To compare the primary outcome of surgical time for long, distally unlocked, intramedullary nails (LUIMNs) versus short, distally locked, intramedullary nails (SLIMNs) and to compare secondary outcomes of blood loss, peri-implant fractures, reoperation events, and mortality between these 2 groups. Retrospective cohort study. One Level I Trauma Center and one community hospital. Patients older than 18 years treated with SLIMNs or LUIMNs for peritrochanteric hip fractures, OTA/AO 31A1, 31A2, 31A3, were included. The primary outcome was surgical time for LUIMNs versus SLIMNs. Secondary outcomes were estimated blood loss, peri-implant fracture rates, reoperation for nonunion or shortening, all-cause reoperation, and mortality within 2 weeks and 3 months of surgery for LUIMNs versus SLIMNs. There were 602 patients in the LUIMN group (68.6% female, 31.4% male), with an average age of 77.3 (range, 29-108) years. There were 142 patients in the SLIMN group (63.4% female, 36.6% male) with an average age of 75.3 (range 33-101) years. Average OR time for LUIMNs was 46.9 minutes compared with 53.7 minutes for SLIMNs ( P < 0.001). Peri-implant fracture rates were 0.6% for LUIMNs and 4.1% for SLIMNs ( P = 0.012). There was no difference in estimated blood loss between LUIMNs (103.8 ± 55.1) and SLIMNs (104.3 ± 87.8); bootstrap analysis showed a mean difference of 0.3 mL (95% confidence interval -13.7 to 16.3; P = 0.97). There was no difference in all-cause reoperation (1.9% LUIMNs and 4.9% SLIMNs, P = 0.113), reoperation for nonunion (0.2% LUIMNs, 0% SLIMNs, P = 1.00), or reoperation for shortening (0.75% LUIMNs, 0% SLIMNs, P = 0.44). There was no significant difference in mortality at 2 weeks (2.8% LUIMNs, 2.5% SLIMNs, P = 0.891) and 3 months (7.1% LUIMNs, 9.8% SLIMNs, P = 0.292). For peritrochanteric hip fractures, LUIMNs reduced operative times and lowered the risk of peri-implant fracture compared with SLIMNs. Accordingly, they may be a preferred treatment option to reduce the risk of future fractures. Therapeutic Level III. See Instructions for Authors for a complete description for levels of evidence.

Rapid self-assembly and signal amplification based on photoactive Z907 for detecting colorectal cancer biomarker vascular endothelial growth factor.

This study examined factors associated with front-line nurse leaders (managers and assistant managers) occupational fatigue and its relationship with cognitive performance. Front-line nurse leaders face substantial work demands that can contribute to occupational fatigue. This fatigue can impact their cognitive performance. However, limited research has explored those relationships. A cross-sectional descriptive correlational study was conducted in a Midwestern academic medical center and a large community hospital. Data were collected from 75 front-line leaders using self-report scales measuring fatigue and cognitive performance. Participants reported high levels of acute, mental, and total fatigue, which were significantly associated with their cognitive performance. Poor sleep quality and long working hours were major contributors to fatigue. Older front-line leaders with tenure in their units reported better intershift recovery and low fatigue levels. The findings underscore the need for targeted interventions to mitigate fatigue and improve front-line nurse leaders' cognitive performance. Hospitals should prioritize fatigue management strategies for novice leaders.

