Patients with kidney stones (KS) often have an increased risk of atherosclerosis (AS). Because endothelial dysfunction (ED) is closely associated with AS, its role in KS remains unclear. This study aimed to examine the roles and mechanisms of AS-related ED genes in KS. Three datasets (GSE73680, GSE117518, and GSE132651) were analyzed. Differential expression analysis was conducted to identify differentially expressed genes (DEGs). To identify potential biomarkers, least absolute shrinkage and selection operator (LASSO) regression analysis and expression validation were conducted. Further analyses including GeneMANIA, gene set enrichment analysis (GSEA), examination of biomarkers within immune cells and subcellular localization analysis, molecular regulatory network analysis, tissue specificity analysis, and competing endogenous (ceRNA) network analysis were employed to comprehensively explore the functions and regulatory mechanisms of the identified biomarkers. Moreover, drug prediction analysis was conducted. Finally, reverse transcription quantitative polymerase chain reaction (RT-qPCR) was proceeded to verify the expression levels of the biomarkers. A total of 22 DEGs associated with KS and AS were identified. Lasso regression selected 4 candidate biomarkers (MMP10, UCHL1, NEK2, and HEY1), among which UCHL1 and NEK2 were validated as key biomarkers. GeneMANIA and GSEA analyses uncovered the potential involvement of these biomarkers in cell adhesion molecules, focal adhesion, and lysosome pathways. Analysis of immune cells and subcellular localization provided insight into the biological functions and intracellular distribution of the biomarkers. Transcription factor regulatory network and ceRNA network analyses elucidated potential upstream regulatory mechanisms. Drug prediction analysis identified 17 potential drugs, including pazopanib and palbociclib, that may target NEK2. RT-qPCR demonstrated that NEK2 was significantly overexpressed in KS samples. This study identified biomarkers associated with KS and AS and comprehensively analyzed their molecular regulatory networks. These findings provide novel understandings of the molecular mechanism underlying KS and lay the foundation for future personalized treatment and drug development.

It is not known whether skin color influences inclusion of substance use on medical students' differential diagnoses for a simulated cardiac arrest. Our objective in this study was to investigate whether the presence of a dark-skinned or light-skinned manikin in the lab correlated with their decision to include substance use on the differential as a possible cause of cardiac arrest.

In this study at a single institution, all fourth-year medical students in an emergency medicine course participated in a manikin-based cardiac arrest simulation case. The simulation sessions alternated between the use of a light-skinned and a dark-skinned manikin. Both were adult sized. After the first shock was delivered, students individually documented their differential diagnosis for the cause of the cardiac arrest on deidentified, free-text research forms. We excluded forms if they were blank, had been completed by a non-medical student, or could not be associated with the skin color of the manikin used. The primary outcome measure was how often students included substance use as a cause of cardiac arrest anywhere in their differential diagnoses. We compared the relationship between manikin skin color and the students' consideration of substance use as a cause of cardiac arrest, using the Fisher exact test.

Of 270 eligible participants, 271 surveys were returned; 75 (27.7%) were excluded. Of the remaining 196 surveys, 96 were associated with the light-skinned and 100 with the dark-skinned manikin. Among the 100 respondents using the dark-skinned manikin, one student (1%) listed substance use as the leading diagnosis, while none (0%) of the students using the light-skinned manikin listed substance use as the leading diagnosis. In each group, only 20% of students (n = 39 total) listed substance use anywhere on the differential diagnosis (P = 1.00).

Among fourth-year medical students participating in a simulated cardiac arrest, we found no correlation between manikin skin color and the inclusion of substance use on their differential for cardiac arrest. Overall, their decision to include substance use in their differentials was low regardless of skin color, suggesting the need to improve their awareness of substance use as a potential cause of cardiac arrest.

Video methods used in medicine have been described as the "gold standard" because they show events as they occurred and with a level of detail unattainable when events are reconstructed using other methods. In stimulated recall, video or pictures during interviews prompt discussion about participants' thoughts or feelings when images were captured. Coupled with video, stimulated recall can deepen researchers' understanding of a participant's thinking at the time. However, conducting video-based stimulated recall interviews with participants is poorly described in the literature because of word count limits in today's journals. In this paper we describe how we used video with stimulated recall interviews to learn how the diagnostic process evolves for emergency physicians.

We used the theory of distributed cognition to describe how information processing develops over time and occurs across physicians, the technologies used, and social organization. We conducted a qualitative study, collecting data in pediatric and adult emergency departments (ED) of an academic Level I trauma center. Participants wore head-mounted video cameras for two hours while providing care to ED patients and revealed their thinking throughout the diagnostic process in subsequent stimulated recall interviews. We reviewed video recordings to identify situations related to the diagnostic process or to one of the concepts in distributed cognition. We identified short video clips from each session to display during interviews and prepared accompanying questions. Stimulated-recall interviews were conducted using video conferencing technology, audio recorded, transcribed, and verified for accuracy. We used content analysis to analyze results.

