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Genetic predisposition is a risk factor for office hypertension. We sought to determine whether genetic predisposition identifies individuals with ambulatory daytime hypertension. 1444 participants from the GAPP study (ages 25-41) were analyzed. We evaluated two measures of predisposition to hypertension: family history and polygenic risk scores (PRS). We evaluated correlation of predisposition with blood pressure traits and compared incremental value of each predisposition measure to a validated ambulatory BP prediction model. 12% of participants had office hypertension, while 37% had out-of-office hypertension. The correlation between PRS and family history of hypertension was low (R2 = 4.96x10-3), but both were strongly associated with ambulatory blood pressure (2.2 mmHg per 1 SD increase [95% CI: 1.6, 2.7] & 2.4 mmHg increase with positive family history [95% CI: 1.3, 3.4], respectively). PRS provides incremental improvement predicting ambulatory systolic blood pressure beyond a validated blood pressure prediction score (ΔAIC = -33), whereas family history does not (ΔAIC = 1). The difference between a baseline prediction algorithm for identifying ambulatory systolic hypertension (positive likelihood ratio of 6.87 [95% CI: 5.56, 8.49]; negative likelihood ratio of 0.45 [95% CI: 0.39, 0.51]) and the same model with PRS integrated (positive likelihood ratio of 7.69 [95% CI: 6.18, 9.57]; negative likelihood ratio of 0.43 [95% CI: 0.37, 0.49]) was modest. In a white European sample from Liechtenstein, PRS provides incremental information in identification of individuals with ambulatory hypertension, unlike family history. However, these gains are modest and warrant further development to improve predictive utility at the point-of-care.

Alcohol-induced blackouts (AIBs) are a common and serious consequence of drinking often associated with increased alcohol-related harms. Understanding factors that place individuals at increased odds of experiencing an AIB is critical to inform interventions aimed at reducing alcohol-related harms. The present study seeks to examine a theory-informed model of biopsychosocial factors that may increase a person's risk for experiencing AIBs over and above drinking. Young adults (n = 175, 52.6% female, 86.9% White, Mage = 20.8) with recent history of heavy drinking and AIBs wore transdermal alcohol concentration sensors and completed twice-daily surveys about previous-day alcohol use and AIBs over six weekends. Multilevel structural equation models were conducted to test for direct and indirect effects (through transdermal alcohol concentration) of social norms (descriptive and injunctive AIB norms, separately), psychological factors (impulsivity and sensation seeking), and family history of alcohol problems on AIB risk. One in three drinking days (n = 535, 33.8%) resulted in an AIB. Descriptive AIB norms (OR = 1.42, 95% CrI [1.06, 1.97]) and family history (OR = 1.41, 95% CrI [1.04, 1.92]) were uniquely associated with increased odds of experiencing AIBs. Psychological influences were not significantly associated with AIBs. No indirect effects were observed. In a theory-informed examination of biopsychosocial factors, higher descriptive norms and family history increased the odds of experiencing AIBs. Our findings highlight the potential value of future research examining interventions targeting misperceptions of peer AIB frequency. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

The short PR interval without preexcitation (Lown-Ganong-Levine-phenocopy) is often considered benign, but its association with malignant substrates is underappreciated. A 45-year-old man with no previous cardiac history presented with palpitations, dyspnea, and diaphoresis. Electrocardiogram (ECG) during symptoms showed supraventricular tachycardia at ∼220 beats/min with a Hisian extrasystole and QRS variability. Postconversion ECG revealed short PR and dual atrioventricular nodal physiology. Echocardiography showed subtle nonterritorial hypokinesia. Family history included sudden cardiac death in 3 siblings. This case demonstrates that Lown-Ganong-Levine-phenocopy with dual atrioventricular nodal physiology and Hisian extrasystoles can be a red flag for a lethal inherited arrhythmogenic substrate requiring comprehensive evaluation including cardiac magnetic resonance, genetic testing, and family screening. A short PR pattern with a malignant family history warrants comprehensive evaluation. Surface ECG red flags should not be ignored even when the resting ECG appears benign.