The NRG Oncology research organization and NSABP B-35 randomized clinical trial prospectively collected margin width data on postmenopausal women with hormone receptor (HR)-positive ductal carcinoma in situ (DCIS) who underwent lumpectomy, whole-breast irradiation (WBI), and randomly assigned adjuvant anastrozole or tamoxifen therapy. This permitted analysis of outcomes per margin width. To analyze the effect of margin width on ipsilateral breast tumor recurrence (IBTR). NSABP B-35 was a phase 3, double-blind, randomized clinical trial in which patients were randomized to either 5 years of tamoxifen or anastrozole. Postmenopausal women with HR-positive DCIS and tumor-free margins were eligible. Enrollment was from January 6, 2003, to June 15, 2006, in academic and community hospital members of the NSABP. Study data were analyzed from July 2024 to April 2025. There were no specific interventions based on lumpectomy margin width. Lumpectomy margin width data were prospectively collected within 3 months of randomization. A pathology form classified margins as positive (ink on tumor), close (<1 mm), or negative (≥1 mm). For the negative margin subgroup, closest margin width was stated separately. Thus, an ancillary analysis using 1-mm and 2-mm margin width partitions was performed. A total of 3104 postmenopausal women (mean [SD] age, 61 [7.8] years) were enrolled in NSABP B-35. In an ancillary analysis, 2707 patients were included in the 1-mm margin width partition group, and 2546 patients were included in the 2-mm margin width partition group. IBTR was the most common first event, occurring in 90 of 2707 patients (3.3%): 24 of 502 patients (4.8%) with a margin width less than 1 mm and 66 of 2205 patients (3.0%) with a margin width greater than or equal to 1 mm. Ten-year unadjusted cumulative incidence of IBTR events was 5.6% vs 4.0% for margins less than 1 mm vs margins greater than or equal to 1 mm (P = .04). Using 2 mm as the discriminant threshold for margin width, 39 of 879 patients (4.4%) with margins less than 2 mm and 49 of 1667 patients (2.9%) with margins greater than or equal to 2 mm experienced an IBTR first. Ten-year unadjusted cumulative incidence of IBTR events with margins less than or equal to 2 mm was 5.3% vs 3.8% for those with margins greater than 2 mm (P = .05). In models adjusting for other patient and tumor factors, margin width was not a significant predictor of IBTR risk (2-mm threshold hazard ratio, 1.33; 95% CI, 0.86-2.06). Results of this ancillary analysis of the NSABP B-35 trial show that absolute differences in IBTR rates using margin width groupings of less than 1 mm or greater than or equal to 1 mm and margin width groupings of less than 2 mm or greater than or equal to 2 mm in postmenopausal women with HR-positive DCIS receiving lumpectomy, WBI, and adjuvant endocrine therapy were small. Omission of reexcision lumpectomies based on margin widths of less than 1 mm or less than 2 mm can be reconsidered in appropriate patients. ClinicalTrials.gov Identifier: NCT00053898.

Health systems around the world are investing in learning health system (LHS) infrastructure to strengthen their capacity to adapt, improve, and respond in real time. While prior work has focused on technical infrastructure, less is known about the conditions that enable learning to happen as envisioned. We aimed to address this knowledge gap by developing a multi-level, empirically grounded theory for operationalizing organizational attributes and leadership practices that influence learning in LHS. We adopted an iterative, theory-informed qualitative approach inspired by realist evaluation principles. Drawing on organizational and LHS literature, we developed an initial program theory hypothesizing key antecedents of organizational learning and conducted semi-structured interviews with formal leaders in a large community hospital using a "teacher-learner cycle" to test and refine the initial program theory. Based on interviews with 12 formal leaders, we developed a mid-range program theory outlining how structural, leadership, and cultural factors interact to create (or impede) the conditions for organizational learning in LHS. Resource investment, organizational governance, shared organizational identity, and leadership approaches emerged as key factors. These factors influence both the relational dynamics and execution dynamics that drive how work is done, determining whether the culture is characterized by learning catalysts or inertial loops. Leadership practices shape the cultural conditions that enable or stall system-level learning in LHS. While structural supports matter, they do not create the conditions for learning without leadership practices that reinforce clarity, connection, and curiosity.

Frontline hospitals are required to care for patients with suspected viral hemorrhagic fever (VHF), yet guidance on laboratory preparedness remains fragmented and incomplete. We conducted a multidisciplinary risk assessment of our institutional capacity to perform routine diagnostic testing for VHF persons under investigation (PUI), focusing on the feasibility of using automated core laboratory instruments. Our assessment revealed substantial gaps between CDC guidance (which permits core lab testing) and the practical ability to implement it safely. Public health mandates for VHF preparedness have not been accompanied by granular guidance on biosafety, laboratory infrastructure, or regulatory clarity necessary for implementation. Community hospitals, which would benefit most from safely using their existing automated core laboratory instruments, lack the infrastructure, staffing expertise, and clear guidance to do so, while well-resourced tertiary centers are often best positioned to develop dedicated point-of-care testing (POCT)-based workflows. Federal and state authorities must provide explicit, validated examples of acceptable mitigation strategies for testing using core lab instrumentation and reconcile conflicting recommendations across guidance documents. Without such authoritative clarity, frontline hospitals cannot confidently meet their mandated VHF preparedness obligations.

