Understanding the mechanisms of nickel (Ni) uptake by hyperaccumulator plants is essential for advancing sustainable phytomanagement. In this study, saponite materials containing either isotopically natural or 61Ni-enriched Ni were synthesised and applied in RHIZOtest experiments with Odontarrhena chalcidica. The amendments were mixed with two ultramafic soils differing in Ni content, alongside a serpentinite control. Ni bioavailability and uptake were evaluated via elemental and isotopic analysis of plant digests and diffusive gradients in thin films (DGT). Stable isotope spiking with 61Ni allowed tracing of amendment-derived Ni uptake into plant tissues, even though total Ni mass fractions in planted versus unplanted soils did not indicate significant mobilisation during the 14-day growth period. Isotope pattern deconvolution (IPD) revealed clear shifts in Ni isotopic composition in both plant and DGT samples. Tracer uptake was more pronounced in the low Ni soil, with amendment-derived Ni (xamendment) contributing 19.3 ± 5.0% of total Ni in shoots, compared to 7.7 ± 1.8% in the high-Ni soil. In standard solutions containing 50 ng g-1 total Ni, isotope pattern shifts were still detectable at enrichment levels as low as 0.01% xspike (≈ 5 pg g-1 61Ni). The findings demonstrate the sensitivity of stable isotope spiking combined with IPD in the detection of subtle uptake processes, even in short-term experiments. This approach enables the differentiation of various Ni sources in soil-plant systems that would not be achievable with quantification alone, and can thereby provide new insights into how soil mineralogy influences uptake dynamics in metal-hyperaccumulating species.
Macrophages are phagocytic immune cells that play a central role in the clearance of apoptotic cells, pathogens and other foreign bodies including particulates that may be injected for therapeutic purposes. Recent work has demonstrated that macrophages that take up microparticles clear pathogens faster; however, the effect of particle uptake on the clearance of apoptotic cells (efferocytosis) remains unclear. Herein, we use cargo-free, non-stimulatory polymeric particles as a tool to investigate how the uptake of such particles affects the efferocytic function of macrophages. Using primary cells isolated from mice, we demonstrate that the uptake of large ∼3 µm sized microparticles, but not smaller 500 nm sized particles, reduces a macrophage's efferocytic ability in vitro. Notably, this effect is pronounced in non-activated M0-type naïve-like macrophages and absent in activated M1- and M2-like macrophages, highlighting polarization-dependent resilience towards particulate stress. Given that efferocytosis contributes to an immunosuppressive tumor microenvironment (TME), we leveraged the phenomenon of microparticle uptake driven lowering of efferocytosis to target apoptotic cell clearance in the TME. In a BALB/C mouse model bearing 4T1 tumors, we demonstrate that direct injection of large microparticles into the tumors results in slower tumor growth. Collectively, these findings reveal that cargo-free, non-stimulatory polymeric microparticles of a specific size impact the efferocytic function of macrophages, which may be utilized to alter the TME for therapeutic purposes.
Classically social prescription interventions focus on loneliness in adulthood, however another transitional stage of the lifespan associated with loneliness is new parenthood. A first-of-its-kind, socially prescribed, creative play programme is being trialed for families with 0-2-year-olds in a deprived ward in the North of England. Yet little is known about the perspectives of key stakeholders on this type of social prescription. This study examined the experience, attitudes and perspectives stakeholders hold around social prescription for families with infants. Individual in depth interview study. This study recruited 12 different stakeholders with practice or policy roles relating to family health and wellbeing, from general practitioners to members of parliament, with different power dynamics and roles to take part in a seven-question semi-structured interview. The interview addressed relationships between stakeholders, how they feel families might value or stigmatize socially prescribed creative play interventions and their thoughts and experiences with social prescription. The interview transcripts were analysed using an inductive descriptive thematic analysis. Three main themes were identified 1) Normalizing a New Offer: Getting it Right the First Time, 2) Barriers to Socially Prescribed Family Intervention and 3) Social Prescription for Complicated Families with Varying Needs. Findings suggest social prescription for families with infants would be welcome, and may relieve strain on our health systems. However, questions remain around how best to deliver such interventions, demonstrating the importance of evaluation to provide evidence to inform wider commissioning and promote sustainability and scaling.