Eleven attending physicians from February 2022-May 2023 (five from the pediatric ED and six from the adult ED) interacted with 52 patients over a total of 24.4 hours on video. We obtained patients' permission to film encounters before a participating physician provided care, wearing the head-mounted camera. We conducted individual stimulated recall interviews (mean 53 minutes, range 33-63 minutes) with all 11 physicians, which uncovered perspectives beyond what was revealed on film. For example, the complexity of cognition resides in patients as well as physicians. Thus, physicians must exert great effort to elicit the patient story and make a likely diagnosis in the chaotic, noisy environment of the ED.

Using innovative methods to uncover emergency physicians' cognitive processes has the potential to advance our understanding in other settings. This methodology brings awareness to how one's thoughts can become visible and, thus, amenable to reflection and change.

Lithium has long been considered to reduce suicidal behaviour in patients with affective disorders, but evidence from large real-world populations remains limited.

To estimate the effects of lithium initiation and continuation on suicide deaths and non-lethal suicidal behaviours among adults with bipolar disorder or major depressive disorder.

We emulated two target trials using electronic health records and administrative claims from US veterans between January 2010 and December 2022. The first trial benchmarked results against the CSP-590 randomised trial by estimating the 1-year risk of suicide-related events (non-fatal suicide attempts, hospitalisations to prevent suicide or suicide deaths) among patients with a recent suicide attempt initiating lithium versus not initiating lithium. The second trial extended follow-up to 10 years to estimate risks of suicide deaths and non-lethal suicidal behaviours separately, including subgroup analyses by age and diagnosis. An additional analysis removed the requirement of a prior suicide attempt.

In the benchmarking analysis, the 1-year risk ratio for suicide-related events comparing lithium initiation with no initiation was 1.06 (95% CI 1.01 to 1.12), consistent with findings from the CSP-590 trial. In the extended analysis, the 10-year per-protocol risk ratio for suicide death was 1.00 (95% CI 0.86 to 1.15) and for non-lethal suicidal behaviours was 0.96 (95% CI 0.90 to 1.02). Results were similar among individuals with and without a prior suicide attempt.

When added to ongoing pharmacological treatment for patients with affective disorders, lithium may not substantially reduce suicide risk highlighting the need for additional suicide prevention strategies in this population. Limitations include lack of information on adherence, dosage or blood levels of lithium which may have obscured existing differences.

Our findings suggest that adding lithium therapy to the ongoing treatment regimens of patients with affective disorders for the sole purpose of reducing suicide may not be well-tolerated or meaningfully reduce suicide risk.

The objective of this scoping review is to characterize the extent and nature of the available research on photovoice studies examining how greenspaces influence community health, and to identify community actions and advocacy arising from these participatory projects.

Greenspaces have been shown to support physical, mental, and social health. Yet research often overlooks community perspectives, particularly in underrepresented environments such as arid regions. Photovoice enables individuals to document and reflect on their lived environments, providing unique insights into the relationships between greenspaces, health, and community wellbeing. Synthesizing photovoice studies that examine how greenspaces impact health across different ecosystems and landscape designs is essential to capture community-driven knowledge and outcomes, including initiatives that inform policy and practice.

This review will include primary studies employing photovoice methods with human participants, of any demographic or cultural background, that focus on greenspaces and associated health outcomes. Eligible studies may use qualitative or mixed-methods designs, provided photovoice is a core component. Quantitative-only studies, reviews, editorials, and those addressing distal health measures will be excluded.

Searches will be conducted in electronic databases and relevant grey literature sources. No language restrictions will be applied, and the time frame will extend from January 1997, when photovoice was first described, to the present. Screening and data extraction will be conducted in duplicate using Covidence. Findings will be summarized descriptively and synthesized thematically, and confidence in key review findings will be assessed using the JBI Critical Assessment Tools.

Chemical, biological, radiological, and nuclear (CBRN) incidents present escalating risks across the Middle East and North Africa (MENA) amid geopolitical instability, cross-border threats, and evolving non-state actor capabilities. This policy analysis examines why prevailing case-level and ministry-siloed governance is insufficient for population-level CBRN readiness, weighs alternative coordination models, and outlines an artificial intelligence (AI)-enabled, centrally coordinated public-health strategy adapted to the region's heterogeneity and resource constraints. We propose a National Emergency Management Advisory Council to provide statutory inter-ministerial authority and stewardship for a National CBRN Dashboard that delivers decision support, inventory tracking, simulation, and rapid triage. We situate this within existing backgrounds and analyze legal authority, financing, data governance, and feasibility in low-resource settings. While prototype AI models report high accuracy for antidote optimization, agent classification, and triage, we argue these metrics reflect controlled research, not operational readiness, and require external validation, robustness testing, and cybersecurity safeguards. A phased, evidence-graded roadmap is proposed to move MENA CBRN management from reactive to predictive and adaptive models.

