Inconsistent pain management in intensive care settings contributes to poor patient outcomes and prolonged hospital stays. Implementing evidence-based pain management strategies is critical to mitigating complications, such as oversedation and excessive analgesia. The process is inherently complex, requiring an exploration of contextual factors that enable implementation, the mechanisms triggered within these contexts, and strategies to enhance stakeholder engagement. In this discussion paper, we examined sociocultural, organisational, professional, and individual factors influencing the implementation of pain management interventions in intensive care settings. We considered their implications for diverse stakeholders and have offered evidence-informed recommendations to strengthen implementation. In this discussion we synthesise findings from a theory-driven, three-phase realist evaluation that examined and refined program theories related to successful implementation of pain management interventions. Phase one involved a scoping review of the literature and a survey with open-ended questions to elicit initial program theories. Phases two and three comprised a rapid realist review followed by stakeholder interviews to iteratively refine these theories. Interventions succeed or fail not solely based on design but within complex contexts where knowledge, power, and professional identity intersect. Across micro, meso, and macro levels of care, mechanisms such as empowerment, moral distress, and institutional trust influenced intensive care nurses' willingness and capacity to adopt interventions. Biomedical hierarchies may marginalise nursing knowledge, while interprofessional hierarchies and organisational cultures can either constrain or enable meaningful change. We have advanced critical nursing scholarship by conceptualising pain management not merely as a clinical intervention but as a socially embedded practice. We have offered implications for educators, policymakers, nurse leaders, and practitioners to promote equitable, context-sensitive strategies for implementing pain management interventions, thereby possibly enhancing clinical practice and improving patient outcomes.

Social norm perceptions are implicit rules of conduct that describe what is normal and acceptable behavior. Changing social norm perceptions through textual and physical social norm communications can be a promising approach to changing behavior. Past studies, however, primarily relied on controlled (lab) experiments, leaving it unanswered to what extent these norm communications relate to social norm perceptions in a complex context. The present study addresses this issue for meat substitute purchases: to what extent can a social norm intervention in real-world supermarkets stimulate meat substitute purchases, and to what extent do social norm perceptions favoring meat substitute purchases mediate this relationship? A 13-week social norm intervention was implemented in three experimental supermarkets (with n = 3 matched control stores). Social norms were communicated textually on stickers and banners in the meat aisle and physically through increased shelf space for meat substitutes and island shelves with legumes. A total of N = 639 participants (n = 327 control) completed a survey upon exiting the supermarket, measuring social norm perceptions and collecting receipts to measure meat substitute purchases in grams. Results show that the likelihood of meat substitute purchases was OR = 3.6 times larger in intervention supermarkets (B = 1.28, SE = 0.512, z = 2.50, p = .012) than in control stores. However, their norm perceptions did not differ between intervention and control stores. In sum, a social normative intervention in a complex surrounding may impact purchasing behavior, but the mechanism driving this remains to be identified.

This study explores the application of artificial intelligence (AI) and geospatial tools to design 15-min cities, focusing on proximity, public space quality, environmental resilience, and inclusion. Using the post-industrial Young City district in Gdańsk, Poland, as a case study, the research integrates semantic segmentation (DeepLabv3) and AI-driven object detection for evaluating public space quality, flood simulation modeling (InVEST UFRM) for climate resilience, and network analysis using adjusted walking speeds (2.95 km/h) to capture the needs of vulnerable populations. By identifying “hotspots” with compounded deficits in access to urban amenities, public space quality, and resilience, the study provides a replicable, data-informed tool for guiding equitable urban transformation. The findings reveal critical spatial and environmental disparities, particularly in former fence-line neighborhoods in Gdańsk, which remain underserved despite ongoing urban redevelopment. The proposed framework offers practical insights for mainstreaming inclusive adaptation strategies into planning policies and contributes to the evolving discourse on operationalizing the 15-min city (FMC) concept in complex contexts. • Introduces an enhanced 15-minute city (FMC) framework combining spatial quality, environmental resilience, and inclusivity. • Applies advanced geospatial tools, including DeepLabv3 (segmentation) and InVEST flood modeling, for scalable urban analysis. • Reveals hotspots where accessibility, livability, and climate resilience deficits overlap, mainly in former fence-line zones. • Demonstrates a replicable methodology that bridges proximity metrics with public space quality and climate adaptation. • Supports inclusive urban transformation by noting the need for equitable investment in historically marginalized areas.