Smoking remains a major issue in the Netherlands. Municipal public health departments (GGDen) and municipalities are playing an increasingly important role in tobacco control policies. However, it is unclear to what extent municipalities actively contribute to tobacco prevention. In recent years, we studied the role of municipal health departments and municipalities in local tobacco control. At the local level, there is a lack of conditions and incentives to prioritize tobacco prevention. To enable municipalities to contribute to national tobacco control goals and prevention, structural funding, clear responsibilities, and measurable targets are needed. Roken blijft een groot probleem in Nederland. We zien dat GGD’en en gemeenten een steeds belangrijkere rol krijgen in het tabaksontmoedigingsbeleid. Het is onduidelijk in hoeverre gemeenten in Nederland concreet bijdragen aan tabaksontmoediging. De afgelopen jaren hebben we onderzoek gedaan naar de rol van GGD’en en gemeenten in lokaal tabaksontmoedigingsbeleid. Op lokaal niveau ontbreken randvoorwaarden en drijfveren om tabaksontmoediging tot een prioriteit te maken. Als we willen dat gemeenten daadwerkelijk een verschil kunnen maken in het behalen van de landelijke doelen op het gebied van tabaksontmoediging en preventie, dan zijn structurele financiering, duidelijke taakstelling en streefwaarden noodzakelijk.
Primary healthcare (PHC) physicians play a pivotal role in the diagnosis and management of hypertension. While guidelines suggest that blood pressure (BP) should be measured in every patient visit at PHC units, the few studies conducted among PHC physicians report a low ratio of BP measurements in PHC settings. Data on PHC physicians' practices concerning BP measurement in Greece are lacking. This study aimed to investigate the practices of PHC physicians regarding BP measurement in Greece. A cross-sectional web-based survey was conducted among PHC physicians across Greece. A total of 284 PHC physicians completed the questionnaire and 282 responses were included in the analysis, 42.9% male, 92.9% General Practitioners, 89.4% working in the public sector, with a median of 25 (17 - 30) daily patient visits. PHC physicians reported measuring BP in 33.3% (20-50%) of their patients and recommending home BP measurements in 31.1% (SD: 24.3%) of them. Among those who measured BP, 22.3% measured it once, 44.7% measured it twice, and only 21.3% measured it three times, while 54.6% used an electronic upper arm BP monitor. The main barriers reported were high daily patient volume (60.5%), together with limited time available with patients (69.5%), while only 1.3% declared insufficient training. This is the first study in Greece investigating the practices of PHC physicians regarding BP measurements. Our findings underscore the need for targeted interventions to improve BP monitoring practices. Education and motivation of physicians and other primary care team members would be fundamental in addressing the challenge of implementing BP measurement recommendations in clinical practice.
Climate change is increasing the frequency and severity of heatwaves across South Asia, with disproportionate impacts on vulnerable populations. Pregnant and lactating women face heightened health risks due to physiological changes, gendered social responsibilities, and constrained access to adaptive resources. Despite this, women's lived experiences and adaptation practices during pregnancy remain understudied and largely absent from institutional climate responses. This knowledge gap hampers the development of effective, gender-sensitive adaptation policies. This qualitative study, embedded within the Heat in Pregnancy (HiP)-India project, will be conducted in three climatically vulnerable sites: Gurugram (Haryana), Bilaspur (Chhattisgarh), and Puducherry. Guided by a socio-ecological framework, we will conduct in-depth interviews with pregnant and lactating women, focus group discussions with caregivers, and key informant interviews with health workers and local stakeholders, alongside non-participant observations. Interviews will take place during and shortly after the heat season to capture both real-time and reflective experiences. Using purposive sampling, we will recruit 20-25 women per site, along with caregivers and stakeholders, primarily from the HiP-India cohort who have consented to follow-up. Data will be thematically analysed using NVivo, with reporting guided by COREQ standards. The study will generate contextualised insights into women's heat-adaptation practices during pregnancy and lactation across diverse agro-climatic zones, document traditional and emerging coping strategies, and identify structural, social, and