In this article, we examine how the Inter-American Commission on Human Rights' (IACHR) 2025 report, The situation of the rights of persons with disabilities in the Americas, serves as a mechanism for incorporating principles from the United Nations Convention on the Rights of the Child (CRC) to improve treatment outcomes for children with communication disorders in the United States, by integrating child-centered and rights-based principles into national policy and clinical practice, in the context of U.S. nonratification of the CRC. Using a legal-analytical method grounded in treaty interpretation, comparative law, and policy analysis, we examine the IACHR's recommendations and the CRC's key provisions (Articles 2, 3, 6, 12, 13, 23, and 28) alongside U.S. disability law, including the Individuals with Disabilities Education Act, Section 504 of the Rehabilitation Act, and the Americans with Disabilities Act. We situate communication as a fundamental human right and identify operational strategies derived from the CRC across three domains: early intervention, inclusive education, and communication access in schools. We conclude that the IACHR report offers a credible framework for aligning U.S. disability practice with global children's rights norms, transforming abstract treaty obligations into practical tools for ensuring timely, equitable, and participatory communication supports in U.S. schools and communities.
Objectives. To describe cross-national variation in suicidal ideation in the past year across transgender women, transgender men, and nonbinary persons and trace the association between ideation and gender along the continuum of country-level public support for transgender rights. Methods. We applied ordered random-intercept logistic regression models to cross-sectional data from the 2023 European Union Fundamental Rights Agency LGBTIQ Survey III fielded in 27 EU member states. These individual-level data were combined with the 2023 "Special Eurobarometer 535" survey used to construct the 4-item country-level composite measure of public support for transgender rights. Results. Higher levels of public support for transgender rights were associated with lower levels of suicidality but unequally across groups. Transgender men were the most and transgender women the least responsive to changes in public opinion. Differences between groups converged at high levels of support. Conclusions. Mental health among transgender men may be especially sensitive to public opinion, suggesting a need for suicide prevention that addresses public opinion as a social determinant of health-and the need to do so in contexts antagonistic to gender minority populations. (Am J Public Health. 2026;116(8):1189-1197. https://doi.org/10.2105/AJPH.2026.308572).
The United Nations Convention on the Rights of Persons with Disabilities (CRPD) is the first human rights treaty of this century. It aims to ensure that persons with disabilities have full and effective inclusion in society and are not the subjects of discrimination. Support for the CRPD was unprecedented, attracting widespread approval from states in all regions, and achieving the highest number of signatories to a UN Convention on its opening day. Whilst most of its provisions have been welcomed, the interpretation of several key articles by UN bodies has led to some unanticipated issues of compliance with areas of the criminal justice system. In particular, it has been argued that the CRPD requires the abolition of any criminal defence which relieves or mitigates liability because of a disability. The relevant mental condition defence focused on in this article is the insanity defence. No State Party to the CRPD has shown any inclination to abolish the insanity defence due to a perception that the interpretations advanced by the UN bodies are flawed and unworkable. This article establishes that the insanity defence can be reformed in a way that is CRPD compliant without the necessity of abolition. It is proposed that the cognitive limb of insanity should be replaced by a legal rule which allows for evidence of a psychosocial disability to negate mens rea. The evaluative and volitional limbs should be replaced with a new defence which focuses on the defendant's ability to generate alternative choices.
