Outcomes of people living with acute lymphoblastic leukemia who received inotuzumab ozogamicin before a stem cell transplant: a plain language summary.

Patient-centered care (PCC) emphasizes providing patients with clear information to support active participation in medical decision-making. However, the fast-paced nature of emergency departments (ED), coupled with communication barriers and varying health literacy, limits effective patient engagement. While large language models (LLMs) have shown potential in generating patient-friendly documents, their use in ED settings remains underexplored. This study aimed to develop LLM-generated patient-friendly clinical notes (PFCNs) that transform clinical notes into plain language, and to evaluate whether PFCNs could enhance patient participation in ED consultations. In this study, a total of 120 PFCNs were generated and evaluated, receiving high understandability ratings from both 10 clinicians and 20 patients (PEMAT score: 87.2%). Patients who used PFCNs during simulated ED consultations reported significantly higher participation levels compared to prior ED experiences (PPQ, P < 0.05). Qualitative data showed that PFCNs supported understanding, question preparation, emotional reassurance and improved relationships with clinicians, though concerns about hallucinations and integration into clinical workflows remained. These findings suggested that PFCNs generated by LLMs show promise for enhancing patient participation in ED consultations. Future work should address accuracy and explore real-world integration to support safe and effective deployment.

Abstract It is unclear how plant growth‐promoting rhizobacteria (PGPR) affect soil multifunctionality (SMF) and production function (SPF) along planting densities. To address this issue, Bacillus licheniformis (PGPR) was inoculated in maize fields with five planting densities (D1–D5 from low to high) in the drought‐prone region of the Yunnan Plateau, southwest China from 2022 to 2023. Data indicated that under non‐inoculation (CK), SMF tended to increase from D1 to D4 ( p &lt; 0.05) and then stabilize in D5 across two growing seasons. Yet, SPF was observed to elevate steadily with increasing densities. PGPR inoculation significantly improved SMF (0.129) and SPF (0.508) under increasing planting densities. Meanwhile, soil carbon and phosphorus cycling indices significantly improved by 0.272 and 0.069 ( p &lt; 0.05), respectively, whereas no significant change was observed in the nitrogen cycling index ( p &gt; 0.05), relative to CK. Increased carbon cycling index was significantly associated with improved soil soluble organic carbon (2.26%) concentration and enhanced carbon‐related extracellular enzyme activities (9.57%). Similarly, phosphorus‐related extracellular enzyme activity significantly increased by 10.51% ( p &lt; 0.05). Interestingly, no significant changes were observed in the levels of soil total nitrogen, ammonium nitrogen and nitrate nitrogen, and the activities of nitrogen‐related enzymes across planting densities. The above‐mentioned phenomenon can be mechanistically explained by the variations in rhizosphere microbiomes, and the accelerated carbon exchanges with nitrogen/phosphorus, which amplified SMF for higher SPF by reshaping the nutrient trade‐off in plant–soil‐microbe system through PGPR‐enhanced microbial activity. Read the free Plain Language Summary for this article on the Journal blog.

Abstract Sexual conflict affects the amount and duration of offspring care each parent invests, resulting in multiple parental care strategies sometimes coexisting within a single population. Understanding the persistence of multiple parental care strategies requires a precise estimate of the benefits and costs associated with parental decisions. Even though the benefits of brood desertion are well known, the reproductive costs of desertion ( i.e., nestlings' physiological conditions and survival), are less explored. We use rock sparrows, Petronia petronia , a species in which both uniparental and biparental care occur in the same population, to investigate the costs of brood desertion. Specifically, we continuously monitored breeding attempts to explore the behavioural mechanisms (desertion decision and compensatory responses) and the reproductive and physiological consequences (offspring corticosterone concentrations, oxidative stress, telomere attrition) of parental care strategies. We show that male desertion was not related to the initial value of the brood (clutch size, brood size) but was associated with a reduction in the survival probability of the nestlings. Females caring alone increased their per capita feeding rate, partially compensating for the lack of male care. Nestlings deserted earlier also experienced higher oxidative stress and had higher corticosterone concentrations during the early stages of development, but these effects did not persist to fledging, and there were no differences in telomere attrition. Our findings indicate combined reproductive and physiological costs associated with brood desertion. Considering these costs is essential to understand the evolution and persistence of polymorphic patterns of care. Read the free Plain Language Summary for this article on the Journal blog.

