Smart windows that function in response to external conditions provide a promising approach to reduce heating, ventilation, and air conditioning energy consumption. However, it remains a major challenge to develop a smart window with environmental adaptability, multiple working states, and most importantly, the ability of dynamic management of solar light and heat with a simple and versatile molecular-designed material. Here, we present a temperature- and light-regulated smart window based on the interplay of light-driven molecular motors and liquid crystal (LC) polymers. The window can dynamically switch among three distinct working states: transparent, reflective, and scattering, depending on ambient temperature and solar light intensity. The fast switching of working states enables excellent modulation of visible light transmittance (ΔTlum = 75.2%) and near-infrared light transmittance (ΔTNIR = 49.3%), showing effective management of daylight and solar heat gain indoors. Simulation of energy regulation demonstrates that the smart window significantly reduces energy demand for indoor cooling and, therefore, is suitable for cities with different climate conditions. Our system provides an attractive approach toward more effective smart windows for sustainable and energy-efficient green buildings.
A persistent challenge in implementation science is the gap between the pace and priorities of academic research and the needs of decision-makers. While traditional research emphasizes methodological rigor, policymakers often require timely, relevant, and stakeholder-engaged evidence to inform decisions. We conducted a real-time discrete choice experiment (DCE) with participants at an implementation science conference in Washington, D.C. during a 75-minute session on rapid implementation science. At the midpoint of the panel, the audience were invited to participate in a 10-minute DCE based on a vignette describing a hypothetical study on implementing a new vaccine facing public hesitancy. Choice sets included six attributes: rapidity of study, study design, primary outcome, level of community engagement, leadership, and costs. We used a mixed logit model to analyze preferences in real time and presented results back to the audience at the end of the session. Ninety-four participants completed the DCE; all reported working in research and 83% reported working in program implementation. Respondents placed high value on timing of results, with strong preferences for receiving results in 6 months compared 12 months (β=-1.1, 95% CI: - 1.6- - 0.6; p < 0.001) and 18 months (β=-1.7,-2.3- - 1.0; p < 0.001). Participants preferred the primary outcome to be vaccine uptake rather than vaccine acceptability (β = 1.7, 1.1-2.2; p < 0.001) and the study to be community-engaged rather than expert-led (β = 1.6, 1.0-2.2; p < 0.001). We found no preference for randomization compared to before and after (p = 0.88), nor leadership by the ministry of health versus academic institutions (p = 0.12). Respondents were willing to wait 11.3 (95% CI 7.0-15.5) additional months for a program developed with engaged stakeholders compared to expert-driven (p < 0.001) and 11.9 months (95% CI 8.1-15.8) for results on vaccine uptake rather than acceptability (p < 0.001). This real-time DCE demonstrated that with adequate preparation, it is feasible-to generate robust, interpretable, and actionable results within an hour. Findings challenge the assumption that randomization is the highest priority in research design, highlighting instead the importance of outcome and community engagement. By aligning more closely with the values of decision-makers, rapid science approaches such as real-time DCEs may help bridge the research-policy gap.
Loneliness in youth (15-24 years old) is increasing. The impacts over the life course are more fully recognised and require co-designed responses. A participatory designed project, a/part of the crowd, has led to a web-delivered, preventive response to loneliness with young adults 18-25 years old. As a part of this, an integrated Lived Experience Advisory Group with co-researcher roles was established to centre youth perspectives and to grow research capabilities. The co-designed response was developed from 128 short stories, poetry, artworks (hand-drawn, digital and collage), and music submitted by 18 to 25-year-olds in Australia. Ethics approval was granted for the larger project. A 12-member Lived Experience Advisory Group provided advice on design, recruiting, and promoting. They shared impressions on data and supported elements of the co-designed web space and steps for further translation. Five members of the LEAG were also appointed as co-researchers. In this paper, we outline the Lived Experience Advisory Group establishment and role, and share co-reflections on the contributions made and how to embed lived experience in the research process and practice. Five co-researchers worked alongside the interdisciplinary research team. Reflections identified the importance of a project coordinator to maintain communication and connection, and that collaborative research meetings supported working alongside as a team sharing interpretations and discussing research. The Lived Experience Advisory Group role has included advising on design elements for the co-designed response, and user testing, which was recently made publicly available. The advisory group and co-research roles created a mechanism to increase participation in decision processes and share roles in research activities. Co-researchers have been trained to analyse content, and frequent reflective meetings have fostered understanding of current lived realities for 18- to 25-year-olds, and grown new collaborations and activities. This has developed the capabilities of co-researchers and the wider research team in youth-centred approaches to loneliness research. Members of the LEAG and co-researchers have now adopted additional roles in other activities supporting an element of implementation into mental health research translation. This led to an example of an integrated lived-experience approach to adopt within research studies in the future. Loneliness is becoming more common for