The proliferation of linear energy infrastructure (e.g., pipelines, powerlines) in forested landscapes throughout North America has advanced the need to understand how to manage these areas for improved species conservation. Habitat management implemented to use the unique vegetative characteristics associated with energy corridors may be a promising direction for future conservation. For songbirds, responses to habitat change can vary based on vegetative characteristics at local and landscape scales. Therefore, a better understanding of how vegetative characteristics across spatial scales affect songbird responses to habitat management that is associated with linear energy infrastructure is necessary for developing proactive solutions. We assessed songbird abundance and richness at point count locations within silviculture treatments along energy corridors (pipelines and powerlines) to habitat characteristics at local (within 100 meters surrounding point counts) and landscape (within 500 meters) scales in West Virginia, USA during 2017-2019. Landscape variables had greater influence on songbirds in silviculture treatments compared to local variables. Species- and community-level responses to variables varied depending on habitat guild association, with some within-guild species responding to the same variable in opposing directions. The proportion of young forest habitat and the size of the nearest young forest patch surrounding silviculture treatments had the strongest influences on songbirds of all landscape variables considered. The width of the right-of-way adjacent to silviculture treatments had the strongest influence on songbirds of all local variables considered. These results suggest that consideration of the surrounding landscape is important when planning habitat management in forested areas in association with linear energy infrastructure.
Ambulatory surgery centers (ASCs) have become a dominant site of orthopaedic procedural growth in the United States, with expanding indications that now include select total joint arthroplasty. Although clinical protocols have enabled safe outpatient care, ASC performance is frequently determined by nonclinical infrastructure. Surgeon-owned ASCs function as regulated financial entities governed by operating agreements and a layered contract architecture that directly influences reimbursement integrity, fixed overhead exposure, throughput reliability, compliance risk, and long-term equity value. Operating agreements define governance authority, ownership rights, capital obligations, profit distribution, dispute resolution, and buy-sell valuation methodology. Managed care contracts establish procedure-level revenue feasibility, including implant reimbursement structure, denial and recoupment risk, audit exposure, and escalation provisions. Lease agreements represent the largest fixed liability and may determine survivability during reimbursement contraction. Equipment, purchasing, anesthesia, and staffing agreements further shape operational capacity and cost control, while revenue cycle and information technology contracts influence collections performance and cybersecurity vulnerability. This review provides a structured, surgeon-focused framework for evaluating ASC contract domains, emphasizing negotiation priorities, implementation strategy, and regulatory safeguards. A disciplined approach to ASC contracting is essential to preserve autonomy, protect margins, and sustain long-term enterprise value in an increasingly outpatient-driven orthopaedic economy.
This Viewpoint discusses the potential effect of recent US Supreme Court decisions that upheld the First Amendment rights of organizations that provide substandard or even unlicensed care that deceives patients.
This article critically examines Japa Pallikkathayil's claim that pre-viability abortion prohibitions violate democratic and legal equality. Pallikkathayil grounds this view in analogies to compelled bodily donation, arguing that inalienable bodily rights, understood chiefly as bodily integrity, protect gestational autonomy. The article challenges that analogy through four arguments. First, human procreation has a morally distinctive character, generating duties from unchosen but special parental relationships, as family law recognizes, which qualifies appeals to bodily inalienability. Second, typical abortion methods are not accurately described as passive bodily withdrawal, since they involve interventions directed at ending fetal life. Third, bodily donation cases fail to capture the distinctive moral and legal stakes of pregnancy. Fourth, alternative feminist critiques suggest that bodily autonomy may not exhaust democratic equality for women, especially where institutional accommodation of pregnancy is concerned. The article therefore reframes the debate around parental responsibility, action, analogy, and equality.
