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Multimorbidity in older adults is common, heterogeneous, and highly dynamic, and it is strongly associated with disability and increased healthcare utilization. However, existing approaches to studying multimorbidity trajectories are largely descriptive or rely on discrete-time models, which struggle to handle irregular observation intervals and right-censoring. We developed a continuous-time hidden multistate modeling framework to capture transitions among latent multimorbidity patterns while accounting for interval censoring and misclassification. A simulation study compared alternative model specifications under varying sample sizes and follow-up schemes, and the best-performing specification was applied to longitudinal data from the Swedish National study on Aging and Care-Kungsholmen (SNAC-K), including 2716 multimorbid participants followed for up to 18 years. Simulation results showed that hidden multistate models substantially reduced bias in transition hazard estimates compared to non-hidden models, with fully time-inhomogeneous models outperforming piecewise approximations. Application to SNAC-K confirmed the feasibility and practical utility of this framework, enabling identification of risk factors for accelerated progression toward complex multimorbidity and revealing a gradient of mortality risk across patterns. Continuous-time hidden multistate models provide a robust alternative to traditional approaches, supporting individualized predictions and informing targeted interventions and secondary prevention strategies for multimorbidity in aging populations.

Psilocybin-assisted interventions are moving from efficacy trials toward psychiatric implementation. Cardiovascular interpretation is central to this transition because trial participants are generally medically selected, receive standardized pharmaceutical-grade doses, and are monitored more intensively than many patients encountered in routine care. This review translates the cardiovascular evidence into a risk-stratified psychiatric decision framework. We conducted a structured narrative review of clinical trials, systematic reviews, meta-analyses, cardiovascular pharmacology, drug-interaction studies, product-standardization literature, and implementation guidance. Searches were updated through July 10, 2026. Evidence was selected purposively to address acute hemodynamics, corrected QT interval (QTc), 5-hydroxytryptamine receptor-mediated effects, valvular biology, repeated exposure, naturally derived product variability, and practical screening and monitoring. In supervised studies, pooled estimates indicate mean increases of approximately 19.0 mmHg in systolic blood pressure and 8.7 mmHg in diastolic blood pressure. The largest and most consistent group differences occur about 60-90 min after dosing and generally resolve within 4-6 h; heart-rate effects are smaller and less consistent. Serious acute cardiovascular events remain uncommon in selected participants. Risk interpretation changes with cardiovascular comorbidity, interacting medications, repeated exposure, and non-standardized mushroom products, whose active-alkaloid content can vary by more than an order of magnitude. Mean QTc effects at standard exposure are small. A 5-HT2B-mediated valvular concern remains biologically plausible under chronic exposure, but assay results and exposure-margin estimates are heterogeneous and clinical valvular injury has not been established. Current evidence supports monitored, intermittent administration of standardized psilocybin in carefully selected populations, not general cardiovascular reassurance across all products, exposure patterns, or psychiatric settings. Product identity, medication review, risk-stratified cardiovascular assessment, session monitoring, and explicit escalation pathways should be integrated into treatment planning.

Vaccine-preventable diseases (VPDs) are re-emerging worldwide, with declining vaccination coverage since the COVID-19 pandemic resulting in outbreaks of previously rare infections in Australasia. Emergency departments are increasingly at the forefront of recognising and managing these diseases while responding to their broader public health implications. This editorial examines the factors contributing to the resurgence of VPDs and declining immunisation rates, and their implications for ACEM training and EM practice. The accompanying articles in this issue provide practical perspectives on managing diphtheria and measles in the emergency department, addressing vaccine hesitancy and preparing for VPD-related examination questions.

Anorectal bacterial sexually transmitted infections, predominantly chlamydia, gonorrhoea and syphilis, represent a substantial and evolving global health challenge, with incidence rising despite widespread testing availability. In this Review, we examine the epidemiology and burden of anorectal sexually transmitted infections, explore the pathogenic mechanisms underlying infection and discuss advances in diagnosis, screening and prevention strategies. Anorectal infections are frequently asymptomatic, particularly among men who have sex with men, in which they often exceed the prevalence of urogenital infections. Asymptomatic persistence results from bacterial adaptation to rectal tissues and attenuated local immune responses that fall below symptom thresholds. Molecular diagnostics have transformed detection capabilities, yet substantial challenges persist in distinguishing viable from non-viable microorganisms, expanding point-of-care testing access and balancing screening benefits against antimicrobial stewardship concerns. Treatment approaches continue to evolve in response to emerging resistance patterns, particularly for gonorrhoea. Promising prevention innovations include doxycycline post-exposure prophylaxis, which substantially reduces chlamydia and syphilis incidence and artificial intelligence applications. However, practical implementation in diverse clinical settings remains limited. We highlight important gaps in knowledge and propose research priorities to advance effective control strategies.