young adults and has large personal and societal impacts. Young adulthood is a time of big life changes, and these can lead to feelings of loneliness. To understand and address this, we must work with people who have lived experience of loneliness. We also need to work together to develop effective supports and solutions. a/part of the crowd seeks to understand how young adult experience loneliness through the lens of big life changes. The broader project has used a participatory approach to gather 128 stories from adults aged 18–25 about their experience of loneliness using creative methods (these findings are reported separately). This has supported a deeper understanding of loneliness than a biomedical approach would have provided. The project involved people with lived experience of loneliness working as advisors and as co-researchers to support activities, which we outline in this paper. This includes reflections from a 12-person Lived Experience Advisory Group as part of writing and during collaborative research meeting discussions. We also outline how safe opportunities to discuss loneliness were created. a/part of the crowd has enabled us to learn together with creative tension and build skills across the team. This model has required intentional work and resourcing from the university-based project leads. This is essential to ensure young adult with a lived experience of loneliness are well supported. Finally, we prioritised young adult most affected by loneliness. They guided this work and co-designed its outcomes.
Occupational therapy interventions for people living with dementia have been shown to have positive outcomes for the person and family carers. However, people from culturally diverse communities and Aboriginal and Torres Strait Islander peoples are largely missing from research studies. People with dementia from these communities have unique needs, and they can experience health inequity. The aim of this study was to use inclusive methods to explore key factors contributing to and identify potential adaptations required for culturally inclusive and acceptable occupational therapy interventions for people living with dementia. We adopted best practice research methodology for working with people living with dementia from diverse communities. We conducted three collaborative workshops using co-design techniques. Attendees discussed a hypothetical vignette using group problem-solving. Findings were mapped to the key cultural adaptation framework elements using content analysis. Twenty-one people from diverse communities with living experience of dementia attended one of three collaborative workshops. Participants were accepting of occupational therapy intervention components. Priority areas for delivering inclusive interventions were knowing the person, establishing a therapeutic relationship and expressing cultural humility. The therapist themselves is the key factor that supports the delivery of inclusive interventions. They should be aware of and be responsive to the cultural needs of diverse communities, adjust their therapeutic approach and be prepared to offer flexibility. Working in partnership fostered successful research collaboration, showcasing how people living with dementia from diverse communities can be supported to contribute to research and potentially influence 'higher order' healthcare issues.
Paramedics in emergency medical services (EMS) work in high-demand environments in which occupational well-being is closely linked to patient safety and workforce sustainability. While transformational leadership has been associated with positive staff outcomes in health care, evidence regarding its associations with work engagement and occupational well-being in prehospital EMS remains limited. This study examines transformational leadership in Finnish EMS in relation to paramedics' work engagement and occupational well-being, including whether the association between transformational leadership and occupational well-being is statistically consistent with an indirect pathway involving work engagement. A cross-sectional online survey was conducted among 322 Finnish paramedics working in EMS at basic or advanced levels. Transformational leadership was assessed using the 43-item Transformational Leadership Scale, work engagement using the Utrecht Work Engagement Scale (UWES-9), and occupational well-being using a single-item self-rated numeric scale (4-10). Descriptive statistics, Pearson correlations, and hierarchical multiple regression analyses were conducted, adjusting for age, gender, education level, professional title, and years of EMS experience. Bootstrap resampling (5,000 samples) was used to examine whether the association between transformational leadership and occupational well-being was statistically consistent with an indirect pathway involving work engagement. Transformational leadership had a mean score of 2.75 (SD = 1.03, range 1-5). Leadership ethics received the highest ratings, whereas feedback and rewards were rated lowest. In multiple regression analyses, transformational leadership was positively associated with work engagement (β = 0.437, p <.001) and occupational well-being (β = 0.501, p <.001) after controlling for demographic factors. Work engagement was positively associated with occupational well-being (p <.001). When work engagement was added to the model, the association between transformational leadership and occupational well-being decreased but remained statistically significant, suggesting that the association was statistically consistent with an indirect pathway involving work engagement. Transformational leadership was positively associated with work engagement and occupational well-being among Finnish paramedics in EMS. The association between transformational leadership and occupational well-being was statistically consistent with an indirect pathway involving work engagement. However, causal or mediational conclusions cannot be drawn due to the cross-sectional design. From a health services perspective, the findings suggest that leadership may represent a key organizational resource for supporting workforce well-being and performance in high-demand EMS systems.
