ConspectusAccurate equilibrium geometries are fundamental to predictive spectroscopy, reliable thermochemistry, and rational molecular design. Yet achieving high accuracy beyond small molecules remains a formidable challenge. High-level wave function methods, while exceptionally accurate, are computationally prohibitive for systems containing dozens of atoms. Density functional approaches, though efficient, often lack consistent reliability across diverse chemical environments. Though reduced-scaling strategies have enabled precise energy calculations for large systems, equivalent progress in the determination of equilibrium structures has been slower, leaving a persistent gap between the predictive accuracy and computational feasibility.This Account presents an integrated framework that tries to bridge this gap by combining composite quantum-chemical methods, data-driven corrections and fragment-based modeling. At its core lie explicitly correlated composite schemes capable of delivering mÅ/mrad accuracy (usually referred to as spectroscopic accuracy) for the geometrical parameters of molecules with up to about 20 atoms. These methods underpin the construction of a benchmark-quality geometry library (LCB25), comprising nearly 400 fragments encompassing all major functional groups and ring systems relevant to chemical, biological and pharmaceutical applications.Building on this reference, systematic bond-based corrections derived from LCB25 transfer spectroscopic-level accuracy to more affordable double-hybrid and hybrid functionals. Linear regressions suffice for double-hybrid models, while machine-learning Δ-corrections extend the same accuracy to hybrid functionals. Together, these refinements lead to geometries of near-spectroscopic accuracy for medium and large molecules (50-100 atoms) at a fraction of the cost of high-level composite methods. For larger architectures, the Nano-LEGO platform automates the assembly of accurate molecular geometries from preoptimized fragments, preserving the local structural fidelity within complex frameworks.Within this modular and hierarchical approach, continuous chemically meaningful descriptors known as synthons serve as the common language linking fragment-based modeling, data-driven corrections, and machine-learning predictions. This representation facilitates the transfer of local structural information across chemical families and supports the exploration of vast regions of chemical space with controlled accuracy.The same principles extend naturally to the design of functional and sustainable materials. Spectroscopically accurate yet affordable structural predictions are instrumental in the rational development of organocatalysts, molecular components for optoelectronic devices and supramolecular frameworks for applications aligned with the goals of circular economy.These methodological advances are complemented by efficient optimization algorithms, vibrational corrections based on second-order vibrational perturbation theory, and fully interoperable workflows that ensure scalability and robustness. Collectively, they establish a hierarchical data-enriched ecosystem delivering accurate, transferable, and cost-effective molecular geometries. Applications range from atmospheric and astrochemical intermediates to biomolecules, pharmaceuticals, and sustainable molecular materials, paving the way for predictive spectroscopy and structure-based design. All components of this framework are openly available through web platforms and GitHub, promoting transparency, accessibility, and community development.
Acute Achilles tendon ruptures (AATRs) are devastating injuries for athletes, yet outcomes in elite rugby union players remain poorly characterized. Elite rugby union players who sustain AATRs will demonstrate significantly reduced performance metrics postinjury compared with preinjury levels. Retrospective case series. Level 4. A retrospective review of elite rugby union players who sustained Achilles ruptures from 2013 to 2025 was performed. Data, including player demographics, injury characteristics, and performance metrics, were collected from rugby databases and media reports. A Wilcoxon signed rank test was used to compare pre- and postrupture performance metrics. Effect size was calculated using matched-pairs rank-biserial correlation, with median paired differences and 95% CIs. A P value <0.05 was determined as statistically significant. A total of 52 elite rugby union players with a median age of 28 years were identified. Overall, 80.8% of players returned to play (RTP) at a median time of 8.5 months. In the season immediately after injury, games played, tries, tries per game, points, and points per game were all significantly lower than preinjury values (all P ≤ 0.003; r = -0.49 to -0.61). Across all seasons, games per season, tries per season, tries per game, points per season, and points per game were significantly lower after injury (all P < 0.001; r = -0.47 to -0.72). AATRs in elite rugby union players were associated with significant declines in performance metrics in both the immediate postinjury season and across subsequent seasons. These findings highlight the substantial performance impact of AATRs and support the need for improved position-specific prevention strategies and targeted postinjury rehabilitation protocols. Clinicians can use these findings to counsel rugby athletes and teams on prognosis, treatment decisions, and realistic performance expectations after AATRs.
