The staging model in psychiatry is heuristic and evolving, provoking debate and stimulating alternative views. This paper reviews major controversies in the field of staging and prevention of psychosis. We review the literature on the classification model, the continuum model and the dynamic systems model applied to psychiatry. Other controversies are stigmatisation of early detection, the prevention paradox and the interpretation of data on prevention of transition to psychosis. DSM classifications still lack validity. The continuum model supports preclinical stages but has no discrete conversions to different stages of illness. The emerging dynamic systems model builds on the interaction of symptoms eliciting networks of symptoms, while at the same time it explains sudden catastrophic shifts (transitions) between different states of equilibrium. Stigmatisation of early psychosis can be balanced against the benefits of early interventions. The prevention paradox states that only a minority of first episode cases arises from the high-risk group. However, there are many reasons to combine indicated prevention with population-based preventive interventions. A long-lasting controversy is on the interpretation of the research data. Several meta-analyses are reviewed on methodological issues. The staging model is adequate to conceptualise psychiatric disorders and the progress over time in more chronic stages. No one is suggesting that help-seeking patients with an ARMS should be denied access to psychosocial treatment and it is recommended and necessary to continue building age and stage specific services to treat them and continue with research into risk factors and helpful interventions.

The illusion of healthy drinking: Methodological bias and selective reporting of effects shape evidence on alcohol and cardiovascular health.

Innovative qualitative methods are important in nursing research for understanding perspectives that are often under-heard, including those of adolescents. This methodological article draws on a focused ethnographic study of 11 urban adolescents aged 12-18 years to examine the use of photo elicitation in nursing research on greenspace, health and place. Using disposable cameras, participant-led photo tasks, semi-structured interviews and integrated visual-verbal analysis, the study explored how photo elicitation supported adolescent engagement while generating insight into how young people perceived and used urban greenspaces. This article discusses the methodological and ethical issues that arose in the study, including camera training, timely return of cameras, assent and parental consent, privacy and image ownership, and the interpretation of photographs alongside interview and fieldnote data. It also reflects on the integration of emic and etic perspectives and on the role of reflexivity in analysing adolescent-generated visual data. Trustworthiness was supported through verbatim transcription, audit trails, NVivo analysis and team triangulation, with analysis informed by the approach of Braun and Clarke (2006) . Photo elicitation supported reflection, participant-led discussion and richer contextual understanding of adolescents' experiences. This article offers practical guidance for nursing researchers using visual methods with adolescents, with an emphasis on study design, ethical planning, and integrated analysis of visual and verbal data. These methodological lessons are relevant to adolescent health, community health and nursing research using participatory qualitative approaches.

Qualitative research offers key insights into enablers and obstacles of healthcare-seeking behavior, and the credibility of findings depends on methodological quality. This study aims to critically appraise the methodological quality of existing qualitative studies on delayed medical consultation in obstructive sleep apnea (OSA) patients, thereby identifying common limitations and offering recommendations for future improvements. A systematic search was conducted in EMBASE, MEDLINE, and CENTRAL databases, covering literature from inception to February 2026. Inclusion criteria were qualitative studies (e.g., phenomenological, ethnographic, or grounded theory paradigms) on medical consultation delays in adult OSA patients, excluding single-case studies or narrative reports with very small samples. Two reviewers independently assessed studies against five dimensions, with disagreements resolved by discussion. Three studies were included, from which eight methodological issues were identified: (1) potential "survivorship bias" from including only diagnosed patients; (2) recall bias in retrospective designs; (3) insufficient consideration of the role of comorbidities in the healthcare-seeking process; (4) unclear directionality between cognitive factors and delayed behavior; (5) lack of in-depth analysis of deviant cases; (6) oversimplified view of family/friend support; (7) insufficient transparency in reporting interview guides and data saturation; and (8) absence of researcher reflexivity during data collection and analysis. Current qualitative studies on delayed medical consultation in OSA patients have several methodological flaws that may affect their validity. Future research should prioritize prospective, community-based studies targeting high-risk OSA populations not yet seeking medical help, and comprehensively document the entire trajectory of their medical consultation delay. This will enhance research rigor and provide clearer guidance for developing more actionable intervention strategies.