Machine-learning surrogate models have shown promise in accelerating aerodynamic design, yet progress toward generalizable predictors for three-dimensional wings has been limited by the scarcity and restricted diversity of existing datasets. Here, we present SuperWing, a comprehensive open dataset of transonic swept-wing aerodynamics comprising 4,239 parameterized wing geometries and 28,856 Reynolds-averaged Navier-Stokes flow field solutions. The wing shapes in the dataset are generated using a simplified yet expressive geometry parameterization that incorporates spanwise variations in airfoil shape, twist, and dihedral, allowing for an enhanced diversity without relying on perturbations of a baseline wing. All shapes are simulated under a broad range of Mach numbers and angles of attack covering the typical flight envelope. To demonstrate the dataset's utility, we benchmark two state-of-the-art Transformers that accurately predict surface flow and achieve a 2.5 drag-count error on held-out samples. Models pretrained on SuperWing further exhibit strong zero-shot generalization to complex benchmark wings such as DLR-F6 and NASA CRM, underscoring the dataset's diversity and potential for practical usage.

This work introduces an eco-friendly spectrophotometric approach for the simultaneous quantification of methocarbamol (MET) and its impurity product guaifenesin (GUF), based on measuring the second derivative amplitudes of each drug in presence of the other, using zero-crossing technique. The second derivative amplitudes were measured at 208.0 nm and at 207.5 nm for MET and GUF, respectively. The proposed method showed good linearity over the concentration ranges of 1.0-110.0 and 1.0-90.0 µg/mL for MET and GUF, respectively with corresponding correlation coefficient of 0.9997 and 0.9999. The detection and quantitation limits for MET were found to be 0.021 and 0.064 µg/mL, respectively, while GUF corresponding values were 0.013 and 0.041 µg/mL. The method was successfully applied for determining MET and GUF in its dosage forms with high selectivity. The developed method produced comparable results to those obtained by the published reference methods in terms of precision and accuracy. A comprehensive assessment was carried out to evaluate the suggested method's economic feasibility, practicality, and environmental sustainability compared to previously reported techniques. This comprehensive assessment leveraged several state-of-the-art tools, including the analytical Eco-scale, Green Analytical Procedure Index (GAPI), Analytical GREEnness (AGREE), Multi-Color Assessment, Analytical Green Star Area (AGSA) and Blueness Assessment Graphical Index tools. The suggested approach exhibited favorable quadrant profiles in GAPI assessment, along with higher AGREE, AGSA and Eco-scale scores, all of which confirmed their eco-friendliness.

A multi-mode immunofiltration detection assay is introduced, which uses Prussian blue-gold nanocomposites (PB@Au NPs) as nanoprobes and integrates four signal output modes: colorimetric (CM), enzymatic catalysis (CL), photothermal (PT), and surface-enhanced Raman scattering (SERS). Rapid vertical flow technology (RVFT) serves as the detection platform, achieving highly sensitive, qualitative, and diversified quantitative detection of brucellosis antibodies. First, PB@Au NPs were successfully synthesized using the wet chemical method, exhibiting excellent catalytic activity, a PT conversion efficiency of 36.2%, and strong Raman signal enhancement. These nanoprobes were then used to construct PB@Au-RVFT for brucellosis detection. In CM mode, the detection limit was 10 IU·mL⁻¹, which decreased to 4 IU·mL⁻¹ with enzyme-mediated CM amplification. PT and SERS modes further improved sensitivity, reaching detection limits of 0.167 and 0.144 IU·mL⁻¹, respectively, which are significantly better than traditional colloidal gold test strips. Additionally, the recovery rates for spiked clinical serum samples ranged from 94.59 to 105.31%, confirming the reliability of the method for practical applications. The proposed method enables multi-signal collaborative detection, enhancing anti-interference capacity and accuracy in complex samples. Its adaptability various detection environments give this technology the potential to conduct early screening and precise control of brucellosis in resource-poor areas. Meanwhile, it also provides a flexible and highly sensitive diagnostic strategy for other infectious diseases.