People with Down Syndrome often experience more barriers to achieving a good quality of life compared to people without disabilities. A lot of the existing research has focused on the views of parents and professionals, rather than directly including the voices and perspectives of people with Down Syndrome themselves. We wanted to find out how this might be done. At the 2024 World Down Syndrome Conference, over 140 adults with Down Syndrome came together at a one-day Forum to talk about their lives—aspects that are going well and what could be better. The goal was to hear directly from them. This article explains how the Forum was run so that others with Down Syndrome can use a similar process. We describe how Artificial Intelligence (AI) was used to assist the authors in organising and sharing the information from participants, such as grouping what people said into different themes and helping to create plain language reports. This process worked. Eight key themes were found that could help people to have a good life, such as having good relationships with family and friends; having a job; making personal choices; and being respected and included. The list was longer than previously reported in other studies. The Forum gave valuable insights and helped us think of new ideas for supporting people with Down Syndrome to speak up for themselves. Used thoughtfully, AI (Artificial Intelligence) could be a helpful tool in the future to help these people share their experiences and needs. More research is needed to understand how people with Down Syndrome can be more involved in making changes through advocacy projects where they take an active role.

Evaluating Ai Chatbots In Enuresis Nocturna Information: A Comparative Analysis Of Readability, Reliability And Quality.

Effect of vagus nerve stimulation therapy on 1-year seizure freedom and quality of life in patients with drug-resistant epilepsy in Japan: plain language summary of a real-world study

Abstract Fostering pro‐conservation attitudes and behaviour is essential to mitigating biodiversity decline. Biophobia—negative emotional responses, such as fear and disgust, towards living organisms—can shape these attitudes, but its effects remain poorly understood. We examined the relationship between disgust towards insects (entomophobia) and consumers' pro‐environmental attitudes (support for buying organic vegetables) and pro‐conventional attitudes (preference for conventionally grown vegetables and support for pesticide use) in Japan. We conducted an online survey with 7200 participants, examining how entomophobia and other personal factors (age, gender, education level, income and aversion to chemicals) are associated with pro‐environmental and pro‐conventional attitudes. Respondents' attitudes varied, though many expressed neutral positions. Regression models indicated that individuals with stronger entomophobia held weaker pro‐environmental and stronger pro‐conventional attitudes. The influence of entomophobia on these attitudes was as strong as, or stronger than, other personal factors. Our results emphasise the importance of considering people's negative feelings towards nature in promoting positive attitudes and behaviour supportive of biodiversity. Read the free Plain Language Summary for this article on the Journal blog.

Abstract Mixed dipterocarp lowland tropical rain forests on Oxisols and Ultisols and heath forests on Spodosols are considered distinct vegetation types in Borneo. Here we present the endmember hypothesis of ecosystem diversification, which describes a continuum of forest structure and composition between these two forest types linked to divergent pathways of pedogenesis and nutrient limitation. One endmember involves the formation of Oxisols or Ultisols via desilication and accumulation of secondary iron and aluminium oxides at moderately acidic pH. The other endmember involves the formation of Spodosols (podzols) through the accumulation of humic material and the eluviation of iron and aluminium at strongly acidic pH. Phosphorus (P) availability decreases towards Ultisols and Oxisols due to phosphate fixation on iron and aluminium oxides, but nitrogen (N) availability does not decrease. In contrast, N availability decreases relative to P availability towards Spodosols because strong acidity suppresses N mineralization. Forests in Borneo occur on soils at different pedogenic stages derived from various parent materials. The endmember hypothesis predicts that these ecosystems align along a continuum between the two pedogenic endmembers. The availability of P and N is therefore asymmetric along the pedogenic axis and forests differ in P and N availability and limitation. The ecosystem continuum between the two endmembers in Borneo can be explained by differential tree adaptations to P versus N deficiency based on ecophysiology principles of nutrient acquisition and the concentrations, locations, and mobility of nutrients in plants. These differences drive turnover of tree species along the pedogenic axis between the two endmembers, leading to a continuum of diverse ecosystems reflecting the asymmetric availability of soil P and N. Diversification in tropical rainforests is a consequence of biogeochemical processes leading towards two divergent pedogenic endmembers under a humid tropical climate. Our hypothesis based on observations of the tropical forests of Borneo highlights the importance of biogeochemical feedbacks for ecological adaptation and community composition in a hyper‐diverse biome. The mechanisms underpinning pedogenic divergence towards the endmembers and the pan‐tropical applicability of this hypothesis merit further study to support our understanding of patterns and drivers of tropical biodiversity. Read the free Plain Language Summary for this article on the Journal blog.

