive methods, and have negligible policy reach. Despite growing awareness, health systems fall short of addressing structural barriers faced by people living with rare disorders. The findings support consideration of a global coordinated action plan for rare disorder management. For researchers, this could include adoption of inclusive research methods. For policymakers, there is a need for stronger inclusion of equity-priority populations and coordinated policy frameworks that recognise the collective impact of disparate and poorly managed care. Critical to supporting change is investment in the upskilling of the health workforce and clinicians' active engagement in diagnosis, coordination, long-term management, and treatment.
Human skin, the body's largest organ, hosts a diverse ecosystem of bacteria, fungi, viruses, and mites collectively known as the skin microbiome. This microbiome supports cutaneous homeostasis through barrier defense, immune education, and metabolic functions. To narratively review the historical evolution of skin microbiome research, synthesize current knowledge on its composition, biogeography, and functional roles in health and disease, and highlight emerging microbiome-based therapeutic strategies in dermatology. This review integrates seminal historical works with contemporary evidence from culture-independent sequencing and multi-omic investigations of the skin microbiome, identified through a selective search of recent dermatology and microbiome literature. Modern molecular and multi-omic approaches have revealed microbial diversity across sebaceous, moist, and dry skin niches and clarified key functions of the skin microbiome, including colonization resistance, immune modulation, metabolite production, and participation in the gut-skin axis. Dysbiosis of these communities is linked to inflammatory conditions such as atopic dermatitis, acne vulgaris, psoriasis, and chronic wounds. A growing body of work supports microbiome-targeted interventions, including probiotics, prebiotics, postbiotics, and microbiome engineering, as promising personalized strategies. As a narrative review, this work may be subject to selection bias and does not provide a quantitative synthesis of all available studies on the skin microbiome. By integrating historical context with mechanistic insights from modern microbiome research, this review underscores the skin microbiome as a central ecological determinant of cutaneous health and disease and provides a framework for translating microbiome science into clinical applications and precision dermatology.
Originally characterized for its roles in T-cell activation and adhesion, CD43 is a prominent mucin-like sialoglycoprotein expressed on hematopoietic cells. CD43 is broadly expressed across leukocyte populations, with its levels, molecular configuration, and ligand interactions varying by cell type, activation state, and differentiation. Growing evidence indicates that CD43 functions as a context-dependent regulator, integrating microenvironmental cues and dynamic glycosylation states with the biophysical organization of the cell surface and intracellular signaling. CD43 simultaneously participates in immune activation, regulation, and dysfunction, depending on the cellular and environmental context. CD43 is associated with distinct, sometimes contrasting, functional outcomes across diverse physiological and pathological settings. For instance, it has been linked to altered leukocyte trafficking and activation, while in infectious diseases, it influences host-pathogen interactions and the balance between protective immunity and immunopathology. Furthermore, in cancer, changes in CD43 signaling, glycosylation, and ligand engagement modulate immune recognition, effector responses, and inflammatory processes, contributing to immune evasion. Here, we review current knowledge on the regulation of CD43 expression, its structural organization, and ligand interactions. We discuss the potential role of CD43 across different disease settings, proposing it as a dynamic, adaptable regulator of immune responses and a potential therapeutic target in immune-mediated diseases.
Patient safety has undergone significant evolution over the past two decades, driven by a shift towards systemsbased approaches, the adoption of technological solutions, and a growing global commitment to improving healthcare outcomes. Early milestones (2000- 2010) saw the establishment of key safety protocols, including the "To Err is Human" report and the World Health Organisation's global initiatives. The following decade (2011-2020) marked the widespread integration of electronic health records and simulation-based training. The coronavirus disease-2019 pandemic presented unique challenges, including healthcare resource shortages and increased errors, but also accelerated innovations, such as telehealth and clinical decision-support tools. More recently, artificial intelligence has emerged as a powerful tool for enhancing patient safety, offering predictive capabilities and personalised care. However, barriers such as organisational resistance, resource constraints and inconsistent data-collection remain. Looking ahead, fostering a culture of safety, collaboration and continuous innovation is essential to address systemic gaps, and to ensure safer healthcare practices globally.