While genetic testing (GT) has become more available over the past decade, it is unclear whether public awareness and use have increased proportionally. We aimed to evaluate national trends in GT awareness and usage. We performed a cross-sectional analysis of nationally representative data from the National Cancer Institute's Health Information National Trends Survey (HINTS). We analyzed survey responses from HINTS 4 Cycle 1-4 (2011-2014), 5 Cycle 1 and 4 (2017, 2020), and 6 (2022). Primary outcomes were overall genetic testing awareness and uptake. Secondary analyses evaluated awareness and uptake of health-related genetic testing (e.g. disease risk, cancer, and carrier testing) among survey cycles in which specific testing modalities were available. Linear regression assessed crude trends and multivariable logistic regression estimated odds ratios (OR). Among 22,256 respondents, overall awareness of GT increased from 36.6% in 2011 to 81.7% in 2022 (trend p&#x2009;<&#x2009;.001). Awareness was lower among individuals who were older (e.g., ref: age 18-34, age 75+: OR 0.53, 95% confidence interval [CI]: 0.43-0.64), male (ref: female, OR 0.85, CI: 0.77-0.95), non-Hispanic Black (ref: non-Hispanic White, OR 0.63, CI: 0.54-0.74), non-Hispanic Asian (ref: non-Hispanic White, OR 0.38, CI: 0.29-0.48), Hispanic (ref: non-Hispanic White, OR 0.60, CI: 0.52-0.69), with less than a college education (e.g., ref: some college, less than high school: OR 0.60, CI: 0.47-0.77), and with annual household income <$75,000 (e.g., ref: >$75,000, <$20,000: OR 0.49, CI: 0.42-0.59). GT uptake increased from 21.4% in 2020 to 35.6% in 2022 (trend p&#x2009;<&#x2009;.001). GT uptake was lower among individuals who were non-Hispanic Asian (ref: non-Hispanic White, OR 0.60, CI: 0.38-0.96) and had household incomes <$35,000 (e.g., ref: >$75,000, <$20,000: OR 0.68, CI: 0.49-0.94), but higher among those with a personal history of cancer (ref: no cancer history, OR 1.44, CI: 1.07-1.92). Although GT awareness has grown, there are notable gaps across sociodemographic groups. Further study should better characterize factors influencing health-related GT uptake patterns.

Like many of Earth's subtropical open ecosystems, the African savanna originated in the Miocene Epoch (23.0 to 5.3 Ma), one of the best historical analogs for future climate states. The first C4 grass, C3 tree, and shrub savanna developed in the subtropics after ~10 Ma in northwest Africa, but the terrestrial sedimentary record of the region is not well preserved, making it difficult to determine when, how, and why the African landscape opened. Here, we leverage plant-wax biomarkers extracted from the marine sedimentary archive to document the origination and history of open ecosystems through Miocene northwest Africa. We show that a C3 grass-rich savanna with no modern analog replaced closed woodlands and forests during the middle Miocene (~15 to 14 Ma), a period of global cooling and aridification. This nonanalog ecosystem transitioned into the C4 savanna in stages in the late Miocene (most rapidly between 7.4 to 6.4 Ma) as global temperatures cooled and aridity increased, roughly coincident with several C4 expansions in other subtropical regions. Our new vegetation history, put in the context of other records, links initial ecosystem opening and C4 expansion to periods of global cooling and drying. It is consistent with a nonlinear system of feedbacks between climate, consumers (herbivory and fire), and plant-trait interactions that allows small changes in one parameter to have dramatic effects on regional vegetation structure and composition. The geologic record indicates that the response of subtropical open ecosystems to future climate perturbations will depend on the nature and strength of these feedbacks.