institutional barriers shaping adaptation capacity. By centering women's lived experiences, this research will inform the design of culturally appropriate, gender-responsive heat adaptation interventions suitable for low-resource settings. Findings will support both practical community-based solutions and evidence-based advocacy for more inclusive climate adaptation policies at local and national levels. Heat Resilience Among Pregnant and Breastfeeding Women in India  As climate change intensifies across India, extreme heat that threatens pregnant women’s health and their babies’ development. Despite their heightened vulnerability, their specific needs remain largely overlooked in both climate adaptation planning and healthcare systems. Recognising this critical gap, researchers from the Heat in Pregnancy (HiP) consortium have launched the HiP-India project to better understand how women navigate these challenges. The study will take place during the summers of 2025–2026 across three diverse locations — Gurugram (Haryana), Bilaspur (Chhattisgarh), and Puducherry — representing different environmental and cultural contexts within India. The research team will talk directly with pregnant and breastfeeding women to understand their daily experiences and how they adjust to heat. They will also speak with family members, community health workers, and local leaders to gain a better understanding of the support available and the challenges women face in staying safe during hot weather. The findings will show how heat affects maternal health and what kinds of support women need. The main goal is to inform better policies and programs that meet the needs of women during pregnancy and early motherhood by identifying practical, affordable, and locally relevant solutions that build resilience and improve health outcomes.
Breast cancer is one of the major causes of cancer-related illnesses and deaths globally, which calls for the use of advanced technologies in early diagnosis, precise imaging, and effective therapy. Quantum dots (QDs) have become extremely versatile nanomaterials due to their size-dependent optical properties, large surface area, and easily modifiable physicochemical properties; thus, they can be used in a wide range of applications from diagnosis to therapy. Latest changes show that inorganic, carbon-based, and graphene-derived QDs can be made more biocompatible, controllable in their targeting, and multifunctional by their synthesis and surface functionalization. Great strides have been made in diagnostic applications such as very sensitive electrochemical and optical biosensors, radiolabeled QD probes, and quantum-optimised artificial intelligence-assisted imaging systems, which can detect at femtogram levels, provide high specificity, and are stable in complicated biological matrices. At the same time, therapeutic interventions including QD-mediated drug delivery, photothermal and photodynamic therapy, and nano-immunotherapy have been demonstrated to exhibit strong antitumor effects, inhibition of tumour recurrence and metastasis, immune microenvironment modulation, and decreased systemic toxicity in animal models. Efforts to transition clinical translation further highlight the increasing significance of QD-based platforms. Taken together, these discoveries position QDs as a potential nanotheranostic platform of the next generation with considerable ability to revolutionize breast cancer diagnosis, treatment precision, and patient outcomes, which, however, necessitate solving issues related to long-term safety, production scalability, and regulatory challenges before successful clinical implementation can take place.
It is always expected that tunneling coupling splits the energy of the eigenstates in proportion to its magnitude. This is also true for bound states in the continuum (BICs) in the waveguide strongly coupled to a Fabry-Pérot resonator. However, in the case of weak coupling, giant enhancement of the splitting takes place. Within the tight-binding model, we show that, in the limit of a weak coupling, the BIC formation conditions take a universal form independent of the particular structure of the periodic perturbations. Moreover, BIC energies become almost uniformly distributed over the energy band of the waveguide in agreement with the Erdős-Turán theorem. Analytical conclusions are supported by numerical calculations of two-dimensional waveguides with finite periodic modulation for both quantum-mechanical and optical cases. The results present a new approach to BIC construction and may pave the way towards quantum design of large-scale integrated systems of giant atoms with spatially distributed coupling to waveguides.
