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Objective: Racial and ethnic disparities in rheumatoid arthritis (RA) outcomes are well recognized. However, whether disparities in RA treatment selection and outcomes differ by urban versus rural residence, independent of race, have not been studied. Our objective was to evaluate whether biologic disease‐modifying antirheumatic drug (bDMARD) initiation after methotrexate administration differs by rural versus urban residence among veterans with RA. Methods: In this retrospective cohort study using national US Veterans Affairs (VA) databases, we identified adult patients with RA based on the presence of diagnostic codes and DMARD administration. We included patients receiving an initial prescription of methotrexate (index date) between 2005 and 2014, with data through 2016 used for follow‐up. Urban–rural status was categorized using the Veteran Health Administration's Urban/Rural classification. Our primary outcome of interest was time to biologic initiation within two years of starting methotrexate. Multivariable Cox proportional hazards models were conducted adjusting for demographics, comorbidities, and rheumatoid factor or anti‐cyclic citrullinated peptide positivity. Results: Among 17,395 veterans with RA (88% male, 42% with rural residence) fulfilling eligibility criteria, 3,259 (19%) initiated a biologic within the first two years of follow‐up. In multivariable models, residence in an urban area was associated with a statistically significant higher biologic administration compared to rural areas (adjusted hazard ratio 1.10 [95% confidence interval 1.02–1.18]). Conclusion: Our study found only modest differences in the initiation of biologic therapies among rural‐ versus urban‐residing veterans with RA in the VA health care system. These findings suggest that disparities are not easily explained by rurality within the VA health care system. [ABSTRACT FROM AUTHOR]

Patients receiving palliative care experience stigma associated with their illness, personal identity, and healthcare utilization. These stigmas can occur at any stage of the disease process. Varying stigmas combine to cause palliative care patients to feel misunderstood, contribute to treatment barriers, and further negative stereotypes held by clinicians. Stigma surrounding palliative care patients stems from complex intersections of varied access to resources, familial and physical environment, socioeconomic status, mental health and disorders, and identity characteristics. This article examines the relationship between the stigmatization of mental health and palliative care through three pathways: stigma and barriers existing within healthcare, the tendency of this stigma to undermine social support, and patient deferral of treatment-seeking in response to stigma. Recommendations to address and diminish stigmatization are presented, including advocacy, increased research and assessment, and contextual and intersectional awareness. Clinicians are also encouraged to turn to their colleagues for peer support and team-based care. [ABSTRACT FROM AUTHOR]

The obnoxious p$p$‐median problem is a facility location problem where we maximise the sum of the distances between each client point and its nearest facility. Since it is nondeterministic polynomial‐time (NP)‐hard, most algorithms designed for the problem follow metaheuristic strategies to find high‐quality solutions in affordable time but with no optimality guarantee. In this paper, a variant of the iterated greedy algorithm is developed for the problem. It adopts the idea of increasing the search radius used in variable neighbourhood search by increasing the number of reconstructed components at each iteration with no improved solution, where the amount of the increase is determined dynamically based on the quality of the current solution. We demonstrate that the new algorithm significantly outperforms the current state‐of‐the‐art metaheuristic algorithms for this problem on standard datasets. [ABSTRACT FROM AUTHOR]

Introduction: The use of artificial intelligence (AI) in health care has the potential to improve clinical and patient outcomes and to reduce rising costs. There is an exponential increase in health technologies that use AI. We present a health technology assessment (HTA) case study demonstrating that the rapid rise in publications presents challenges for HTA bodies seeking to provide robust, timely assessments. Methods: We conducted an HTA of AI-assisted endoscopy in the detection and characterization of lower gastrointestinal (GI) cancer. Searches were conducted up to October 2023. Unusually, the search targeted only the intervention: artificial intelligence and lower-GI-tract endoscopy (including colonoscopy, proctoscopy, etc.). The search strategy was peer reviewed. MEDLINE, Embase, KSR Evidence, CINAHL, Cochrane Library, and the INAHTA HTA database were searched, as well as ongoing trial registers and key websites. A date limit of 2010 onwards was applied, as Xbox Kinect launched in 2010 and was the first mainstream device used for healthcare imaging. Results: Two network meta-analyses, 15 meta-analyses, one systematic review of meta-analyses, and three systematic reviews published since 2020 were identified. One review conducted searches to January 2020, identifying three randomized controlled trials (RCTs); a review that searched up to February 2023 identified 21 RCTs. There was substantial overlap regarding included primary studies, but not all reviews included the same outcomes. An additional seven RCTs were published in 2023. We also identified 12 cohort studies published between 2021 and 2023. We prioritized higher quality meta-analyses of clinical RCTs to include all outcomes of interest and updated the meta-analyses for primary outcomes. Conclusions: This case study of an HTA of an AI-related technology demonstrates how rapidly the field is moving. It is necessary to use well targeted but not overly exclusive search strategies, limit by date, and prioritize inclusion of identified evidence according to quality and availability of outcomes. Time should be allowed to update existing meta-analyses. [ABSTRACT FROM AUTHOR]

