Medicine, as both clinical and moral practice, is increasingly complex. As such, there is growing appreciation for the importance of practical wisdom (phronesis), a multidimensional capacity that clinicians develop as they navigate practice. Narrative serves as a mode by which clinical exemplars communicate wisdom and therefore provides a rich structure through which practical wisdom can be observed as manifest in lived experience. The purpose of this study was to analyze clinical phronesis narratives to uncover how participants understand practical wisdom through the real-life challenges of clinical encounters. This article describes a qualitative study using structured interviews of 62 participants (40 medical students and 22 physicians). Phronesis narratives describe a particular clinical situation involving an ethically or professionally challenging patient case in which respondents thought practical wisdom was demonstrated. Narratives frequently identified practical wisdom as being needed in encounters involving patient advocacy, individualized patient care, and communication skills. Character traits associated with practical wisdom included empathy, patience, and emotional intelligence. Narratives most often revealed dimensions of practical wisdom such as person-centeredness, poise, or goal-directed decision making. Findings confirm the clinical relevance and multiple dimensions of practical wisdom in medicine "in vivo" that had previously been described theoretically "in vitro." Analysis also revealed that clinical medical students appear able to observe practical wisdom in their supervising physicians, highlighting the need for role-modeling by wise exemplars. The moral content of clinical medicine can be illuminated by rich narratives that can assist in the formation of wise clinicians. Based on the richness of moral content found in these phronesis narratives, the inclusion of narrative-based practices in medical education may help cultivate practical wisdom in medicine.
Women in the United States (U.S.) healthcare system often receive care that is subpar or inadequate in relation to the care received by their male counterparts. In particular, medical gaslighting appears to be a systemic issue for women, where their symptoms and concerns are often invalidated or outright dismissed by healthcare providers. Utilizing the theory of communicative disenfranchisement, this study used thematic analysis to qualitatively analyze a sample of 21 publicly available videos posted on TikTok by women who had been victims of medical gaslighting in the US. The three major themes in the videos were medical gaslighting as a power-laden process, disenfranchising consequences of medical gaslighting, and vindication through diagnosis. The findings of this study highlight the issues with medical gaslighting of women, and can help improve communication between providers and patients to ensure that adequate and appropriate healthcare is provided. Providers should listen to women as they explain their symptoms and experiences, even if those symptoms and experiences appear to be outside the bounds of evidence-based medicine.
Chronic obstructive pulmonary disease (COPD), which includes chronic bronchitis and emphysema, is highly prevalent worldwide and is the third leading cause of death. While some aspects of the disease were known since the Enlightenment, Laennec's work in the 19th century began the process of our current understanding of this disease. In this narrative review, 13 clinicians and scientists with over three centuries of cumulative experience treating and studying COPD give their perspectives on the science underpinning our modern concept of this disease and its management. These include (1) the challenges of coming up with a name for what is a complex syndrome; (2) the evolution of our thinking on the natural history of the disease; (3) the importance of particulate matter inhalation in its pathogenesis; (4) the often-overlooked but important-and often treatable-systemic effects of the disease that contribute to its morbidity and mortality; (5) the changes in our perspective of not just addressing pathologic or physiologic abnormalities but also measuring outcomes, such as breathlessness or health-related quality of life, that are of considerable importance to the patient; (6) the role of pharmacologic therapy in not only providing symptomatic relief by increasing airway caliber but also in disease modification, especially by reducing exacerbation frequency; (7) lung hyperinflation as an essential feature of COPD pathophysiology, driving symptom burden, exercise limitation, and mortality risk; (8) long-term oxygen therapy, despite being demonstrated to prolong survival in a defined set of hypoxemic patients with COPD, still having unanswered questions regarding its application and delivery; and (9) pulmonary rehabilitation, a major component of the non-pharmacologic treatment of COPD patients and prominently situated in clinical guidelines for this disease. While this, by necessity, must be a brief review of a very complex disease, the perspectives of these esteemed clinicians and scientists should be of use to other clinicians in understanding and managing this disease.
