Despite global progress in developing integrated mental healthcare on primary healthcare level, particularly in low-and-middle income countries, descriptions of scaling-up efforts remain scarce. The aim of this study was two-fold. First, to describe a collaborative approach to embed a common mental health conditions screening tool and process within district primary health care systems in KwaZulu-Natal, South Africa. Second, to explore perceptions of participating frontline workers and policy makers of the barriers and facilitators to embedding the tool using this collaborative approach as part of a scale-up process. Following a participatory action research approach, a learning collaborative was established that involved (1) mental health service coordinators from each district of the province of KwaZulu-Natal (n = 11), (2) provincial managers and policymakers (n = 4), and (3) members of the local research team. The capacity building programme was co-developed during a series of participatory workshops, and the common mental health conditions screening tool and associated processes were implemented and workshopped iteratively. The development and implementation of this programme as part of scaling up the screening intervention was assessed drawing from workshop proceedings, individual interviews with district coordinators (n = 11), and a focus group discussion (n = 8). Data were transcribed verbatim and thematically analysed guided by the Consolidated Framework for advancing Implementation Research. The participatory development and implementation process resulted in consensus building, curriculum development, situational analyses, training, and continuous quality improvement. The collaborative and co-development approach to the capacity building curriculum was broadly favoured. Outer Settings emerged in terms of a lack of formal guidance documents for district mental health services, limited intersectoral collaboration, and limited community mental health literacy. In terms of Inner Settings, mental health continued to be under-prioritised in district services, with a lack of ring-fenced funding and data monitoring systems. Regarding Individuals, PHC staff were less well-trained and did not always want to engage in mental healthcare, with limited opportunity for capacity development. In terms of Implementation Processes, the flexibility of programme was particularly well illustrated during the disruptions of COVID-19, and adaptations were added to the programme to help address mental health and containing leadership among primary healthcare workers. While this period resulted in virtual workshops, face-to-face meetings were favoured. The scaling-up of an integrated primary mental health screening innovation requires capacity building among mid-level management, and a co-developed, collaborative programme built on continuous quality improvement provides promise in providing flexibility and communal problem-solving for more sustained implementation.

Superficial esophageal cancer (SEC) within a diverticulum is extremely rare and poses a high risk of perforation during endoscopic submucosal dissection (ESD), presenting unique technical challenges. This study aims to evaluate the feasibility, safety, and efficacy of ESD for treating SEC in diverticula. The retrospective study was conducted on patients diagnosed endoscopically with SEC in a diverticulum who subsequently underwent ESD with histological confirmation of esophageal cancer. Data on demographics, closure methods, incidence of adverse events, histopathological characteristics, and prognostic outcomes were collected from medical records and video recordings of endoscopic procedures and analyzed. Twelve patients were enrolled, and R0 resection was achieved in all cases. Post-ESD wound management varied, tailored to the defect characteristics: titanium clips were used to close wounds with a preserved superficial muscular layer in five patients (5/12, 41.7%), while endoscopic hand-suturing-developed by our research team primarily for closing large mucosal defects after endoscopic resection of colorectal tumors-was performed in three patients (3/12, 25.0%) with defects in the intrinsic muscular layer. Four patients (4/12, 33.3%) with small defects in the muscularis propria were left untreated. None of the patients experienced serious adverse events, such as post-operative bleeding or perforation, and there were no cases of recurrence or metastasis during follow-up. This study provides evidence supporting ESD as a feasible, effective, and safe treatment for SEC in diverticula. Tailoring closure techniques to the defect characteristics is crucial for preventing complications and achieving optimal clinical outcomes.

Our research team conducted a large-scale literature review of health humanities teaching publications to track the evolution of its methods, trends, and hints on where we might be headed. After decades of piecemeal integration, the health humanities now appear to be evolving at a dizzying pace. Catalyzing H.E.A.L. (Humanities Education and Anticolonial Learning) Medicine is a scoping review of 432 peer-reviewed articles that specifically address the inclusion of humanities and arts methods and methodologies in the education and professionalization of healthcare workers. We included peer-reviewed articles in global contexts, published in English and French, and spanning the timeframe of 1970 to 2022. This paper reports on 11 key categories of assessment. Results show a growing shift in instructor leadership from medical to humanities backgrounds, a wider variety in arts methods and collaborating disciplines, and an increase in intrinsic values as pedagogical aims. While language-based arts and university classrooms remain dominant, non-linguistic arts methods and alternative learning spaces are on the rise. The increased diversity in aims, collaborating disciplines, and evaluation methods points to a more interdisciplinary and social justice-oriented future. We hope that our data will shed valuable light on where the medical humanities have been and what may be on the horizon.