Cognitive behavioral therapy (CBT) is the most effective treatment for binge eating disorder (BED) but is limited by modest efficacy and low reach of in-person delivery. Combining mindfulness training with CBT could enhance efficacy by targeting emotion dysregulation, a key factor in BED that CBT does not adequately target. Digital delivery can enhance the reach of treatment. Accordingly, we developed CBT-based Mindful Courage, a 16-session digital intervention combining CBT and mindfulness training for BED. The aim of this study is to conduct a pilot randomized controlled trial to evaluate the feasibility (intervention and assessment completion) and acceptability (usability, overall satisfaction, engagement, visual appeal of content, understandability of program content, desire to continue the program, perceived skill acquisition, perceived confidence in implementing skills, and perceived helpfulness) of CBT-based Mindful Courage. We will also evaluate changes in outcomes (binge eating frequency, eating disorder symptoms, clinical impairment, and depression symptoms) and mechanisms (emotion dysregulation, dietary overrestriction, and trait mindfulness). This is a parallel-group, single-blinded, randomized controlled trial with a 1:1 allocation ratio. It will be conducted from November 2025 to November 2026, with study assessments at baseline, midtreatment, end-of-treatment, and 2-month follow-up. We will recruit a volunteer sample of adults with BED (N=40) aged 18 to 75 years via online advertisements. Exclusion criteria include a BMI <18.5, current anorexia or bulimia nervosa, and current treatment for BED or weight loss. Participants will be randomly allocated to an active control that includes coached self-monitoring (self-monitoring of food intake in Recovery Record and coaching calls by a research assistant) or to CBT-based Mindful Courage+coached self-monitoring. Both conditions will have a duration of 18 weeks. All study sessions will take place over Zoom. The study was funded in April 2023. Data collection began in November 2025, and we anticipate recruitment to be completed by November 2026. Results are expected to be analyzed by May 2027 and published by May 2028. This will be an important first step in creating a scalable and efficacious treatment for BED. ClinicalTrials.gov NCT07212673; https://clinicaltrials.gov/study/NCT07212673. DERR1-10.2196/91761.
Given significant advances in the treatment of viral hepatitis and the growing epidemic of obesity, the burden of the different types of chronic liver diseases in Bangladesh may be changing. Our aim was to assess the shift in the prevalence of different chronic liver disease etiologies in a tertiary level hospital of Bangladesh over the last 10 years. This was a retrospective observational study conducted in the Department of Hepatology in Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh. It was based on data from the hospital records (2013-2016 and 2017-2022). A total of 4658 patients were included from the hospital registry between 2013 and 2022. The etiologies of chronic liver disease were compared between two time periods: (2013-2016) and (2017-2022) among these patients. A significant decrease in the prevalence of chronic hepatitis B from 51.1% (2013-2016) to 44.4% (2017-2022) (p < 0.001), chronic hepatitis C from 11.3% (2013-2016) to 10.4% (2017-2022) (p = 0.032), and non-B-non-C from 11.7% (2013-2016) to 8.6% (2017-2022) (p < 0.001) was observed. In contrast, the prevalence of nonalcoholic fatty liver disease (NAFLD/NASH) increased from 1.2% (2013-2016) to 8.1% (2017-2022) (p < 0.001); anti-HBc (total) from 3.2% (2013-2016) to 5.1% (2017-2022) (p = 0.001), and autoimmune hepatitis (AIH) from 0.2% (2013-2016) to 0.4% (2017-2022) (p = 0.038) also showed a significant increase. Over the last decade (2013-2022), NAFLD has emerged as a rapidly increasing cause of chronic liver disease in Bangladesh, whereas viral etiologies and AIH show a declining trend. Policy makers, clinicians, and stakeholders should take attention to recognize the situation and act properly.