The continuous Medicaid enrollment provision adopted during the COVID-19 pandemic ended in March 2023, after which approximately 24 million individuals were disenrolled. This unwinding was associated with worsening mental and behavioral health, an urgent public health concern in the US. On July 1, 2023, Georgia implemented Pathways to Coverage, a limited Medicaid expansion program that conditions eligibility on meeting monthly work or community engagement requirements. To evaluate changes in mental health outcomes following implementation of Georgia's Pathways to Coverage program. This cross-sectional study with a difference-in-differences design used survey data from the national Behavioral Risk Factor Surveillance System. The analysis compared the survey responses of adults residing in Georgia with those of adults residing in neighboring non-Medicaid expansion states (Alabama, Mississippi, Tennessee, and South Carolina). The sample included adults aged 18 to 64 years with household income at or below 100% of the federal poverty level. The preintervention period spanned January 2, 2017, through March 28, 2023, and the postintervention period spanned July 11, 2023, through December 31, 2024. To account for potential confounding related to the end of pandemic-era continuous enrollment, observations from March 29 through July 10, 2023, were excluded. Implementation of Georgia's Pathways to Coverage Medicaid expansion program. Self-reported number of days in the past 30 days when mental health was not good and self-report of ever having been told that one had a depressive disorder. The analytic sample ranged from 7071 to 7259 observations, depending on the outcome, with a total of 8138 observations in all 5 states. The mean respondent age was 46.4 years (95% CI, 46.1-46.7 years). Most respondents (6155 of 8084 [76.1%]) were single, and 1756 (21.6%) resided in Georgia. Among income-eligible adults, implementation of Pathways to Coverage was associated with an increase of 4.0 days per month (95% CI, 2.0-6.0 days per month; P < .001) when mental health was not good and an increase of 7.2 percentage points (95% CI, 2.4-12.0 percentage points; P = .003) in the probability of ever being told they had a depressive disorder, compared with adults in neighboring non-Medicaid expansion states. In this difference-in-differences analysis of national surveillance data, Georgia's Pathways to Coverage program was associated with worsening mental health among low-income adults. These findings suggest that conditioning Medicaid eligibility on work or community engagement requirements may create additional barriers to coverage and mental health care access, with potential implications for population health and equity.
Previous research has provided valuable insights into how virtual likes and comments on self-presentational content affect users' emotions and self-evaluations, yet less is known about the causal attributions people make in response to such feedback. This study analyzed responses to an open-ended question to explore the types of causal attributions individuals make for favorable and unfavorable feedback on different types of Instagram posts - selfies, elsies (self-images taken by others), and memes. Undergraduate participants (N = 125; 77% female; 81% 17- to 24-years-old) were randomly assigned to one of three image conditions (selfie, elsie, or meme) and told their selected image would be posted to a university-affiliated Instagram account. After a 5-minute distraction period, during which participants believed their image was posted for feedback, they were told they had received either favorable or unfavorable (fabricated) feedback. They were asked to write down the perceived causes of the feedback they received in an open-ended question. Additionally, participants reported their perception of societal attitudes toward selfies compared to elsies, to explore whether these perceptions may have influenced their attributions. Findings revealed that self-focused images (selfies and elsies) more frequently prompted internal attributions - especially appearance-related - compared to meme posts, which elicited primarily external attributions tied to audience reception. Despite recognizing society's negative perceptions of selfie-posters, participants rarely attributed feedback to these broader social norms. The results suggest that posting self-images can heighten self-awareness and self-objectification, leading individuals to internalize social feedback. These attribution patterns carry implications for self-esteem and self-presentation. Understanding how users interpret feedback may inform efforts to promote healthier engagement with social media.
Interest in public involvement in UK health and social care research continues to grow, yet many initiatives are short-lived and offer public collaborators little meaningful influence. Established in 2019 within the NIHR Applied Research Collaboration North West Coast (ARC NWC), the Community Research and Engagement Network (CoREN) was created to provide a sustained platform for co-production of health and social care research. This article reports a theory-informed qualitative process evaluation of the CoREN, examining its progress towards democratic, long-term co-production and the factors that enable or impede it. Methodologically, a qualitative, relational approach informed by deliberative democratic theory was used. Data were collected via semi-structured interviews with CoREN Leadership Group members (n=6) and affiliated researchers (n=4) and three focus groups with community members and partners (total n=17). Framework analysis was applied using a priori and inductive codes. Participants described the CoREN as a coordinating nexus that connects researchers and community organisations, brokers relationships and "plants seeds" that later grow into co-produced projects. Other key impacts included amplifying community voices in the research process, helping to equalise power dynamics in researcher-community relationships, and building research literacy and capacity within communities. Challenges included a lack of clarity regarding the CoREN's role and structure, bureaucratic inertia, and difficulties in including a representative range of diverse and less privileged communities across the region. The CoREN model demonstrates the promise of sustained, non-project-bound engagement networks as a means of strengthening democratic participation in research and building capacity for future co-production. Sustained investment, ongoing feedback and evaluation, and a commitment to overcoming structural barriers to participation are needed to ensure that progress towards equitable community-led research is maintained. This article reports the results of an evaluation of the Community Research and Engagement Network (CoREN), an initiative started in 2019 in the North West of England, aiming to give local people, voluntary and community organisations, practitioners and researchers a longer-term way to work together on health and social care research. To understand the CoREN’s impacts and how it works in practice, we spoke to six members of its Leadership Group, four academic researchers who had worked with the CoREN, and held three focus groups with community members with experience of the CoREN. Participants told us the CoREN helps to link up partners who would not otherwise meet, bridging the gap between academic work and real-world problems, and “planting seeds” that later grow into joint research projects. Other key impacts included boosting the voices of communities in research, helping to balance power in research teams between academics and members of the public, and increasing community understanding of research. However, the network also faces challenges. Some participants were confused about its exact role and felt working with it could be slow or formal. Although it has made progress in including a range of diverse communities in the region, there remains room for improvement. Overall, the CoREN shows how a long-term network can support greater patient and public involvement in research. Further investment, clearer communication about its role, and stronger communication with under-represented groups would help it maintain progress and reach its potential.
