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461 papers

"I'm Not Here to Teach You How to Be Gay:" LGBTQ+ Client Experiences of Othering in Emotionally Focused Couple Therapy.

Edwards C et al. · Jul 1, 2026

Despite the increasing emphasis on addressing the intersections of client and therapist identity to improve therapeutic outcomes, therapy clients holding marginalized identities continue to experience othering. Othering is a process that engenders marginalization and inequality based on preconceived group identity, involves the hegemonic construction of belonging and not belonging, and often entails both stereotyping and racialization. This paper reports on the experience of lesbian, gay, bisexual, transgender, queer/questioning plus (LGBTQ+) emotionally focused couple therapy (EFCT) clients' experience of othering both in their own therapy and as part of participating in a research study on tailoring EFCT to account for the unique lived experience of members of the LGBTQ+ communities. This study relied on negative case analysis in the context of thematic analysis (TA) to develop three themes: (1) understanding versus inflating identity, (2) educating the therapist, and (3) deepening discussions around identity.

Psychology

Feasibility and Acceptability of a Breastfeeding Support Intervention Among Mothers of Infants Under Six Months Old Discharged From Malnutrition Treatment in Kilifi County.

Unda J et al. · Jul 1, 2026

Malnourished infants under 6 months experience poor growth and development. A pilot study applied the WHO guideline for treatment of acute malnutrition and found that it was possible to re-establish exclusive breastfeeding during inpatient treatment. However, weight gain could not be sustained 6 weeks after discharge suggesting that follow-up breastfeeding support may be required. Our study aimed to pilot the feasibility and acceptability of a follow-up intervention among infants discharged from malnutrition treatment. A home-based post-discharge breastfeeding support intervention was developed to be delivered by breastfeeding peer supporters in a series of three home visits and three intervention phone calls over a period of 7 weeks after discharge from the hospital. The intervention was piloted among 20 mother-infant pairs providing quantitative and qualitative data from a standardized questionnaire and in-depth interviews. Data was analyzed descriptively and using thematic analysis. The median infant birth weight was 2.07 kg and > 50% of the mothers had primary education or less. The intervention was feasible with 100% reach of the target participants with a geographic spread of 25% urban and 75% rural areas. All intervention components were applied consistently, resulting in 100% adherence over a 6-month period. The intervention was accepted by mothers, perceived to be beneficial, and reported to increase breastfeeding confidence. It was adaptable, adjusting to emerging challenges, and was successfully integrated into existing health services. The pilot demonstrated high feasibility and widespread acceptance of the intervention. Its effectiveness to improve weight gain among recovering infants is being determined in a trial.

Nursing

Validation of an automated chromogenic in situ hybridization protocol for detection of cytomegalovirus in formalin-fixed, paraffin-embedded renal graft biopsies.

Rangel JV et al. · Jul 1, 2026

Introduction Histopathological diagnosis of human cytomegalovirus (HCMV) infection in formalin-fixed, paraffin-embedded (FFPE) tissues stained with hematoxylin-eosin relies on the identification of characteristic cytopathic changes, including eosinophilic intranuclear and cytoplasmic viral inclusions. Chromogenic in situ hybridization (CISH) enables the localization of specific nucleic acid sequences in histological sections, increasing diagnostic sensitivity. Automated CISH platforms allow standardized and reproducible detection of viral RNA or DNA in FFPE tissues. This study aimed to validate an automated CISH protocol for the detection of HCMV in multiple tissue types, including renal allograft biopsies processed at the Anatomical Pathology Division of UERJ. Methods Two groups of FFPE samples were analyzed. The first group included ten samples from various tissues, including kidney, palate, esophagus, stomach, and colon; nine positive and one negative for HCMV by immunohistochemistry (IHC). The second group included twenty renal allograft biopsies; nineteen without previous diagnosis and one positive by IHC. For CISH, fluorescein-conjugated oligonucleotide probes targeting HCMV RNA expressed during the early replication phase were used, with hybridization and detection performed on an automated platform. Results In Group 1, all samples, including the case previously negative by IHC, were positive for HCMV by CISH. In Group 2, six of the twenty renal biopsies were positive, including the sample already identified as positive by IHC. Conclusions The automated CISH protocol demonstrated high sensitivity and reproducibility for HCMV detection, supporting its validation and use in the diagnosis of renal biopsies and other tissues, as well as its incorporation into the routine workflow of Anatomical Pathology laboratories.

Medicine

The Role of Family Functioning in the Relationship Between Job Burnout and Parental Burnout in Working Parents: A Moderation Model.