Paediatric population screening for type 1 diabetes is emerging internationally. It is critically important to understand the acceptability of screening to inform these initiatives. In this systematic review, we aimed to assess the psychosocial impact, acceptability and ethics of screening for paediatric type 1 diabetes. We searched MEDLINE, EMBASE, APA PsycInfo, ASSIA, CINAHL, Web of Science, Scopus, and included quantitative, mixed methods and qualitative articles until 25 November 2025. We assessed the emotional, cognitive and behavioural implications, acceptability or ethics of type 1 diabetes early detection for parents and/or children. We used the mixed methods appraisal tool and critical appraisal skills checklists for quality assessment. We performed a mixed methods evidence synthesis, identifying key themes from qualitative data and merging with quantitative data to generate meta-inferences. Seventy articles (12 qualitative, 57 quantitative and one mixed methods) involving 62,244 parents and 6363 children aged <18 years were included. Seven articles (10.0%) met all quality criteria (high quality), 43 (61.4%) met 60-80% of criteria (moderate quality) and 20 (28.6%) met <50% of criteria (low quality). We generated five themes and 19 sub-themes. Identification of early-stage type 1 diabetes generated anxiety, which waned over time but could recur. Overall, parents who opted into an early detection research programme valued knowing their child's risk and perceived benefits to outweigh harms, although paediatric blood sampling was considered challenging. Research ethics of screening centred on joint decision making according to the child's age, right to results disclosure and importance of data integrity. We synthesised a large pool of heterogenous studies, reflecting how understanding of early disease has evolved, but likely influencing the acceptability of screening. This, the most comprehensive review of the literature to date, demonstrates that despite the emotional, cognitive and behavioural implications, thus far, screening and early detection of paediatric type 1 diabetes appears to be acceptable to parents/guardians who take part but critical evidence gaps remain. PROSPERO registration no. CRD42024566937 FUNDING: EDENT1FI (grant no. 101132379).
Suicide is a leading cause of death among young adults and is influenced by economic crises and the COVID-19 pandemic. This study aims to examine trends in suicide mortality rates in Türkiye between 2007 and 2022 using Joinpoint regression analysis. This retrospective ecological time-trend study utilized publicly available data from the Turkish Statistical Institute. Suicide mortality rates per 100,000 population were calculated by age and gender. Joinpoint regression analysis was applied to identify significant changes in trends over time. Annual Percent Changes (APCs) and Average Annual Percent Changes (AAPCs) were computed. The overall suicide rate increased annually by 5.86% (95% CI: 1.24-12.50) between 2019 and 2022. For females, the APC was 8.11% (95% CI: 0.96-18.43) in the same period. For females, a decreasing trend was observed from 2007 to 2019 (APC: -2.27%), followed by a significant increase between 2019 and 2022 (APC: +8.11%). In contrast, the suicide rate among males exhibited a consistent upward trend from 2007 to 2022 (APC: +2.28%). It has been shown that suicide-related deaths in young adults in Türkiye are increasing. The fact that the increase especially in women is significantly high requires health authorities to take steps in this field.
A traditional view of selective attention distinguishes between goal-directed and stimulus-driven mechanisms of attentional control. More recently, a large (and growing) body of research has identified a third class of control system-termed selection history-wherein attentional prioritisation is shaped by our prior experience with stimuli, independently of our goals and the physical salience of those stimuli. This article reviews work within this selection history literature demonstrating that prioritisation is rapidly and automatically modulated by learning about the rewards associated with stimuli, and argues for a framework that distinguishes between history-driven processes implementing attentional exploitation (the drive to leverage reliable information) and attentional exploration (the drive to resolve uncertainty, with the aim of validating potential new sources of information). Findings such as these highlight a fundamental and intricate interaction between learning and attention, wherein our prior experience shapes the way in which we extract information from our environment - with potential consequences for understanding the subsequent decisions that we make and choices that we take.
Despite playing a significant role in the development of a child, prevalence of exclusive breastfeeding remains unsatisfactory in both global and low- and middle-income countries' context, which includes Bangladesh. Since women are the primary providers of exclusive breastfeeding, understanding their level of empowerment and autonomy over decision making is critical. This study aims to examine the effect of women's empowerment on exclusive breastfeeding in Bangladesh. A nationally representative data from the 2022 Bangladesh Demographic and Health Survey (BDHS) was analyzed. Data on 884 women of reproductive age whose youngest child was under six months of age, and living with her were extracted. Exclusive breastfeeding was determined from children aged under six months who received only breastmilk during the 24 h preceding the interview and women's empowerment was developed following the DHS guideline. Bivariate relationships were assessed using chi-square tests, while generalized estimating equations (GEE) were used to account for clustering in multivariable analyses. For causal inference, the g-formula, inverse probability weighting (IPW), and doubly robust (DR) estimators were applied, with bootstrap confidence intervals for g-formula and DR methods. Among 884 mothers with infants under six months, 52% practiced exclusive breastfeeding. Multivariable GEE analysis identified mother's employment, division, child's sex, early initiation of breastfeeding, and women's empowerment as significant predictors of exclusive breastfeeding. Empowered mothers were found to have 35% higher odds of exclusively breastfeeding (OR = 1.35, 95% CI = 1.02, 1.79). Causal effect estimation using all the methods showed that women's empowerment significantly increased the odds of exclusive breastfeeding by 33%. Women's empowerment is a significant determinant of exclusive breastfeeding in Bangladesh. Women with agency to take their own decision over health, household, and mobility, awareness regarding their rights, and sense of dignity are more likely to exclusively breastfeed their infants. Therefore, interventions and policies should be designed and executed to enhance women's decision-making autonomy to improve exclusive breastfeeding rates and, consequently, child health outcomes.