Falls among older adults are now the leading cause of traumatic brain injury worldwide. We aimed to identify historical and clinical characteristics including the visible head impact location indicative of significant acute traumatic intracranial hemorrhage in older patients presenting to emergency department with mild traumatic brain injury subsequent to a ground-level fall. We conducted a multicentre prospective cohort study across five university-affiliated emergency departments over a 2-year period (1 July 2023 to 30 June 2025) in Europe. We included patients aged 65 years or older who presented with mild traumatic brain injury (defined as head trauma with a Glasgow Coma Scale score of 13-15 upon emergency department presentation) following a ground-level fall and who underwent a computed tomography scan. The primary outcome was significant acute traumatic intracranial hemorrhage, defined as a neuroimaging radiological interpretation system (NIRIS) score&#x2009;>&#x2009;1. Predictors were identified using logistic regression and recursive partitioning. A predictor was included in the decision rule if its association with the primary outcome and its interobserver reliability were strong. Using logistic regression, associations between independent variables and the outcome were adjusted for age, antithrombotic medication, and precipitating factors for the fall. Internal validation was performed using bootstrapping. The study included 1,620 patients (mean age, 84.6&#x2009;&#xb1;&#x2009;8.5 years). A significant acute traumatic intracranial hemorrhage was identified in 72 patients (4.4%, 95% CI [3,6]) of which five (0.3%, 95 CI% [0,1]) required urgent neurosurgical intervention. Eight criteria were identified as strong and reliable predictors: visible forehead-scalp impact, Glasgow Coma Scale score below baseline, focal neurological deficit, sign of basal skull fracture, acute confusion, vomiting, loss of consciousness, and headache. We then derived two clinical decision rules (PIWI 1 and PIWI 2), which both showed 100% sensitivity (95% CI [95,100]) with specificities ranging from 25.3% (95% CI [23,28]) to 43.6% (95% CI [41,46]). Application of either clinical decision rule would have allowed reductions (41.7% or 24.2%) of the numbers of patients sent to the CT scan unit. Internal validation confirmed the strong performance of both rules, based on C-statistics of 0.84 (95% CI [0.8,0.9]) and 0.79 (95% CI [0.7,0.9]). Because we only included patients who underwent a head CT scan during their emergency department stay, the potential for selection bias must be considered. Additionally, a risk of misclassification bias exists because we did not perform a centralized independent review of the CT scans. Our findings revealed that factors drawn from patient history and physical examination were associated with significant acute traumatic intracranial hemorrhage in older adults after a ground-level fall. Incorporating these factors into decision rules could provide a reliable strategy to stratify risk and reduce unnecessary CT scan. We hypothesize that the PIWI 1 rule could be used in patients with a clear history of the fall, while the PIWI 2 rule could be applied in other cases. Such rules need to be validated externally and independently for their implementation in clinical practice, but may already be of aid for identifying high-risk patients.

To determine whether objective biometry can guide intraocular lens formula selection in post-laser vision correction (LVC) eyes with indeterminate classification of actual LVC type (total keratometry [TK] TKave - keratometry [K] Kave = 0.00 to 0.06), and to compare refractive accuracy among contemporary LVC formula strategies. A total of 507 post-LVC eyes (inclusive of both myopic [M-LVC] and hyperopic [H-LVC] eyes) with TKave - Kave between 0.00 and 0.06 measured by swept-source optical coherence tomography biometry (IOLMaster 700; Carl Zeiss Meditec AG) were analyzed. Refractive prediction errors were calculated for 22 formulas, including eight H-LVC, eight M-LVC, and six non-LVC formulas. Formula performance was assessed using root mean square error rankings and heteroscedasticity testing for dependent data. The main outcome measure was refractive prediction error and proportion of eyes within &#xb1;0.50 diopters (D) of target refraction. H-LVC formulas demonstrated superior refractive accuracy across all eyes, regardless of reported LVC type. Pearl DGS and Barrett True K No-History (H-LVC) achieved the highest proportion of eyes (approximately two-thirds) within &#xb1;0.50 D of target. K-based H-LVC formulas outperformed variants incorporating posterior K or TK. Standard formulas showed intermediate performance, whereas M-LVC formulas ranked lowest. Differences between top-performing formulas were statistically significant. In post-LVC eyes with TKave - Kave between 0.00 and 0.06, H-LVC formulas provide the most accurate refractive outcomes, independent of reported treatment type. These findings challenge reliance on historical LVC classification for formula selection and support a measurement-driven approach in which biometry-guided formula selection improves outcomes when history is unreliable in ambiguous post-LVC eyes.