Many countries use geographical funding formulae to distribute public funds for health care to local planning areas in proportion to need. In England, these aim to distribute resources in proportion to all healthcare needs regardless as to whether these are currently met or unmet. The National Health Service also has an additional objective to allocate resources to reduce health inequalities (i.e. differences in health between socioeconomic groups). Adjusting for unmet needs could help achieve this second objective, if a greater proportion of needs are unmet in disadvantaged socioeconomic groups with poorer health compared to more advantaged socioeconomic groups. Alternatively, if there are greater unmet needs for relatively expensive conditions that tend to affect older age groups (e.g. cancer), this could lead to a greater proportion of needs being unmet in more advantaged socioeconomic groups, who will tend to be older due to greater life expectancy. Adjusting for unmet needs would then lead to allocation of a greater share of resources to these more affluent populations with better health, potentially increasing health inequalities. It is, however, unclear how met and unmet healthcare needs should be measured in these formulae and how better accounting for unmet needs influences health inequalities. We outline a framework for estimating the relative need in geographical healthcare resource allocation and show how the distribution of needed resources between local health planning areas in England changes when accounting for unmet needs due to underdiagnosis for 11 long-term conditions. We derive a synthetic data set for all people aged ≥ 30 years in England, in 2018, including age, sex, socioeconomic deprivation, region, local health planning area and whether people have diagnosed or undiagnosed long-term conditions. We calculated the annual primary and secondary care costs for each condition using linked electronic healthcare record data, then estimated needed expenditure for each health planning area for two scenarios: (1) when only accounting for diagnosed cases and (2) including all cases (diagnosed and undiagnosed). We examine how the distribution of need between places changes between these scenarios and the consequences of this for health inequalities. Based on the estimates of underdiagnosis used, areas with the lowest overall needs tended to have a greater proportion of their needs unmet. Adjusting resource allocation by accounting for these unmet needs due to underdiagnosis would move resources from areas with the highest level of needs to areas with lower overall needs. Moving to this 'fair share distribution' would tend to benefit less deprived areas more than more deprived areas, potentially widening health inequalities. We show how accounting for unmet needs due to underdiagnosis in allocating resources could widen health differences between more and less deprived areas when underdiagnosis and treatment costs increase with age. Further research is needed to confirm our provisional estimates, but we provide a useful framework for improving assessments of relative need for healthcare resource allocation. Alternative approaches are likely to be needed where resource allocation policy additionally aims to reduce health inequalities. This article presents independent research funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme as award number NIHR130258. Many countries share out healthcare funding to local areas so that places with greater needs get more money than places with fewer needs. The National Health Service aims to account for unmet needs, for example undiagnosed conditions, in this process. The National Health Service also tries to share out resources to reduce the gap in health between more deprived and more affluent populations. It is unclear how providing a greater share of resources to those places with more undiagnosed conditions might influence this health gap. For 11 serious health conditions, we estimate the number of people diagnosed and undiagnosed and the costs of treating these conditions for each local health planning area in England. We estimate the share of the National Health Service budget that each area would receive in two scenarios. Firstly, providing each area with sufficient resources to treat the number of people diagnosed, and secondly, providing each area with sufficient resources to treat the number of people diagnosed or undiagnosed. We assess the likely effect on the gap in health between more deprived and more affluent populations of moving from the first to the second scenario. We estimate that more affluent areas would receive a greater share of National Health Service resources when the number of undiagnosed people were considered compared to when only diagnosed people were taken into account. This would widen the health gap between more deprived and more affluent populations. This is because, diseases that were more prevalent in older populations were estimated to be less likely to be diagnosed and more expensive to treat, and more affluent places tend to have older populations. Estimates of the number of people with undiagnosed conditions in each area are, however, very uncertain and better data are required to improve the accuracy. We provide a framework for improving these estimates.