Causal inference of the effect of a treatment on an outcome is usually done on the group or subgroup level. Although the typically reported average treatment effect may be positive, suggesting that the treatment is effective, at the level of individual participants, the treatment effect may be zero or even negative-the treatment may even harm some individuals. For making decisions on whether a specific person should take the treatment, information on the probability of benefiting or being harmed by the treatment for a single person is necessary. Estimating the probability of possible benefit or possible harm for a person involves counterfactual reasoning and thus strong assumptions about unobservable events. Precise statements about the causal effect of a treatment for an individual are only possible to a limited extent. This tutorial introduces the method of causal attribution to psychology that allows for estimating bounds in which the probability of benefit or harm lies. These bounds can be calculated using data at the group level, which can come from experimental or observational studies. The bounds can be narrowed by simultaneously using data from both randomized trials and observational studies and by using information from pretreatment covariates. R functions are provided for calculating these bounds from binary data and are illustrated with examples from basic laboratory research and clinical intervention research. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
Oral contraceptives are a popular choice of contraception globally. The objective was to assess whether oral contraceptive use is associated with diagnosis, treatment, and symptoms of depression in healthy women. Databases (MEDLINE, EMBASE, and PsycINFO databases via OvidSP for relevant studies, from database inception to 01 July 2025) were searched for prospective and observational studies comparing users of any currently prescribed oral contraceptives to non-users. Binary outcomes were summarised via relative risks (RR) with 95% confidence intervals (95% CI). Continuous outcomes were evaluated via standardised mean differences (SMD) along with 95% CI. Main outcomes and measures included incident depression diagnosis, antidepressant initiation, and depressive symptom scores measured with externally validated depression scales. Out of 438 screened references, 14 (2,425,648 participants) were included in the analysis. Of the five studies (1,607,461 participants) that examined depression diagnoses, oral contraceptives were associated with a 31% increased relative risk of being diagnosed with depression compared to non-users (RR: 1.31; 95% CI: 1.07 to 1.61, I2 = 94.18%, moderate certainty, high heterogeneity). Three studies (2,150,352 participants) with incidence of antidepressant use showed oral contraceptive users were 25% more likely to take antidepressants than non-users (RR: 1.25; 95% CI: 1.20 to 1.30 I2 = 75.4%, moderate certainty). Eight studies (2,525 participants) measuring depressive symptom scores found oral contraceptive users had statistically significantly higher, but clinically small, differences in depressive symptom scores than non-users (SMD: 0.12, 95% CI: 0.05 to 0.20). Subgroup analyses of depressive symptom scores showed no evidence of group differences by study design, follow-up length or progestogen content. Evidence from this meta-analysis suggests oral contraceptive use is associated with increased risks of depression diagnoses, antidepressant initiation, and higher depressive symptom scores. The findings, which reflect the association between hormonal oral contraceptives and depression in women without pre-existing psychological or gynaecological conditions, suggest that adverse effects on mood should be closely monitored by contraception prescribers.