Examining critical care nurses' support for and willingness to participate in voluntary assisted dying: A mixed-method study.

Photocatalytic proximity labeling has become a versatile tool for probing biomolecular interactions, with growing interest in longer-wavelength activation, owing to its biocompatibility with various tissue types. Despite recent advances, highly efficient and residue-agnostic labeling systems operating under such conditions remain underdeveloped. Herein, we report the development of a novel labeling probe incorporating an α-sulfonium diazo aryl ketone (sulfonium diazo aryl ketone (SDAK)) scaffold as the reactive warhead, together with a terminal alkyne as the bioconjugation handle. Upon activation by chlorin e6 under red-light irradiation, the SDAK probe enables robust in vitro protein labeling as well as effective mapping of cellular target microenvironments with good spatial and temporal control, providing a foundation for future applications in complex biological contexts.

The organized integration of research competencies into nursing curricula is still a global challenge and is key for preparing professionals to respond to complex clinical contexts, technological advancements, and contemporary societal demands. At the School of Health of the Polytechnic Institute of Setúbal, a longitudinal research axis was implemented across the four years of the undergraduate nursing program, involving epistemological foundations, the research process, evidence-based practice, and applied practice. Objective: The objective of this study was to describe the design and implementation of the longitudinal axis of research, analyzing institutional indicators of academic success and the progressive development of students’ scientific competencies. Methods: A descriptive documentary study based on institutional data analysis (the number of enrolled students, pass rates, and mean grades in the four research-related curricular units) was conducted, complemented by a review of pedagogical materials produced (two published course booklets: “Research I—From the origin to the dissemination of knowledge” and “Research II—(De)Constructing the Research Process: A Critical and Practical Analysis”) and evidence of scientific dissemination (conference presentations and published articles). Results: A continuous progression in academic performance was observed across the research curricular units, accompanied by increased complexity of student work and enhanced scientific literacy. The sequential structure proved essential: the articulation of epistemology, methodology, critical appraisal, and scientific production demonstrated strong coherence and pedagogical efficiency. Conclusions: The longitudinal research axis constitutes a curricular innovation that strengthens essential scientific competencies in undergraduate nursing education. Longitudinal models that reflect both conceptual and practical progression can significantly contribute to the development of nurses who are critical thinkers, reflective practitioners, and capable of integrating evidence into clinical decision-making.

Sequence-based deep learning has advanced genome interpretation, yet most models remain task-specific and rely on retraining, limiting scalability across biological contexts. Here we present SUCCEED, a supervised multi-task DNA foundation model pretrained on 6,389 ENCODE functional genomics tracks to learn transferable regulatory representations. By integrating convolutional layers with a Transformer architecture, SUCCEED captures both local sequence motifs and long-range regulatory dependencies, achieving performance comparable to or exceeding Enformer across benchmark tasks. Through transfer learning, it predicts cell-type-specific epigenomic profiles, denoises sparse chromatin accessibility signals, and predicts three-dimensional chromatin contacts without CTCF input across data scales and cell types. Across diverse genomics tasks, SUCCEED performs comparably to supervised foundation models such as Sei and outperforms self-supervised models trained solely on DNA sequence. Overall, SUCCEED is a transferable and scalable foundation model that provides a unified framework for genome-scale regulatory modeling in complex biological contexts.

Exploring radiography students' preparedness and emotional responses to trauma radiography case exposure during clinical placements.