Caregiving can be time-consuming, and it can be challenging for caregivers to combine caregiving tasks with other obligations. While we know a lot about the problems of combining informal care with employment and family obligations, past employment and family histories are seldom discussed. This study tries to fill this gap by examining the association between employment and family histories and caregiving in later life. We used pooled data from the Survey of Health, Ageing and Retirement in Europe (SHARE, waves 1 and 2) and the English Longitudinal Study of Ageing (ELSA, waves 2 and 3) and combined them with the life history interviews from both surveys conducted in wave 3. First, we used sequence analysis and cluster analysis to analyze employment, partnership, and children histories between 25 and 50 years of age, separately for men and women. Then, we used logistic regression analysis to examine the relationships between these clusters and informal caregiving at ages 50 and above. Results indicate that women who stayed home (homemakers) and those who were self-employed were more likely to provide informal care in later life. Partnership histories matter only for men. Men who were separated were less involved in in-household caregiving and more in care provision outside of the household. Furthermore, childless men and women were more likely to be caregivers. Finally, differences in long-term care policies across countries significantly affected the likelihood of informal caregiving for men and women.
The history of the German Society for Experimental and Clinical Pharmacology and Toxicology (DGPT), which has played an important role in pharmacology in Germany and Europe for more than 100 years, is examined in this article. Many studies have addressed parts of this history, but they usually focus on short periods or specific topics. This article tries to bring together and explain the main sources on the DGPT and the development of pharmacology in German-speaking countries. Important references include early works by Philippu and Seifert, chronological surveys by Lindner, and the multi-volume histories by Philippu. Personal and institutional sources, such as Wolfgang Heubner's diaries and the DGPT Archive curated by Erich Muscholl, are also discussed. Using the sources of the archive, several articles about the DGPT's history have been published. The society's history during the Nazi era, the division of Germany after 1945, the reunification of German pharmacology, and the development of its journals and organizational structure are reviewed. Rather than providing a full historical account, this article offers a clear guide to the most relevant sources and lays the groundwork for future research on the DGPT.
There has been a persistent lack of synthesized knowledge on mental health treatment models that attune to the realities of low-income countries at large. To address this significant mental health knowledge gap, this scoping review tries to identify and synthesize the literature on psychological intervention models developed for or adapted to these contexts. After conducting a thorough search of academic databases, we went through a two-stage screening process to identify relevant articles. From those eligible studies, we collected and organized data on various theoretical and therapeutic counseling models, synthesizing the information into clear themes. The 42 included articles revealed five primary model categories: (1) Task-Shifting and Simplification, (2) Indigenous and Culturally-Grounded, (3) Systems-Level and Meta-Models, (4) Cultural Adaptation Frameworks, and (5) Technology-Based Delivery. The results indicate evidence base for the effectiveness of task-shifting simplified Western therapies and a growing movement toward validating indigenous psychologies. The findings demonstrate a clear shift toward pragmatic and culturally grounded interventions. Task-shifting is proven to be a promising approach in the field, but its effectiveness depends on having intense supervision. It is vital for research to focus on making the strategies sustainable for the long run, assessing their economic effectiveness, and comparing different models to see what works best for low-income nations.
Pulmonary arterial hypertension (PAH) is a severe disease characterised by a progressive thickening and obliteration of pulmonary vessels, resulting in increased vascular resistance, elevated pulmonary artery pressures, and right heart failure. Among the various conditions associated with PAH, systemic sclerosis (SSc) is the most common in Western countries. Compared to other forms of PAH, SSc-PAH presents with a more aggressive clinical course, poorer response to conventional therapies and a worse prognosis. However, despite these differences, the overall management of SSc-PAH remains close to idiopathic PAH; and therefore, there is a crucial need for treatment strategies dedicated to this disease. To help fill this gap, we assessed the level of evidence currently available on SSc-PAH management in a systematic literature review that compiled data regarding conventional therapies, immunosuppressants, nonconventional drugs and surgical/interventional procedures. For each study, we highlighted the results specific to the connective tissue disease or SSc subgroups, the haemodynamic characteristics of the patients, and their comorbidities. By doing so, we identified critical gaps in the field, consisting mostly of the lack of studies focusing on SSc-PAH, a substantial heterogeneity in haemodynamic severity (with notable scarcity of data for mild PAH) and the systematic exclusion of relevant comorbidities (such as interstitial lung disease). Building on these data and our cumulative experience, we provide pragmatic, experience-based suggestions tailored to the management of SSc-PAH, that tries to capture the full scope of clinical situations encountered in these patients and help clinicians manage difficult cases where robust data are lacking.