Methodological commentary. To summarise key methodological and operational principles for designing and conducting large, international, investigator-driven clinical trials involving physical interventions for people with recent spinal cord injuries (SCI). This paper draws on our experience designing and conducting The Early and Intensive Motor TrainingforSCI Trial (SCI-MTTrial). 15 spinal injury units across Australia, Scotland, England, Italy, the Netherlands, Norway, and Belgium. We reviewed the SCI-MT Trialprotocol, documentation, and procedures to identify key methodological and operational issues relevant to large, international trials involving physical interventions for people with recent SCI. Guidance was developed based on both our practical experience and current recommendations from clinical trial experts, with the aim of informing and supporting future trialists. We identified key principles that should be considered when designing and conducting trials of physical interventions for people with recent SCI. These included principles related to trial design (Methodological Principles) and trial conduct (Operational Principles). This paper provides guidance on the principles and practicalities of designing and implementing large, international, investigator-driven clinical trials. It is intended to assist future trialists in planning trials that are methodologically rigorous, operationally feasible, and ethically robust. ACTRN12621000091808 (1.2.2021). U1111-1264-1689. Version 1.3, 22nd Oct 2021.

ABSTRACT Global university rankings (GURs) have become a prominent feature of contemporary higher education, yet little is known about how they are represented and discussed in the media. This paper examines the media coverage of GURs in three major Italian newspapers (Corriere della Sera, La Repubblica, and Il Sole 24 Ore) between 2004 and 2023. Combining longitudinal content analysis with regression models, the study investigates patterns of media attention across different rankings and assesses whether journalistic coverage reflects critiques raised in the academic literature. The findings show that media coverage is highly selective: attention to the QS ranking has increased over time, while coverage of THE and ARWU has declined. Critical engagement remains limited, with only a small share of articles raising concerns, primarily related to methodological issues, while broader impacts such as institutional isomorphism or stratification are largely absent. The results suggest that the observed patterns of media visibility may be interpreted in light of an interaction between the characteristics of ranking outputs, institutional communication practices, and journalistic routines, contributing to rankings being treated as routine reference points in public discourse.

This theoretical paper (1) defines linguistic geoengineering as a theoretical framework, (2) distinguishes its unique characteristics from established theories of language and power, and (3) analyzes its implications for public persuasion and democratic engagement. Linguistic geoengineering, a novel framework for analyzing language, power, and public influence, is defined as the deliberate, systematic restructuring of discourse environments with the goal of shaping collective perception, behavior, and decision-making. A typology is developed—metaphoric, narrative, lexical, and infrastructural engineering—demonstrating how linguistic practices can recalibrate collective perception, behavior, and decision-making. It addresses three overlooked aspects in current scholarship: intentionality, scale, and systemic impacts. This paradigm conceptualizes language as an engineerable environment, facilitating the analysis of how various actors, including states and activists, craft linguistic interventions to impact public life. However, this reframing presents ethical and methodological issues. How can scholars differentiate between organic discourse shifts and artificially constructed ones? What measures should be implemented to avert the misuse of language interventions? In what ways could the public oppose or counteract such interventions? Future studies must address these inquiries by formulating methodologies for identifying linguistic geoengineering in practice, analyzing its function across many crises and domains, and scrutinizing its normative consequences. This paradigm necessitates viewing language not only as a reflection of society but as a domain of design and conflict, where the contention over words represents a contest over futures.