IPASDU: A DSS based on MAUT to evaluate intervention programs based on physical activity and sport for the prevention of drug use.

While nonhuman animals are often described as family, beloved, irreplaceable when fulfilling a companion animal role, they sit in a complex socio-legal context that does not value them as subjects of a life, but rather as optional appendages to the humans who own them. While this description may not resonate with the depth of emotion and strength of relational ties many humans share with their animal companions, in the context of dwindling housing stock, rising rents and increasing precarity of tenure, the disposability of companion animals upheld at a society level cannot be ignored. This article traces the experiences of tenants and housing stakeholders attempting to navigate the South Australian rental market to secure accommodation for multispecies families. In doing so it furthers existing work calling to situate experiences of housing inequality in their policy and structural contexts by explicitly articulating the intersection between anthroparchy (systemic speciesist domination) and capitalism. I conclude by arguing that despite recent legislative changes around multispecies tenancies, in the current structural context multispecies housing is, and can only ever be, precarious.

Who keeps watch? Structural safeguarding against epistemic erosion in integrated nursing curricula.

ABSTRACT The post-truth era has intensified epistemic challenges in higher education, as digital misinformation and emotional persuasion increasingly shape how knowledge is accessed and evaluated. This study presents a scoping review examining critical thinking development in higher education between 2015 and 2024. Guided by the Joanna Briggs Institute methodology and reported according to PRISMA-ScR guidelines, 26 peer-reviewed studies were identified through systematic database searches. An Input – Process – Output (IPO) framework was applied to synthesise patterns across individual, pedagogical, and institutional dimensions. The findings indicate that critical thinking development is influenced by students’ epistemic dispositions, metacognitive awareness, and prior knowledge, alongside systemic conditions such as curriculum design, educator quality, and academic culture. Core developmental processes include inquiry-based learning, reflective strategies, and digital epistemic practices such as truth-checking and lateral reading. Although most studies report improved analytical reasoning, challenges remain regarding sustainability and transfer in digitally complex contexts.

Proteins act as the terminal effectors of cellular function, encoding the phenotypic consequences of genomic and transcriptomic programmes. Although transcriptomic profiles serve as accessible proxies, they remain incomplete surrogates for the proteomic landscape that ultimately defines cellular phenotypes. Current single-cell foundation models, however, are trained exclusively on transcriptomes, resulting in biased and partial characterizations of cellular states. To address this limitation, we introduce CAPTAIN, a multimodal foundational model pretrained on over four million single cells with concurrently measured transcriptomes and a curated repertoire of 382 surface proteins across diverse human and mouse tissues. Our results show that CAPTAIN learns unified multimodal representations by modelling cross-modality dependencies and capturing the diversity of cellular states across complex biological contexts. CAPTAIN generalizes robustly across both fine-tuning and zero-shot settings, excelling in core downstream tasks such as protein imputation and expansion, cell type annotation, and batch harmonization. Beyond improved accuracy in multi-omics integration, CAPTAIN generates novel hypotheses regarding protein-driven intercellular dynamics, including potential immune interaction patterns linked to COVID-19 severity.

This qualitative study explores how public school principals perceive effective leadership and the challenges they encounter in Morocco’s Oriental Region. Twenty eight principals participated in an online qualitative survey, and their responses were analyzed following Braun and Clarke’s (2006) six-phase process of thematic analysis. Findings indicate that participants perceive their roles as involving a balance between administrative management and leadership. Successful school leadership is described as involving a set of attributes including effective communication, collaboration, shared decision-making, ethical and professional integrity, offering guidance, and role modeling. Participants also stress that successful leadership requires patience and composure. School leaders’ efforts, however, might be hindered by the various challenges that reflect the demanding nature of leadership within this context. Key challenges that are highlighted involve managing relationships and collaboration, engaging stakeholders, work overload, dealing with unqualified or difficult staff, and enforcing regulations. These findings highlight the contextual complexity of school leadership in the Moroccan context and suggest the need for professional development programs that emphasize communication, relationship-building, stakeholder engagement, and contextual understanding.