Introduction: Artificial intelligence (AI) technologies are becoming more widespread in daily life, including in health and care settings. AI is being developed for use in many areas, including diagnostics, treatment planning, and patient monitoring. There are new challenges and additional considerations when performing a health technology assessment (HTA) for AI use in healthcare. Methods: Health Technology Wales has developed additional guidance and a checklist of considerations for researchers to use when undertaking an HTA on AI. These documents were created as a result of involvement in discussions with healthcare services around AI; attendance at meetings and training sessions with government, healthcare, and academic institutions; and observations from undertaking our first HTAs investigating AI technologies. Results: We identified seven main areas to consider: (i) the AI model being used and its training datasets; (ii) clarity on where in the clinical pathway the AI sits and whether this is appropriate for the local healthcare service; (iii) clear identification of the target patient population and whether there are gaps in the evidence base for subgroups; (iv) who uses the AI and the training required; (v) possible barriers and inequities in usage, particularly if the AI is patient facing; (vi) ongoing monitoring of the AI model; and (vii) data security and usability. Conclusions: HTA assessment of AI presents new challenges for HTA bodies. Additional outcomes for assessment (including user acceptability) may be required, and an awareness of background information that allows for contextualization of the technology and clear indication of its usefulness in the local healthcare setting is key. The development of guidance related to AI technologies may enable rigorous evaluation. [ABSTRACT FROM AUTHOR]

This study investigates the role of Ni in CNT production using Fe-based catalysts. Among the various catalysts used, such as 40Fe-0Ni, 40Fe-1Ni, 40Fe-3Ni, 40Fe-5Ni, 40Fe-7Ni, and 40Fe-10Ni, the 40Fe-5Ni catalyst achieved a notable yield of 5.80 gC per g metal, which is higher than the 1.03 gC per g metal obtained with the pure Fe catalyst. DFT study reveals that Fe 3 Ni exhibits stronger carbon binding, enabling more efficient CNT production and supporting our experimental results.

The impacts of degradation and deforestation on tropical forests are poorly understood, particularly at landscape scales. We present an extensive ecosystem analysis of the impacts of logging and conversion of tropical forest to oil palm from a large-scale study in Borneo, synthesizing responses from 82 variables categorized into four ecological levels spanning a broad suite of ecosystem properties: (i) structure and environment, (ii) species traits, (iii) biodiversity, and (iv) ecosystem functions. Responses were highly heterogeneous and often complex and nonlinear. Variables that were directly impacted by the physical process of timber extraction, such as soil structure, were sensitive to even moderate amounts of logging, whereas measures of biodiversity and ecosystem functioning were generally resilient to logging but more affected by conversion to oil palm plantation.