Emergency department (ED) crowding affects patient flow, care timeliness, staff well-being, and frontline workload. Although several crowding metrics are available, their interpretability across EDs of different sizes remains uncertain. We compared Census Rate (CR) and the Community Emergency Department Overcrowding Scale (CEDOCS) against frontline-perceived workload across three French EDs. We conducted a multicentre prospective observational study from 15 to 28 May 2023 in one university hospital and two community hospitals. Twice daily, operational variables were recorded and eligible frontline staff completed a 6-point staff workload assessment (SWA). The primary outcome was the association between SWA and each crowding metric. Spearman's rank correlation was prespecified as the primary analysis, with Pearson correlations and linear regression as sensitivity analyses. Overlapping dependent correlations were compared using Williams' test. Additional exploratory analyses examined empirical CR tertiles. Eighty-four site-time observations were expected, of which 81 had complete data for the main analyses. CR showed a strong association with SWA (Spearman's ρ = 0.744, 95% CI 0.619 to 0.832; p < 0.001), whereas the association for CEDOCS was more moderate (ρ = 0.471, 95% CI 0.289 to 0.616; p < 0.001). The association between CR and SWA was significantly stronger than that between CEDOCS and SWA (difference in correlations 0.273, 95% CI 0.116 to 0.438; Williams' t = 4.728, df = 78; p < 0.001). In community hospitals, both metrics performed similarly, whereas CR showed a clearer advantage overall. Empirical CR tertiles were significantly associated with SWA and were used for exploratory interpretation within this dataset. Across EDs of different sizes, CR showed a stronger association with frontline-perceived workload than CEDOCS. These findings suggest the potential value of CR as a simple and interpretable crowding metric to support shared situational awareness and workload-informed discussions, pending validation in broader settings and nurse-specific studies.

IntroductionEmergency EEG (emEEG) is increasingly used in the emergency department (ED), but its diagnostic yield remains uncertain. This protocol describes a multicentre observational study aiming to evaluate emEEG findings and their relationship with diagnostic pathways and therapeutic management of patients admitted to the ED.Methods and analysisThis multicentre retrospective study will analyse emEEGs performed on patients admitted to the ED of some Italian teaching and community hospitals over a 1-year period with a target sample size of 3850 patients. The diagnostic yield of emEEG will be evaluated by assessing abnormal and epileptiform findings and the relationship between emEEG findings and subsequent clinical decisions, including confirmation or revision of the initial diagnostic suspicion, decisions regarding home discharge or hospitalisation and medication changes. EEG will be classified according to the terminology of the American Clinical Neurophysiology Society. Clinical and instrumental data will be respectively reviewed by emergency physicians and neurologists/neurophysiologists. In particular, via traditional biostatistics and interpretable machine learning models, the study will evaluate the diagnostic yield of emEEG and its association with subsequent clinical management across defined clinical scenarios in the ED.Ethics and disseminationThis first large-scale multicentre protocol will provide valuable insights for emergency department (ED) clinicians in selecting appropriate candidates for an emergency EEG (emEEG), supporting ethically sound, proportionate use of this resource in a time- and risk-critical setting. By clarifying diagnostic yield and its relationship with subsequent clinical decisions, the study is expected to generate robust evidence to guide emEEG ordering, reduce unnecessary testing and delays, and promote safer, more equitable decision-making (including appropriate home discharge) while minimising potential harms from misdiagnosis or overtreatment. The study has been approved by the Ethics Committee Regione Toscana - Area Vasta Centro (n. 27241). Findings will be disseminated through peer-reviewed publications, conference presentations and engagement with relevant clinical societies to inform international recommendations and facilitate translation into ED practice. Furthermore, developed models will be made openly available for external and public validation.