Animal-vehicle collisions (AVCs) are a growing global problem with significant implications for human, animal, and ecosystem health. In the United States, approximately one million vertebrates are killed by vehicles each day. Research on roadkilled animals has increased over time, especially regarding wildlife and ecosystem impacts, economic costs, and human physical health risks. However, less is known about how involvement with AVCs or encounters with roadkilled animals influences human health more broadly, including psychological, emotional, psychosocial, and community-level outcomes.

Guided by the One Health framework, this study protocol presents the methodological plan to identify and synthesize current evidence on how AVCs and exposure to roadkilled animals affect human health. The scoping review has not yet been conducted.

The methodological approach follows PRISMA-ScR guidelines and Arksey and O'Malley's five stage framework. A comprehensive, librarian‑assisted search will be conducted across six databases-Scopus, CABI Digital Library, Web of Science, Wildlife & Ecology Studies Worldwide, TRID, and PubMed-without restrictions on publication year or peer‑review status. Reference lists of included records will also be screened. Three reviewers will independently screen the titles, abstracts, and full texts, with each record reviewed by a combination of two reviewers.

Records will be included if they examine how AVCs or roadkilled animals affect any dimension of human physical, mental, or social well‑being and are available in English.

Data will be extracted using a standardized form and analyzed through content analysis to describe the distribution of evidence and organize findings into themes.

By consolidating dispersed knowledge across disciplines, this review will provide the first comprehensive overview of how AVCs and roadkilled animal exposure affect human health. Findings will inform public policy, transportation planning, wildlife management, and future interdisciplinary research aimed at integrated One Health solutions.

Evidence guiding how often adults with type 1 diabetes mellitus should self-monitor blood glucose, when to monitor, and which glycaemic targets to use is limited and inconsistent. The available research has not clearly linked different self-monitoring strategies to meaningful clinical outcomes, and evidence is particularly scarce for low-resource settings. Clarifying these uncertainties is important to support informed decision-making and equitable diabetes care worldwide.

To assess the effects of different timing, frequency, and glycaemic target values for self-monitoring of blood glucose (SMBG) in adults with type 1 diabetes mellitus.

We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Science Citation Index Expanded and Emerging Sources Citation Index (Web of Science), ClinicalTrials.gov, and the WHO ICTRP, without language restrictions. The date of the last search across all databases was 7 January 2026.

We included randomised controlled trials and eligible non-randomised comparative studies with a minimum duration of 24 weeks that evaluated different timing, frequency, or glycaemic target values for SMBG in adults with type 1 diabetes mellitus. We excluded cross-over and cluster-randomised trials, modelling studies, studies of pregnant individuals, and studies focused solely on self-monitoring in the context of insulin pump use.

Our critical outcomes were glycaemic control (haemoglobin A1c and fasting blood glucose), hypoglycaemia (mild or moderate, severe, and nocturnal), diabetic ketoacidosis, microvascular and macrovascular complications, and quality of life.

We assessed the risk of bias in included studies using the Cochrane RoB 2 tool for randomised controlled trials and the ROBINS-I tool for non-randomised comparative studies.

We did not conduct a meta-analysis, as effect measures and outcome reporting varied across the included studies and only three studies met the eligibility criteria. Instead, we followed Cochrane guidance on Synthesis Without Meta-analysis (SWiM) and summarised findings through structured tabulation of study characteristics and results, complemented by visual presentation of individual study effect estimates without statistical pooling. We did not use vote counting based on statistical significance. We assessed the certainty of the evidence using GRADE.

We included three studies conducted in Europe and North America, involving a total of 16,481 adults with type 1 diabetes mellitus. One study was a randomised controlled trial, and two studies were observational comparative studies. All studies evaluated the frequency of SMBG; none reported eligible data on timing or glycaemic target values. Follow-up durations ranged from 9 to 24 months.