Regular physical activity (PA) improves clinical outcomes and quality of life after solid organ transplantation, yet many recipients remain inactive during early recovery. Health literacy (HL) may influence posttransplant health behaviors. In this prospective observational study, consecutive adult kidney, liver, and lung transplant recipients at the Centre hospitalier de l'Universit&#xe9; de Montr&#xe9;al (CHUM) between March 1 and December 1, 2023 were assessed approximately two months after discharge. Functional HL was measured using the Short Test of Functional Health Literacy in Adults (S-TOFHLA). Weekly moderate to vigorous PA was assessed using face-to-face interview during outpatient visits and categorized according to World Health Organization recommendations (<150&#xa0;vs. &#x2265;150 min/week). Multivariable logistic regression evaluated the association between HL and PA, adjusting for age, sex, body mass index, history of depression and/or current antidepressant treatment, education level, and transplant type. Eighty-five recipients were included; Thirty-two patients were not eligible for inclusion (language barrier, re-transplantation, refusal, or death). Thirty-nine participants (45.8%) met recommended PA levels. Higher HL was independently associated with achieving PA recommendations (OR per 1-point increase: 1.09; 95% CI 1.02-1.17; p = 0.01). PA engagement was not associated with age, sex, education level, history of depression and/or current antidepressant treatment, or transplant type. Nearly half of recipients achieved guideline-recommended PA approximately two months after transplantation, indicating that meaningful activity is feasible during early recovery. Higher functional HL was independently associated with PA engagement, supporting the integration of literacy-sensitive approaches into posttransplant rehabilitation.

This paper explores identifying, "coming out" and "coming in" as Two Spirit, lesbian, gay, bisexual, trans, and/or queer (2SLGBTQ+) during the AIDS crisis in Canada (1981-1997). We conducted 30 oral history interviews about this unique historical moment between 2022 and 2025 with participants from eight Canadian provinces. Informed by queer oral history, we approached community as multiple, and at times, contradictory. We sought interviews from racialized and rural participants, and women, to help further diversify existing archival materials. Our analysis highlights the ways interviewees described coming out and visibility not only as an ongoing, relational, and a strategically managed process, but as a form of solidarity, care, and responsibility to others during the AIDS crisis. This sense of responsbility to others, and to create more inclusive spaces and services, was pronounced for interviewees who experienced racism in LGBT spaces and Canadian society at large. Two Spirit participants described complex processes of returning to community shaped by colonial violence as well as the cultural ethic of noninterference. We found that for HIV+ interviewees, sharing they were seropositive with others was a more difficult process of disclosure, with higher stakes. Across the narratives, realizations about sexual and gender difference were closely tied to gender nonconformity. Overall, the findings underscore how community was forged through the urgent need for solidarity in the context of the AIDS crisis.

Despite the history of religious-based persecution faced by the queer community, spirituality continues to be a source of resilience for many lesbian, gay, and bisexual (LGB+) individuals. However, there is limited research empirically examining the psychological pathways through which spirituality can support LGB+ well-being. The present study aimed to examine whether self-compassion and psychological flexibility mediate the relationship between spirituality and positive LGB+ identity, defined as low internalized heterosexism and high authenticity, in a sample of LGB+ adults. Participants (n&#x2009;=&#x2009;577) completed an online survey with self-report measures on spirituality, self-compassion, psychological flexibility, internalized heterosexism, and LGB+ authenticity. Results from a structural equation modeling analysis indicated that, as hypothesized, spirituality indirectly predicted positive LGB+ identity. More specifically, spirituality predicted greater self-compassion, which predicted greater psychological flexibility and subsequently lower internalized heterosexism, which in turn predicted greater LGB+ authenticity. These findings have important implications for interventions designed to support the well-being and identity development of LGB+ individuals. Self-compassion and psychological flexibility may be targeted in therapy to facilitate identity integration among spiritual LGB+ clients.