Right-sided accessory pathways can cause ventricular dyssynchrony through early right ventricular preexcitation, mimicking left bundle branch block and leading to reversible cardiomyopathy even without sustained tachycardia. Although catheter ablation is standard, pharmacologic reversal in adults has not been reported. Single-patient case from a US community hospital. Literature review (PubMed/Embase) confirmed no previous adult cases of complete pharmacologic reversal. A 44-year-old man with known Wolff-Parkinson-White presented with palpitations, dyspnea, chest pain, and syncope. Electrocardiogram showed right-sided preexcitation with left bundle branch block morphology. Echocardiography demonstrated left ventricular systolic function with ejection fraction (LVEF) 10%-15% with LV dilation. Coronary arteries were normal and no other cardiomyopathy etiologies were identified. The patient declined ablation. Amiodarone was initiated. Within 2 months, preexcitation resolved (loss of delta wave) and LVEF improved to 30%-35%. By 4 months, LVEF normalized to 60% with resolution of dilation. Amiodarone was discontinued and switched to flecainide. No cardiac MRI performed (patient preference and rapid improvement); no extended ambulatory rhythm monitoring; and no formal electrophysiology study. Amiodarone-induced suppression of antegrade right-sided accessory pathway conduction can lead to complete reversal of severe dyssynchrony-mediated cardiomyopathy in adults when ablation is declined.

Objectives Prone positioning improves oxygenation and survival in patients with severe acute respiratory distress syndrome (ARDS). Transport of intubated patients in the prone position is considered high risk, particularly during air medical transport, where patient access is limited. Evidence on prolonged helicopter transport in the prone position remains limited. We aimed to describe helicopter transport of intubated patients with severe ARDS in the prone position in North Norway. Methods We conducted an observational, retrospective case series of six consecutive adult patients with severe ARDS who were transported intubated in the prone position by helicopter within mainland North Norway from community hospitals to tertiary referral intensive care units between June 2020 and February 2025. Data were extracted from transport charts and hospital medical records and included transport characteristics, ventilatory parameters, adverse events, and clinical outcomes. Results Six intubated patients with severe ARDS were transported by helicopter in the prone position. Five patients were transported in a true prone position and one in a modified semi-prone position because of aircraft constraints. In four transports, the patient was transferred together with the hospital mattress onto the transport stretcher, minimizing repositioning and preserving the established prone position. All patients had severe ARDS with pre-transport PaO₂/FiO₂ (P/F) ratios below 100 mmHg and required vasoactive support. Median transport time was 73 min (range 45–135 min). No catastrophic transport-related events occurred. One patient developed clinically significant hypotension, and one had worsening oxygenation requiring ventilator adjustment. The P/F ratio improved after arrival in five of six patients. Three patients survived to hospital discharge. Conclusions In remote regions with long transport distances, prone helicopter transport may be a feasible option for selected intubated patients with severe hypoxemic respiratory failure. Our observations suggest that successful execution depends on careful preparation, appropriate transport resources, experienced air medical teams, and a pragmatic approach aimed at minimizing unnecessary patient handling.

Although magnetic resonance imaging (MRI) is the gold standard for diagnosing degenerative cervical myelopathy (DCM), its cost and limited availability can delay diagnosis. Deep learning (DL) models with convolutional neural networks (CNNs) may offer a screening alternative with plain radiographs. We aimed to develop a CNN-based DL algorithm to predict spinal cord compression (SCC) using dynamic cervical lateral radiographs (flexion, neutral, extension), perform multi-institutional validation, and identify potential causal features using gradient-weighted class activation mapping (Grad-CAM) analysis. 7878 patients who underwent both cervical radiographs and MRI at a tertiary center were labeled as SCC or control based on T2-weighted sagittal MR images and assigned to training (80.0%), validation (10.0%), and test (10.0%) sets. Ten ImageNet-pretrained architectures were trained on single-position, combined, and combined-plus-demographics models. External validation included 575 patients from an independent community hospital. The combined model with VGG-16 achieved the highest area under the receiver operating characteristic curve of 0.888 internally and 0.820 externally. Grad-CAM highlighted regions that may correspond to disc herniations, osteophytes, ossification of the posterior longitudinal ligament, and segmental instability. These results suggest that our algorithm may serve as a cost-effective screening tool with the potential to enhance diagnostic efficiency and clinical outcomes in DCM.