Medical Assistance in Dying (MAiD) and related services are legally available in a number of countries under specific conditions and continue to be the subject of ongoing international debate. In Canada, MAiD has been legally available since 2016, with eligibility expanded in 2021 to include individuals whose natural death is not reasonably foreseeable (Track 2), in addition to those whose death is reasonably foreseeable (Track 1). MAiD is federally regulated, but services are organized and delivered at the provincial and territorial levels, resulting in substantial variation in staffing, funding, oversight, and training. To date, most research has focused on the experiences of individual professional groups, such as physicians, or on single jurisdictions. Less is known about how the service delivery process functions as a whole and how its organizational and operational features shape the experiences of the healthcare professionals (HCPs), administrators, and policymakers involved. This study examines the barriers to and facilitators of MAiD service delivery from the perspectives of professionals across the service delivery process throughout Canada and identifies key system-level and operational factors that may inform MAiD policy and program planning both domestically and internationally. Participants were recruited through professional networks, provincial and territorial MAiD working groups, and MAiD-related non-profit organizations. Participants included healthcare professionals (HCPs), program administrators, and policymakers involved in MAiD service delivery. Interviews were held virtually and were recorded and transcribed. Data was analyzed using a qualitative descriptive design with a structured, five-phase inductive thematic analysis approach and constant comparison to identify barriers to and facilitators of MAiD service delivery. A total of 46 semi-structured interviews were conducted between July 2024 and January 2025 with participants from seven provinces and one territory. Ten themes and 25 sub-themes were identified. Barriers included high workloads, limited collaboration with other health services, limited coordination, and inadequate training and financial support. Emerging issues included misinformation about MAiD eligibility criteria, limited bereavement support services for patients' families, and acquiring and transporting MAiD-related medications. Facilitators included centralized coordination systems, standardized documentation and reporting, interprofessional collaboration, and supportive leadership. These findings offer a process-level view of how MAiD services have been operationalized in Canada a decade after its legalization. They highlight persistent and emerging challenges in MAiD service delivery as well as promising innovations used to address them. As Canada prepares for the March 2027 expansion of MAiD to persons whose sole underlying medical condition is a mental illness, and as other jurisdictions continue to develop assisted dying legislation, these findings map the system-, operational-, and support-level factors needed to sustain and strengthen MAiD service delivery.
Patient and public involvement and engagement (PPIE), alongside community engagement, are crucial in mental health research to ensure relevance and impact. This study, part of the Medical Research Council (MRC) UK-funded, Traditional HEalers working with primary care and mental Health for early intervention in Psychosis in young pErsons (THE HOPE) project, describes the implementation of PPIE and community engagement in THE HOPE project and their impact on the project and community. A six members advisory group, including individuals with lived experience of psychosis, caregivers, and a TSH, contributed to the study design, topic guides, and community engagement initiatives. Thirty-four community engagement sessions were conducted in four phases, utilizing sermons, posters, pamphlets, and direct outreach. The thematic analysis highlighted key issues like medication adherence, service delivery, and the role of traditional healers and primary care. Insights from the advisory group informed recommendations for shared decision-making and capacity-building, emphasizing the importance of inclusive, culturally relevant, and collaborative approaches in mental health research. People living with psychosis often experience stigma and discrimination, which act as barriers to accessing appropriate health care needs. As part of THE HOPE Feasibility Study, we aimed to strengthen partnerships between researchers, patients, carers, and the general community in Peshawar, ensuring that individuals with lived experience of psychosis actively contribute to the research process from inception to implementation. A Patient and Public Involvement and Engagement (PPIE) group, consisting of six members, including individuals with lived experience of psychosis, caregivers, and a TSH, the Lived Experience Advisory Panel (LEAP), was established to provide regular input on study intervention development and the community awareness sessions. Capacity-building sessions were organized for both researchers and advisory members to understand the importance of patient and public involvement in research. Additionally, community engagement sessions were conducted to explore perceptions of psychosis, experiences, myths, stigma, and barriers to accessing health care. Feedback from the advisory group and community engagement sessions helped in the development of culturally sensitive intervention and awareness campaigns. THE HOPE Study’s PPIE and CEI initiatives demonstrate how meaningful public partnerships can lead to more relevant and effective mental health research in low-resource settings.