Genistein and the immune system: experimental evidence, key challenges, and future perspectives.

Lithics from the lower gallery at La Garma (Zone IV): new data for an understanding of a Magdalenian site

Effect of transcutaneous auricular vagus nerve stimulation (taVNS) on inhibitory control as a function of motor task complexity.

To further understand young people's perceptions of using online arts and culture and how it impacts on mental health. This qualitative study was embedded in a proof-of-principle randomised controlled trial (RCT) comparing the effectiveness of two different online arts and culture experiences on mental health in young people (aged 16-24 years). The RCT compared the Ashmolean website (Ash) a generic museum website and Ways of Being (WoB), a codesigned stories based web experience. Three sources of data were analysed; focus group transcripts, free text responses and viewpoints. We adopted an interpretive phenomenological approach allowing deductive and inductive hybrid thematic analysis to gain critical insight into how young people make sense of phenomena relating to mental health in a complex context within a critical realist paradigm. In total, 117 free text responses relevant to the interventions were received. The first focus group was attended by seven Ash participants and the second by six WoB participants. A total of 108 separate viewpoints were entered. The main themes identified across sources were of human connection, the content and journey of the online experience, the features, setting and when it was used, positive mental health impacts and neutral/negative effects. Positive mental health impacts were often described in association with human connection in WoB participants. Neutral and negative effects were more commonly described in participants allocated to Ash. Continued development of online arts and culture for diverse populations using participatory and mixed methods to identify potential mechanisms are promising future areas of mental health research. NCT04663594; Results.

Reproductive genetic carrier screening (RGCS) identifies people who have an increased chance of having a child with a serious genetic condition. In Australia, since November 2022, RGCS for three conditions, cystic fibrosis, spinal muscular atrophy, and fragile X syndrome, has been publicly funded via Medicare (Australia's universal health insurance scheme). Therefore, tests are offered at no cost to eligible people and are accessible through general practitioners (GPs), making primary care a key point of access. This study aimed to develop a rich graphic illustrating the ecosystem of offering RGCS in Australian primary care. The three-stage, exploratory, qualitative approach involved: (1) constructing the first draft of the rich graphic using literature, policy documents, and team expertise; (2) conducting semi-structured interviews with eleven key informants representing diverse stakeholders; and (3) conducting a survey with key informants to review the penultimate version and produce the final version. The final rich graphic positioned GPs at the centre of a network of six stakeholder groups: consumers, government, laboratories, professional bodies, healthcare organisations, and consumer support groups. Inductive thematic analysis identified three overarching themes: (1) reinforcing patterns and feedback cycles; (2) structural misalignments and systemic tensions; and (3) emergent adaptations and system responses. Our analysis revealed that several factors influencing GPs' ability to offer RGCS are not isolated but parts of dynamic patterns of linkages, relationships, interactions, interdependencies, feedback loops, and behaviours that generate complex, sometimes unintended and contradictory, system-level effects, collectively shaping the complex system. Using rich graphic methodology revealed chains of interdependencies that would have remained obscured by using traditional linear implementation frameworks.

This work employs 3D single-molecule super-resolution microscopy to provide quantitative physical analysis of the spatial organization of a vital myosin motor, MyoH, in the model apicomplexan parasite Toxoplasma gondii . While previous studies have provided high-resolution views of the parasite's invasion machinery, MyoH has remained elusive at the nanoscale. We resolved differences in radial organization between the N- and C-termini of the motor, thus determining the orientation of the protein in the apical space. Two-color imaging revealed the organization of the motor in the greater context of the parasite's invasion complex. 3D single-molecule imaging in gel-expanded samples revealed an increase in labeling efficiency but perturbed localization of only the MyoH C-terminus, highlighting the nuanced effects of gel expansion on protein organization.