Health is a direct determinant of human well-being and an essential input to economic productivity and societal resilience. In the Economic Community of West African States, persistent deficits in equitable access to healthcare and inclusive human capital development are caused by socioeconomic inequalities, financial barriers, and a fragmented healthcare system. These factors lead to low economic productivity and a continuous cycle of poverty and also violate people’s fundamental right to health and education. This research examined the impact of healthcare accessibility on inclusive human capital development among ECOWAS countries using a time series data from 1980 to 2023. Human capital theory is the theoretical framework for this study. The variables used are the inequality human development index (IHDI) (dependent variable) and other independent variables, such as education expenditure (EDEx), public health expenditure (PHEx), real GDP per capita (GDPp), poverty headcount ratio, and institutional quality (INSQ). An instrumental variables (IV) estimator of dynamic panel models based on the System Generalized Method of Moments (SGMM) was used in the estimation. The study found that public health expenditure, GDP per capita, and institutional quality have a negative and significant impact on the inclusive development of the region due to structural corruption lag, high administrative overhead and systemic leakages. Education expenditure and poverty headcount ratio have a negative and insignificant impact. This study recommends, amongst others, that access to health care such as county or community hospitals, mobile clinics, and Ward ambulance services should be provided to increase health accessibility. The government can also promote inclusive growth policies, such as free or sponsored access to education and health care, to ensure that economic gains reach the poor in ECOWAS countries.

Building upon continuous pharmaceutical care (CPC) models led solely by clinical pharmacists, this study evaluated a collaborative pharmacy team model for reducing drug-related problems (DRPs) in coronary heart disease (CHD) patients during care transitions. In a randomized controlled trial, 60 hospitalized CHD patients were allocated equally to a CPC group or a usual-care control group. The CPC group received structured pharmaceutical interventions in which clinical pharmacists led hospital care and community pharmacists led post-discharge care during key care transition periods: within 24 hours of admission (T0), 24 hour pre-discharge (T1), 24-72 hour post-discharge (T2), and at 1-month follow-up (T3). DRPs were identified using the Pharmaceutical Care Network Europe (PCNE) classification. Mean DRPs per patient were comparable at T0 (Control: 3.03 ± 1.16 vs. CPC: 3.10 ± 1.24; p = 0.827). Subsequently, the CPC group showed significantly fewer DRPs than the control group at T1 (0.17 ± 0.59 vs. 2.13 ± 1.04), T2 (0.03 ± 0.18 vs. 1.97 ± 1.03), and T3 (0.67 ± 0.76 vs. 2.63 ± 1.13) (all p < 0.001). Pharmacist interventions in the CPC group had a high DRP acceptance rate 91.4% (181/198) and a resolution rate 89.1% (106/119). At 1-month follow-up, the CPC group demonstrated superior outcomes compared to the control group: LDL-C goal attainment (63.3% vs. 30.0%, p = 0.010), medication adherence (90.0% vs. 66.7%, p = 0.028), patient satisfaction (Numeric Rating Scale: 9.27 ± 0.52 vs. 8.59 ± 0.52, p < 0.001), and willingness to pay for pharmaceutical services (86.7% vs. 50.0%, p = 0.002). This collaborative pharmacy team model effectively reduced DRPs and improved lipid control and patient-reported outcomes in CHD patients, offering a scalable approach for integrated healthcare systems.Registered at the Chinese Clinical Trial Registry on July 1, 2024 (Registration number: ChiCTR2400086416; URL: https://www.chictr.org.cn/bin/project/edit?pid=235446).