Marchetti D et al. · Jul 1, 2026

Research has underscored the interconnection between work and family domains, showing that an imbalance between demands and resources can lead to job and parental burnout. Our study examined the moderating role of family functioning in the association between job burnout and parental burnout among working parents in Italy. Drawing on Olson's Circumplex Model, balanced family functioning was conceptualized as optimal levels of cohesion and flexibility, reflecting a well-regulated family dynamic. Three-hundred-nine working parents of children aged 0-18 completed a survey assessing sociodemographic characteristics, job burnout, parental burnout, and family functioning. Results indicate that parental burnout was positively related to job burnout and negatively to family functioning. Simple slope analyses showed that the association between job and parental burnout progressively weakened as family functioning increased and became non-significant beyond a specific threshold. Our findings highlight the clinical value of balanced family functioning's buffering effect on work-family stress processes.

Social Sciences

Bayesian Analysis of Postoperative Complication Risk Associated With Preoperative Exposure to Fine Particulate Matter: A Single-Center Cohort Study.

Pearson JF et al. · Jul 1, 2026

Background Air pollution, especially particle pollution, is increasingly recognized as a potential perioperative risk factor, yet modeling environmental exposures in surgical cohorts remains methodologically underdeveloped. We demonstrate a Bayesian hierarchical framework to quantify probabilistic associations between preoperative fine particulate matter (PM 2.5 ) exposure and postoperative complications, highlighting its interpretability and flexibility for clinical environmental epidemiology. Methods We conducted a single center, retrospective cohort study using data from 49,615 surgical patients in Utah who underwent elective surgical procedures from 2016 to 2018. Patients' addresses were geocoded and linked to daily Census-tract level PM 2.5 estimates. The exposure variable was defined as the maximum PM 2.5 concentrations in the 7 days prior to surgery. The binary outcome was a composite of postoperative complications: pneumonia, surgical site infection, urinary tract infection, sepsis, stroke, myocardial infarction, or thromboembolic event. A hierarchical Bayesians regression model with weakly informative priors was used adjusting for age, sex, season, neighborhood disadvantage, and the Elixhauser index of comorbidities with census tract as a group (random) effect. We present posterior estimates with credible intervals, highlight model transparency and sensitivity, and discuss contrasts with standard frequentist methods. Results Postoperative complications were associated in a dose-dependent manner with higher concentrations of PM 2.5 exposure. We found a relative increase of 8.2% in the odds of complications (OR = 1.082) for every 10.ug/m 3 increase in the highest single-day 24-h PM 2.5 exposure during the 7 days prior to surgery. For an increase in PM 2.5 from 1 to 30 ug/m 3 , the odds of complication rose to over 27% (95% CI: 4%-55%). The results were robust across prior choices and model specifications. We report full posterior distributions and highlight advantages of Bayesian modeling for uncertainty quantification and clinical interpretability. Conclusions This case study demonstrates the application of hierarchical Bayesian modeling to quantify the probabilistic associations between preoperative PM 2.5 exposure and postoperative complications, highlighting transparent risk estimation and uncertainty characterization that may inform the design of future multicenter perioperative environmental studies. Editorial comment Using Bayesian statistical analysis, the authors demonstrate a dose-dependent risk for postoperative complications in patients exposed to air polluted with fine particulate matter with a size of less than 2.5 μm.

Environmental Science

Mex-3 RNA-binding family member A limits macrophage ferroptosis-associated injury linked to the SLC7A11/GPX4 pathway in diabetic atherosclerosis.