Primary care practitioners are well-positioned to support people of reproductive age in preparing for pregnancy and parenthood. Such "preconception care" is ideally delivered opportunistically during routine consultations, although limited time presents a barrier. To achieve consensus on priority topics for opportunistic preconception care in general practice. A three-step consensus study involving UK-based primary care practitioners and people of reproductive age. The consensus process involved: 1) identifying potential topics through literature and guideline reviews, workshops with people of reproductive age (n=15), and interviews with primary care practitioners who work in general practice (n=14); 2) prioritising topics using a Delphi survey (n=85 participants completing round one, n=63 completing all three rounds); and 3) agreeing on priority topics during an online consensus workshop (n=21 participants). Participants were recruited through a Public Advisory Group, charities, and professional organisations. Reviews and workshops/interviews with people of reproductive age and practitioners identified 37 potential topics. The Delphi survey and consensus workshop identified 16 priority topics. These were combined into four overarching topic areas for discussion during relevant consultations:1. Patient knowledge of preconception health and pregnancy2. Ideas, concerns and expectations (e.g. pregnancy intention, prior pregnancy experiences)3. Health conditions (e.g. medication use, mental/physical health, immunisation)4. Health behaviours (e.g. folic acid supplement use, smoking, alcohol consumption). The agreed priority topic areas offer a structured foundation for delivering patient-centred, opportunistic preconception care in primary care. The findings support future co-development of practical tools and resources to enable routine implementation.

Kanamycin (KANA), a widely used aminoglycoside antibiotic, may accumulate in food products and pose potential risks to human health, calling for sensitive and reliable analytical strategies. A dual-mode detection method integrating surface-enhanced Raman spectroscopy (SERS) with colorimetric sensing was developed. This approach enabled sensitive and rapid detection of KANA. A core-shell Au@CeO2 nanozyme-mediated aptasensor was synthesized, which exhibited oxidase-like activity and enhanced SERS performance. Without KANA, adsorption of the aptamer onto the nanozyme surface inhibited the nanozyme-catalyzed oxidation of 3,3',5,5'-tetramethylbenzidine (TMB), leading to a simultaneous decrease in both SERS and colorimetric signals. Under optimized conditions, the aptasensor enabled quantitative KANA analysis with favorable sensitivity and selectivity, achieving limits of detection of 3.20 × 10-10 mol/L (SERS mode) and 5.10 × 10-6 mol/L (colorimetric mode), with linear ranges of 1.00 × 10-9-1.00 × 10-5 mol/ L (SERS) and 5.00 × 10-5-5.00 × 10-3 mol/L (colorimetric). The practicality of this platform was validated in milk and egg white samples, with recoveries ranging from 98.6% to 107.0% in milk and from 95.6% to 105.0% in egg white. In this strategy, Au@CeO2 is designed to function simultaneously as an oxidase-like nanozyme and a SERS-active substrate. Although the two modes differ in sensitivity and linear range, they provide complementary analytical information: the SERS mode is suitable for trace-level quantitative analysis, whereas the colorimetric mode offers an auxiliary visual response at relatively higher KANA concentrations. This work provides a dual-readout approach for KANA analysis in food samples.

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Advanced practice nurses play a vital role in addressing the growing complexity of healthcare. Although well-established internationally, advanced practice nursing in Austria remains in its early stages. The University Hospital Salzburg introduced its first advanced practice nurses in 2017, and in 2020 launched a comprehensive initiative to develop and implement advanced practice nursing roles across multiple specialties. This initiative included role development based on international frameworks, the creation of an advanced practice nurse network, scientific mentoring and an adapted skill and grade mix. This study aims to evaluate the development and implementation of advanced practice nursing roles at the University Hospital Salzburg across multiple disciplines and at the system level. It will analyse their impact on clinical, professional and organisational outcomes, integrating the perspectives of various healthcare professionals as well as the advanced practice nurses. This mixed methods study will follow an explanatory sequential design. Advanced practice nurses, registered nurses, nurse assistants, nurse managers and physicians will be invited to participate. The quantitative phase will employ validated instruments and research team-developed questionnaires. Quantitative results will inform the development of the interview guide and sampling strategy for the qualitative phase. In the qualitative phase, expert interviews and focus groups will be conducted, with data analysed thematically. Quantitative and qualitative findings will be integrated using a joint display across clinical, professional and organisational levels. The study will be conducted from June 2025 to November 2027 at an Austrian university hospital. According to the Ethics Committee of Salzburg, formal ethical approval was not required. Study findings will be disseminated through publications in peer-reviewed journals, presentations at scientific conferences and internal events for participants. July 2026. DRKS00036497.