Mycobacterium avium subspecies paratuberculosis (MAP) is the etiologic agent of paratuberculosis (Johne's disease), a chronic granulomatous enteritis. A cross-sectional survey was conducted between 2022 and 2023 to determine the seroprevalence of MAP and identify associated risk factors in dromedary camels sampled in southern Punjab, Pakistan. Sera were tested using a commercial indirect ELISA (ID Screen&#xae; Paratuberculosis Indirect Screening Test, ID VET, Montpellier, France). The overall seroprevalence was 3.31% (20/604), and the Rogan-Gladen estimator yielded a true prevalence of 4.13%. The highest tehsil-level prevalence was recorded in Bahawalpur (6.3%), followed by Yazman (3.4%) and Liaqat Pur (1.96%). Multivariate logistic regression identified diarrhea (OR&#x2009;=&#x2009;8.39, 95% CI: 2.46-28.59%, p&#x2009;=&#x2009;0.001) and a history of abortion (OR&#x2009;=&#x2009;6.75, 95% CI: 1.70-26.81, p&#x2009;=&#x2009;0.007) as significant predictors of MAP seropositivity; sex, age, breed, body condition score (BCS), and contact with other ruminants remained non-significant. These findings provide sero-epidemiological evidence of MAP in camels in Southern Pakistan and highlight the need to strengthen the surveillance, coupled with molecular diagnostics, for early detection and control.

To examine variability in baseline concussion symptom burden and symptom reporting among UK university student athletes (SA) with preexisting neurodevelopmental, psychological, or mental health (NP/MH) conditions, with/without concussion history (CH), to inform clinical interpretation and best practice. 404 SA (male&#x2009;=&#x2009;188, female&#x2009;=&#x2009;216) from University of Chichester, across 12 sports, completed baseline screening using the Sports Concussion Assessment Tool (SCAT) 22 item symptom checklist (severity scored 0&#x2009;=&#x2009;none, to 6&#x2009;=&#x2009;severe; total severity score range 0-132) prior to participation over three university sports seasons. Symptom distributions were summarized using medians and interquartile ranges (IQR). Prevalence of &#x2265;1 symptom was compared using &#x3c7;2 tests with differences in symptom burden between concussion groups within NP/MH conditions assessed using Mann-Whitney U tests. Hierarchical linear regression analyses examined variance in symptom burden determined by NP/MH diagnosis and CH. SA with NP/MH diagnosis reported higher overall symptom burden than those without, SA without NP/MH diagnosis with CH had greater symptom count (p&#x2009;<&#x2009;.001) and severity (p&#x2009;<&#x2009;.002). Hierarchical regression indicated NP/MH explained 12% of variance in symptom count (R2&#x2009;=&#x2009;.12) and 16% in symptom severity (R2&#x2009;=&#x2009;.16), with previous concussion and depression/anxiety adding significant incremental variance (p&#x2009;<&#x2009;.001). Chi-square analysis showed SA with NP/MH and CH were more likely to report&#x2009;&#x2265;&#x2009;1 symptom (&#x3c7;2 (1)&#x2009;=&#x2009;9.96, p&#x2009;<&#x2009;.001). Symptom pattern analysis revealed difficulty concentrating, fatigue/low energy, trouble sleeping as most frequent baseline symptoms with females reporting consistent prevalence. Preexisting NP/MH conditions and CH can substantially influence baseline symptom reporting in UK student athletes. Clinicians should consider these factors when interpreting SCAT symptom checklists, as variability is expected, and management of SA return to sport is often determined by baseline values.