Patient and Public Involvement and Engagement (PPIE) is integral to ensuring health research remains grounded in patient priorities and lived experience. This is especially critical for underrepresented groups, such as adults aged 90 and over considering elective total hip replacement (THR). This demographic experiences a small but meaningful risk of postoperative mortality, yet conventional numeric risk communication often fails to align with their values, communication preferences, and the existential context of very advanced age. Traditional PPIE methods, like focus groups, may inadvertently exclude this group due to sensory, mobility, or digital barriers. This PPIE activity engaged eight public contributors aged 90-96 years with lived experience of total hip replacement or caring for someone who underwent it (including two carers) through semi-structured one-to-one telephone conversations, aligned with the GRIPP2 Short Form and UK Standards for Public Involvement. We detail our approach to building rapport and facilitating nuanced conversations remotely, focusing on three domains: research context, communication preferences, and decision-making. Our methodology was designed to prioritise relationship-building and flexibility to overcome barriers to participation. Inductive review of facilitator notes identified three central themes: 1.A Pragmatic Conceptualisation of Risk: Participants framed mortality risk as an acceptable "chance you take," shaped by life experience and advanced age.2.Values-Based Decision-Making: Quality of life outcomes: mobility, independence, and maintaining an optimistic outlook were prioritised over longevity alone.3.The Imperative for Compassionate Communication: Participants emphasised a need for clear, respectful, and multi-modal communication, while explicitly rejecting ageist or overly clinical language. Contributors unanimously affirmed the importance of this topic, feeling that as an underserved community, their perspectives on mortality were both valuable in decision making and long overdue. This PPIE activity involved a small number of contributors and used telephone-only engagement. While this ensured accessibility, it may limit transferability to other contexts. Future work should test alternative formats and include larger, more diverse samples to enhance generalisability to the nonagenarian populations. Nonetheless, the rich feedback insights from this unrepresented group provide a valuable foundation for future work. The findings challenge the primacy of numerical risk presentation for this demographic, underscoring that communication must prioritise dignity, optimism, and clarity. Crucially, contributors affirmed that discussing mortality is a necessary part of informed consent, countering assumptions that this topic should be avoided. These insights directly inform more sensitive and relevant research design and clinical communication tools, ensuring they are grounded in the values and priorities of the patients they are meant to serve. This project involved talking directly to eight contributors aged 90 and over — including people who had undergone total hip replacement (THR) and their carers — to understand their views on the risk of dying from this operation. THR can greatly improve mobility and quality of life, but it carries a small risk of death. Patients and families need this information explained clearly and sensitively. We spoke individually with each contributor by telephone. They told us that:They see the risk of surgery as a normal part of life.Improving their quality of life, by reducing pain and keeping them mobile, is more important than just living longer.Doctors should talk about the risks of hip replacement honestly, respectfully, and using simple words and pictures.The contributors felt they were part of an age group that is often underrepresented and overlooked in healthcare, making their input especially valuable. Their feedback is being used to create better information leaflets and communication guides, ensuring that future patients and their families can have supportive and understandable conversations about surgery.