The increasing proportion of older adults in today's societies has created a growing need for specialized and ethical nursing care. One of the main challenges in geriatric care is ageism and the neglect of human dignity, both of which can compromise the quality of care. Providing ethics education, especially through interactive and reflective approaches such as storytelling can enhance nursing students' awareness and sensitivity toward the values and rights of older adults. This quasi-experimental study was conducted on 76 senior students divided into intervention and control groups. The intervention group participated in five two-hour educational sessions based on ethical storytelling, while the control group received only their routine internship training. Both groups completed the Ageism in Care Settings Scale and the Elderly Patients' Human Dignity Scale before, immediately after, and one month following the intervention. Data were analyzed using SPSS version 22, applying independent t-tests, chi-square tests, and repeated measures ANOVA at a significance level of 0.05. Before the intervention, no significant difference was found between groups in mean ageism scores (p = 0.275). However, significant differences emerged immediately after (p = 0.012) and one month later (p = 0.009). Similarly, there was no significant difference between groups in the "importance" dimension of dignity before the intervention (p = 0.607), while significant improvements were observed immediately (p < 0.001) and one month after (p < 0.001). Regarding the "observance" dimension of dignity, no significant difference was seen before (p = 0.490) or immediately after (p = 0.069), but a significant improvement was detected at one-month follow-up (p = 0.002). Ethical education through storytelling significantly reduced ageism and enhanced nursing students' understanding and observance of human dignity in elderly care. Incorporating narrative-based ethics education into nursing curricula is recommended as a complementary approach to improve ethical competence and address challenges associated with population aging. Registered at the Iranian Registry of Clinical Trials (www.irct.ir) with the number IRCT20250311065039N1 (Date 21.05.2025).
India's National Education Policy (NEP) 2020 and the Rights of Persons with Disabilities (RPwD) Act, 2016 set a strong framework for inclusive higher education, yet a substantial implementation gap persists for students with disabilities. This study investigates the quality of assistive technology (AT)-driven services for students with disabilities in Indian Higher Education Institutions (HEIs) by measuring the alignment between current service delivery and student expectations. A convergent mixed-methods design was used. The quantitative strand surveyed 300 students with disabilities drawn from 50 HEIs across five regions using multi-stage stratified random sampling during the 2024-2025 academic year. A SERVQUAL-based instrument measured perceptions and expectations across reliability, assurance, tangibility, empathy, and responsiveness, with analysis in IBM SPSS Statistics. The qualitative strand thematically analysed open-ended responses from 247 of these participants using NVivo. Findings show a negative overall service quality gap (-7.74), with tangibility recording the largest deficit (-2.28), followed by responsiveness (-1.64) and empathy (-1.34). Regression analysis indicated a significant positive relationship between AT adoption and perceived service quality (β = 0.45, p < .001). Thematic analysis identified four barrier themes (financial constraints, technical and compatibility challenges, institutional and attitudinal barriers, and infrastructure gaps) and four prospect themes (learning independence, digital accessibility by design, career readiness, and institutional reputation). Triangulation showed convergent evidence that infrastructure deficits and low faculty awareness underlie the measured gaps. The study provides empirically grounded guidance for HEI and policy action under NEP 2020 and SDG 4. Assistive technology meaningfully improves service quality, but is not sufficient on its own. The regression analysis showed a significant positive relationship between AT adoption and perceived service quality (β = 0.45, p < .001), with AT adoption explaining about 20% of the variance. Rehabilitation programmes serving persons with disabilities should therefore embed a range of assistive technologies—screen readers, text-to-speech and speech-to-text software, Braille displays, adaptive keyboards, captioning systems, and eye-tracking devices—as standard service components. The modest variance explained also shows that AT alone cannot carry rehabilitation outcomes; it must be paired with reliable infrastructure, trained staff, and responsive workflows.The largest service quality gaps are in tangibility, responsiveness, and empathy, and these must be addressed in parallel. The study recorded critical gaps in tangibility (−2.28), responsiveness (−1.64), and empathy (−1.34), with 145 of 247 qualitative respondents directly describing infrastructure failures. Rehabilitation settings should treat physical and digital accessibility as the foundational layer—well-maintained equipment, WCAG 2.1-compliant digital platforms, prompt technical support, and individualised, respectful care. The SERVQUAL framework offers rehabilitation practitioners a practical tool to audit and benchmark these service dimensions on a recurring basis.Capacity-building for rehabilitation and support staff must address both technical and attitudinal barriers. The assurance gap (−1.30), together with the 121 participants who reported low staff AT literacy, points to a training need that goes beyond device operation. Therapists, counsellors, faculty, and disability support coordinators should receive structured, assessed training that combines hands-on AT competence with disability-affirming communication, directly addressing the stigma and low expectations documented in the qualitative findings. Without this dual focus, technical training alone will not translate into improved rehabilitation experiences for persons with disabilities.Rehabilitation planning should be person-centred and disability-specific, not one-size-fits-all. Persons with intellectual and developmental disabilities reported the largest service quality gap (−9.62), and only 30% reported access to any specialised AT—a clear signal that uniform service models systematically underserve some groups. Rehabilitation programmes should involve service users directly in assessment, goal-setting, and AT selection, and should develop distinct service pathways for sensory, physical, learning, and intellectual/developmental disabilities. Built-in mechanisms such as periodic user-input panels and member-checked goal reviews can help ensure that AT solutions remain genuinely matched to individual functional goals and lived experience.