Purpose: This systematic review aimed to assess the updated literature for the prevention of salivary gland hypofunction and xerostomia induced by non-surgical cancer therapies., Methods: Electronic databases of MEDLINE/PubMed, EMBASE, and Cochrane Library were searched for randomized controlled trials (RCT) that investigated interventions to prevent salivary gland hypofunction and/or xerostomia. Literature search began from the 2010 systematic review publications from the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) up to February 2024. Two independent reviewers extracted information regarding study design, study population, cancer treatment modality, interventions, outcome measures, methods, results, risk of bias (RoB version 2), and conclusions for each article., Results: A total of 51 publications addressing preventive interventions were included. Eight RCTs on tissue-sparing radiation modalities were included showing significant lower prevalence of xerostomia, with unclear effect on salivary gland hypofunction. Three RCTs on preventive acupuncture showed reduced prevalence of xerostomia but not of salivary gland hypofunction. Two RCTs on muscarinic agonist stimulation with bethanechol suggested a preventive effect on saliva flow rate and xerostomia in patients undergoing head and neck radiation or radioactive iodine therapy. Two studies on submandibular gland transfer showed higher salivary flow rates compared to pilocarpine and lower prevalence of xerostomia compared to no active intervention. There is insufficient evidence on the effectiveness of vitamin E, amifostine, photobiomodulation, and miscellaneous preventive interventions., Conclusion: This systematic review continues to support the potential of tissue-sparing tecniques and intensity-modulated radiation therapy (IMRT) to preserve salivary gland function in patients with head and neck cancer, with limited evidence on other preventive strategies, including acupuncture and bethanecol. Preventive focus should be on optimized and new approaches developed to further reduce radiation dose to the parotid, the submandibular, and minor salivary glands. As these glands are major contributors to moistening of the oral cavity, limiting the radiation dose to the salivary glands through various modalities has demonstrated reduction in prevalence and severity of salivary gland hypofunction and xerostomia. There remains no evidence on preventive approaches for checkpoint inhibitors and other biologicals due to the lack of RCTs., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Purpose: The purpose of this study was to investigate adolescent perspectives of parent-adolescent communication, type 1 diabetes mellitus (T1DM)-specific family conflict, self-efficacy, and their relationship to adolescent self-management of T1DM., Methods: A cross-sectional survey design was employed. Adolescents completed measures of parent-adolescent communication, T1DM-specific family conflict, self-efficacy, and self-management, which included activation and division of responsibility for management tasks., Results: Surveys were completed by 113 adolescents ages 11 to 17 years (mean age 13.85 years, SD 1.78) and living with T1DM for 6 months and longer. Hierarchical multiple regression sought to determine what variables make the most unique contribution to self-management of T1DM, division of family responsibility for management tasks, and activation. Self-efficacy was a significant predictor of division of family responsibility for T1DM management, patient activation, and all self-management subscales except collaboration with parents. Openness in parent-adolescent communication was a significant predictor of the diabetes communication and goals subscale of the self-management measure and activation. Problems in communication was a significant predictor of collaboration with parents and self-management goals., Conclusions: These findings suggest that family context characteristics, particularly parent-adolescent communication, and self-efficacy are important for engagement with self-management for adolescents living with T1DM. Findings can inform future family-focused self-management interventions to improve T1DM outcomes for adolescents living with T1DM., Competing Interests: Declaration of Conflicting InterestsThe authors declare that there is no conflict of interest.

Aims: To examine survivors' experiences of discharge information including risk communication after hospitalisation for a stroke and the characteristics associated with receiving information in accordance with their preferences., Background: With advances in acute stroke care and an ageing population, the number of survivors of stroke is increasing. It is important that healthcare providers ensure patients have adequate information after a stroke-related hospitalisation., Design: Cross-sectional study., Methods: Adults recently discharged after a stroke from eight Australian hospitals were mailed a survey. Items examined risk and discharge care information, with participants asked to indicate both their preferences for and receipt of the information. Concordance with preferences was calculated, and characteristics associated with information preference concordance were assessed with binomial logistic regression. Study reported in accordance with STROBE Checklist., Results: Of 1161 eligible patients invited, 403 (35%) completed the survey. All items were endorsed by 80% or more of respondents as being wanted. However, for all items, fewer respondents reported the care as received. Only 28% of participants received information on all five items according to their preferences. Hospital site, Body Mass Index and age were statistically significantly associated with participants receiving information in accordance with their preferences., Conclusion: Most participants indicated a preference to receive recommended discharge information. Findings suggest that patients may benefit from increased information provision prior to hospital discharge after stroke., Relevance to Clinical Practice and Patient Care: Nurses have an important role in the provision of stroke care and information. The findings of this study may be used to improve the provision of post-hospital discharge care and support for survivors of stroke, and assist in identifying patients at lower odds of experiencing information aligned with their preferences and who may benefit from support., Reporting Method: Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) checklist for cross-sectional studies., Patient or Public Contribution: No patient or public contribution., (© 2025 The Author(s). Journal of Clinical Nursing published by John Wiley & Sons Ltd.)