Non-autistic individuals find it difficult to read the behaviour of autistic people in comparison to non-autistic others. We investigated whether non-autistic people's ability to read autistic individuals is improved by providing diagnostic information, and whether this ability is associated with a person's knowledge about autism, prior contact with autistic people, and autism stigma. Participants (N = 128) viewed videos that were taken from a previous study. These showed autistic and non-autistic individuals reacting to events enacted by the researcher, and participants were asked to infer what event had taken place. Videos were presented either with no diagnostic information, a correct diagnostic label, or an incorrect label (autistic individuals labelled as non-autistic and vice versa). Autism knowledge, contact with autistic people, and autism stigma were measured by questionnaires. Participants performed less well for videos of autistic than non-autistic others. Diagnostic information had little impact on performance, although labelling non-autistic individuals as autistic reduced accuracy. Autism knowledge, contact with autistic people, and autism stigma were not associated with relative strength in interpreting the behaviour of autistic individuals. We conclude it might be difficult to train people to read autistic people's non-verbal behaviour more effectively; instead, intervention might focus on raising awareness of this issue.Lay AbstractRecent research has shown that non-autistic people are prone to misinterpreting the behaviour of autistic individuals, which may contribute to the difficulties autistic people often experience during social interactions. This suggests that interventions should identify ways to improve other people's ability to interpret autistic people's behaviour. However, little is known about what circumstances may improve non-autistic people's ability to read autistic others. This study investigated whether telling people that someone is autistic would improve their ability to interpret the behaviour of that person. We also investigated whether having more knowledge about autism, having previous contact with autistic people, or holding stigmatic attitudes about autism relates to this ability. The researchers used video clips that were recorded for a previous study. They showed autistic and non-autistic people reacting to aspects of the researchers' behaviour, such as being told a joke or paid a compliment. Participants' task was to watch the video clips and infer what the person in each video was reacting to and accuracy in doing so was recorded. The videos were presented with either no diagnostic information or with a diagnostic label alongside the video, which was either correct or inaccurate (labelling autistic individuals as non-autistic and vice versa). We used questionnaires to assess participants' autism knowledge, previous contact with autistic people, and autism stigma. We found that participants had more difficulty judging the reactions of autistic individuals than the non-autistic individuals. Telling participants that a person was autistic did not make people better at interpreting their behaviour, although labelling non-autistic participants as autistic reduced accuracy. Knowledge about autism, previous contact with autistic people, and autism stigma did not relate to a person's ability to interpret autistic people's behaviour. This suggests that it may not be easy to create interventions to improve people's ability to interpret the behaviour of autistic others. Intervention might focus on raising awareness of the need to avoid making assumptions based on the non-verbal behaviour of autistic people.
Reinstating context from encoding to retrieval increases true recognition (e.g., testing object memory on reinstated versus switched background scenes), but context reinstatement also increases false recognition of similar objects (a "context reinstatement illusion"; see Doss et al., Psychological Science, 29, 914-925, 2018). Here we report three experiments extending these context reinstatement effects to semantically associated words (i.e., the Deese/Roediger-McDermott (DRM) false memory task), thereby demonstrating that the context illusion generalizes beyond the object pictures used in prior work. We found robust context reinstatement effects on both true and false recognition, even though participants were told that the encoding and retrieval context would not always match (Experiments 1 and 3). Moreover, context reinstatement boosted claims of "recollecting" details, thereby boosting the typical DRM illusion. By contrast, when we gave a stronger warning to avoid context as misleading (Experiment 2), context reinstatement effects on both true and false recognition were smaller and unreliable, suggesting that strategic attempts to minimize this illusion during retrieval came at the cost of context reinstatement's benefit to true recognition. Overall, our demonstration of a context reinstatement illusion using the DRM task provides another example of how context reinstatement can increase both true and false recognition. These results also provide new evidence that item-context conceptual associations can drive these misleading effects of context reinstatement during memory retrieval.
When we believe something, we favor information supporting that belief, a myside bias. Despite decades of research showing its influence on reasoning, we lack a clear understanding of how context and age influence this bias. We examined how the presence versus absence of an argumentative context shifts information seeking in 484 participants aged 5-55. After making a prediction, participants were tasked with learning whether their prediction was correct or told that they would need to convince another person that their prediction was correct at the end of the experiment. Half were told that another person made a conflicting prediction; half received no information about the other person's beliefs. Participants selected envelopes as information samples, containing information supporting or undermining their predictions. Having to convince someone in the future biased information seeking. This bias increased and changed across the lifespan: 5-year-olds selected positive information supporting their predictions. From age 11, participants selected a more balanced set of self-favoring evidence: positive information supporting their prediction and counterevidence undermining the alternative. The impact of a conflicting perspective depended on the goal. When the goal was convincing, conflict increased information seeking and slightly reduced the bias. When the goal was learning, conflict reduced information seeking and slightly increased the bias. In sum, we showed that myside bias is influenced by the presence of an argumentative context, that is, primarily by the aim of convincing someone in the future and to some extent by the presence of a conflicting perspective, and increases with age. (PsycInfo Database Record (c) 2026 APA, all rights reserved).
The importance of access to reliable information during pregnancy is heightened in pregnancy complications. Impaired fetal growth (including small for gestational age (SGA) and growth restricted (FGR) fetuses) affects up to 10% of pregnancies and is associated with increased risk of morbidity and mortality. However, there is a paucity of accessible, evidence-based, information to support parents told their baby is not growing as expected. This study sought to explore patient experiences of information provision and seeking during pregnancies at risk of impaired fetal growth. Focus groups and individual in-depth interviews (totalling 24 participants from across Aotearoa New Zealand) were conducted and recorded via Zoom. Discussions were led using pre-defined prompts to explore the experiences, preferences, and suggested improvements for information delivery. Interviews were transcribed verbatim, and data underwent inductive thematic analysis. Participants held expectations that their pregnancy would proceed normally; the majority experienced some level of distress at a diagnosis of complications. Information provided by the clinical team was highly valued, particularly when well curated and delivered with empathy. However, for many, this information needed to be supplemented. Additional, nuanced information was sought through online sources, and this included information on causes of impaired fetal growth, the meaning of medical terminology used, and lived experiences of pregnancy and birth. The timing of information provided by their clinical team impacted participant perceived capacity to comprehend information and their response to it. Participants preferred information to be offered at various times, in a range of forms, each adding to the layering of a more complete understanding of their situation. Preferences for information included being able to access a range of credible information in one place to promote greater coherence between the needs and lived experiences of patients and their healthcare providers. Timely, nuanced and salient information is extremely important to pregnant people and their families when navigating high-risk clinical pathways during pregnancy. Our results provide guidance on improving informational resources in the context of impaired fetal growth.