Parental factors are known determinants of internet gaming disorder (IGD) among adolescents. However, the associations between gaming-specific parental factors (eg, parental gaming frequency and parental invitations for cogaming) and IGD have been less investigated, and relevant longitudinal evidence is lacking to inform effective IGD interventions. This study aimed to investigate (1) the prevalence of IGD conversion (from a noncase at baseline to a case at follow-up) and (2) the prospective associations between two parental gaming behaviors and IGD conversion as well as their mediation mechanisms via parental supportive attitude toward adolescents' gaming behaviors and behavioral intention of increasing gaming time. A 12-month prospective longitudinal study, with the baseline survey in December 2018 (T1) and the follow-up survey in December 2019 (T2), was conducted among students from 6 convenience-selection junior middle schools in Chengdu and Guangzhou, China. All grade 7 and 8 students of these schools were invited for participation; students self-administered the structured questionnaire on paper and pencil, in classroom settings, and in the absence of schoolteachers. The 9-item DSM-5 Internet Gaming Disorder Symptoms Checklist was used to assess IGD (Cronbach α=0.73). Those with IGD at T1 were excluded, and the final sample size was 2172 (mean age 12.56, SD 0.02, 95% CI 12.52-12.60 years; n=1102, 50.7%, 95% CI 48.7%-52.8% female). The prevalence of IGD conversion was 5.2% (113/2172; 95% CI 4.4%-6.1%). Adjusted for background factors and respective mediator and outcome scores at T1, two path analysis models showed satisfactory model fit indices (ie, root mean square error approximation=0.02 and 0.03, comparative fit index=0.97 for both models, and standardized root mean square residual=0.02 for both models). The prospective associations between perceived parental gaming frequency and perceived parental invitations for cogaming and IGD conversion were significantly and fully mediated by the 1-mediator indirect path via parental supportive attitude (β=0.02, 95% CI 0.01-0.04 and β=0.02, 95% CI 0.01-0.04) and the 2-mediator indirect path first via parental supportive attitude and then via behavioral intention of increasing gaming time (β=0.006, 95% CI 0.002-0.009 and β=0.005, 95% CI 0.001-0.009) but not the 1-mediator indirect path via the behavioral intention (β=0.01, 95% CI -0.01 to 0.03 and β=0.01, 95% CI -0.01 to 0.03), respectively. This longitudinal study revealed the prospective associations between 2 parental gaming behaviors and adolescent IGD conversion, as well as the mediation mechanisms, addressing inconsistencies in previous cross-sectional studies and filling in the knowledge gap in longitudinal studies that overlooked parental gaming behaviors. It suggests that parental gaming behaviors may form important family environments shaping adolescents' perceptions and behaviors related to internet gaming. Family-based prevention and intervention programs on IGD conversion may hence take into account these findings.
When outbreaks of emerging and reemerging zoonotic diseases are discussed, little attention is paid to differential gender impacts, or to gender involvement and roles in different settings during the outbreak. Gender roles shape how individuals' interactions with animals, wildlife, other people and the environment, which influences exposure to zoonotic pathogens. For example, in some rural communities, men may face risks of exposure to emerging pathogens during hunting whilst women who primarily take care of domestic animals may face prolonged exposure to other zoonotic diseases. In some settings, women (and men) lack access to health protection, education or communication with health officials (medical doctors or veterinarians). In some cultures, women are not allowed to speak directly with male service providers, further limiting their access to critical information and services. One Health is a holistic, inclusive approach which should be incorporating a gender lens when considering zoonoses. This includes thinking about the need to create appropriate gender sensitive policies that address disparities in surveillance, response, prevention, detection, and control of the disease (or health issue) being addressed. In this paper, we highlight these issues through several case studies that demonstrate the importance of including gender in zoonotic disease response and, ideally, when implementing prevention measures.