Background: Disorders of gut-brain interactions (DGBI) affect more women, and marital quality may have been a factor that explains clinical manifestations of DGBI-however, the mechanism is unclear. This study aimed to elucidate supported relationships between DGBI with marital quality and clinical attributes in married Malay women., Methods: This cross-sectional study involved married Malay women with functional dyspepsia (FD), irritable bowel syndrome (IBS), and FD-IBS overlap per Rome IV criteria. Multivariate analysis of variance (MANOVA) and Pearson correlation analysis were performed to determine the association between DGBI, marital quality, and clinical attributes of catastrophizing, psychological dysfunction, and quality of life. Path analysis models were developed, tested, and fitted to elucidate relationships that satisfied significance testing and fit indices (termed supported relationship)., Key Results: Of 1130 screened participants, 513 were analyzed. The prevalence of FD, IBS, and FD-IBS overlap was 33.9% (n = 174), 29.5% (n = 151), and 36.6% (n = 188), respectively. Of 17 variables in MANOVA, significant differences in variables were observed for FD vs. FD-IBS overlap (10), IBS versus FD (10), and IBS versus FD-IBS overlap (5). Pearson correlation matrices found significant correlations for 15 of 17 variables. After testing and fitting, the third path model (Model 3) was deemed the final model. Model 3 suggested that relationships between DGBI and marital and clinical attributes were complex and bidirectional. The number of supported relationships were 50, 43, and 39 for FD-IBS overlap, FD, and IBS, respectively., Conclusions and Inferences: Relationships between DGBI, marital quality, and clinical attributes among married Malay women are complex and bidirectional., (© 2025 John Wiley & Sons Ltd.)

Mental fatigue is referred to as a psychophysiological or neurobiological state caused by prolonged periods of demanding cognitive activity. Sports and exercise science research have investigated the effects of experimentally induced mental fatigue on cognitive performance, with mixed results. It has been suggested that negative effects of mental fatigue on cognition performance in laboratory studies could translate to impaired sport performance. However, it remains unclear if impairments in sport performance are due to mental fatigue and how mental fatigue may differ from physical fatigue. Fatigue is well understood as a complex multifactorial construct involving interactions between physiological and neuropsychological responses across brain regions. It may be prudent for researchers to return to the origins of fatigue and cognition before attempting to connect mental fatigue and sport cognition. This article reviews the concept of mental fatigue, its mechanisms and neuroanatomical basis, models of cognition relevant to sports science, how mental fatigue may influence cognition, and suggests future research directions. Mental fatigue as a construct separate from fatigue could be an oversight that has hindered the development of our understanding of mental fatigue. Future sports science research could work to enhance our knowledge of our definitions of fatigue., Competing Interests: The authors declare that they have no conflict of interest., (Thieme. All rights reserved.)

Background: The Age-Friendly Health System (AFHS) initiative seeks to improve care for older adults through assessing and acting on the 4Ms (What Matters, Medication, Mentation, Mobility). The Department of Veterans Affairs (VA) joined the initiative in 2020, and from 2022 to 2023, VA led its first Age-Friendly Action Community, a 7-month online educational series to teach clinicians about implementing the 4Ms across VA care settings., Methods: The VA Action Community was designed to spread awareness about Age-Friendly care for older Veterans, improve interprofessional team knowledge for providing care guided by the 4Ms, and support AFHS implementation across multiple care settings. The VA Action Community included online synchronous webinars, Community of Practice coaching calls, and office hours. A learner experience questionnaire was administered at the completion of the Action Community., Results: Totally 186 care teams enrolled in the VA Action Community, representing 78/171 (45.6%) VA medical centers (VAMCs), across 36 US states and 20 types of care settings. Participants reported high rates of satisfaction and confidence in their ability to apply the knowledge and skills learned. Overall, 58 Action Community teams earned Level 1, Participant recognition, and 43 teams also earned Level 2, Committed to Care Excellence recognition from the Institute for Healthcare Improvement., Conclusions: The VA Action Community facilitated learning about the 4Ms, supported interprofessional teams in earning AFHS recognition, and offers a promising model for spreading AFHS in other large health systems. Further work is underway to evaluate the impact of this educational experience on clinical process and outcomes measures., (Published 2025. This article is a U.S. Government work and is in the public domain in the USA.)

Aims: To understand the current capacity and capability for nursing, midwifery and allied health professional (NMAHP) principal investigator roles in England., Design: Quantitative online survey., Methods: Online national quantitative survey across England analysed using descriptive statistics., Results: The number of NMAHP PIs in an organisation was unrelated to the size of the NMAHP workforce. NMAHP PIs were more common in non-CTIMP studies. A quarter of organisations had no specific education or support for NMAHP PIs. Most respondents indicated that a national approach to support and training would be helpful., Conclusions: Having more research-active NMAHPs provides career progression, improved staff retention and improves the evidence base for practice. Having a broader range of CI/PIs allows for more targeted and specialty-specific oversight of research studies and streamlines the acceptance process to allow research to be delivered in a more timely manner., Implications for Practice: This will require more collaboration between NMAHP, medical and industry communities to promote a multidisciplinary approach to healthcare research delivery and to ensure that CI/PI roles are fulfilled by the most appropriate person, regardless of their profession., Impact: To ascertain NMAHP capacity and capability for PI research roles. Shows where national and organisational effort should be focused to increase this nationally., Reporting Method: Cross reporting guidance for survey studies was utilised., Patient Contribution: No patient or patient contribution., (© 2025 John Wiley & Sons Ltd.)