Approximately 50,000 neonates weighing under 1,500 grams are born annually in the United States, with 15-20% delivered in smaller community hospitals without a neonatal intensive care unit. These "outborn" infants face higher risks of adverse outcomes due to limited resources. Implementing tele-resuscitation services with targeted training workshops may enhance providers' technical skills, confidence, and perceptions of feasibility and acceptability. In January 2023, Oklahoma Children's Hospital launched a tele-resuscitation program offering real-time, audio-video support to community hospital staff. This service targeted neonates ≤32 weeks' gestation, <1,500 g, and those >32 weeks requiring advanced resuscitation. Workshops were hosted to give community hospital providers a first hand experience with the technology, and it included background on tele-resuscitation, technical skills training, and neonatal resuscitation simulations incorporating telemedicine. Pre- and postworkshop surveys with Likert scale questions assessed attendees' confidence in advanced resuscitation and feasibility of integrating tele-resuscitation into practice. Briefly, 20 community providers attended two interprofessional workshops, including 5 physicians (25%), 11 nurses (55%), and 4 respiratory therapists (20%). One-quarter of attendees reported prior experience with telemedicine, and one attendee reported prior experience with tele-resuscitation. Following the workshops, participant confidence in performing tasks such as intubation, umbilical line placement, needle thoracentesis, and debriefing increased significantly (p < 0.001 for all procedures). While ratings for the appeal and applicability of telemedicine to their practice showed no significant changes (p = 0.267 and p = 0.056, respectively), the perceived feasibility of tele-resuscitation significantly improved after the workshop (p = 0.029). Neonatal tele-resuscitation workshops improved providers' perceptions of this service and increased their acceptance of such a program. Additionally, the skill sessions and simulated resuscitations increased their confidence with procedures commonly performed during advanced neonatal resuscitation.

In rural northern Sweden, community hospitals serve as essential first-response centres. During emergencies, general practitioners remotely collaborate on-call with on-site nurses via videoconferencing. This setup of geographically distributed teams enables healthcare delivery across long distances. However, little is known about how healthcare professionals make sense of and negotiate roles and responsibilities in such distributed emergency settings. Hence, the aim of this study was to analyse how healthcare professionals position themselves and others in interprofessional teams when collaborating in distributed emergency settings in rural areas. Interprofessional focus group interviews (n = 17) were conducted with staff (one nursing assistant, one registered nurse and one physician per focus group) at community hospitals in rural northern Sweden, following full-scale, simulated, in-situ team training. The analysis was inspired by Billig's concept of ideological dilemmas and Wetherell's concept of interpretative repertoires. Participants drew on three interpretative repertoires-Involvement, Responsibility and competence, and Control and dependency-to account for teamwork in distributed emergency settings. Across these repertoires, participants accounted for involvement as both enabled and difficult to sustain, responsibility as not readily transferred, and control as limited and dependent on others' accounts. These ways of accounting reflected ongoing dilemmas, as professionals positioned themselves in relation to competing demands when acting under conditions of distance, uncertainty and mediated access to the clinical situation. Distributed teamwork reshapes the conditions for collaboration in emergency care, as roles and responsibilities become continuously negotiated in relation to tensions concerning involvement, responsibility and control. As a result, collaboration is unevenly achieved and cannot be taken for granted. Not applicable.

The COVID-19 pandemic was a global public health crisis that demanded a "whole-of-society" response. In many countries, coordinating efforts across public and private health care sectors proved challenging. Yet South Korea maintained one of the world's lowest excess mortality rates despite having a predominantly privatized health care system, with 90.3% of hospital beds privately owned. This outcome was enabled in part by the government's strategy of disproportionately mobilizing and repurposing public hospitals as dedicated COVID-19 treatment facilities. These hospitals, historically few in number, chronically under-resourced, and marginalized as safety nets for vulnerable populations, became the backbone of Korea's health care system response. This qualitative study examines how this process unfolded and its consequences for public hospitals and marginalized populations they serve, drawing on in-depth interviews with public hospital staff and community activists, complemented by publicly available government reports and administrative data. Our findings reveal that the repurposing of public hospitals was carried out through a highly centralized, top-down process with minimal coordination, inadequate legal safeguards, and no institutional protection. This approach generated short-term gains but ultimately led to reduced patient trust, financial instability, and a staffing exodus that compromised the long-term capacity of the public health sector.

Improving the Perioperative Outpatient Patient Experience: How Pre-op and PACU Made a Difference.