Prenatal drug exposure (PDE) has been linked to persistent alterations in adolescent brain development, yet the mechanisms by which structural and functional networks jointly contribute to later neurodevelopmental vulnerability remain unclear. Existing approaches typically analyze brain connectivity as static or treat modalities independently, limiting insight into how structure-function interactions are jointly characterized in relation to individual cognitive profiles. We present NeuroKoop++, a graph neural network-based multimodal framework that characterizes brain structure-function coupling through subject-level latent dynamical modeling. Modality-specific graph neural network (GNN) encoders extract structural connectivity (SC) and functional network connectivity (FNC) representations, which are integrated via bidirectional cross-attention and subsequently advanced through a spectrally constrained Koopman operator conditioned on subject-specific cognitive scores. Applied to the ABCD cohort of 10,199 adolescents, NeuroKoop++ outperformed leading state-of-the-art multimodal approaches with statistically significant improvements and revealed interpretable signatures of altered large-scale brain network organization associated with PDE history. Modeling structure-function coupling as a cognition-modulated latent dynamical process yields robust and interpretable gains for PDE classification over existing fusion approaches. This work offers a principled computational pathway toward identifying neurodevelopmental biomarkers of PDE, with broader applicability to multimodal neuroimaging in pediatric and adolescent brain health research.

Status dystonicus (SD), also called dystonic storm or dystonic crisis historically, represents a rare and life-threatening exacerbation of dystonia characterized by continuous (tonic) or phasic rapidly recurring dystonic spasms. Common triggers include infections, abrupt changes in medication, and metabolic stress, among others, and necessitate early recognition with multidisciplinary management to prevent multisystemic failure or dysfunction. SD arises in patients with generalized dystonia, more commonly in those with secondary causes, and is associated with basal ganglia dysfunction and predominantly dopaminergic disturbances. The Dystonia Severity Action Plan is a widely accepted staging tool that requires bedside assessment and helps inform therapeutic decisions and intervention levels. Management principles center on identifying and removing triggers, optimizing sedation and airway management, and administering disease-specific therapies. The review aims to provide an overview of the clinical spectrum, the physiological basis, commonly described precipitating factors, and updated management strategies for SD, highlighting a practical approach to the early identification of the syndrome and the bundling of care. A narrative review of peer-reviewed literature from PubMed and Scopus databases was conducted, with emphasis on publications covering etiopathogenesis, risk factors, clinical grading systems, therapeutic options, and outcomes. Key consensus guidelines and case series were appraised. It is evident that early diagnosis and triage, with adequate management, are key to improving survival and neurological outcomes in SD. Adoption of standardized clinical pathways and multicenter data reports will help improve understanding of SD's natural history, clinical evaluation, and therapeutic efficacy across different etiologies.

Telomere length (TL) is a well-established biomarker of biological ageing, sensitive to cumulative physiological and psychosocial stress. This review synthesises current evidence on how pregnancy, postpartum stressors, and reproductive history shape maternal biological ageing, integrating findings from telomere biology and emerging epigenetic ageing measures. Pregnancy represents a period of substantial metabolic, hormonal, and immunological demand and is increasingly conceptualised as a transient state of accelerated biological ageing. While telomere shortening is not consistently detectable during gestation, epigenetic clocks indicate a temporary increase in biological age, which is only partially reversible postpartum. Across the life course, higher parity is associated with shorter TL, with evidence suggesting a cumulative effect that becomes most apparent in later life and around the menopausal transition. However, this relationship is heterogeneous and modified by factors including age at last birth, breastfeeding, and socioeconomic context. Postpartum represents a critical and underexplored window in which sleep deprivation, psychological stress, and social factors converge to influence telomere dynamics. In particular, poor sleep quality and postpartum depression (PPD) are consistently linked to accelerated telomere attrition and epigenetic ageing, with emerging evidence of a bidirectional relationships whereby shorter TL may also predispose to PPD. Overall, evidence supports a model in which reproductive events impose are associated with measurable transient and cumulative costs to cellular ageing biomarkers. These findings highlight the importance of incorporating postpartum health, particularly sleep and mental health support, into life-course models of ageing and underscore the need for longitudinal, mechanistic, and intervention-focused research in maternal populations.