Importance: Although sharing care with local oncologists after allogeneic hematopoietic cell transplantation (HCT) has been proposed for patients living far from HCT centers, it is not known whether a shared strategy is safe or improves patient quality of life (QOL)., Objective: To determine the efficacy and safety of sharing follow-up care after HCT between the HCT specialty center and local oncologists., Design, Setting, and Participants: This was a multicenter collaborative randomized clinical trial of patients undergoing HCT at Dana-Farber Cancer Institute (DFCI)-a high volume HCT center in Boston (Massachusetts)-and 8 local oncology practices. Eligible patients were enrolled from December 2017 to December 2021 and were randomized 1:1 to shared vs usual care after neutrophil engraftment, stratified by local sites in Massachusetts, Rhode Island, New Hampshire, New York, and Maine. Data analyses were performed in January 2024., Intervention: Shared care involved alternating post-HCT visits at DFCI and local oncology practices through day 100; for usual care, all post-HCT visits occurred only at DFCI., Main Outcomes and Measures: Coprimary outcomes were nonrelapse mortality (NRM) at day 100, and QOL measured by the FACT-BMT (Functional Assessment of Cancer Therapy-Bone Marrow Transplantation) instrument and the QLQ-C30 (European Organization for Research and Treatment of Cancer's Quality of Life Questionnaire) at day 180. Prespecified secondary outcomes included day 100 QOL and 1-year overall survival., Results: A total of 302 participants (median [range] age, 63 [20-79] years; 117 [38.7%] females; 185 [61.3%] males) were included in the analysis; 152 were randomized to shared care and 150 to usual care. Day 100 NRM was noninferior for shared vs usual care (2.6% [95% CI, 0.7% to 6.6%] vs 2.7% [95% CI, 0.7% to 6.7%]; P = .98). There were no differences at day 180 for the FACT-BMT total score (mean difference, 3.8; 95% CI, -2.1 to 9.6; P = .20) or QLQ-C30 global score (1.9; 95% CI, -4.9 to 8.8; P = .58). At day 100, the FACT-BMT total score was better for shared care (mean difference, 6.6; 95% CI, 1.0 to 12.1; P = .02) as was the QLQ-C30 global score (8.8; 95% CI, 1.8 to 15.7; P = .02)., Conclusions and Relevance: This randomized clinical trial found that shared care resulted in noninferior NRM at day 100 but similar QOL at day 180, with improved QOL at day 100. These data suggest that shared care is safe, improves QOL early on, and has the potential to become a routine model for post-HCT care., Trial Registration: ClinicalTrials.gov Identifier: NCT03244826.

Recent reports raise concerns on the changing epidemiology of mpox in the Democratic Republic of the Congo (DRC). High-quality genomes were generated for 337 patients from 14/26 provinces to document whether the increase in number of cases is due to zoonotic spillover events or viral evolution, with enrichment of APOBEC3 mutations linked to human adaptation. Our study highlights two patterns of transmission contributing to the source of human cases. All new sequences from the eastern South Kivu province (n = 17; 4.8%) corresponded to the recently described clade Ib, associated with sexual contact and sustained human-to-human transmission. By contrast, all other genomes are clade Ia, which exhibits high genetic diversity with low numbers of APOBEC3 mutations compared with clade Ib, suggesting multiple zoonotic introductions. The presence of multiple clade I variants in urban areas highlights the need for coordinated international response efforts and more studies on the transmission and the reservoir of mpox., Competing Interests: Declaration of interests The authors declare no competing interests., (Copyright © 2024 The Author(s). Published by Elsevier Inc. All rights reserved.)

Adolescent idiopathic scoliosis (AIS) is the most common spinal disorder among children and adolescents, with most cases being diagnosed around puberty. While the majority of people with AIS do not undergo treatment, a small but significant number are treated, depending on the extent of their spinal curvature. Treatment typically involves bracing, which requires substantial adherence, and/or surgery, which is invasive and permanent. Furthermore, decisions about treatment often need to be made at a critical stage of the person's development. This article examines the evidence on AIS and its treatment, synthesising the current literature and drawing from the authors' empirical work to explore the clinical outcomes of bracing and surgery, as well as the longer-term effects on people's quality of life. Drawing from this evidence, the authors provide guidance for nurses and healthcare professionals who care for people with AIS., Competing Interests: None declared, (© 2024 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.)