Workplace incivility is a pervasive challenge in nursing, yet its sources, correlates, and consequences remain underexplored in Saudi Arabia. Saudi Arabia's nursing workforce is among the most internationally diverse in the world and operates within a rapidly evolving healthcare system marked by hierarchical structures and high turnover rates. This study examined the level of workplace incivility experienced by nurses in Saudi Arabia, identified the demographic and professional factors associated with exposure to incivility, and investigated the associations among incivility, work-related quality of life, and turnover intentions. A quantitative cross-sectional survey design was employed. A convenience sample of 278 nurses working in hospital settings across Saudi Arabia was recruited through online platforms between September 30, 2025 and January 6, 2026. Data were collected using three validated instruments: the Nursing Incivility Scale, the Work-Related Quality of Life scale, and the Anticipated Turnover Scale. Data analysis included descriptive statistics, independent-samples t-tests, one-way ANOVA with post hoc comparisons, Pearson correlation analysis, and hierarchical multiple regression. The majority of participants (84%) reported moderate to high levels of workplace incivility; given recruitment through convenience sampling, this figure is best interpreted as an upper-bound estimate within a self-selected sample. The highest incivility scores were observed for patient and family sources, followed by nurse colleague sources. Younger nurses and those with fewer years of experience reported significantly higher levels of incivility. Nationality was a significant differentiator, with Saudi nurses reporting higher incivility than Arab nurses. Married nurses reported lower levels of incivility than single nurses. Workplace incivility was significantly and negatively associated with work-related quality of life and positively associated with turnover intentions. In the hierarchical regression analysis, work-related quality of life explained substantial additional variance in turnover intentions beyond incivility alone, after which the direct effect of incivility was no longer significant. Workplace incivility is prevalent among nurses in Saudi Arabia and is associated with poorer work-related quality of life and higher turnover intentions. The findings suggest that work-related quality of life may account for the relationship between incivility and turnover. Multilevel interventions targeting patient and family incivility, peer dynamics, and organizational culture are needed to protect nurse well-being and support workforce retention in the Saudi healthcare system.
Older adults are vulnerable to poor oral health due to physiological and cognitive changes, multiple medications, and dependence on carers. Despite national guidance, oral care in UK care homes remains inconsistent, and many staff report lacking the personal skills, organisational support, and confidence to deliver consistent oral care despite highlighting their commitment to deliver effective "mouth minutes" as part of daily routines. This study aims to examine care home and dental stakeholders' views on supporting residents' oral health, using the COM-B model to identify factors shaping staff oral-health-related behaviours. Focus groups were undertaken between June 2022 and November 2022 with the following 4 stakeholder groups to explore perspectives of supporting oral health maintenance in care home residents: (1) residents and relatives, (2) care home frontline workers, (3) care home managers and (4) external oral healthcare professionals (Oral HCPs) with care home experience. Framework analysis was undertaken at a semantic level and then matrices were mapped onto the COM-B model. Fifty participants from three care homes (residential and nursing homes), and external oral HCPs in Great Britain took part: 11 residents, 6 relatives, 25 care home staff (managers and frontline workers) and 8 external oral HCPs. Mapped against the COM-B framework; Opportunity, particularly Physical Environment, Context, and Resources, was the most frequently coded construct. There was also alignment with Capability, especially Behavioural Regulation and Skills, and within Motivation, beliefs about Consequences and Capabilities. Access to external oral healthcare professionals, tailored training, and organisational support were pivotal to improving oral health in care homes. The study confirms that micro‑level interventions are insufficient, as structural barriers-including limited dental access, workload pressures, and inconsistent resources-continue to undermine practice. Care home staff emphasised condition‑specific training and structured communication; relatives sought guidance to support loved ones; and external oral HCPs highlighted working and recognition of oral health as part of wellbeing. Aligning intervention design with the COM‑B framework provides a pathway to address structural, motivational, and capability barriers as interacting influences on oral care behaviour in care homes. This study explains why existing interventions fail by illustrating how Capability, Opportunity, and Motivation intersect, advancing COM‑B from a categorisation tool to an implementation‑focused framework.