Timing of SMBG No eligible studies investigating the timing of SMBG were identified. Frequency of SMBG Three studies involving a total of 16,481 adults investigated the frequency of SMBG in adults with type 1 diabetes mellitus. Overall, more frequent self-monitoring may be associated with lower haemoglobin A1c levels, although the evidence is very uncertain. In the randomised controlled trial (123 participants), the mean change in haemoglobin A1c at nine months was -0.43% in the intervention group compared with +0.23% in the control group, corresponding to approximately 0.7% lower haemoglobin A1c with more structured and frequent monitoring (mean difference (MD) -0.66, 95% confidence interval (CI) -0.94 to -0.38). The certainty of the evidence for this outcome was very low. In one observational study (1159 participants), adherence to self-monitoring guidelines may be associated with a 1.0% lower adjusted mean haemoglobin A1c (MD -1.00, 95% CI -1.21 to -0.79) compared with non-adherence. The third study (15,199 participants) reported lower haemoglobin A1c values with increasing monitoring frequency (P < 0.001), with the lowest values among those monitoring more than six times per day. Across both studies, the certainty of the evidence was very low. No included study reported effects on hypoglycaemia, diabetic ketoacidosis, microvascular or macrovascular complications, or quality of life. Glycaemic target values for SMBG No eligible studies investigating glycaemic target values for SMBG were identified.

No studies evaluated different timings of self-monitoring or different glycaemic target values. Three studies (one randomised controlled trial and two observational studies) assessed the frequency of self-monitoring and haemoglobin A1c. More frequent self-monitoring may be associated with lower haemoglobin A1c, although the evidence is sparse, frequency categories were inconsistent across studies, and the included studies had methodological limitations. The certainty of the evidence was very low for all outcomes, driven by risk of bias, imprecision, and inconsistency across studies. No studies reported hypoglycaemia, diabetic ketoacidosis, quality of life, or other critical outcomes. The evidence is insufficient to draw any firm conclusions about the effects of different self-monitoring strategies in adults with type 1 diabetes mellitus.

This review was funded by the World Health Organization through an Agreement for Performance of Work (APW 203512799).

The review was registered in PROSPERO (CRD42025639736) in February 2025.

Background and objective Home-based palliative care (HBPC) can reduce suffering and improve the quality of life for patients with serious chronic illnesses. However, its integration into routine government primary healthcare remains limited. Understanding health system readiness and provider perspectives is essential for its feasible integration. This study aimed to explore the barriers, facilitators, and stakeholder recommendations for integrating HBPC into urban Primary Healthcare Centers (PHCs) in Jodhpur, Rajasthan. Methods A qualitative study was conducted using purposive sampling. Data were collected through Key Informant Interviews (KIIs) with district health administrators and a palliative care physician, In-Depth Interviews (IDIs) with Medical Officers, and Focus Group Discussions (FGDs) with frontline workers, including Accredited Social Health Activists (ASHAs) and Auxiliary Nurse Midwives (ANMs). A total of 30 participants were included. Data were analyzed using thematic analysis. Results Barriers were identified at two levels. Knowledge and behavioral barriers included limited awareness and confidence among providers, low community awareness, sociocultural hesitation, and follow-up challenges. Structural barriers included a lack of formal PHC-level programs, weak referral pathways, limited availability of essential medicines such as morphine, high workload among frontline workers, and logistical constraints. Facilitators included community trust in ASHAs and ANMs, availability of basic medicines, referral linkages with tertiary care centers, and willingness for training and integration. Conclusion Integration is limited by gaps in provider capacity, medicine access, and service structure. Existing community trust and referral linkages provide a foundation for integration. Strengthening structured pathways, workforce capacity, and access to essential medicines is required for effective integration.

Periodontitis remains one of the most prevalent chronic diseases worldwide and is strongly socially patterned. However, contemporary disease classifications and guideline-based management largely emphasise individualised, clinically intensive, long-term maintenance approaches. Whether these models are feasible, equitable, or sustainable when applied at the population level has received little attention.

We synthesised evidence from global and national epidemiological studies, health systems research, clinical practice guidelines, and health policy analyses to examine the implications of current periodontitis classifications and care models for service demand, workforce capacity, equity, and universal health coverage. We developed a conceptual framework linking disease definitions, recommended care intensity, and health system constraints.

Current periodontitis classifications and maintenance-oriented care recommendations generate levels of service demand that substantially exceed the capacity of most oral health systems. This creates a feasibility paradox whereby increasingly comprehensive disease definitions and intensive maintenance schedules lead to implicit rationing of care and socially patterned access, disproportionately disadvantaging populations already at highest risk. The prevailing clinical paradigm also places limited emphasis on structural determinants of disease, population prevention, and value-based allocation of resources.

A population-oriented reorientation of periodontal care is needed. We propose a framework that prioritises documented disease progression, risk of harm, and person-centred outcomes; aligns treatment intensity with expected benefit through risk-based and value-oriented approaches; and explicitly incorporates health system capacity together with the structural and commercial determinants of health. Moving beyond maintenance-for-all models toward feasible, equitable, and system-aware strategies is essential to reducing the population burden of periodontitis and advancing universal health coverage.