Children and young people's (CYP) nursing leaders have experienced considerable challenges in the context of a complex health and social care system with rapidly changing organisational structures, including the establishment of integrated care systems in England on 1 July 2022. The CYP nursing lead at NHS England commissioned a review of CYP organisational structures in emerging integrated care systems across England. The review encompassed a vision for CYP services, leadership, governance structures and opportunities for progression. A proforma was used to collate data from CYP trusts, CYP standalone hospitals and children's wards in district general hospitals. Qualitative interviews were also undertaken with senior children's nurses. At the same time, the first author of this article interviewed senior children's nurses as part of a Florence Nightingale Foundation leadership scholarship. The aim was to explore how they navigated their leadership journey and understand what advice they may give to future leaders in CYP nursing. The findings in this article identify 'what good looks like' in terms of CYP nursing leadership. Six recommendations for future development and enhancement of CYP nursing leadership are outlined., Competing Interests: None declared, (© 2024 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.)

A virtual ward can provide hospital-level care for older people in their usual place of residence during an episode of acute illness. Care on a virtual ward may be delivered through a mix of in-person home visits, telephone or video calls and remote monitoring. This model of care can prevent unnecessary inpatient admissions, which in turn can prevent the development of associated complications in this patient population, such as deconditioning, delirium and hospital-acquired infections. However, there are barriers to the use of virtual wards in the care of older people. This article provides an overview of technology-enabled virtual wards and discusses some of the barriers to their use in older people's care as well as ways in which these can be addressed. The author also considers how nurses can help ensure that the care provided to an older person admitted to a virtual ward is person-centred and safe., Competing Interests: None declared, (© 2025 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.)

Background: The ability to access and navigate online sexual health information and support is increasingly needed in order to engage with wider sexual healthcare. However, people from underserved populations may struggle to pass though this "digital doorway". Therefore, using a behavioural science approach, we first aimed to identify barriers and facilitators to i) seeking online sexual health information and ii) seeking online sexual health support. Subsequently, we aimed to generate theory-informed recommendations to improve these access points., Methods: The PROGRESSPlus framework guided purposive recruitment (15.10.21-18.03.22) of 35 UK participants from diverse backgrounds, including 51% from the most deprived areas and 26% from minoritised ethnic groups. Using semi-structured interviews and thematic analysis, we identified barriers and facilitators to seeking online sexual health information and support. A Behaviour Change Wheel (BCW) analysis then identified recommendations to better meet the needs of underserved populations., Results: We found diverse barriers and facilitators. Barriers included low awareness of and familiarity with online information and support; perceptions that online information and support were unlikely to meet the needs of underserved populations; overwhelming volume of information sources; lack of personal relevancy; chatbots/automated responses; and response wait times. Facilitators included clarity about credibility and quality; inclusive content; and in-person assistance. Recommendations included: Education and Persuasion e.g., online and offline promotion and endorsement by healthcare professionals and peers; Training and Modelling e.g., accessible training to enhance searching skills and credibility appraisal; and Environmental Restructuring and Enablement e.g., modifications to ensure online information and support are simple and easy to use, including video/audio options for content., Conclusions: Given that access to many sexual health services is now digital, our analyses produced recommendations pivotal to increasing access to wider sexual healthcare among underserved populations. Implementing these recommendations could reduce inequalities associated with accessing and using online sexual health service., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2025 McLeod et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Background: Patients with cancer account for 15% of all admissions to critical care and so an understanding of the pathophysiology and anticipated complications of specialist treatment is essential for the intensive care clinician. The development of chimeric antigen receptor T-cell therapy for haematological malignancies and immune checkpoint inhibitors for solid organ tumours has led to significant improvements in the prognosis of those patients whose tumours respond. This review is intended to provide the non-specialist with an understanding of the current concepts in pathophysiology, diagnosis and management of complications due to chimeric antigen receptor T-cell therapy and immune checkpoint inhibitors for malignant disease., Methods: We performed searches of electronic databases to identify relevant peer-reviewed publications in the literature. Basic science; clinical trials; cohort studies; systematic reviews; meta-analyses; and guidelines were eligible for inclusion. Abstracts were screened to identify publications relevant to immune effector cell toxicities of chimeric antigen receptor T-cell therapy and immune-related adverse events of immune checkpoint inhibitors., Results: While the pathophysiology for toxicities due to chimeric antigen receptor T-cells and immune checkpoint inhibitors remains incompletely understood, targeted drug therapies have been successfully implemented for toxicities such as cytokine release syndrome. Corticosteroids remain an important component of pharmacological management. The diagnosis of toxicities remains largely clinical, and a high index of suspicion should remain for infective complications. Management of toxicities should be undertaken in conjunction with the patient's primary oncologist., Conclusion: Despite significant advances in the development of targeted immunotherapy, the mechanism of action for the resultant toxicities remains poorly understood and limits the development of predictive models, diagnostic biomarkers and highly effective treatment options. Further research is needed to identify treatment regimens which minimise the use of corticosteroids in chimeric antigen receptor T-cell and immune checkpoint inhibitor-associated toxicities., (© 2025 Association of Anaesthetists.)