Early-career operating room nurses work in highly technical, high-demand environments and are at elevated risk of stress, stalled development and turnover. Yet little is known about how their career growth patterns differ, or which resource configurations are associated with more favorable profiles. Guided by Conservation of Resources (COR) theory, this study aimed to (1) identify latent profiles of career growth among early-career operating room nurses and (2) examine how COR-based foundational resource indicators and selected work-related psychological and organisational variables are associated with these profiles. We conducted a multicenter cross-sectional online survey between March and August 2025 among early-career operating room nurses working in tertiary hospitals in Zhejiang Province, China. Using multicentre convenience sampling, 516 nurses from 102 hospitals provided valid responses. Career growth was assessed using the Career Growth of Nurses Scale. Guided by COR theory, resource-related indicators and selected work-related psychological and organisational variables were examined in relation to profile membership. Latent profile analysis was used to identify distinct career growth profiles. Multinomial logistic regression examined associations between resource variables and profile membership, with statistical significance set at α = 0.05. A three-profile solution provided the best fit to the data. We identified three latent classes based on cross-sectional response patterns: a lower-level uneven group (C1, n = 66, 12.8%), a moderate-level balanced group (C2, n = 238, 46.1%), and a higher-level comprehensive group (C3, n = 212, 41.1%). Compared with C1, formal employment contracts, employment in higher-tier hospitals, higher monthly income, better self-rated health, and stronger interest in the nursing profession were cross-sectionally associated with higher odds of membership in C2 and C3. Higher thriving at work, organisational commitment, and perceived organisational career management were also cross-sectionally associated with membership in the more favorable profiles. The examined object resource (homeownership status) was not associated with profile membership in the univariate analysis and was therefore not retained in the adjusted model. Early-career operating room nurses showed heterogeneous patterns of career growth, which could be classified into three profiles: a lower-level uneven profile, a moderate-level balanced profile, and a higher-level comprehensive profile. Multiple resource-related indicators were associated with more adaptive profile membership among early-career operating room nurses. These findings suggest that career growth is linked to the combined influence of employment, organisational, health, motivational, and work-related psychological factors rather than any single dominant factor. Nurse managers can use these findings to design resource-focused strategies and targeted development programs to support sustainable career growth and retention among early-career operating room nurses.
Population aging has increased demand for home-visit dental care in Japan, yet regional disparities persist, as in other aging societies. This study aimed to identify factors associated with regional variation in the utilization of home-visit dental care. As part of an exploratory approach, we also examined home-visit medical care data to consider possible contrasts with dental service provision. This ecological cross-sectional study followed the STROBE guidelines and used prefecture-level aggregated data. We calculated the standardized claim ratio (SCR) for home-visit dental services using the 9th edition of the National Database of Health Insurance Claims and Specific Health Checkups of Japan (NDB) Open Data (April 2022 to March 2023). Spearman's correlation coefficient was computed to examine associations between SCR and relevant variables, including average age of dentists, number of dental clinics, and number of dentists in medical facilities. Then, multiple regression analyses were conducted using the SCR of the home-visit dental services, adjusting for the average age of dentists, the number of dental clinics, and the regional aging rate. Prefectural SCRs for home-visit dental services varied widely (range 24.68-168.79, median 70.52). SCR was negatively correlated with the average age of dentists (R = - 0.65, p < 0.001). In addition, it was positively correlated with the number of dentists working in medical facilities per 100,000 population (R = 0.60, p < 0.001) and number of dental clinics per 100,000 population (R = 0.71, p < 0.001). Multiple regression analysis showed that the average age of dentists had a negative relationship with SCR; the standardized regression coefficient (β) was - 0.30 (p = 0.017), whereas the number of dental clinics had a positive relationship (β = 0.47, p < 0.001). Regional variation in home-visit dental care utilization was associated with structural characteristics of the dental workforce. However, these findings should be interpreted as ecological associations influenced by both supply- and demand-side factors, rather than as indicators of individual provider behavior or capacity. The results suggest that workforce structure, including age composition and service infrastructure, may be related to regional disparities in home-visit dental care. Further studies incorporating individual-level and socioeconomic data are needed to clarify underlying mechanisms.