To characterize the learning curve of inflatable mediastinoscope-assisted synchronous laparoscopic esophagectomy and to compare perioperative outcomes between synchronous and combined approaches. A retrospective analysis was performed on the clinical data of 229 consecutive patients who underwent minimally invasive radical esophagectomy in the Department of Thoracic Surgery between January 2018 and December 2020. All patients were divided into the synchronous group (n = 118) and the combined group (n = 111), and after 1:1 propensity score matching, 106 patients were successfully matched in each group for final analysis. The cumulative sum (CUSUM) method was used to construct learning curves for both the synchronous and combined groups based on operative time, and learning phases were identified according to inflection points, dividing it into initial, plateau, and proficiency phases based on inflection points. Baseline characteristics, perioperative indicators (operative time, intraoperative blood loss, etc.), postoperative complications, and short-term outcomes were compared between the overall groups and across learning phases within the synchronous group. Baseline characteristics were balanced and comparable between the two groups (P > 0.05). Overall, the synchronous group demonstrated significantly superior outcomes compared to the combined group in terms of operative time, intraoperative blood loss, postoperative drainage volume at 3 days, total lymph node yield, time to first flatus, time to first ambulation, and postoperative hospital stay (P < 0.05). The CUSUM learning curve equation for the synchronous group was Y = - 0.001x3-0.146x2 + 30.865x-80.301 (R2 = 0.987), with inflection points at the 40th and 70th cases. Dividing the learning curve into the initial phase (cases 1-40), stabilization phase (cases 41-70), and proficiency phase (cases 71-106). As learning progressed, the synchronous group demonstrated significant improvements in operative time, blood loss, drainage volume, lymph node dissection rate, time to ambulation, and length of hospital stay (P < 0.05). Furthermore, the overall complication rate during the proficiency phase was significantly lower than that during the initial phase (P < 0.05). Compared with the sequential combined inflatable mediastinoscope-assisted laparoscopic approach, the synchronous approach was associated with improved perioperative outcomes, fewer pulmonary complications, and a favorable learning trajectory in this retrospective cohort. These findings support its feasibility as an alternative minimally invasive strategy, although further prospective multicenter studies are required for validation.