ObjectivesThis study aimed to analyse trends in youth mental health service utilisation across hospital and community settings by integrating incidence, prevalence, and DALY estimates from the Global Burden of Disease (GBD-2023) to account for changes in underlying population burden.MethodsWe used a triangulation approach, comparing trends in hospital separations and community contacts with independent indicators of underlying occurrence and burden from GBD-2023 to contextualise changes over time. A retrospective analysis of national data for individuals aged 0-25years (2013-14 to 2023-24) examined hospital separations and community contacts for substance-use, mood, neurotic/stress-related, and behavioural/emotional disorders. Diagnoses were mapped to GBD categories. Age-standardised and age-specific rates were calculated, and temporal trends were assessed using Joinpoint regression.ResultsHospitalisation rates for depressive, anxiety, bipolar, and substance-use disorders rose until 2021 and then declined. Community service use strongly correlated with hospital trends, particularly for mood and anxiety disorders. GBD data showed sustained increases in anxiety (6.5%), modest growth in depression (1.7%), and slight decline in substance-use disorders (-0.5%).ConclusionYouth mental health care in Australia is shifting toward community-based services, with reduced hospital reliance. Rising internalising disorders, especially anxiety, reflect the need for sustained, system-wide strategies that address clinical care and underlying determinants.

Individuals with intellectual and learning disabilities (ILD) face significant barriers to dental care and experience disproportionately poor oral health outcomes. Evidence on dentists' preparedness, confidence, and stress in providing care for this population across public hospital settings in Thailand remains limited. A cross-sectional survey was conducted among 306 dentists in public-sector hospitals across 17 provinces of Northern Thailand (November 2024 to May 2025). A validated online questionnaire assessed individual-, institutional-, and system-level preparedness factors. Chi-square tests compared hospital settings, and multivariable binary logistic regression identified independent predictors of high confidence and high stress. Most respondents (80.72%) had experience treating patients with ILD, though 65.69% treated fewer than ten patients per year. The main challenges were communication difficulties (86.93%) and behavioural management difficulties (83.66%). High or very high stress was reported by 53.26%, and 15.69% reported stress reduced care quality. Access to specialist referral and facility readiness were significantly lower in community hospitals (p < 0.001 and p = 0.003). Overall, 92.48% perceived undergraduate training as insufficient. In the multivariable analysis, adequate personnel and equipment was the only independent predictor of high confidence (OR = 2.739, 95% CI: 1.390-5.396, p = 0.004). High stress was independently associated with more than ten years of clinical experience (OR = 2.325, 95% CI: 1.272-4.251, p = 0.006), postgraduate education (OR = 1.926, 95% CI: 1.030-3.602, p = 0.040), and being a general dentist rather than a specialist (OR = 0.285, 95% CI: 0.146-0.555, p < 0.001). Dentists' preparedness is shaped by individual, institutional, and system-level factors. Adequate personnel and equipment was the key predictor of confidence, while stress was linked to clinical experience, postgraduate education, and professional role. Strengthening education, workplace resources, and referral support may improve preparedness and access to dental care for patients with ILD.

ABSTRACT Exertional heat illness (EHI) is an under-recognized cause of emergency department admissions in otherwise healthy young people in athletic and occupational settings. Specifically, the frequency and severity of end-organ damage in EHI, which include exertional heat stroke (EHS), heat injury (HI), and heat exhaustion (HE) require better characterization to optimize triage and patient care. In the present study, we characterized end-organ damage following emergency department admission for EHI in young, otherwise healthy military service members who collapsed during training exercises. Standard clinical measures of creatinine (Cr), alanine transaminase (ALT), aspartate aminotransferase (AST), creatine kinase (CK), and troponin were used. Active-duty service members who were seen in the Martin Army Community Hospital emergency department and diagnosed with an EHI were eligible. Relevant laboratory data was retrieved from the electronic medical record after informed consent was obtained. Acute kidney injury was the most common form of end organ damage observed (73–86%) followed closely by liver damage (59–73%). EHS cases had higher peak damage levels for Cr, CK, AST, and ALT compared to either HI or HE. Muscle damage only occurred concurrently with liver or kidney damage. There was no disseminated intravascular coagulopathy, cardiovascular complications, or organ failure observed in this study. The frequency and severity of end-organ damage was greatest in EHS, followed by HI and HE. No patients developed organ failure or required transport to a higher level of care. Data suggest that cooling modality did not impact end-organ damage.