Abstract While serving many useful functions, artificial light at night (ALAN) also leads to the erosion of natural darkness, and of the various benefits that exposure to darkness provides. Yet, we know little about how people perceive ALAN—where they want it, why and when they prefer darkness. Using an online survey of 1000 participants broadly representative of the New Zealand adult population, we assessed participants' self‐declared importance of different benefits derived from ALAN and from natural darkness. For each benefit, we fitted a conditional inference tree with demographic, dark‐sky related and built‐environment related explanatory variables. For a subset of benefits derived from ALAN, we also assessed what people felt was the most appropriate mode of delivery (i.e. always on at night, on‐when‐needed (using sensors) or bring‐your‐own). Benefits derived from ALAN were generally rated as more important than those derived from darkness, especially for safety functions and orientation—however ratings were poorly described by the explanatory variables. Darkness benefits rated lower overall, showed less variability and were relatively well explained. Across the subset of ALAN benefits assessed, the preferred mode of delivery for at least 31% of respondents was ‘on only when needed’ (e.g. using sensors). This nationally representative study exploring public perceptions of both artificial light and natural darkness at night is the first of its kind in Aotearoa New Zealand, and possibly globally. We contribute to reframing the discourse around ALAN to consider both light and dark as essential yet countervailing resources. Our findings advocate for a more balanced and nuanced approach to nighttime lighting policy—one that recognises artificial light and darkness as coexisting, interdependent resources and that actively supports a recalibration of their respective benefits to achieve preferred future states. Read the free Plain Language Summary for this article on the Journal blog.

Abstract Central precocious puberty (CPP) results from premature activation of the hypothalamic-pituitary-gonadal (HPG) axis. The GnRH stimulation test remains the diagnostic gold standard, especially in girls with undetectable basal LH levels. However, native GnRH is expensive and often unavailable. Rapid-acting subcutaneous triptorelin has been proposed as a reliable alternative. This retrospective study evaluated the diagnostic accuracy of subcutaneous triptorelin compared with intravenous gonadorelin and investigated the optimal timing for LH peak assessment. A total of 341 girls referred for suspected precocious puberty were evaluated: 102 underwent the triptorelin test and 239 the gonadorelin test, with gonadotropins measured by electrochemiluminescence assay at baseline and after stimulation. Based on clinical, radiological, and laboratory criteria, 143 girls were diagnosed with CPP and 198 with non-progressive thelarche (NPT). Triptorelin elicited significantly higher FSH peaks than gonadorelin, while LH peaks were comparable, consequently FSH/LH ratios were higher after triptorelin. ROC analysis identified an optimal diagnostic LH peak cut-off of 7.14 IU/L following triptorelin administration (sensitivity 94%, specificity 96%; AUC 0.985), while a threshold of 4.7 IU/L was observed after gonadorelin (sensitivity 100%, specificity 87%; AUC 0.982). Peak LH occurred predominantly at 180 minutes after triptorelin in both CPP and NPT groups (78 and 90%, respectively). Despite the limitations of its retrospective and non-parallel design, this large cohort study demonstrates that subcutaneous triptorelin provides excellent diagnostic accuracy, comparable to gonadorelin. These findings support triptorelin as a reliable and accessible alternative for CPP diagnosis and contribute to the standardization of diagnostic protocols in clinical practice. Plain Language Summary This study tested triptorelin stimulation as an alternative to the standard gonadorelin test to diagnose precocious puberty in girls. Triptorelin proved equally accurate and reliable, especially when hormone levels are measured 3 hours after injection, offering a practical diagnostic tool in clinical practice.