Objectives: This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To determine the effects of psychological interventions for depression in people with diabetes mellitus., (Copyright © 2025 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.)

Introduction: The ability to admit patients to enhanced or critical care may be limited by bed availability. In a network with low provision of critical and enhanced care beds, we aimed to assess the proportion of patients having surgery with moderate (1%-< 5%) or high (≥ 5%) predicted risk of 30-day postoperative mortality and their postoperative care location. We also aimed to study referral and admission outcomes to critical care., Methods: This prospective, 7-day observational study was conducted across 19 acute hospital sites within the South West Critical Care Network. All adult inpatients having a procedure under the care of an anaesthetist (excluding cardiac and obstetric procedures) had a surgical outcome risk tool score calculated retrospectively, and their postoperative destination captured. Synchronously, all critical care referrals, admissions and refusal decisions were captured, along with critical care bed capacity., Results: Of 2222 eligible patients, 1728 (78%) were captured. Retrospective surgical outcome risk tool score calculation revealed 1060 (61%) patients had a low, 418 (24%) a moderate and 250 (15%) a high risk of postoperative mortality. In patients with a moderate predicted risk of postoperative morbidity, 72/418 (17%) received enhanced or critical care and 64/249 (26%) patients with a high predicted risk received critical care. All critical care referral and admission activity was captured; in total, 263/680 (39%) of patients referred were admitted to critical care. Referrals to critical care exceeded the available level 3-equivalent beds on 79% of occasions., Discussion: These data describe constraints in access to postoperative and emergency enhanced/critical care in the south-west of England. There is poor compliance with national guidance regarding the postoperative care location of patients with a moderate or high risk of postoperative mortality., (© 2025 Association of Anaesthetists.)

Introduction: There is a continued increase of older dependant adults in England. Foundation Dentists (FDs) are often the dental workforce being tasked with providing dental care to dependant older adults resident in care home settings. This study explores whether FDs have the experience and confidence to deliver this., Aim: This service evaluation aimed to explore FDs' attitudes, perceptions and experiences delivering dentistry to dependant older adults' resident in care home settings; to help inform workforce and service delivery planning., Methods: All North West England (NW) FDs were invited to complete a semi-structured questionnaire at a regional study session. Results were analysed using descriptive and thematic analysis., Results: There were 93 (80.1%) respondents, with the majority aged 20-24 years old (56, 60.2%), female (57, 61.3%) and with an United Kingdom undergraduate dental degree (88, 94.6%). Most respondents had no experience in delivering care in a care home setting at either undergraduate (85, 91.4%) or FD level (84, 90.3%). Only 14 respondents (15.1%) reported confidence to deliver dentistry in a care home setting., Conclusion: To deliver dental care for dependant older adults resident in care home settings, FDs require additional training and clinical support. There is a need to review the undergraduate dental curriculum and NHS postgraduate training programmes to increase knowledge and skills for this vulnerable group., Competing Interests: Competing interests: The authors declare no competing interests. As this was a service evaluation study in the UK, prior ethical approval was not required. Consent for completion of the questionnaire was implied by Foundation Dentists (FD) completing the questionnaire., (© 2024. The Author(s).)