The present study tries to examine spatial health disparities between tribal and non-tribal districts in Odisha, identifying key socio-economic, infrastructural, and behavioural factors driving these inequities. Using a composite Health Deprivation Index based on thirteen health indicators the analysis draws on secondary data from NFHS-5 (2019-21), Annual Health Survey (2012-13), and HMIS (2017-19). The findings reveal severe health deprivation clustered in socio-economically marginalized, predominantly tribal, and geographically isolated districts like Balangir, Nabarangapur, Kandhamal, Malkangiri, and Nuapada. Transitional districts such as Koraput and Sundargarh show a dual burden of persistent tribal health inequities alongside rising non-communicable disease risks. The study highlights the inadequacy of uniform health interventions in addressing these disparities and calls for geographically differentiated, context and region specific strategies, prioritizing maternal-child healthcare, sanitation, female education, and culturally tailored behaviour change initiatives.
B cells contribute to many facets of adaptive immunity, including key roles as Ag-presenting cells, cytokine-producing cells, and plasma cells secreting protective antibodies. However, B cell functional dysregulation can result in myriad immune dyscrasias, such as immunodeficiency, chronic infection, autoimmunity, allergy, and malignancy. Thus, it is critical to understand fundamental aspects of human B cell differentiation and effector function. A B cell subset that has attracted much attention over the past 2 decades is a population known by many identities-CD21lo, atypical memory, CD27negIgDneg, age-associated, exhausted-and associated with many diseases, especially humoral immune dysregulation. However, these cells likely also contribute to humoral immunity in the setting of vaccination and natural infection. This Review tries to provide an overview of the discoveries, origins, and complexities of CD21lo B cells, and how studying inborn errors of immunity can provide a unique window to understand the molecular requirements for generating these cells, as well as mechanisms underpinning function in health and disease.
Soil associated with intensive poultry farming serves as a seminal reservoir of antimicrobial resistance genes. This study employed an integrated approach that combined metagenomics, phenotypic analysis, and whole-genome sequencing to investigate the soil resistome of poultry farms in the Jorhat district, Northeast India, and to evaluate Bacillus altitudinis as an environmental potential indicator for antimicrobial resistance. Metagenomic analysis of poultry-affected soil revealed a diverse array of resistance genes, including 753 unique resistance ontologies related to β-lactam, glycopeptide, macrolide, aminoglycoside, chloramphenicol, and colistin resistance. Culture-based testing of soil and fecal isolates (400 isolates) showed high resistance rates to colistin and ciprofloxacin (~60%), as well as notable resistance to erythromycin and kanamycin, indicating strong antibiotic selection pressures in these ecosystems. Among multidrug-resistant strains, B. altitudinis S2 was particularly notable, exhibiting high minimum inhibitory concentrations for last-line antibiotics such as vancomycin (>50 µg/mL), colistin (>50 µg/mL), and fourth-generation cephalosporins. It also demonstrated multidrug β-lactam resistance supported by synergistic inhibitors. Whole-genome sequencing (3.7 Mb) uncovered a complex antimicrobial resistance gene (ARG) profile, including vanZ, mcr-1, catA, mph, aph, and oxa-type β-lactamase genes, alongside multiple SMR, MATE, and RND efflux mechanisms. Many of these genes were located within genomic islands, prophage traces, and mobile genetic elements, strongly indicating horizontal gene transfer from various bacteria, including gut-associated enterococci. The genome also contained genes for resistance to heavy metals and oxidative stress, suggesting co-selection processes that sustain ARGs in soil. The study tries to show B. altitudinis as a crucial environmental indicator for ARGs, serving a genetic bridge between poultry gut microbiota and soil antimicrobial resistance pools, highlighting its significance for One Health antimicrobial resistance surveillance.