Iconic words, especially animal onomatopoeia, are more prevalent in infant- than adult-directed speech, possibly because iconicity bootstraps word learning. However, because infants may be unfamiliar with the sounds onomatopoeia imitate, it remains unclear whether this advantage reflects greater ease of learning. Across two experiments (2024-2025, Experiment 2-pre-registered), 111 children (69 male, 98 white, 55 18-month-olds, 56 3-year-olds) were randomly allocated to congruent or incongruent groups and told onomatopoeic names for toys that matched or mismatched animal-sounds the toys made. Children were tested on their learning of toys' names. Children learned congruent names significantly better (r ≈ .24); however, the effect was significant only for 3-year-olds. Thus, iconicity in onomatopoeia facilitates children's word learning, possibly more strongly for older children. Adults commonly use words that sound like what they mean when talking to infants. These words may help children learn language. Onomatopoeia, like “moo” or “woof,” are especially frequent, but it is unclear whether they help children learn words because children may not have heard the real sounds they are based on. We did two experiments with 111 children aged 18 months or 3 years. Children were taught new names for animal toys. For some, the name matched the sound the toy made; for others, it did not. Children, especially 3-year-olds, learned matching names more easily. This suggests that when adults use words that sound like what they mean, this supports word learning and may benefit older children most strongly.
Delivering speech and language therapy (SLT) services within mainstream schools remains a global challenge, particularly in contexts with limited professional resources. While multiple service delivery models have been proposed, evidence regarding their feasibility and effectiveness in low-resource educational systems is limited. This study investigated the feasibility and outcomes of selected SLT service delivery models in Iranian regular schools. A randomized controlled trial was conducted in six primary schools in Semnan, Iran, involving 340 children in kindergarten through second grade. Classes were randomly assigned to one of two service delivery models: (a) self-contained classroom, (b) collaborative-consultative teacher-based, and control group. Interventions lasted 10 weeks and targeted curriculum-based vocabulary, syntax, and narrative skills. Children's language abilities were assessed using the Persian version of the Test of Language Development-Primary, 3rd Edition (TOLD-P3) at baseline, immediately post-intervention, and at six-month follow-up. Analyses were conducted using repeated-measures ANOVA with Bonferroni adjustments. Both models demonstrated significant improvements in overall language abilities compared with baseline (p < 0.05). The self-contained classroom model produced broader and more consistent gains across semantic, grammatical, and narrative domains. In contrast, the collaborative-consultative teacher-based model showed selective improvements, particularly in grammar and expressive skills. Findings highlight the feasibility and relative effectiveness of self-contained classroom and teacher-based collaborative-consultative models for supporting children at risk of language difficulties in Iranian mainstream schools. Results underscore the importance of adapting service delivery frameworks to local educational contexts and resource constraints. Future large-scale trials are warranted to confirm these findings and guide national policy on inclusive educational practices.