Racially/ethnic minoritised people with multiple long-term conditions (MLTCs) face inequalities across different dimensions of healthcare, yet little is known about how to improve their healthcare outcomes. This systematic review and narrative synthesis seeks to identify and describe healthcare interventions designed to improve health outcomes for racially/ethnic minoritised people with MLTCs and identify areas for further exploration. Given that primary care is considered the ideal setting to manage MLTCs, we focus on interventions targeted at healthcare providers/systems. We searched 9 bibliographic databases and one website and identified 6566 studies, 15 of which met the inclusion criteria. Given the heterogeneity of interventions, health conditions and outcomes of interest, we conducted a narrative synthesis. The studies were conducted in the US (n = 13), Canada (n = 1) and Australia (n = 1). Most studies recruited racially/ethnic minoritised people mainly of African American and Hispanic/Latinx descent with comorbid Depression and a physical condition (Diabetes (n = 3), Hypertension (n = 3), Cancer (n = 2). Depression/mental health outcomes, patient-reported outcomes, clinical outcomes, medication use, and adherence were the most frequently assessed outcomes. Few studies reported on provider-related outcomes. All interventions made socio-cultural adaptations, thereby, promoting equitable and inclusive care. Community actors/assets were considered key to improving health outcomes. Of the 15 interventions, five resulted in statistically significant improvements in all outcomes of interest and nine resulted in improvements in some outcomes. This review illustrates the feasibility of socio-culturally adapted interventions, many of which successfully integrate physical and mental healthcare, delivered through multidisciplinary teams working collaboratively, and leveraging community assets to improve health outcomes for racially/ethnic minoritised people with MLTCs. Future research is needed to assess the impact of these interventions beyond North America and Australia. Studies are also required to identify provider-related outcomes with the potential to improve outcomes for racially/ethnic minoritised people with MLTCs.
France faces growing challenges with an aging population and neurodegenerative disorders. French health law allows patients to appoint a trusted person ("personne de confiance") to communicate their medical preferences if incapacitated. Introduced by the Kouchner Law in 2002, this reflects a shift from paternalistic to autonomist care, emphasizing patient autonomy. Despite their importance in conveying patient wishes in nursing homes, research remains limited, with most studies focusing on hospitals. We conducted semi-structured interviews with 14 healthcare professionals (directors, psychologists, coordinating physicians, nurse managers, psychometricians) working in or with French nursing homes from February 2021 to September 2022. Interviews lasted 26-80 min and we analyzed them using grounded theory methodology. Theoretical saturation was achieved after 9 interviews and confirmed through 5 additional interviews. Through grounded theory analysis, we identified that professionals continuously balance three competing needs when collaborating with trusted persons: patient-oriented needs (ensuring care quality, safety, dignified end-of-life), relatives-oriented needs (supporting families, protecting mental health), and self-oriented needs (legal protection, professional well-being, administrative efficiency). This core balancing process is shaped by three contextual factors: (1) evolving nursing home environments with cognitively impaired residents and regulatory complexity; (2) insufficient knowledge of the trusted person system among families and professionals; and (3) family burden during end-of-life phases, including guilt and death-related taboos. Under the influence of these contextual factors, professionals' balancing efforts manifest through heterogeneous practices in informing families about designation and varied approaches to involving trusted persons in decision-making and care. From the perspective of healthcare professionals, effective trusted person involvement would be facilitated by early education before admission. Our findings suggest organizational and educational interventions may improve trusted person collaboration, though research engaging trusted persons and patients directly is needed to validate these professional perspectives and develop appropriate interventions.
To systematically evaluate the economic burden of preventable dental-related emergency department visits (PDEDV) and preventable dental-related hospital admissions (PDHA), identify reasons for these presentations, and synthesise recommendations to reduce avoidable utilisation. This systematic review followed the PRISMA 2020 guidelines. A comprehensive multiple database search was conducted in PubMed, Embase, Cochrane Library, EBSCOHOST, and Web of Science for studies reporting direct and/or indirect costs of PDEDV and PDHA in any age group, published in English from 2000 to March 2026. Three calibrated reviewers screened and critically appraised the identified studies. Data including patient characteristics, estimated charges/costs, reasons for PDEDV and PDHA, and recommendations to minimise the avoidable burden were extracted. Charges/costs were inflation-adjusted and standardised to 2024 US dollars. Of the 2600 total studies identified, 25 met the inclusion criteria. The majority were conducted in the United States and focused on direct medical costs. Uninsured individuals, public health insurance enrolees and residents of low-income areas were more likely to experience PDEDV. Mean charges per any PDEDV ranged from $409.73 to $2740.76. Mean charges per any PDHA ranged from $5234.46 to $62 298.25, while mean hospital costs ranged from $350.42 to $22 375.53. Dental caries was the commonest cause for PDEDV. Odontogenic infections were the costliest to manage, with mean charges of $2740.76 per PDEDV and $62 298.25 per PDHA. PDEDV and PDHA were primarily driven by financial barriers, socio-demographic disparities, limited access to routine dental care, and health workforce constraints. Proposed strategies focused on improving affordability and access to preventive dental care, enhancing oral health literacy, strengthening integration between medical and dental services, and expanding the dental workforce. PDEDV and PDHA, particularly those due to dental caries and odontogenic infections, impose a significant economic burden on healthcare systems, highlighting the need to reduce financial and access barriers to routine dental care for high-risk groups and priority conditions.