Traditional pedestrian inertial navigation (PDR) algorithms usually assume that the carrying mode of a smartphone is fixed and remains horizontal, while ignoring the significant impact of dynamic changes in the carrying mode on heading estimation, which is the core element of PDR algorithms. In practical application scenarios, pedestrians often change their way of carrying smart terminals (e.g., calling) according to their needs, corresponding to the difference in the heading estimation method; especially when the mode is switched, it will cause a sudden change in heading, which will lead to a significant increase in the localization error if it cannot be corrected in time. Existing smart terminal carrying mode recognition methods that rely on traditional machine learning or set thresholds have poor robustness; lack of universality, especially weak diagnostic ability for mutation; and can not effectively reduce the heading error. Based on these practical problems, this paper innovatively proposes a PDR framework that tries to overcome these limitations. Based on this research purpose, firstly, this paper classifies four types of common carrying modes based on practical applications and designs a CNN-LSTM hybrid model, which can classify the four common carrying modes in near real-time, with a recognition accuracy as high as 99.68%. Secondly, based on the mode recognition results, a multi-layer heading correction strategy is introduced: (1) introducing a quaternion-based universal filter (VQF) algorithm to realize the accurate estimation of initial heading; (2) designing an algorithm to accurately detect the mode switching point and developing an adaptive offset correction algorithm to realize the dynamic compensation of heading in the process of mode switching to reduce the impact of sudden changes; and (3) considering the motion characteristics of pedestrians walking in a straight line segment where lateral displacement tends to be close to zero. This study designs a heading optimization method with lateral displacement constraints to further inhibit the drifting of the heading caused by the slight swaying of the smart terminal. In this study, two validation experiments are carried out in two different environment-an indoor corridor and a tree shelter-and the results show that based on the proposed multi-layer heading optimization strategy, the average heading error of the system is lower than 1.5°, the cumulative positioning error is lower than 1% of the walking distance, and the root mean square error of the checkpoints is lower than 2 m, which significantly reduces the positioning error and shows the effectiveness of the framework in complex environments.
The formation of oil-bearing pores in tight tuff has attracted considerable attention from petroleum geologists since the discovery of industrial oil.Devitrification may be an important cause for the formation of these pores; however, the relevant geological circumstance for devitrification still remains unclear. This study tries to decipher the formation of devitrification pores in the tight tuff in the Tiaohu Formation,the Santanghu Basin, Xinjiang, NW China. The result shows that the oil-bearing pore size in tuff is mainly in the range of micrometers to a few nanometers, and the porosity is mainly distributed between 0.10% and 26.71%; the permeability is mainly distributed between 0.17 and 1.20 mD. After high-temperature soaking, the oil-bearing tight tuff illustrated devitrification under both acidic and alkaline circumstances, with glassy tuff showing the greatest variation in porosity, followed by crystal pyroclast glassy tuff, while the mudstone tuff and silicified tuff show relatively small variations in porosity. The 140 °C threshold marks the optimal thermal window for devitrification-driven porosity: it coincides with the smectite-illite transition and the main hydrocarbon-generation stage in the Santanghu Basin. Porosity in all tuff varieties peaks at this temperature, recording a net gain of up to 16.31%; above 140 °C, porosity declines progressively. Devitrification proceeds in three successive stages: (1) neo-mineral nucleation, (2) metasomatic replacement, and (3) dissolution.
Pathocentric epistemic injustice is a form of epistemic injustice that affects ill persons. In this paper I deal with pathocentric epistemic injustice in psychiatry that impacts persons with psychiatric conditions. There are several sources of such epistemic injustice, ranging from the agential level to the structural, institutional and even to the theoretical level of healthcare and medicine. In this paper I explore theoretical conceptions as sources of pathocentric epistemic injustice in psychiatry. Specifically, I focus on the notion that the naturalistic conception of health is an epistemically unjust theoretical conception when it exclusively privileges the epistemic resources of biomedical sciences. Supposing this claim is correct, this paper tries to offer a way of ameliorating the pathocentric epistemic injustice caused by the naturalistic conception of health. I argue that the first step of the ameliorative project lies in emphasis and acknowledgement of the concepts that embody the patient perspective, such as harm, well-being and suffering. While these concepts are found in the theoretical sphere of psychiatry, they are underdeveloped and lack proper attention. Furthermore, while elaborating on these concepts is necessary, it is not sufficient for epistemic justice in psychiatry. Thus, I introduce the idea of epistemic pillars of psychiatry - scientific research, clinical work and patient's perspective. Epistemic justice in psychiatry does not rely on any one these elements, rather it rests on the collaboration, compromise and mutual recognition of these spheres. It lies in harmony of the three pillars of psychiatry, rather than in either element being the dominant one.