The analytic mind is a way of thinking that includes understanding the effects of the unconscious on behavior, relationships and decisions expressed in myriad ways. A supervisor and supervisee reflect upon the development of their psychoanalytic minds through their own experiences of training and supervision. The two do not have the same experiences and goals even in the same supervision. A supervisor aims to impart analytic thinking and practice; a supervisee strives to become an analyst. Their goals are achieved within a supervisory relationship holding an optimal tension-the supervisor balances between teacher and analyst and the supervisee between support and autonomy. The learning relationship with its overlapping goals contains convergence (support and scaffolding) and divergence (differing thoughts about what helps a person learn).

Recent trends towards a "leave nothing behind" strategy are reshaping coronary artery disease management. Drug-coated balloons (DCB) deliver an antiproliferative drug via their abluminal surface, reducing neointimal proliferation without risks attributable to drug-eluting stents (DES). While emerging data support DCB safety and efficacy, real-world usage and outcome data remain limited. This study examines DCB use, trends, and clinical outcomes in Victoria, Australia. Registry data from all percutaneous coronary intervention-capable centres within the Victorian Cardiac Outcomes Registry over an 11-year period from January 2013 to December 2023 were collected. Indications for DCB use, short and long-term mortality, and 30-day major adverse cardiovascular events, defined as cardiac death, myocardial infarction, target vessel revascularisation or target lesion thrombosis, were assessed. Among 117,308 patients undergoing percutaneous coronary intervention during the study period, 1,266 received DCB-only intervention, rising from 0.17% in 2013 to 2.8% in 2023. Compared with DES, DCB recipients were older (69.0 vs 66.5 years; p=0.002), with higher lesion complexity (B2/C; 70.1% vs A/B1; 29.9%). The predominant indication for DCB was stable angina (70.2%), followed by myocardial infarction (ST-elevated myocardial infarction [STEMI] 5.3%, non-STEMI 17.1%) and unstable angina pectoris (unstable angina pectoris 7.4%). Thirty-day all-cause mortality and major adverse cardiovascular events rates in the DCB group compared to DES remained low (0.5% vs 1.6%; p=0.012, and 1.6% vs 3.0; p=0.009). A total of 470 patients (0.4%) received a combination DCB and DES strategy over the study period. DCB usage has significantly increased over the past decade, reflecting evolving clinical practice, although absolute numbers remain small. With advancing guidelines, growing experience, and emerging evidence, its utilisation is expected to rise further.

Given around 50% of people with heart failure have a degree of iron deficiency, guidelines recommend screening. It is uncertain to what extent this is done in primary care and whether testing is equitable. To report the proportion of people with incident heart failure who undergo a ferritin test within 12 months. Retrospective primary care cohort study using Clinical Practice Research Datalink Aurum data, between 2016 and 2021. We report the proportion of adults with an incident diagnosis of heart failure who received a ferritin test within 12 months. Multivariable logistic regression was used to examine the odds of testing based on key demographic covariates and co-morbidities. Among 105 749 individuals with an incident diagnosis of heart failure (mean age 71.6 years, SD 14.3), only 35 688 (33.7%) received a ferritin test within the subsequent year. Increasing age (odds ratio 1.25 per 10-year increase, 95% CI: 1.24-1.27), female sex (male sex OR 0.86, 0.84-0.89) and Asian ethnicity (OR 1.70, 1.59-1.80) were all associated with increased odds of testing as were diagnoses of coeliac disease (OR 1.86, 1.58-2.21), type 1 diabetes (OR 1.82, 1.51-2.19) and cirrhosis (OR 1.64, 1.43-1.87). There was geographic variation in testing, even in adjusted analyses. In a large primary care dataset, two thirds of people with incident heart failure did not receive a ferritin test for iron deficiency within a year of diagnosis demonstrating a gap in current practice and an opportunity for improvements in service delivery.

Preventing farmers' exposure to pesticides is a major public health issue. However, research on farmers' practices, particularly in high-income countries, rarely explores the combined role of sociodemographic, occupational and psychosocial factors or considers behaviours beyond the use of personal protective equipment. This study investigated pesticide risk prevention behaviours among French farmers, focusing on agricultural specialisation (ie, the main production on the farm), individual characteristics and key psychosocial determinants. A comprehensive telephone survey conducted among French winegrowers or grower-breeders probed their pesticide knowledge, psychological constructs (attitudes and perceptions, social norms and control) and individual and occupational factors. Associations with three preventive behaviours were studied separately by logistic regression. 162 male farmers were surveyed (median age 50, 74% with high school education), including 99 grower-breeders and 63 winegrowers, with differences in farm size, labour structure and employment status. Preventive measures were not implemented systematically: 59% wore gloves, 65% washed their hands and 45% read hazard information on labels. Agricultural specialisation was a major factor influencing behaviour as well as psychosocial determinants (self-efficacy, perceived barriers and social norms). In contrast, sociodemographic factors and knowledge levels had little effect. The adoption of pesticide risk prevention behaviours remains limited over time, even in high-income countries. Our study demonstrates that (1) behaviours relying on distinct determinants should be analysed separately, (2) agricultural specialisation is a major factor influencing behaviours and (3) psychosocial variables play a predominant role in behaviour adoption. This appraisal is crucial for designing an appropriate intervention targeting French farmers.