This study examines the relationship between chondroitin sulfate, proteinoids, and computational neuron models, with a specific emphasis on the Izhikevich neuron model. We investigate the effect of chondroitin sulfate-proteinoid complexes on the behavior and dynamics of simulated neurons. Through the use of computational simulations, we provide evidence that these biomolecular components have the power to regulate the responsiveness of neurons, the patterns of their firing, and the ability of their synapses to change within the Izhikevich architecture. The findings suggest that the interactions between chondroitin sulfate and proteinoid cause notable alterations in the dynamics of membrane potential and the timing of spikes. We detect adjustments in the features of neuronal responses, such as shifts in the thresholds for firing, alterations in spike frequency adaptation, and changes to bursting patterns. The findings indicate that chondroitin sulfate and proteinoids may have a role in precisely adjusting neuronal information processing and network behavior. This study offers valuable information about the complex connection between the many components of the extracellular matrix, protein-based structures, and the functioning of neurons. In addition, our analysis of the proteinoid-chondroitine system using game theory uncovers a significant Prisoner's Dilemma scenario. The system's inclination toward defection, due to the appeal of cheating and the significant penalty for cooperation, with a mean voltage of -9.19 mV, indicates that defective behaviors may prevail in the long term dynamics of these neuronal interactions.

Introduction: Rheumatoid arthritis (RA) is a systemic inflammatory disease associated with an increased risk of cardiovascular disease (CVD) and premature mortality. The risk of CVD is closely associated with RA disease activity, and achieving RA remission using disease-modifying anti-rheumatic drugs (DMARDs) can significantly mitigate this risk. However, despite the availability of highly effective DMARDs, many veterans fail to achieve sustained RA remission., Areas Covered: We will discuss DMARD adherence in U.S. veterans with RA as it relates to RA disease activity and CVD risk, describe factors associated with DMARD non-adherence in individuals with RA, and discuss intervention strategies to improve DMARD adherence. For this review, the authors performed an extensive literature search using Embase, PubMed, Google Scholar, MEDLINE, Cochrane Library, Web of Science, and Duke University library resources., Expert Opinion: Barriers to DMARD adherence in veterans with RA are multifactorial and include patient-related factors, systemic barriers, and suboptimal adherence screening practices. Additional research is needed to create validated screening tools for DMARD adherence, train rheumatology providers on how to assess DMARD adherence, develop effective interventions to promote veteran self-efficacy in DMARD management, and to learn how to sustainably utilize multidisciplinary resources to support DMARD adherence in veterans with RA.

Adolescence and young adulthood are sensitive developmental periods to environmental influences. Investigating pre-emptive measures against stressors, such as those associated with the COVID-19 pandemic, on mental health is crucial. We aimed to synthesize evidence on pre-pandemic resilience factors shaping youth mental health outcomes during this period. For this pre-registered systematic review, we searched seven databases for longitudinal studies of youth populations affected by the COVID-19 pandemic, assessing a priori defined resilience factors at the individual, family, or community level before the pandemic. Studies required validated mental health or wellbeing measures collected both before and during the pandemic. Study quality was assessed using the corresponding NIH Quality Assessment Tool. From 4,419 unique records, 32 studies across 12 countries were included, using 46 distinct resilience measures. Due to the heterogeneity of study designs, we applied a narrative synthesis approach, finding that resilience factors were generally associated with better mental health outcomes both prior to and during the pandemic. However, most factors did not mitigate pandemic-related mental health effects. Nonetheless, family-level resilience factors emerged as promising under specific conditions. Study quality was generally fair, with concerns in resilience assessment and sampling quality. Future research should prioritize rigorous study designs and comprehensive resilience assessments.

Approximately 3.8 million people in the UK are affected by acute or chronic wounds each year and it is essential that nurses are equipped with the knowledge and skills to assess and manage these patients. This article covers the main aspects that nurses need to consider to provide evidence-based care to patients with a wound, including skin anatomy, normal wound healing physiology and the factors that can delay healing. The author also discusses holistic wound assessment, including wound healing risk factors, wound bed preparation and wound management products, providing nurses with a practical overview of the complex topic of wound care., Competing Interests: None declared, (© 2024 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.)

This article explores the use of effective communication for nurses when interacting with people experiencing mental health issues. Emphasis will be on the importance of nurses adopting person-centred communication styles that prioritise empathy, with the aim of developing a therapeutic rapport. The article underscores the role of the nurse in promoting positive mental health outcomes through the use of techniques such as active listening, empathy and validation. The author also details some of the barriers to effective communication and how nurses can address them., Competing Interests: None declared, (© 2024 RCN Publishing Company Ltd. All rights reserved. Not to be copied, transmitted or recorded in any way, in whole or part, without prior permission of the publishers.)