Are bullet points the silver bullet to accessible health information? Cross-sectional analysis of community health information preferences.

The American Academy of Neurology (AAN) 2017 Women With Epilepsy Quality Measure advises all neurologists, including child neurologists, to counsel all 12- to 44-year-old female patients with epilepsy annually about at least 2 of 3 following topics: folic acid supplementation, interactions between antiseizure medications (ASMs) and contraception, and the effect of ASMs on pregnancy and/or fetal or child development. We hypothesized that child neurologists do not consistently conduct clear, factually accurate, and guideline-concordant counseling in this area. Therefore, as a targeted educational needs assessment, we performed a simulation-based evaluation of child neurologist knowledge and skill in this area to inform future educational intervention development. We recruited child neurology trainees (residents and fellows), attending physicians, and advanced practice providers (APPs) through a national listserv to engage in 3 virtual scenarios, simulating telemedicine appointments. We instructed them to perform reproductive health counseling for a female youth with epilepsy and their parent. We provided participants with detailed medical information about the patient before each scenario. We recorded and transcribed simulations. Coders performed content analysis to identify discussion of guideline-concordant counseling topics, assess factual accuracy, and analyze style of counseling for consistency with plain language. Twenty-one individuals each performed the scenarios (11 attending physicians, 9 child neurology trainees, and 1 APP). Twelve (57%) addressed at least 2 of the 3 topics in the AAN quality measure across all scenarios. None (0%) performed guideline-concordant counseling without inaccuracies or omissions of key information across all scenarios. We identified no significant differences between attending physicians vs other provider types in stratified analyses. Qualitative analysis revealed that provider communication was rarely consistent with plain language standards. Common stylistic features included (1) long conversational turns, (2) multiple topics per turn, (3) complex sentence structures, and (4) use of jargon. In case-based stimulation scenarios, most child neurologists discussed at least 2 of 3 AAN-recommended topics. However, participants commonly included factual inaccuracies and omitted key information, and did not use plain language, highlighting the need for training. Informed by our study findings, we will design and test a training intervention for child neurologists in this area as a future direction.

Agents are all you need: Pioneering the use of agentic artificial intelligence to embrace large language models into dairy science.

A plain language summary of patient preferences for treatments for multiple myeloma that has relapsed or is refractory to prior therapy.

SISAQOL-IMI consensus-based guidelines to design, analyse, interpret, and present patient-reported outcomes in cancer clinical trials.

Abstract Agricultural expansion and intensification are the main drivers of pollinator decline. To reverse the negative effects of agriculture on pollinators, it is important to involve key agricultural stakeholders in designing and implementing pro‐pollinator conservation actions. Although farmers are recognized as key stakeholders in pollinator conservation, psychological research about what determines their pro‐pollinator actions is lacking. We interviewed 89 farmers of pollinator‐dependent fruit crops across the United Kingdom, with the majority of interviews carried out in person. A combination of closed and open questions was used to analyse farmer perceptions of the importance of pollinators, and the crop yield and quality outcomes they deliver. We used Likert‐scale statements to measure psychological factors based on the theory of planned behaviour, and tested the determinants of the intention to plant flowers as nectar and pollen sources for pollinating insects with multiple linear regression. We found that fruit farmers who perceived a high importance of pollinators also perceived high dependence. Compared to values of crop pollinator dependence reported in the literature, farmers' perceptions of their crop's pollinator dependence were the same or lower for apple farmers, and the same or greater, for blackcurrant farmers. Fruit farmers in our sample were motivated to plant flowers for pollinating insects more by what they believed to be the benefits of doing so, and their ability to do so, than by their beliefs about social approval, for example from other farmers or customers. In accordance with this result, attitudes and perceived behavioural control were the major determinants of apple and blackcurrant farmers' intentions to perform the behaviour. Given the importance of perceived behavioural control, we recommend outreach activities that provide training, guidance and field demonstration on the practicalities of planting flowers for pollinators in fruit farms. Read the free Plain Language Summary for this article on the Journal blog.