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Individuals of Black heritage comprise 6.2% of the General Practice workforce in the UK. Representation is even lower in Primary Care Research. The understanding of why this misrepresentation exists is limited. We explored the representation of researchers of Black heritage at various career stages within primary care, alongside factors influencing retention and career advancement. Semi-structured interviews were conducted with 18 researchers of Black heritage and 7 primary care senior academic leaders (current or former heads of primary care departments in UK universities). Interviews explored representations within academic primary care, researcher career journeys, barriers and enablers to progression, and recommendations for improving diversity in the UK's primary care research workforce. Interviews were digitally audio recorded, transcribed and analysed thematically. All participants recognised significant underrepresentation of researchers of Black heritage in primary care research. Key barriers to career progression and retention included systemic and structural inequities, racism and exclusionary academic culture. Facilitators included proactive leadership, tailored training and support for researchers (including international scholars), mentorship, sponsorship and safe networking spaces. Participants offered recommendations to improve representation and career progression: training for leaders to recognise bias, discrimination and inequity, leadership development opportunities, tailored career support for researchers of Black heritage and targeted assistance for international researchers navigating UK academic systems. Visibility of Black role models in academic primary care was seen as essential to attracting and inspiring future researchers. These findings highlight key areas for change to foster a more inclusive and equitable research environment in primary care.

Strong opioids are central to effective symptom control in palliative care. In cases of complex symptom burden, primary care teams frequently rely on palliative care consultation services (PCCSs) for expert guidance. This survey explored the recommendations issued by hospital-based PCCS teams regarding the use of strong opioids in patients with advanced disease (e.g. clinical indications, opioid agent). A closed online survey was conducted via the SoSci Survey platform. All PCCS teams registered with the German Association for Palliative Medicine were invited to participate in November 2024, with a reminder sent three weeks later. Thirty-nine PCCS teams participated (21 university hospitals, 18 general hospitals). All respondents agreed on the indication for strong opioids in cancer-related pain and dyspnea. Differences emerged regarding the use of opioids in patients with non-malignant conditions: although most PCCS considered opioids appropriate for dyspnea associated with pulmonary (n = 37) or cardiac disease (n = 33), non-cancer pain was less consistently endorsed (n = 20). Hydromorphone and morphine were the most commonly used opioids (> 30 services reporting frequent use), whereas the use of fentanyl, oxycodone, and buprenorphine varied widely across services. There is consensus regarding the use of opioids in patients with cancer-related pain and dyspnea. The differing approaches to their use for symptoms caused by non-malignant conditions suggest varying clinical interpretations and underscore the need for further research and clearer guidelines.

Respiratory failure after surgery and other major invasive procedures, defined as the unanticipated need for invasive or noninvasive ventilation, is a life-threatening complication affecting ∼10 million patients annually. At present, there are no guidelines for risk assessment and prevention of postprocedural respiratory failure. We developed expert-informed practice recommendations for the prediction and prevention of postoperative and postprocedural respiratory failure. These recommendations focused on modifiable pre- and post-procedural risk factors and implementation feasibility, using a structured multidisciplinary expert panel process. An international expert panel reviewed current literature, supplemented evidence gaps with expert opinion, and drafted preliminary action statements. Iterative voting rounds were used to refine expert panel statements, which were classified as recommendations with broad applicability and low likelihood of delaying care, or suggestions that can be applied selectively. The study panel included 25 experts from four continents and multiple medical disciplines. An initial set of 54 preliminary statements was refined into 13 recommendations and 15 suggestions. Recommendations included using screening tools systematically, promoting tobacco cessation, reconsidering procedure timing in patients with symptomatic respiratory tract infections, mobilising patients early and maximising upright positioning, maintaining good oral hygiene, using noninvasive respiratory support to minimise need for invasive ventilation, and minimising deep sedation while promoting early tracheal extubation. These recommendations reflect expert interpretation of a broad and heterogeneous body of evidence and provide practical strategies to predict and prevent postprocedural respiratory failure, offering a framework for future study of a risk-targeted care bundle.