Ma Y et al. · Jul 1, 2026

Background Diabetes accelerates atherosclerotic plaque expansion and loss of stability, but the plaque-resident mechanisms through which the diabetic milieu promotes macrophage lipid-oxidative injury are not fully understood. Methods We used apolipoprotein E-deficient (ApoE -/- ) mice with Mex-3 RNA-binding family member A (MEX3A) deficiency and primary bone marrow-derived macrophage (BMDM) experiments under diabetic conditions to investigate the role of MEX3A in diabetic atherosclerosis and macrophage lipid-peroxidation injury. Results MEX3A loss worsened diabetic atherosclerosis while leaving body weight, glycaemia and lipid measurements largely unchanged relative to diabetes alone. MEX3A deficiency enlarged aortic lesions, enhanced lipid deposition, increased macrophage content, expanded necrotic cores and thinned fibrous caps, while reducing collagen content. In lesional macrophages, loss of MEX3A coincided with increased lipid reactive oxygen species, malondialdehyde, increased labile iron, 4-hydroxynonenal, a disturbed glutathione redox state, mitochondrial abnormalities compatible with ferroptotic stress, lower GPX4/SLC7A11 and higher ACSL4. CRISPR/Cas9-mediated Mex3a knockout in BMDMs recapitulated this phenotype, whereas restoring MEX3A blunted it. RNA immunoprecipitation-qPCR together with actinomycin D decay analyses demonstrated preferential recovery of Slc7a11 and Gpx4 transcripts with MEX3A and decreased stability of Slc7a11 and Gpx4 mRNAs after Mex3a knockout. GPX4 or SLC7A11 overexpression reduced lipid-peroxidation injury in Mex3a-knockout macrophages, whereas Gpx4 or Slc7a11 knockdown weakened the protection conferred by MEX3A re-expression. Ferrostatin-1 partially attenuated macrophage lipid peroxidation and plaque injury. Conclusions Together, these results place MEX3A among the protective regulators of diabetic plaque stability and support a MEX3ASLC7A11/GPX4-linked ferroptosis-associated mechanism in plaque macrophages. Key points MEX3A deficiency worsens diabetic atherosclerosis without further aggravating systemic metabolic indices. Loss of MEX3A promotes plaque lipid deposition, macrophage accumulation, necrotic core expansion and fibrous cap thinning. MEX3A limits macrophage lipid-peroxidation injury linked to the SLC7A11/GPX4 pathway. Ferrostatin-1 partially attenuates macrophage lipid peroxidation and plaque injury associated with MEX3A deficiency.

Medicine

Immediate Effects of Delayed Auditory Feedback on Stuttering: A Systematic Review and Meta-Analysis of Literature Published 2000-2024.

Iimura D et al. · Jul 1, 2026

Purpose This systematic review and meta-analysis evaluated the fluency- enhancing effect of DAF alone in individuals with developmental stuttering. Methods Following PRISMA 2020 guidelines, we searched multiple databases for studies published between 2000 and 2024. Eligible studies examined DAF conditions applied to speech tasks with stuttering-related outcomes. Meta-analyses were conducted using a random-effects model, with subgroup analyses by disfluency type, delay time, speech task, stuttering severity, and participant age. Results Of the 194 records screened, eight studies involving a total of 98 participants in total met the inclusion criteria, and five studies involving 61 participants were eligible for quantitative synthesis. Each study included 8-20 participants ranging from school-age children to adults. Most participants were male, and stuttering severity ranged from mild to severe. DAF conditions were evaluated using oral reading and spontaneous speech/monologue tasks. Meta-analysis revealed no significant overall benefit of DAF compared with normal auditory feedback (NAF; mean difference = -1.46, 95% CI [-4.83, 1.91]). Conclusion DAF alone does not consistently reduce disfluencies; however, specific populations and conditions may derive greater benefits from it. Larger, well-controlled studies are needed to clarify its therapeutic potential and clinical applications. What this paper adds What is already known on this subject Delayed auditory feedback (DAF) has been reported to improve fluency in people who stutter and is used in several assistive devices. However, its independent effect remains unclear because DAF is often combined with other altered auditory feedback conditions. What this study adds to existing knowledge This systematic review and meta-analysis evaluated the exclusive effect of DAF on stuttering. The results indicate that DAF alone does not consistently reduce disfluency compared with NAF, although certain conditions (e.g., shorter delays or reading tasks) may show greater benefits. What are the potential or actual clinical implications of this work? Clinicians should interpret the fluency-enhancing effects of DAF cautiously when used alone. Further well-controlled studies are needed to determine which individuals and speech contexts may benefit most from DAF-based interventions.

Psychology

Long-Term Cardiometabolic Outcomes in Children With Metabolically Healthy and Unhealthy Obesity.