Substance use disorder (SUD) recovery typically requires transformative change and prioritizing long-term healthy goals. Unfortunately, successful recovery is threatened by relapse rates that typically exceed 50% in the first year. We previously reported on an experiential virtual reality (VR) SUD recovery intervention using personalized future self-avatars that produced emotional engagement and positive behavioral change, ie, stronger connection with the future self and future rewards, and reduced craving. Here, we used fMRI to identify brain engagement to a future self experience with divergent futures. Twenty adults (14 males, 33 years old) in early SUD recovery (<1 year) interacted with age-progressed versions of themselves in two different VR future "realities": an SUD Future Self and a Recovery Future Self. Vivid lifelike visual and audio animation was augmented with a personalized narrative concerning future drug use and recovery. MRI immediately followed. Participants viewed videos of their future selves in the virtual environment and were directed to contemplate what they were seeing during MRI. Viewing and contemplating the future selves elicited activation in midline default mode regions (posterior cingulate and ventromedial prefrontal cortices), visual regions including the occipital and fusiform face areas, and left middle frontal gyrus. The Recovery Future Self produced significant left occipital face area activation compared with the SUD Future Self. Midline default mode activation correlated with VR-induced increases in delayed reward preference, and also with greater trait perseverance. Using digital selves as therapeutic agents reveals novel possible interventions and opens exciting new frontiers in behavior change methodology. Future studies targeting decision-making and future behavior could be informed by evaluating increased midline default mode engagement, with uniquely self-focused mechanisms signaled by executive network and face area coactivation. While preliminary, these data suggest promise for a range of new restorative experiences enabled by immersive digital therapeutics. High relapse rates in early substance use disorder recovery remains a serious challenge. To promote better outcomes, our team recently developed a virtual reality experience where people interacted with future versions of themselves. We used magnetic resonance imaging (MRI) to understand how the brain activated to this experience, and what brain responses were linked to relevant outcomes. We worked with 20 adults in early recovery. Each person used a headset to experience immersive virtual reality and interact with two different future selves 15 years in the future: one who had returned to substance use, and one who had stayed in recovery. These digital future selves looked and sounded like the participants and were paired with a personalized story about future drug use and recovery. Right after the virtual reality session, participants were told to “think about what you see”, while they watched videos of these future selves and had their brains scanned. When people viewed and reflected on their future selves, brain areas involved in self-reflection and imagining the future became activated, along with regions that process faces. The future selves triggered brain activation in “self-focused” brain networks and in face-processing regions. Activity in key “self-focused” brain regions was linked to choosing larger, delayed rewards over smaller, immediate ones, and to lower impulsivity. These findings suggest that lifelike digital versions of people’s future selves engage brain systems that support thinking ahead, persistence, and valuing long-term outcomes, and that the degree of this heightened brain activity corresponds with behavior favoring a better future. This creates a promising new avenue for immersive digital therapeutic experiences to encourage lasting behavior change in early recovery from substance use disorder.
Human immunodeficiency virus (HIV) RNA viral load testing is the gold standard for monitoring antiretroviral therapy (ART), and sustained viral suppression is critical for preventing HIV-related morbidity and transmission. However, children and adolescents with HIV (CAWH) often experience lower viral suppression rates than adults. Data on the incidence of HIV RNA viral non-suppression and its determinants among CAWH in northern Uganda remain limited. To determine the incidence and factors associated with HIV RNA viral load non-suppression among CAWH receiving ART in Gulu City, Uganda. Retrospective cohort study. We reviewed records of CAWH receiving ART at public health facilities in Gulu City. Data were abstracted for HIV RNA viral load outcomes at 6, 12, 18, and 24 months and at the most recent follow-up. The primary outcome was HIV RNA viral non-suppression during follow-up. Bivariable and multivariable Cox proportional hazards regression models were used to identify factors associated with viral load non-suppression. Adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) were reported. Among 218 participants, the median age was 12.5 years (interquartile range (IQR), 7-18), and 153 (70.2%) were female. During follow-up, 99 participants (45.4%) experienced viral load non-suppression. The incidence rate of viral load non-suppression was 25.6 cases per 100 person-years. Factors independently associated with non-suppression included age <5 years (aHR: 2.59, 95% CI: 1.30-5.17), poor ART adherence (aHR: 1.96, 95% CI: 1.21-3.17), non-disclosure of HIV status (aHR: 2.19, 95% CI: 1.27-3.80), advanced WHO clinical stage (III-IV) at presentation (aHR: 3.07, 95% CI: 1.41-6.69), and economic hardship (aHR: 2.13, 95% CI: 1.32-3.42). Viral load non-suppression among CAWH in Gulu City was high, with the majority experiencing viral non-suppression by approximately 6 months after ART initiation. Strengthening adherence support, early disclosure of HIV status, and targeted interventions for younger children and socioeconomically vulnerable households may improve viral suppression outcomes in this population. Why some children and adolescents living with HIV in Gulu City, Uganda, do not achieve viral suppression Why was the study done? The researchers wanted to find out why many children and adolescents living with HIV in Gulu City, Uganda, do not achieve or maintain viral suppression, that is maintaining their viral load at low level. Viral suppression is important because it helps people stay healthy and reduces the chance of transmitting the virus. Children and adolescents often face unique challenges, such as difficulty taking medicines regularly or not knowing their HIV status. How was the study done? The team reviewed medical records of 218 children and adolescents receiving HIV care at public health facilities in Gulu City. They collected information on each person’s HIV viral load results, age, treatment adherence, stage of HIV illness, disclosure status, and family economic situation. They used statistical analysis to find which factors were linked to poor viral control. What did the study find? Nearly half (45%) of the young people did not achieve or maintain viral suppression. Those under five years old, those who missed taking their medicines, those who had not been told about their HIV status, those with advanced HIV disease, and those from families facing economic hardship were more likely to have poor viral control. What do the findings mean? These findings show that medical treatment alone is not enough to help young people living with HIV achieve viral suppression. Stronger support is needed, especially counselling, early disclosure, and help for families facing economic difficulties, to improve adherence and health outcomes. HIV care programs for children and adolescents should combine medical treatment with social and emotional support to help every young person live a healthy, fulfilling life.