This study investigated how young Australians experience sexuality education in schools and what can be done to make it better. Sexuality education is important because it helps young people learn about sexual health, relationships, and how to protect themselves from things like sexually transmitted infections (STIs) and unplanned pregnancies.Although Australia’s national curriculum tries to cover these topics, it often falls short. The quality, delivery and content of sex education seem to vary a lot depending on the school and the teacher, with many students feeling it does not meet their needs. At the same time, STIs remain common among young Australians, and more adults need help to have children through medical treatments.To better understand what young people want and need from sex education, researchers talked with teens aged 15–18 in focus groups. A Youth Advisory Group also helped analyse the results and come up with practical suggestions based on both the focus group findings and their own experiences.Three main issues came up: the way sex is viewed in society, what's actually taught in sex ed classes, and where young people learn about sex outside of school. These areas are deeply connected and highlight why Australia’s current approach isn’t working well.The study provides valuable insights into how sex education can be improved in Australia by making it more relevant, inclusive, and reflective of young people's real experiences.
The present paper reports fundamental aspects of host-parasite interaction between a cymothoid isopod, Norileca indica (Milne Edwards, 1840), and the fish Indian Mackerel Rastrelliger kanagurta (Cuvier, 1816). N. indica is recovered from the branchial cavity of the host fish R. kanagurta. The appendages like pereopods and the mouth part of N. indica exhibit morphological adaptation for the parasitic mode of life. The parasitic mode of feeding in N. indica was confirmed by amplifying DNA from its gut contents, which matched the tissue of the host fish (R. kanangurta). The effect on the host fish includes a reduction in the length and weight of the host fish. The continuous lodging of the parasite inside the gill chamber causes the degeneration of the gill filaments of the host fish. Further, the mucus protease activity was higher in infected fish when compared to uninfected fish. Overall, this paper tries to address the effect of cymothoid parasitism on marine fishes.
Intra-operative hypotension is common during caesarean section and may result in adverse maternal effects, such as nausea and vomiting. While oscillometric blood pressure and continuous non-invasive arterial pressure monitoring enable reactive treatment, the hypotension prediction index offers a machine learning-based approach that may allow proactive haemodynamic intervention. This study investigated whether hypotension prediction index-guided management could reduce the incidence of intra-operative hypotension compared with oscillometric and continuous non-invasive arterial pressure monitoring. Patients scheduled for elective caesarean section under spinal anaesthesia were allocated randomly to one of three haemodynamic monitoring strategies: oscillometric blood pressure; continuous non-invasive arterial pressure; or hypotension prediction index-guided monitoring. Hypotension and hypertension were defined as mean arterial pressure < 65 mmHg and ≥ 100 mmHg, respectively. Hypotension was treated using intermittent intravenous boluses of noradrenaline. The primary outcome was the time-weighted average of hypotension. Secondary outcomes included time-weighted average hypertension and maternal adverse effects, including bradycardia, nausea and vomiting. Data from 171 patients were analysed. Median time-weighted average hypotension was significantly higher in patients allocated to the oscillometric and continuous non-invasive arterial pressure groups compared with the hypotension prediction index group (0.89 mmHg and 0.30 mmHg vs. 0.08 mmHg, respectively, p < 0.001). Patients allocated to the oscillometric group had a higher incidence of maternal nausea and vomiting compared with those allocated to the continuous non-invasive arterial pressure and hypotension prediction index groups (nausea: 43/59 vs. 29/55 and 30/57, respectively, p = 0.038; and vomiting: 13/59 vs. 6/55 and 3/57, respectively, p = 0.023). Hypotension prediction index-guided management during caesarean section significantly reduced intra-operative hypotension without increasing the risk of hypertension. This approach provides a proactive strategy for haemodynamic optimisation in obstetric anaesthesia. We studied 171 people who were having a planned caesarean birth with a spinal anaesthetic. They were put into three groups, each using a different way to check blood pressure during the operation: a normal arm blood pressure cuff that checks blood pressure every few minutes; a machine that checks blood pressure all the time without a needle; and a computer system that tries to predict when blood pressure is about to drop. If a person's blood pressure fell too low, they were given medicine to raise it. Low blood pressure is common during caesarean births and can make people feel sick or vomit. Usual machines only show the problem after it has already happened. We wanted to see if a system that can warn doctors early could help stop blood pressure from dropping in the first place. People using the prediction system had much less episodes of low blood pressure during their operation. People using the normal arm blood pressure cuff had the most problems with low blood pressure. People in the normal arm blood pressure cuff group also felt sick and vomited more often. This means that using a system that predicts low blood pressure can help keep blood pressure more stable and reduce sickness during caesarean birth.