To investigate the retinal microcirculation changes in children with anisometropic amblyopia through multimodal assessment and explore its correlation with neurophysiological dysfunction. This prospective cross-sectional study recruited 68 treatment-naïve children (aged 4-14 years) with primary monocular anisometropic amblyopia. The fellow healthy eye served as the control. Macular microvascular parameters, including foveal avascular zone (FAZ) area and superficial capillary plexus (SCP) perfusion density, were quantified using optical coherence tomography angiography (OCTA). Pattern visual evoked potentials (P-VEP) assessed P100 latency and amplitude. Central macular thickness (CMT) and retinal nerve fiber layer (RNFL) thickness were measured. Correlations and multiple linear regression analyses were performed to identify predictors of best-corrected visual acuity (BCVA) in amblyopic eyes. Compared to fellow eyes, amblyopic eyes exhibited significant microcirculatory impairment: reduced SCP perfusion density (central: 0.27 vs. 0.29, P < 0.001; full: 0.44 vs. 0.46, P < 0.05), enlarged FAZ area (0.30 vs. 0.26 mm², P = 0.035), and increased CMT (141.00 vs. 131.50 μm, P < 0.05) and RNFL thickness (113.00 vs. 110.00 μm, P < 0.001). P-VEP revealed prolonged P100 latency (119.0 vs. 109.5 ms, P < 0.001) and decreased amplitude (12.8 vs. 19.25 µV, P < 0.001). SCP perfusion density correlated negatively with P100 latency (ρ=-0.341, P = 0.004), and SCP vessel density correlated negatively with CMT (ρ=-0.363, P = 0.002) and FAZ area (ρ=-0.424, P < 0.001). Multiple linear regression analysis (adjusted R²=0.625, P < 0.001) identified RNFL thickness (β = -0.546, P < 0.001) as a significant negative predictor of BCVA (logMAR), while SCP full perfusion density (β = 0.375, P < 0.001) and axial length (β = 0.237, P = 0.007) were significant positive predictors. Anisometropic amblyopia is marked by a neurovascular mismatch, manifested through simultaneous retinal hypoperfusion, paradoxical thickening of structures, and delayed neural conduction. The combined OCTA-P-VEP assessment provides a comprehensive biomarker framework. RNFL thickness, SCP perfusion density, and axial length emerge as key independent predictors of visual acuity, suggesting complex interplays between structure, perfusion, and function.
Electrochemical oxidative dehydrogenation (ODH) of ethane in solid oxide electrolysis cells (SOECs) offers an energy-efficient route to ethylene but faces a trade-off between conversion and selectivity due to over-oxidation. Conventional voltage-current regulation can suppress deep oxidation but inevitably compromises ethane conversion. Here, we engineer surface electronic structures by depositing a V2O5 layer on SrFe0.9Ti0.1O3-δ (STF), introducing intrinsic O 2p (-1.33 eV) and V 3d (-0.18 eV) states closer to the Fermi level than in STF (-1.49/-4.52 eV). Density functional theory and operando infrared spectroscopy reveal three synergistic effects: enhanced ethane adsorption (ΔEads -0.33 vs. -0.11 eV), reduced first dehydrogenation barrier (ΔG1 1.13 vs. 1.15 eV), and promoted ethylene desorption ((ΔGdes-ΔG3) -4.98 vs. -1.92 eV). The optimized anode delivers 65% yield and 90% selectivity at 750°C, exceeding unmodified STF by 10%. This work highlights band-center engineering as a promising design concept for regulating hydrocarbon electrode reactions.