Abstract The biodiversity loss and human health crises are deeply interconnected, but existing frameworks linking the two are largely derived from high‐income contexts, limiting their applicability to much of the world. While these frameworks have been valuable, this gap is especially critical in rapidly urbanising low‐ and middle‐income regions, where health inequalities and biodiversity loss converge. To address this gap, we conducted research in Accra, Ghana, exploring how urban biodiversity influences health and well‐being. Using photovoice, 36 participants documented their lived experiences of local biodiversity and their perceptions of its impact on their health and well‐being. The resulting data were coded both using emergent and a priori codes based on existing conceptual frameworks. We found that biodiversity interacts with multiple domains of health and well‐being through four pathways (‘reducing harm’, ‘building capacities’, ‘restoring capacities’ and ‘causing harm’) that align with existing framings. We also observed two additional pathways (‘spirituality’ and ‘livelihood support’), both of which may have greater prominence in lower income contexts. Incorporating these pathways into our understanding of how biodiversity influences health and well‐being contributes to a more inclusive framework that reflects the socio‐economic and cultural diversity of rapidly urbanising regions in low‐ and middle‐income regions. We present an adapted framework that integrates these pathways, offering a context‐sensitive model to guide future research. Such a framework is essential for informing policy and practice in a way that benefits a broader range of communities, and thus, potentially, better allows us to address health and biodiversity crises together. Read the free Plain Language Summary for this article on the Journal blog.

A plain language summary of the EORTC 1333/PEACE-3 study of enzalutamide alone vs enzalutamide plus radium-223 in patients with metastatic castrationresistant prostate cancer (mCRPC) and bone metastases.

Abstract Mixed forests have gained increasing attention for afforestation effort on the Chinese Loess Plateau (CLP), while the understanding of how tree water use strategies change across pure and mixed forests is still challenge. In this study, we compared the water use strategies of typical pure Pinus tabuliformis (PT), pure Robinia pseudoacacia (RP) and mixed PT × RP forest in central CLP during a wet year (2022) and a normal year (2023). We examined vertical distribution of fine root dry biomass and length density, monitored soil water content (SWC) and stand transpiration ( T r ), applied stable water isotopes to analyse water source utilization and assessed stomatal regulation strategies during the growing seasons. The results indicated that the PT × RP forest exhibited higher fine root dry biomass than both pure forests, while its fine root length density was intermediate, exceeding that of the PT forest but remaining lower than that of the RP forest. Variations in SWC and T r across growing seasons was greater in PT × RP forest than in PT forest but less than in RP forest. The T r trends corresponded to fine root length density and showed significant responses to environmental drivers (air temperature, net radiation, vapour pressure deficit (VPD) and reference evapotranspiration). All forests reduced water absorption from surface layer from a wet to a normal year, with the PT × RP forest exhibiting a larger increase in the absorption proportion from the deep layer (7.8% for PT and 6.4% for RP in the PT × RP) compared to both the PT (6.3%) and the RP (6.0%) forests. Analysis of the stomatal conductance's response to VPD showed that stomatal regulation was stricter in the PT × RP forest ( m / G cref : 0.7–1.3) than in the pure forests (0.4–0.9). Overall, mixed forests employed more conservative water use strategies than pure forests, as evidenced by deep water acquisition and stricter stomatal regulation. This study provides critical scientific insights for CLP afforestation and water resource management. Read the free Plain Language Summary for this article on the Journal blog.