Trauma-informed care (TIC) emphasizes understanding the impact of trauma and integrating this knowledge into patient engagement and treatment. Implementing TIC in genetic counseling practice has the potential to enhance patient-clinician relationships, improve patient outcomes, and reduce the risk of retraumatization. This study assessed the knowledge, attitudes, and practices of genetic counselors regarding TIC. A cross-sectional study was conducted using an anonymous online survey of practicing clinical genetic counselors in the United States and Canada who were board-certified or board-eligible. Data were analyzed using descriptive statistics. A total of 101 responses were included in the analysis. The survey revealed variability in TIC knowledge among genetic counselors, with 46.0% (46/100) knowledgeable about trauma prevalence, but 86.0% (85/99) unfamiliar with TIC principles. Almost all participants (99.0%, 98/99) recognized the importance of creating a safe environment for trauma-affected patients, and 55.6% (55/99) felt confident adapting counseling approaches based on trauma history. However, only 21.4% (21/98) regularly incorporated TIC principles into practice. Training in TIC was received by 18.4% (18/98) of respondents, and interest in further TIC training was high, with 92.9% (92/99) motivated to improve these skills. This study identified gaps in genetic counselors' knowledge of the principles of TIC. With a minority of genetic counselors who have received training in TIC principles, and strong interest in further training, this study highlights an opportunity for structured TIC training.

Mental health care professionals face emotionally demanding work and often carry invisible personal trauma histories. To examine cumulative lifetime trauma exposure among employed psychiatric mental health care professionals and its associations with burnout, secondary traumatic stress, and compassion satisfaction. A cross-sectional survey among 309 staff (31.4% registered nurses, 43.7% healthcare assistants, 12.0% psychiatrists and psychologists, 12.9% other) at a Danish psychiatric centre assessed cumulative lifetime trauma exposure, operationalised as a count of ten potentially traumatic event categories, using the Brief Trauma Questionnaire and professional quality of life (ProQOL). Among those reporting trauma, 34.3% endorsed two or more categories. Higher trauma exposure was associated with secondary traumatic stress (&#x3b2;&#x2009;=&#x2009;1.27, p&#x2009;=&#x2009;0.005) and burnout (&#x3b2;&#x2009;=&#x2009;1.05, p&#x2009;=&#x2009;0.028) but not compassion satisfaction (p&#x2009;=&#x2009;0.759). Cumulative trauma exposure is a largely invisible background characteristic contributing independently to trauma-related professional strain. Thisis particularly relevant for nursing, as nurses and nursing support staff constitute 75.1% of the inpatient workforce. Cross-sectional design and single-centre sample limit causal inference and generalisability. Findings support universal, trauma-informed organisational approaches that do not require disclosure of personal trauma histories, making them feasible for all staff. Longitudinal studies should examine associations between trauma exposure and occupational demands. Mental health nursing takes place in emotionally demanding environments where staff are routinely exposed to patients' traumatic experiences. This study demonstrates that employed psychiatric mental health care professionals commonly carry cumulative lifetime trauma histories that are associated with secondary traumatic stress and burnout, independent of workplace exposures. These findings are directly relevant to mental health nursing practice, as they highlight a largely invisible source of workforce vulnerability that is unlikely to be effectively addressed through individual screening or targeted interventions. The findings support the implementation of universal, trauma-informed organisational strategies that protect all mental health care staff, including nursing staff, regardless of personal trauma history.

Persistent or slow-growing subsolid nodules and atypical lung cysts often represent indolent forms of lung cancer. These nodules require careful assessment by a multidisciplinary tumor board to determine risk, natural history, treatment options, and patient preferences. When the preferred management is imaging surveillance rather than active intervention, the main objective is to detect significant changes that could alter patient management. The choice of imaging modality should be based on its accuracy and whether the findings will influence the decision to pursue treatment. If the team determines that treatment is necessary, a diagnostic imaging workup and a biopsy are typically indicated and should not be considered part of surveillance. Therefore, this document aims to outline evidence-based guidelines specifically for imaging surveillance of indolent pulmonary nodules in patients for whom the clinical team has chosen to delay intervention. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.