ABSTRACT Research collaborations between university scholars and K-12 educators have grown in recent decades, largely due to their ability to disrupt the top-down traditions of educational research and develop authentic practices informed by teachers’ knowledge. However, in-depth inquiry is needed to determine how those collaborations unfold at an interpersonal/relational level. In this self-reflexive qualitative study, we explored how our research team navigated strengths and tensions in an ongoing partnership with secondary science educators. A theme of ‘if it’s helpful’ (encouraging but not forcing) was apparent in our approach to both soliciting and responding to teachers’ ideas. We analyze how this theme may influence the balance of building a flexible and reciprocal project that supports a clear purpose while still producing deliverable materials. We connect our contextual analysis to the broader constraints and possibilities of co-design and action research, advocating for more researcher-teacher collaborations that are humble, self-reflexive, and cognizant of the challenges and power relations inherent in any partnership. This study may implicate co-design and action research alike by acknowledging common tensions and challenges but not treating these as necessarily failures.

Clinical trials are the best method for evaluating new treatments for people with interstitial lung disease (ILD). However, recruitment in ILD clinical trials is often challenging. Certain trial characteristics may influence willingness to participate but this has not been investigated in people with ILD. This study aims to identify the factors that influence participation in clinical trials in people with ILD. This is a qualitative study using thematic analysis. Participants with ILD were recruited from a tertiary hospital in Melbourne, Australia between 2023 and 2024. Interviews were conducted over the phone, recorded and transcribed. The study was approved by the Alfred Hospital Ethics Committee (598/22). 17 participants with mild-to-moderate ILD were included. Overarching themes were: 1) reasons for participation, including development of new treatments, acceptable burden of participation and positive relationship with the research team; 2) reasons for refusing participation, consisting of disruption to daily life including financial burden, impact on health and uncertainty of benefits; and 3) experience when participating, including lack of communication and poor relationship with the research team. Participants described positive experiences (care and support from the research team) and negative experiences (discontinuation of treatment, insufficient information on trial outcomes) of trial participation. People with ILD prefer trials that offer clear information and minimise disruption to their daily routines. A unique finding in this population is the importance placed on communication and support from the research team, as well as the desire to receive feedback about the trial's outcomes.

Best Interests decision-making processes in learning disability services in Northern Ireland.

RAD51 promotes osteogenic differentiation and inhibits DNA damage in osteoporosis though regulating cGAS-STING signaling pathway.

Development of lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual, and other gender and sexual minority (LGBTQIA+) identities and a disability identity is critical for positive mental health outcomes for LGBTQIA+ autistic individuals. To understand identity development and evaluate the resonance of support among a large sample of LGBTQIA+ autistic adults. A sequential mixed-methods, participatory approach. Data collection for both phases occurred remotely. LGBTQIA+ autistic adults completed the qualitative phase and the survey (Ns = 57 and 107, respectively). Phase 1, the qualitative phase, included semistructured interviews and focus groups based on queer, crip, and intersectionality theories. Questions related to identity exploration and development. Themes regarding barriers and supports were used to develop a survey, used in Phase 2, to collect quantitative data to confirm the resonance of the findings. Participants described exposure, personal research, trial and error, and individuals external to the LGBTQIA+ and autistic communities as contributing to their evolving identities. If these contributing factors were positive, people described experiencing narrative gain, whereby they felt a sense of relief and pride over their identities, and if they were negative participants reported going through a journey toward self-acceptance. Occupational therapy practitioners can support LGBTQIA+ autistic adults in the identity development process by fostering connections with other LGBTQIA+ autistic individuals, providing accessible sexual health education supporting personal research and providing accessible resources, offering opportunities to explore identities through creative means, and creating supportive environments and safe spaces for self-exploration. Plain-Language Summary: Identity development is the process of understanding who you are. Occupational therapy practitioners can help support positive identity development for LGBTQIA+ autistic clients. In Phase 1 of the study, we talked to 57 LGBTQIA+ autistic people and asked them how they learned they were LGBTQIA+ and autistic. We used what we learned from those people to create survey questions, and we asked another 107 LGBTQIA+ autistic people whether the findings from our conversations in Phase 1 resonated with them as well. LGBTQIA+ autistic participants reported that they found it helpful to be exposed to people with diverse LGBTQIA+ and autistic identities; to be connected with articles, blogs, and people online who held diverse LGBTQIA+ and autistic identities; and to trial different identities. They also said it was helpful if people who were not LGBTQIA+ or autistic were supportive during this process. When people had more help, they had better acceptance of themselves. When people had less help, they said they had to learn to accept themselves. Positionality Statement: In this article, we use the term LGBTQIA+ (lesbian, gay, bisexual, transgender, queer/questioning, intersex, asexual, and other gender and sexual minority identities) to refer to a spectrum of marginalized sexual orientations (e.g., lesbian, gay, bisexual, asexual), gender identities (e.g., transgender, nonbinary, agender), and biological variations in sex characteristics (e.g., intersex). We recognize that these identities are distinct but often interrelated, and unless otherwise specified we use LGBTQIA+ inclusively to reflect participants' self-identification. The first author is a White, straight, cisgender female with a history of generalized anxiety disorder. The second author is a mixed-race, queer, cisgender woman who is multiply neurodivergent, including autism, attention deficit hyperactivity disorder, and posttraumatic stress disorder. The third author is a White, queer, nonbinary autistic person. The fourth author is a White, straight, cisgender female. The research team has varied experience and expertise in conducting research. The first author has a PhD and is a licensed occupational therapist, the second author has worked for many years in research laboratories as a research assistant and coordinator and is a licensed occupational therapist, the third author has a background in quantitative designs and statistical analyses and has worked as a research assistant, and the fourth author worked as a research assistant while in graduate school and is a licensed occupational therapist.