As adverse childhood experiences (ACEs) are increasingly referenced in criminology, several factors question the salience of ACEs to forensic and correctional populations in both the juvenile and adult criminal justice systems. Here, our scoping review of 99 studies examines the ACEs paradigm and its application to forensic/correctional populations by (1) synthesizing research on ACEs among diverse forensic/correctional populations, particularly youth but also among adults for whom childhood and adolescent adversity has sentencing implications, (2) highlighting intervening processes which mediate, moderate, or redirect the effects of ACEs, and (3) identifying methodological issues and potential confounding effects that pose validity threats to ACEs as an explanatory variable among adolescent and adult offenders and regarding downstream justice system outcomes (e.g.,recidivism). When mediating variables are considered, the association between ACEs and antisocial conduct is substantially reduced. Among juvenile offenders, temperament, social bonds, current drug use, or psychopathic features account for 40%-100% of the associations between ACEs and recidivism, gang association, or serious, violent, and chronic offending. These intervening effects are so substantial that studies should migrate from simple ACE-offending designs to more complex, ecologically valid models which specify ACEs as a distal predictor, preferably using longitudinal data. In terms of forensic practice, assessment establishes validity only by respecting the unique experience of the individual rather than homogenizing reactions to abusive home environments, or other circumstances that fractured the family unit. Forensic examination should not overlook downstream life circumstances regardless of their statistical association with ACEs. As a person matures, adult events and experiences more directly influence criminal choices and criminal activity relative to adverse experiences during childhood.

We read with interest the study by Cirakoglu and Yuce on overactive bladder (OAB) and central sensitization (CS) in rheumatoid arthritis (RA) patients. While the study provides valuable hypothesis‑generating insights, several methodological limitations warrant consideration. The OAB-V8 cut‑off of 8 was validated in a primary care population, not in RA patients, and dichotomising this ordinal scale discards information and reduces statistical power. The regression model included correlated variables (HAQ-DI, VAS-pain, DAS-28) without testing for multicollinearity, which can inflate standard errors and produce unreliable p‑values. Additionally, the authors did not verify key logistic regression assumptions, including linearity of continuous variables with the logit and absence of influential outliers. These limitations suggest that the findings should be interpreted as hypothesis‑generating rather than definitive. Future studies should address these methodological issues to clarify the relationship between CS and OAB in RA.

Horan and colleagues recently reported a pilot study examining quality-of-life outcomes following early versus late elective lumbar microdiscectomy, concluding that surgery within twelve months is associated with superior patient-reported outcomes and proposing a six-month maximum waiting time. While the clinical question is both relevant and timely, we believe several methodological and conceptual issues merit discussion before such a recommendation is translated into practice. First, the study conflates waitlist time with symptom duration, yet its Discussion and proposed threshold are predominantly grounded in literature examining the latter. Second, only 38 of 64 eligible patients (59%) were included in the analysis, with no characterisation of non-responders, and the postoperative assessment window varied from ten to thirty-four months, introducing substantial noise into between-group comparisons. Third, the absence of preoperative baseline scores precludes calculation of minimal clinically important differences and leaves the authors’ conclusions vulnerable to baseline imbalance. Fourth, the authors’ own data reveal a cost and complication paradox: the early group experienced a longer length of stay, a higher median cost, and a ten per cent cerebrospinal-fluid leak rate versus zero per cent in the late group—findings that directly oppose the cost-consequence literature invoked in support of their thesis. Finally, the study period coincided with the COVID-19 pandemic, which substantially altered surgical throughput and perioperative pathways across Europe; this temporal confounding is neither acknowledged nor adjusted for. A robust answer to this important question will require a prospective design with capture of symptom duration, preoperative and standardised-interval postoperative outcome measures, an a priori sample-size calculation, formal characterisation of non-responders, and adjustment for era-related confounders.

Welding processes generate complex aerosols containing fine and ultrafine particulate matter, metal fumes, and gaseous by-products that may pose significant respiratory risks for exposed workers. Exhaled breath condensate (EBC) has emerged as a promising non-invasive matrix for human biomonitoring, offering the opportunity to assess exposure directly at the pulmonary target site and to evaluate early biological responses. This study systematically reviewed the scientific literature available in PubMed, Scopus, and ISI Web of Science to examine the role of EBC in exposure and effect biomonitoring among welders. Sixteen studies met the inclusion criteria. Overall, the evidence indicates that EBC is a suitable matrix for assessing occupational exposure in welding activities. Several studies reported increased concentrations of metals-including manganese, nickel, iron, and chromium in welders compared with unexposed controls, as well as higher post‑shift levels compared with pre‑shift samples across the workweek. Associations between cumulative exposure to inhalable dust and metal concentrations in EBC were also observed, even at low exposure levels. EBC has additionally shown potential for detecting early-effect biomarkers, such as indicators of oxidative stress, lipid peroxidation, protein and nucleic acid oxidation, and inflammatory mediators. These findings provide insight into biochemical alterations occurring in the airway lining fluid of welders. Despite encouraging findings, key methodological issues persist. The lack of standardized protocols for EBC collection, storage, and analysis hampers comparability across studies. Indeed, further research should elucidate EBC production and dilution kinetics and clarify metal toxicokinetics to fully establish EBC as a reliable biomonitoring matrix for occupational health research and practice.