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Due to the limited data available among middle-income countries, we aimed to determine the characteristics, outcomes and associated factors with death or graft failure in pediatric liver transplantation (LT). Based on the Thai National Liver Transplantation Registry, we analyzed the data of patients under 18 years who underwent LT in Thailand from 2016 to 2024. The study included 324 liver transplants (five re-LT), mainly from living donors (246 donors, 75.9%). Among 319 recipients, the most prevalent underlying condition was cirrhosis (274 patients, 85.9%; mostly biliary atresia), followed by acute liver failure (30 patients, 9.4%). In comparison with deceased donor LT, patients who underwent living donor LT (LDLT) reported less waiting time (485 days vs. 146 days, P < 0.001) and a lower pediatric end-stage liver disease (PELD)/model for end-stage liver disease (MELD) score (20.9 vs. 18.1, P = 0.02). The registry revealed 1- and 5-year patient survival rates of 91.7% and 89.6%, respectively. Mortality was noted in 34 patients, with infection as the leading cause of death (19 patients, 55.9%). PELD/MELD score ≥ 20 was associated with death (HR: 2.95; 95% CI: 1.29-6.27) or graft failure (HR: 3.10; 95% CI: 1.37-7.06) in patients who underwent LT due to cirrhosis. Pediatric LT in Thailand, mainly LDLT, has a satisfactory outcome. Patients with severe ESLD or high PELD/MELD scores are at risk for death and graft failure after LT. Infection is the most common cause of death. Therefore, timely LT and early effective treatment of infection are crucial.
Spinal muscular atrophy (SMA), caused by mutations in survival motor neuron 1 (SMN1), presents with severe muscle atrophy and prevalent osteoporosis. Transcriptomic profiling of patient muscle biopsies revealed enrichment of extracellular vesicle genes, yet the contribution of SMA-EVs to SMA-associated bone loss and their link to SMN deficiency remain undefined. Clinical CT/MRI images of SMA and control subjects were acquired to quantify osteoporosis and muscle atrophy. SMA model mice (Smn1hSMN2/hSMN2ROSA26hSMN2/+) were phenotyped at 6 weeks by micro-CT and histology. EVs were isolated from muscles, validated (western blot, transmission electron microscope, nano-flow cytometry, BCA protein assay), and compared between genotypes. DiL-labelled EV biodistribution was tracked in vivo; uptake by BMSCs/BMMs was confirmed by confocal microscopy. Cytotoxicity was assessed by live/dead staining. Dose-response experiments evaluated the osteogenic and anti-osteoclastic activity of SMA-EVs. Comparison of the effects of SMA-EVs and CON-EVs were performed with adequate doses in vitro and in vivo, followed by EV replenishment in SMA mice. Osteogenic and osteoclastogenic gene expression was quantified by qPCR; ALP activity by ELISA. Bone and cell parameters were assessed by HE staining, TRAP staining, COL-1 immunofluorescence staining, and micro-CT. RNA-seq data were validated by Western blot. Lentiviral shRNA and over-expression plasmids were used to generate muscle cells with stable SNAP23 knock-down or up-regulation, and AAV-mediated muscle-specific Snap23 over-expression was employed in mice to define the role of muscular SNAP23 in EV secretion and its impact on bone mass. Mice carrying extra SMN2 transgenic copies were analyzed to delineate the SMN-SNAP23 relationship. SMA patients and mice exhibited a significantly diminished capacity of skeletal muscle to secrete EVs, which were readily internalized by BMSCs and BMMs, dose-dependently promote osteogenic differentiation and suppress osteoclast formation. Adequate-dose SMA-EVs matched CON-EVs efficacy, and SMA-EVs supplementation effectively rescued the osteoporotic phenotype in SMA. Transcriptomics indicated impaired SNARE complex-mediated vesicle secretion pathway. We further demonstrated that deficiency of SMN protein drives downregulation of its downstream key SNARE component, SNAP23, thereby impairing the efficiency of SMA-EV secretion. Our work elucidates a novel disease-specific mechanism for SMA osteoporosis-dysfunction of the SMN-SNAP23-EVs axis-and highlights the therapeutic potential of replenishing SMA-EVs or targeting this axis, offering a promising strategy to improve skeletal health in SMA.
Multimodal profiling of circulating tumor cells (CTCs) and non-tumor circulating cells was performed in six patients with advanced colorectal cancer to identify biological programs beyond enumeration-based analyses. Across all patients, we identified 3,981 CTCs characterized by pronounced EpCAM/L1CAM co-expression, variable PD-L1 expression, and low LGR5 expression, consistent with metastatic-associated phenotypes. Integrated single-cell multi-omics analysis of 1,720 cells revealed genomic instability within EpCAM⁺, L1CAM⁺, LGR5⁺, and PD-L1⁺ CTC subsets, including Y-chromosome loss in male patients and marked intra-patient heterogeneity. In parallel, non-CTCs exhibited upregulation of inflammatory and metabolic dysregulation programs. This hypothesis-generating study highlights the relevance of blood-based multimodal single-cell profiling for interrogating tumor-host states beyond insights from CTC enumeration alone.