Okara, a nutrient-dense by-product of soybean processing, is abundantly produced in many Asian countries and holds significant potential for multiple purposes. Solid-state fungal fermentation represents a promising approach to improve its nutritional quality and functional properties; however, there is currently no research available on how fungal starter selection shapes the metabolites in the final product. This study aimed to investigate and compare the metabolite profiles of okara fermented using five different fungi: three species of Rhizopus (Rhizopus microsporus, Rhizopus oligosporus, and Rhizopus oryzae), Aspergillus oryzae, and Neurospora sitophila. Increased glucan content, which represents the fungal biomass, was observed after all fermentation periods (24 h for Rhizopus spp.; 48 h for A. oryzae; 72 h for N. sitophila). The highest glucan content, at 9.07% w/w, was achieved after fermentation with N. sitophila, representing an 11.20-fold increase, with α-glucan accounting for 6.38%. Meanwhile, R. microsporus yielded the highest β-glucan content at 5.93%, achieving a 20.45-fold increase. The LC-MS results showed that each starter facilitated the expression of different metabolites. A total of 181 metabolites were detected, with Rhizopus spp. notably producing 49-61 unique metabolites, while A. oryzae and N. sitophila distinctively resulted in formation of betaine and L-glutamic acid. In addition, fungal-fermented okara exhibited elevation of phenolic compounds by 2.19- to 4.13-fold and correspondingly possessed superior antioxidant properties compared to non-fermented okara. All told, the present study provides substantial information on considerations in fungal starter selection for fermenting okara.
Traumatic brain injury (TBI) brings inevitable and significant changes for family members, yet there is little to relieve their trauma, resolve their grief, or prevent ongoing suffering. The aim of this qualitative pre-feasibility study was to understand the clinical potential of storytelling for families after TBI using the 'Life Threads' approach (LTA). An in-depth inductive qualitative design was adopted within an interpretivist paradigm. Following informed consent, participants took part in an online focus group, then engaged with the LTA over four weeks before completing an unstructured, in-person interview. A final focus group explored participants' reflections on the LTA. A purposive sample of 20 family members began the study, three withdrew after the first focus group leaving a final sample size of 17. The analytical approach used was Braun and Clarke's reflexive thematic analysis. Eleven participants reported tangible benefits from engaging with the LTA, and thirteen described being able to tell their story in a way not possible through traditional methods. Four main themes were identified: 'Scaling Cliffs with Broken Wings' and 'An Entanglement of Wellbeing' illustrated the evolving and contextual needs of families post-TBI. 'Hear Me, See Me: The Power of Story' highlighted how the LTA facilitated voice, agency, and sense-making, while 'Creating the Conditions for Stories to Be Told' identified the enabling environment required for such benefits to emerge. The findings suggest that the LTA offers a meaningful way for family members to explore, express, and make sense of their experiences following TBI. It supports narrative reconstruction, fosters connection and agency, and provides a rare opportunity for self-reflection. However, implementation must be trauma-informed, paced, and supported by skilled facilitators capable of holding space for complex emotional responses.
Patient-reported outcome measures (PROMs), when used at the point-of-care, provide a mechanism to systematically integrate patients' voices into shared decision-making. We examined clinicians' perspectives on the acceptability and preferred timing of PROM completion in routine clinical care for respiratory, musculoskeletal, cardiac, kidney and diabetic condition management. Semi-structured interviews were conducted over videoconference between October 2024 and May 2025. Participants worked at various New South Wales Health clinics, providing care for patients with chronic conditions, and were eligible to collect and review PROMs digitally using the Health Outcomes Patient Experience platform (NSW PRMs-HOPE program). Reflexive thematic analysis was undertaken. Twenty-two physiotherapists and nurses were interviewed. Acceptability themes included: (1) purpose of PROMs; (2) broader ethical considerations for PROMs collection and use; (3) practical aspects of PROM administration. Findings highlighted the elusiveness of an "ideal" timing for PROMs. Timing themes included: (1) (mis)alignment in timing of PROM administration; (2) preferences for fixed or customised timing and frequency of administration; (3) temporal fit and workflow alignment. PROMs were reported as most acceptable when their selection, content, and timing aligned with clinical purpose, scope of practice, and existing workflows. Flexibility in PROM administration was perceived to enhance relevance at the point-of-care and support timely, condition-specific clinical conversations and interventions. However, clinicians also recognised that increased flexibility may reduce the comparability of aggregated PROM data across cohorts, highlighting an inherent acceptability trade-off between meeting individual clinical needs and supporting system-level performance monitoring and benchmarking. People with long‑term health conditions can fill out health surveys called patient‑reported outcome measures (PROMs). These health surveys help patients share how they are coping day to day and how their health condition or treatment is affecting their quality of life. PROMs are used more in healthcare now, but we do not know enough about how clinicians feel about using them or when they should be given to patients to improve their care.In this study, we spoke with physiotherapists and nurses who use PROMs. They told us what they think about PROMs and when these should be completed by patients.Physiotherapists and nurses said PROMs can help them better understand their patients, find changes in their patients' health, and support conversations about care. But they also said they needed extra time to help patients fill in PROMs, some of the questions were unclear for patients, there were language and cultural barriers for some patients, and they did not always know how to use the results.Overall, physiotherapists and nurses wanted more choice in which PROMs they use and when patients complete them. They felt this would make PROMs more useful for patient care. But, too much choice could make it harder to compare results across clinics and to see how well services are looking after people.