MRI is essential for diagnosing and monitoring neurological diseases. Conventional protocols require multiple sequences to obtain complementary contrasts, increasing scan time, cost, and tolerability. Generating multiple contrasts from a single acquisition may streamline workflow while maintaining clinical utility. To train attention-based convolutional neural networks (ACNNs) to generate clinical-quality Fluid-Attenuated-Inversion-Recovery (FLAIR), Magnetization-Prepared-Rapid-Gradient-Echo (MPRAGE), R2* maps, and derived contrasts from a single Gradient Echo Plural Contrast Imaging (GEPCI) acquisition. Retrospective. 43 MRI scans from individuals with multiple sclerosis (25/18 F/M, 49 ± 11 years-of-age). 3 T MRI, 3D GEPCI, MPRAGE, and FLAIR. Technical quality of AI-generated contrasts was evaluated against directly acquired MRI using structural similarity index (SSIM). Clinical image quality was assessed by physicians. Lesion volumes and counts were obtained using automated segmentation. One-sample one-sided Wilcoxon signed-rank test was used to establish the clinical quality of images. Agreement between native- and AI-derived lesion volume and lesion count measurements was assessed using intraclass correlation coefficients (ICC). Quantitative accuracy for R2* maps was evaluated using normalized root-mean-square error (NRMSE). AI-generated FLAIR and MPRAGE achieved mean SSIM values of 0.923 ± 0.028 and 0.935 ± 0.022, respectively. Generated R2* maps achieved a mean SSIM of 0.996 ± 0.006 and NRMSE of 0.031 ± 0.020. Physicians-assigned mean clinical quality ratings of 4.2 for GEPCI-FLAIR and 4.5 for GEPCI-MPRAGE exceeded the 4.0 clinical standard on a 1-to-5 scale. Lesion volume and count comparisons from automated segmentation showed strong agreement between AI-generated and ground-truth measurements: R2 = 0.988 and R2 = 0.933, ICC = 0.988 and ICC = 0.967, respectively. AI-GEPCI generated multiple clinically relevant MRI contrasts from a single GEPCI acquisition with high similarity to corresponding acquired images, supporting high-quality, intrinsically co-registered multi-contrast brain evaluation. 2. Stage 1. This study developed a new MRI method called AI‐GEPCI that can create many important brain images from a single scan. Normally, people with neurological diseases need several different MRI scans, which take a long time, are costly, and can be hard to tolerate. We trained artificial intelligence (AI) to turn one GEPCI scan into several clinical images (called FLAIR, MPRAGE, and R2*) that doctors routinely use. The AI‐generated images looked very similar to standard MRI images and were rated as high quality by physicians. This approach may allow faster, more comfortable, and more consistent MRI exams for brain diseases.
Post-traumatic stress disorder (PTSD) is a common psychiatric condition, with a global prevalence of 3.9% and a lifetime prevalence of 7.4% in the Netherlands. Although numerous evidence-based treatments are available, their use varies considerably. Understanding patient perspectives and experiences in the decision-making process when choosing a specific treatment is crucial for improving the quality of care. This study aimed to explore the decision-making process from the perspective of patients with PTSD, focusing on their considerations and experiences when choosing a specific psychotherapeutic treatment. In this qualitative study, twelve semi-structured interviews were conducted with patients with PTSD (aged 21-55 years) receiving care at a mental health organisation in the east of the Netherlands. Data were analysed using reflexive thematic analysis, informed by grounded theory-inspired analytic techniques. Analysis was iterative and inductive, focusing on the identification and interpretation of patterns of meaning across patients' accounts. Five themes were identified, connected through an overarching interpretive concept of patient-attunement: (1) the role of treatment characteristics (2), the role of therapeutic factors (3), the role of treatment duration and intensity (4), the role of significant others, and (5) the role of information about trauma-focused treatment. Patients emphasised the importance of personalised information and support from clinicians and significant others. Ongoing responsiveness within the therapeutic relationship, including trust and collaboration, was central to experiencing the decision-making process as supportive and meaningful. For patients with post-traumatic stress disorder, multiple factors play a role in choosing a psychotherapeutic trauma-focused treatment. This study shows that continued attunement to patients' diverse needs is central to the decision-making process. Such attunement may take various forms, including attention to the therapeutic relationship, discussion of treatment characteristics and frequency, and responsiveness to patients' preferences regarding information provision. Involving patients' support systems may further support decision-making. Together, these findings suggest that clinicians should remain attentive to patients' needs at multiple points during the pre-treatment phase. Approaches such as shared decision-making may help facilitate this attunement. Not applicable.