The Sepsis Prevention in Neonates in Zambia (SPINZ) trial was a prospective observational cohort study conducted in the neonatal intensive care unit of the University Teaching Hospital in Lusaka, Zambia. Introduction of an infection prevention and control (IPC) bundle reduced hospital-associated mortality, total mortality, suspected sepsis, and confirmed bloodstream infections. This companion analysis was undertaken to analyze intervention costs and cost-effectiveness in this low-resource setting. We conducted a retrospective cost analysis, using SPINZ study-related records, and expressed costs in real 2016 US dollars. We also estimated intervention cost-effectiveness using both outcomes from SPINZ (avoided deaths, confirmed bloodstream infections, and suspected episodes of infection) and estimated disability-adjusted life years (DALYs) averted by the intervention. To provide data for policymakers, a future cost projection was undertaken to estimate costs of the program implemented nationally over a 10-year period in real 2025 US dollars. A total of 2,035 neonates were enrolled from September 2015 to March 2017. Total costs during implementation (introduction of the IPC bundle) (April-May 2016) and the subsequent intervention period were $17,641 and $5,265, respectively, of which most expenses were incurred during the preparation period due to travel and training. During the intervention period, the program's running cost was approximately $478 per month. The estimated cost per death, confirmed infection, and suspected episode averted was $208, $204, and $32, respectively; the estimated cost per DALY averted was $7. The future model was estimated to cost an average of $107,561 annually to implement nationally. The analysis indicated that the IPC bundle to prevent sepsis-related neonatal mortality was highly cost-effective. Cost reductions from task-shifting, reduced preparation (start-up) costs, and longer intervention periods would further decrease cost per death averted. IPC bundle implementation can thus be recommended for resource-constrained settings where sepsis and other nosocomial infections are associated with high neonatal mortality.
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This study discusses the value and characteristics of prenatal ultrasound diagnosis of unilateral agenesis of pulmonary artery (UAPA). Two cases of prenatal ultrasound diagnosis of UAPA have been reported in our centre, involving either a distal right or left pulmonary artery receiving retrograde perfusion from the corresponding ductus arteriosus. Amniocentesis chromosome testing had no significant value in the prenatal diagnosis of UAPA. Postnatal computed tomography angiography confirmed the diagnoses. Both infants underwent surgical reconstruction. One case required a balloon dilation for postoperative stenosis, while both showed good outcomes during follow-up. Our study provides valuable clinical experience and guidance for prenatal ultrasound diagnosis of UAPA to improve the prognosis of children with UAPA.
We report a 14-year-old boy with MRI-negative drug-resistant frontal lobe epilepsy presenting with the chapeau de gendarme sign. SEEG showed diffuse low-voltage fast activity with rapid bilateral propagation, precluding reliable visual localization. Ictal phase-amplitude coupling (PAC) analysis revealed a right-dominant increase in modulation index at seizure onset, localizing to the anterior insula and adjacent prefrontal cortex. Informed by these findings, right frontal disconnection with operculo-insular resection was performed, resulting in seizure freedom at 1 year. This case highlights the utility of ictal PAC analysis in guiding surgical decision-making when SEEG findings are non-localizing.
Acute mesenteric ischemia is a rare but serious vascular complication often accompanied by intestinal damage. Treatment typically involves surgical and endovascular procedures. Proper diagnostic and interventional techniques are critical for preventing complications, resulting in short bowel syndrome, sepsis or need for repeated surgeries. Based on the case report, our publication provides an overview of managing acute mesenteric ischemia with intestinal involvement, highlighting both conventional and modern treatment approaches. A 57-year-old woman with thyrotoxicosis suffered from acute visceral ischemia, caused by subtotal obstruction of the superior mesenteric artery along with small bowel infarction. After surgical arterial recanalization and intestinal resection, despite palpable pulsations in the hepatic region, a new occlusion of the accessory right hepatic artery was diagnosed.Following the second revision, blood flow was restored. During follow-up, abdominal complaints recurred, requiring ileocecal resection due to delayed ischemic changes. Causes of visceral ischemia are multiple. Effective diagnosis and treatment require an interdisciplinary approach. This includes open, endovascular, or hybrid techniques combined with intestinal resection.
Deficits in executive control following stress have been proposed to drive depression-related dysfunction. Current theories of these executive control deficits in depression suggest these deficits reflect deficits in implementing control. However, aberrant computations of the value of said control can mimic a deficit in control, even in the absence of a deficit. The current study aimed to determine the mechanisms underlying depression-related deficits in executive control task performance following stress. To that end, individuals with a verified history of major depressive disorder (MDDh) and matched control participants without a history of psychopathology completed a modified Stroop task following an acute stressor. We took a multimethod, converging operations approach using fMRI and a novel cognitive model to assess how MDDh relates to both control-related (right inferior frontal gyrus; rIFG) and affective-related processes involved in the computation of control (dorsal anterior cingulate cortex; dACC) during executive control task performance following stress. We found depression-history-related differences in dACC but not rIFG responses to Stroop conflict. Further, computational modeling and control-related self-reported affect suggested that MDDh-related differences in task performance following stress were consistent with differences in computing the expected value of control. Our results suggest that depression-history-related deficits in executive control task performance following stress may reflect aberrant computations of the value of control.