This article evaluates the impact of the Compass Program over the last six years, with a focus on access to mental health services in Northern British Columbia (BC) and Indigenous communities within the region. Compass program data from September 2018 to April 2024 were analyzed. Demographic and clinical characteristics were compared between Northern and other BC regions. Quantitative variables were summarized using descriptive statistics. Northern BC accounts for 21.4% of total Compass encounters. Indigenous youth in this region are particularly underserved, and community providers are more likely to request specialized virtual consultations at Compass than other regions. Anxiety was the most common presenting concern across all regions. Northern BC represented 46% of all Indigenous consultations and showed a steady increase in Indigenous-related calls-from 18% in 2018 to 41% in 2024. Among direct consults in Northern BC, 55% involved Indigenous patients and medication questions were the most common reasons for calling. The study highlights the distinct mental health challenges in Northern BC compared to other regions of the province, suggesting the unique socioeconomic and geographical factors contributing to different mental health issues. Further research should be done to explore the impact of specialized child and youth mental health and substance use provider-to-provider consultations in other similarly underserved areas in Canada. The Compass program at BC Children's Hospital provides a model that tries to navigate mental health disparities of Northern BC, where there is high demand for mental health services. Clinical trials registry number: H23-03251-A001.
Regulatory T cells (Tregs) play a pivotal role as key modulators of immune tolerance in kidney transplantation, a critical therapeutic approach for end-stage renal disease. Despite advances in surgical techniques and immunosuppressive regimens, kidney transplantation continues to face significant challenges, including immune rejection and complications arising from long-term immunosuppression. In recent years, Tregs have garnered considerable attention due to their potential to promote graft immune tolerance, reduce the reliance on immunosuppressive drugs, and improve transplant outcomes. This review provides a comprehensive overview of the biological characteristics and immunoregulatory mechanisms of Tregs in the context of kidney transplantation. It highlights the clinical relevance of Tregs and summarizes the progress in Treg-based cellular therapies. Special emphasis is placed on emerging molecular pathways regulating Treg function, the role of immune metabolism, and innovative strategies utilizing nanocarrier systems to selectively expand Tregs. Furthermore, the review addresses current challenges in translating Treg research into clinical practice and outlines future research directions aimed at enhancing immune tolerance and graft survival. By synthesizing recent advances, this article aims to offer theoretical support for the clinical application of Treg-mediated immunomodulation in kidney transplantation. How regulatory T cells could help kidney transplant patientsKidney transplantation is the best treatment for kidney failure, but the body’s immune system often tries to reject the new organ. To prevent rejection, patients must take strong anti‑rejection drugs for life, which can cause serious side effects like infections and cancer. This review looks at a special type of immune cell called regulatory T cells (Tregs), which naturally stop the immune system from attacking the body’s own tissues. Researchers are now finding ways to use Tregs to help kidney transplant patients accept their new organ with fewer anti‑rejection drugs. The article explains how Tregs work, what goes wrong with them after transplantation, and what new treatments are being tested. Some of these treatments take Tregs from the patient’s own blood, grow more of them in a lab, and then give them back. Others use nanoparticles or genetic engineering to make Tregs work better and only at the transplant site. Special attention is given to children, because they face unique challenges and may benefit from Tregs taken from the thymus (an organ removed during some heart surgeries). The review also discusses risks, such as the possibility that Tregs could weaken the immune system too much, leading to infections or even cancers. Overall, Treg‑based therapies are a promising and exciting area of research that may one day allow kidney transplant patients to live healthier lives with less medication.