REACT-PXE: a consensus on diagnosis and future research concerning pseudoxanthoma elasticum (PXE).

An alternative linear impactor for impact research.

Pioneers: Growing Together With Molecular Dynamics Simulation and NMR for Studying Biomacromolecules in China.

PurposeTo understand general COVID-19 pandemic-related stressors among caregivers of children ages 3-15, and describe institutional, interpersonal, and personal protective factors used to cope with pandemic-related stress.DesignSemi-structured, in-depth interviews.SettingMaryland.ParticipantsCaregivers of children enrolled in the COVID-19 Family Study; 38 caregivers during 2020 (T1) and 22 caregivers during repeat interviews in 2021 (T2).MethodThe research team developed interview guides informed by the Family Stress Model (FSM) for T1 and T2 interviews. Interviews were analyzed using content coding to later construct themes related to how stressors and protective factors changed over time.ResultsThe thematic analysis is described across four concepts: caregiver stressors, institutional protective factors, interpersonal protective factors, and personal factors. In T1 interviews, stressors included viral exposure, remote work and school, and social distancing. During T2 interviews, caregivers described re-opening of work, school, and businesses and shifting back into pre-pandemic routines as continuing stressors. In both rounds of interviews, caregivers described a variety of institutional, interpersonal, and personal protective factors to cope with stress. Commonly mentioned protective factors included government aid (i.e., stimulus checks, free school lunches), family time, and hobbies.ConclusionFindings highlight the necessity of multi-tiered (institutional, interpersonal, personal) approaches to support caregivers navigating stressful experiences during times of extraordinary duress, especially emphasizing interventions that incorporate various levels of the socioecological model.

Emerging evidence suggests that researchers studying sensitive topics are prone to secondary emotional distress, and graduate students and trainees are particularly vulnerable as novice researchers. While many studies account for potential emotional distress in participants of research on sensitive topics, very few include considerations for mitigating emotional harm to researchers. Therefore, this article examines the experiences of graduate research assistants in a study on live discharge from hospice care. Distress stemmed from repeated exposure to sensitive narratives, blurred role boundaries, and personal identity challenges, with prolonged participant engagement deepening the emotional impact. Coping strategies included debriefs, mentorship, and self-care practices. These findings highlight the ethical need to integrate researcher well-being into study design, especially for novice researchers. Institutions and principal investigators might use protocols including training, boundary-setting guidance, and mental health resources to protect researchers' mental health.

The 2022 global outbreak of clade IIb mpox disproportionately impacted lesbian, gay, bisexual, transgender, and queer (LGBTQ+) communities and highlighted issues of stigma, access to health care, and health care‒associated trauma. Together with LGBTQ+ community partners, our research team implemented venue-based mpox virus and antibody testing. In response to feedback from our community partners, this effort evolved to include broader elements of sexual health services, including distribution of prescriptions for doxycycline postexposure prophylaxis. (Am J Public Health. 2026;116(3):307-311. https://doi.org/10.2105/AJPH.2025.308309).

Needs of pregnant women with epilepsy-a mixed methods study.

Advances in thyroid hormone system disruption testing - In vitro method for monitoring disrupted thyrotropin signaling through the human TSH receptor (hTSHR).