The proper application of evaluation tools is critical to ensuring the usability of human-machine interaction (HMI) in intelligent vehicles. However, a systematic understanding of the current usage patterns, applicability boundaries, and methodological issues of evaluation tools remains absent in this field. To help practitioners conduct evaluations effectively, this study systematically analyses the evaluation tools used across 105 applied research cases in this field. The results indicate that the field has established methodological paradigms of balancing preference report tools with performance observation tools, delineating the roles of user testing and expert inspection tools, and implementing multi-method and mixed-method evaluation. Nevertheless, practitioners still exhibit a tendency toward excessive reliance on subjective preference tools in practice, expert inspection tools such as heuristic evaluation and human performance modeling (HPM) have long been absent, general HCI questionnaire scales are adopted without considering their adaptability to driving scenarios, and the cross-validation function of mixed-method evaluation is largely overlooked. To address these challenges, this study proposes actionable recommendations and distils decision guidelines at both theoretical and practical levels, thereby providing practitioners with concrete guidance for transitioning from general-purpose screening to evidence-based matching and advancing evaluation practice in this field from experience-driven approaches toward scientific standardisation.

Systemic glucocorticoids, widely prescribed for inflammatory and autoimmune diseases, have long been suspected of increasing cancer risk through immunosuppressive and metabolic effects. Randomized trials are often unethical and difficult to conduct, leaving observational studies the best option to determine whether the use of systemic glucocorticoids affects cancer development. However, these studies face significant methodologic issues that may compromise the validity of their findings. We systematically reviewed observational studies published up to May 1, 2025 (PubMed, Embase, Web of Science, and the Cochrane Library). We included 38 cohort and case-control studies assessing systemic glucocorticoid use and site-specific cancer risks. All included prevalent users, 34% had time-window bias, 50% lacked appropriate lag time, and 74% were not restricted to specific patient populations based on glucocorticoid indications. Some studies reported positive associations for non-Hodgkin lymphoma. Similarly, some positive estimates were reported for lung and nonmelanoma skin cancers, but these findings were inconsistent and likely influenced by inadequate latency consideration. In contrast, evidence was largely null for breast cancer, whereas results were inconsistent for colorectal cancer and melanoma. Our review highlights the need for robust study designs and analytic approaches to generate unbiased estimates of drugs' effect on cancer incidence.

Mesoscale solubility, solvophobicity-driven mesoscale structures, and ‘the ouzo effect’

How machine learning has been used to detect alcohol-induced driver impairment using in-vehicle sensors: A systematic review.

The effect of hypnotherapy on vulvovaginal pain. A systematic literature review.

Interpretation of the IARC quantitative bias analysis of talc and ovarian cancer.

This article analyzes the woman question in Vilfredo Pareto's thought. It demonstrates that, throughout his life, he consistently supported women's unrestricted access to all occupations and endorsed political equality—though not universal suffrage—for both sexes. However, the article shows that over time Pareto became increasingly concerned that feminism might lead to the dissolution of the family, the destruction of wealth, and the subversion of the existing social order: For him economic growth and social stability depend on women maintaining their traditional role within the family. The article also addresses methodological issues related to the use of unintentional sources.

A critical look at disease classification/diagnosis criteria in rheumatology.

A systematic review of observational studies of sodium-glucose cotransporter 2 inhibitors and COVID-19 outcomes: a methodological assessment.