Reading on paper reportedly improves story comprehension compared to its digital version, although the underlying neuroscientific mechanisms remain unclear. We used a format of Japanese manga stories as visual narratives told in halves, each of which depicted the same events from the different perspectives of two protagonists. We examined how the medium used to read the first halves, either on a paper book (Paper preparatory condition) or on an electronic tablet (Tablet preparatory condition), facilitated reading of the second halves for the memorized stories, which they read on an electronic display with continuous empathy ratings. Magnetic resonance scanning was conducted during the latter reading and during answering two sets of questions: Set 1 that could be answered after reading the first half alone, and Set 2 that required comprehension from both halves. Behavioral results showed prospective effects of reading manga stories on a paper book or an electronic tablet, such that the response times were prolonged in Set 2 for the Tablet condition. By comparing the results of Sets 1 and 2 with correct answers for each story, we found significant response time differences for the Tablet condition alone. Moreover, for the Paper condition, activations in the left frontal regions significantly decreased while reading the second halves, and those in the right frontal regions also decreased in Set 1. Furthermore, core left frontal activations were highest in Set 2 for the Tablet condition, while supportive right frontal activations correlated with individual accuracy rates in Set 2 for the Tablet condition, indicating that excessive integration processes support improved performances required by correct answers. The present results demonstrate stronger prospective effects of reading on paper books, such that linguistic and narrative-structural integration processes are facilitated and led to saved excessive activations.
Incorporating lived experiences into research is claimed to enhance depth, relevance, real-world applicability and equity. However, data scientists have been relatively slow to adopt this approach. The "Depression Detectives" (DD) project aimed to bridge this gap by connecting Big Data researchers with individuals with lived experience of depression. Depression is both a significant global health issue and a deeply personal experience. Feelings of isolation often drive people to seek information and support online, making this project's digital presence particularly relevant. Building on methods developed in Parenting Science Gang, we conducted a co-production project within a private Facebook group from February to September 2021. Seventy individuals with depression and thirty researchers participated in discussions and chose a research question. Together, they designed and implemented a survey and focus groups exploring health-seeking behaviours and under-reporting of depressive episodes to GPs. Concurrently, a PhD student analysed UK Biobank data for discrepancies in depression reporting. We used multiple methods to evaluate the process and participant experiences. In the UK Biobank, 67% of individuals whose questionnaire responses indicated depression had no coded GP record of it. Similarly, 84% of DD participants reported visiting their GP for half or fewer of their depressive episodes. Key barriers included stigma, dissatisfaction with healthcare, and a preference for non-medical interventions. These alternatives were perceived as better addressing the root causes of depression. Participants described the research process as rewarding, noting it broadened their understanding both of depression and their own experiences. Researchers valued the insights gained, but found the process demanding. This project demonstrates the value of incorporating lived experiences into mental health research through co-production. Lived experience participants contributed unique perspectives that differed from those of university researchers. By combining these insights with big data analysis, the project generated findings that better reflect real-life experiences, enhancing their applicability to personalised mental health care. Participants found the process to be 'quasi-therapeutic' and advocated for healthcare systems to adopt diverse, holistic treatments for depression. These findings support inclusive policy development and underscore the importance of epistemic justice and democratic knowledge production. Depression affects many people, and researchers want to help. Data scientists use powerful computers to find patterns in large data sets. While data shows what has happened, it is not very good at working out the reasons behind it. People who have experienced depression can have insights that researchers might miss. So sometimes researchers and other people work together. This is called ‘co-produced research.’ We ran a project with data researchers and people who’d had depression. They had online conversations to learn about research and the science of depression. Together, they thought of many potential research questions. They explored these and chose: “Do people report all episodes of depression to their GP? And if not, why not?” Then, they decided which research methods to use. The data scientists checked the UK Biobank, a large health database. They found that 67% of depression episodes were missing from medical records. Had people not told their doctors? The lived experience participants carried out discussions and surveys to find out why. They found that people only visit the GP for about half of their episodes. Reasons for this included feeling hopeless, thinking the GP wouldn’t help, and not wanting antidepressants [medicine for treating depression]. The lived experience participants enjoyed the project. They appreciated the chance to talk to others and reflect on their experiences. They valued the opportunity to do real research, but sometimes found it stressful. The researchers learned more about patient perspectives but found the process hectic. We would like to do it again, but better.