Information disclosure during the informed consent process presents a dilemma. If too little information is presented, participants are unable to make an informed decision. Exhaustive disclosure is, however, a practical impossibility. In the United States, this dilemma was historically navigated in the research context by requiring that disclosure include enumerated items: the purpose of the research, potential risks, etc. In 2018, federal guidelines were updated to require that disclosure adhere to the reasonable person standard, whereby participants must be given all information that an “average” person would want to know. Drawing on the Autistic community’s unique concerns regarding research, we argue that, because of its emphasis on the informational wants of the “average” person, the reasonable person standard systematically fails to meet the informational needs of (many) people from minoritized populations. We argue for an individualized understanding of the reasonable person standard and provide recommendations for research teams.

*Here is the link to the talk I gave for the LifeSciLab in Uppsala, Sweden. I posted the slides on this website earlier.* [How reporting on study limitations can diminish Avoidable Research Waste](https://www.youtube.com/watch?v=lQaKzdo4sh8) *In the 45-minute talk, I cover the Avoidable Research Waste (ARW) papers of 2009 and 2014. I comment on the links between UNESCO's Open Science Recommendations paper (2021) and Robert Merton's CUDOS principles that describe and prescribe good ways of doing science (1942). I talk about my own work (with Dr. Halil Kilicoglu and others) on self-acknowledgment of limitations and connect that to the question of how we may organize skepticism (the 'OS' in CUDOS) in our research teams). I distinguish four types of limitations and link the types 3 and 4 to multiverse sensitivity analysis, a radical form of testing the robustness of study findings. Finally, I spend 10 minutes on the results of a small study we did at our open science support desk to find out to what extent our faculty's researchers embraced the 14 principles of our internal open science checklist between 2020 and 2023. The last slide discusses slow science, team science and again the organization of skepticism within research settings.* The link between more transparency about our own study limitations and the reduction of research waste should have been made much clearer. A nice challenge for another talk.

To explore Primary Health Care (PHC) professionals' perception and practices regarding chronic pain. This is a qualitative study involving 60 PHC professionals who responded to an interview based on a semi-structured script. All questions were prepared by the research team itself. The responses obtained were recorded in audio format and later transcribed and analyzed using the IRAMUTEQ software, using descending hierarchical classification to analyze the results. According to the perception of the PHC professionals, five classes were categorized: Class 1 - Aspects of healthcare network and care coordination; Class 2 - Primary care and the user's subjective perspective; Class 3 - Scientific considerations and professionals' experiences; Class 4 - Strategies for managing chronic pain; and Class 5 - Approach to pain relief and assessment. It was evident that PHC professionals adopt different strategies in managing chronic pain, guided by the user's subjectivity, service conditions, and professional beliefs, with no standardized institutional protocols. The participants' reports revealed diverse practices and perceptions regarding chronic pain management, with the influence of beliefs and attitudes shaping the approaches adopted, contributing to the reflection on planning and qualification of care in this context.

Background Esketamine is an innovative treatment for individuals with treatment-resistant depression (TRD). However, its adoption could depend on the perceptions and motivations of prescribing psychiatrists, among other factors. Objective This study aims to explore the attitudes of psychiatrists (of all levels, including those in training) across Saudi Arabia toward the use of esketamine for TRD and investigate the motivational factors related to their willingness to adopt it. Methods This is a cross-sectional study that utilized a convenience sampling method. The study tool consisted of a questionnaire developed by the research team and the Physician-Motivation Adoption Scale. Results Of the 223 participants surveyed, 19.73% reported having prescribed esketamine, most commonly to 1–2 patients. The most frequently perceived adverse effects were dissociation/delusions/hallucinations (66.82%), followed by dizziness/vertigo (59.19%). Esketamine prescription was significantly associated with older age (p = 0.049), consultant-level practice (p = 0.003), practice in the Western Region (p < 0.001), lower concern about potential misuse (p = 0.027), perceiving easier access (p = 0.004), and fewer concerns about the administration process (p = 0.007). Ordinal logistic regression demonstrated that senior registrars, registrars, and residents were significantly less likely to prescribe esketamine than consultants (OR = 0.21, 0.17, and 0.10, respectively). “Not being sure” that cost was a barrier was associated with lower odds of prescribing (OR = 0.32, p = 0.022), whereas higher functional subscale scores were strongly associated with willingness to prescribe (OR = 1.62, p < 0.001). The most commonly reported barriers to prescribing esketamine included the administration process (66.37%) and cost (65.02%). Conclusion Despite significant interest, actual adoption of esketamine is low, mainly due to logistical barriers, high costs, and availability issues. Concerns about side effects and potential misuse are also linked to hesitation. Accordingly, interventions to address the obstacles and concerns are needed.