Tourette syndrome (TS), a common pediatric neurodevelopmental disorder characterized by motor and vocal tics, is often accompanied by high rates of comorbidities, including attention-deficit/hyperactivity disorder and obsessive-compulsive disorder. The TS pathophysiology remains incompletely understood, with current theories focusing on the basal ganglia and cortico-striatal-thalamo-cortical (CSTC) circuit dysfunction. However, discrepancies in the brain volumetric changes were reported by studies involving children with TS. Therefore, the present study aimed to analyze the brain volumetric changes in the treatment-naïve pediatric TS patients without comorbidities to reduce the possible effect of medications and comorbidities. Forty pediatric TS patients and 40 age- and sex-matched healthy controls underwent brain magnetic resonance imaging, and their brain volumes were measured using FreeSurfer software. Our results revealed the trend of volumetric reductions in the right short insular gyrus and right inferior circular insular sulcus among TS patients, suggesting possible insular involvement in TS pathophysiology. Additionally, the loss of normal asymmetry was observed in the subcortical gray matter regions, including the putamen and accumbens nucleus, in TS patients. By focusing on a carefully selected, comorbidity-free and treatment-naïve cohort, the present study provides a clearer picture of the structural brain alterations directly related to TS. Our study results offer new insights into the morphometric alterations associated with TS, highlighting the potential role of the insula and basal ganglia in its pathogenesis. Further studies exploring the relationship between the volumetric changes and clinical course are warranted.
BACKGROUND Right internal jugular vein (RIJV) catheterization is a routine clinical procedure for gastrointestinal surgery. The conventional blind puncture method is often unable to detect vascular anatomical variations, particularly in premature infants. Through widespread adoption of ultrasound-guided puncture techniques, the success rate of catheterization has substantially increased, and vascular anatomical abnormalities can be promptly identified. Internal jugular vein occlusion after catheterization is rarely reported in premature infants. This case report describes RIJV occlusion in a premature infant after 43 days of catheterization without preceding warning signs. CASE REPORT A premature infant underwent surgery for intestinal obstruction on June 28, 2024. A catheter was inserted into the RIJV and kept in place for 43 days. During catheterization, the catheter was managed according to standard nursing procedures. On October 22, 2024, central venous catheterization was required again. Ultrasound examination showed complete occlusion of the RIJV. Catheterization was successfully performed in the left internal jugular vein under ultrasound guidance as an alternative approach. CONCLUSIONS Several risk factors contribute to catheter-related thrombosis in premature infants undergoing central venous catheterization. Meticulous care measures should be implemented to maintain vessel patency after internal jugular vein catheterization. Early detection of thrombosis and occlusion is essential in infants. As a noninvasive and convenient assessment tool, ultrasound should be used to detect anatomical abnormalities and minimize vascular injury, particularly in infants with a history of catheterization.
The prognosis of childhood cancers has been improved in the past few decades owing to better diagnosis and advanced treatments. This has led to an increase in the population of cancer survivors and also the challenges associated with the management of long-term adverse effects. This case report presents the oral and dental manifestations in an adolescent male cancer survivor who was diagnosed with para-meningeal rhabdomyosarcoma with lung metastasis at infancy. The case was managed successfully with the local radiotherapy along with chemotherapy; however, treatment was associated with maxillary hypoplasia on the right side and altered dental development with multiple teeth as a long-term adverse effect.