Postpartum psychosis is a rare but severe psychiatric crisis that generally occurs during the early postpartum period and requires immediate attention. This case report focuses on an under-recognized case of postpartum psychosis and its consequences. The patient, a 28-year-old mother, presented with symptoms 6 months after her uncomplicated childbirth. She had no prior history of psychiatric illnesses. Despite this, due to poorly understood stressors, she developed severe psychotic symptoms such as hallucinations, delusions of guilt, and intense emotional dysregulation. Her condition led to an infanticide and an attempt on the lives of her two older children before she attempted suicide. Her detailed clinical assessment revealed a severe mood disorder with psychotic and manic characteristics (PANSS = 69, YMRS = 8). The patient was treated with sessions of electroconvulsive therapy and antipsychotic trials. While her symptoms gradually improved, the aftermath of her actions left her dealing with unbearable grief, legal consequences, and societal stigma, giving us proof of the far-reaching consequences of the initial misdiagnosis and non-cooperation of the family toward early hospitalization, ultimately leading to delayed critical intervention. This case tries to understand the triggers of this mental state better and calls attention to conventional limitations in perinatal mental health awareness and insists on the prolongation of maternal mental health surveillance beyond the usual postpartum period. It is further discussed how more efficient screening tools (e.g., PPSS) in antenatal obstetric care setups and culturally appropriate family education need to be implemented, especially in marginalized populations where high family-related psychosocial stressors can be a clinical risk. Postpartum psychosis and accompanying circumstances can burden patients with ethical and legal dilemmas surrounding their actions during the psychotic episodes. We also emphasize the need for rehabilitation of patients and their families, concluding with a focus on a multidisciplinary approach to address the outcomes of this disease.
Rangelands play a vital role in supporting livelihoods, biodiversity, and ecological balance across arid and semi-arid regions. However, these fragile ecosystems are increasingly threatened by overexploitation, land degradation, and unsustainable management practices. Understanding the human and behavioral dimensions of rangeland conservation has therefore become an urgent priority. Many of the world’s rangelands, including those in Iran, have recently been exposed to destruction and serious damage. Collaboration among various stakeholders (especially pastoralists) in sustainable land use and management is considered a key factor in reducing this degradation. Guided by the Theory of Planned Behavior (TPB), this study tries to identify and analyze the behavioral nudges for the sustainable land use and management in Iran. This research employed a cross-sectional survey design involving 248 pastoralists in Fars Province, southern Iran, selected through simple random sampling. An extended version of the TPB was applied, incorporating two additional constructs—awareness of consequences and moral norms—to enhance its explanatory power in predicting sustainable land use intentions. Behavioral nudges, such as increased awareness of consequences, strengthening moral norms, perceived behavioral control, and attitudes, can lead pastoralists to sustainable land use and management, thereby helping to conserve rangelands. To operationalize the research, a cross-sectional survey of 248 pastoralists with livestock grazing certificates, who were selected using simple random sampling, was used. The results of the research showed that the constructs of attitude towards sustainable land use and management had a positive and significant effect on the intention towards sustainable land use and management (Beta = 0.292; T = 4.239; Sig = 0.001). The direct effects of two variables, awareness of consequences of rangelands’ destruction (Beta = 0. 335; T = 3.333; Sig = 0.001) and moral norms of sustainable land use and management (Beta = 0. 323; T = 2.791; Sig = 0.005), were positive and significant on Intention. In addition, the results of this study showed that moral norms not only act as a constructive factor in the intention of the pastoralists towards sustainable land use and management, but also can play a mediating role for some other variables such as awareness of consequences of rangeland destruction. The results of SEM analysis showed that the extended TPB can explain 75% of the variance of pastoralists’ behavioral intention, which shows the high explanatory power of the model. These findings provide practical insights for policymakers and land managers by emphasizing the need to design interventions that enhance moral and environmental awareness, promote participatory management, and align behavioral policies with local cultural norms. However, as this study is based on a cross-sectional design, causal inferences should be made cautiously, and future longitudinal research is recommended to validate these relationships over time. The online version contains supplementary material available at 10.1038/s41598-026-39511-6.