Putri RR et al. · Jul 1, 2026

Importance Metabolically healthy obesity (MHO) in children has been considered a low-risk phenotype, potentially not requiring treatment. However, their long-term cardiometabolic outcomes remain unclear. Objective To compare the occurrence of type 2 diabetes, hypertension, dyslipidemia, and mortality up to young adulthood in children with metabolically healthy obesity (MHO), metabolically unhealthy obesity (MUO), and general population peers, and to investigate the association between obesity treatment response and disease risk. Design, setting, and participants This was a prospective cohort study including children undergoing obesity treatment recorded in the Swedish Childhood Obesity Treatment Register (BORIS) between 1997 and 2020 and their general population comparators, linked with national registers. Children in the cohort with obesity were aged 7 to 17 years at obesity treatment initiation and had complete cardiometabolic data. General population comparators were matched (ratio 1:5) based on sex, birth year, and residential area. Study data were analyzed from February to March 2025. Exposures Exposures included metabolically healthy obesity (MHO), defined as the absence of high blood pressure, impaired fasting glycemia, elevated transaminases, elevated triglycerides, and low high-density lipoprotein cholesterol; otherwise, children were categorized as having metabolically unhealthy obesity (MUO). Main outcomes and measures Type 2 diabetes, hypertension, dyslipidemia, and mortality up to age 30 years. Results A total of 7275 children (median [first quartile {Q1}-third quartile {Q3}] age, 11.1 [9.1-13.5] years; 4004 male [55.0%]) were included, along with 35 636 general population comparators (median [Q1-Q3] age, 11.1 [9.1-13.5] years; 19 596 male [55.0%]). MHO at baseline was present in 3626 children (49.8%; median [Q1-Q3] age, 10.6 [8.8-12.8] years; 1981 male [54.6%]), and MUO was present in 3649 children (50.2%; median [Q1-Q3] age, 11.6 [9.4-14.0] years; 2023 male [55.4%]). By age 30 years, cumulative incidences were as follows: type 2 diabetes (MHO, 9.1%; MUO, 16.8%; general population, 0.5%), hypertension (MHO, 10.8%; MUO, 18.3%; general population, 3.7%), and dyslipidemia (MHO, 5.3%; MUO, 12.7%; general population, 0.9%). A reduction of at least 0.25 body mass index (BMI) z score was associated with reduced incidence rate ratio (IRR) of type 2 diabetes (IRR, 0.22; 95% CI, 0.14-0.35), hypertension (IRR, 0.56; 95% CI, 0.34-0.93), and dyslipidemia (IRR, 0.28; 95% CI, 0.14-0.57), with similar risk reduction for MHO and MUO. Conclusions and relevance Results of this cohort study reveal that a reduction in BMI z score of at least 0.25 was associated with similar risk reductions for both MHO and MUO. Children with MHO face a substantially increased cardiometabolic disease risk already as young adults compared with the general population. Hence, obesity treatment should be recommended for all children with obesity, regardless of initial metabolic status.

Medicine

The intergenerational transmission of reflective functioning in adoptive families: A prospective study from pre-adoption to early adolescence.

Fiore S et al. · Jul 1, 2026

Parental reflective functioning is crucial for the development of children's reflective functioning, with cross-sectional evidence supporting this idea. However, there is a lack of long-term, prospective studies in this area and no previous studies have examined parental reflective functioning and child reflective functioning in the context of adoption. Using a structural equation modeling approach, this study addressed this knowledge gap by examining the associations between 96 Belgian adoptive mothers' and fathers' reflective functioning during the transition to adoptive parenthood, their levels of parental reflective functioning during their adopted child's early childhood, and the children's reflective functioning in early adolescence (M age = 12 years, SD = .58, range = 11-13; 17 boys, 11 girls). Findings showed that parents' pre-adoptive reflective functioning was positively associated with parental reflective functioning in early childhood. Parental reflective functioning in early childhood, but not pre-adoptive reflective functioning, predicted child reflective functioning in early adolescence. Maternal reflective functioning mediated the association between pre-adoptive reflective functioning and child reflective functioning. Although the small sample size precludes drawing strong conclusions from this study, this study provides new evidence for the intergenerational transmission of reflective functioning even in the context of adoption. Implications for future research are discussed.

Psychology

A Multi-Stage Drop-the-Loser Design With Superiority Boundaries.

Greenstreet P et al. · Jul 1, 2026

Multi-arm multi-stage (MAMS) trials have gained popularity, due to their improved efficiency in evaluating multiple treatments. A traditional MAMS trial often decreases the expected sample size of the trial compared with just running a multi-arm approach, but with the drawback of an increase in maximum sample size. For academic led trials, this poses a particular challenge, as funding is typically based on the maximum required sample size. To address this, drop-the-loser designs were introduced, where a fixed number of treatments are dropped at each interim stage, thereby reducing the maximum sample size. In this work, we propose an enhanced multi-stage drop-the-loser design that also allows for early stopping of the entire trial for superiority. This approach aims to retain the benefits of a reduced maximum sample size while also lowering the expected sample size. The proposed design is motivated by a trial in atrial fibrillation. We derive analytical expressions for the type I error rate, power, and expected sample size, and compare the proposed design's performance to alternative methods. We outline the key requirements for implementing the proposed design and discuss the contexts in which it should be considered. For the motivating example, the results show that the proposed design substantially reduces the expected sample size compared to a standard drop-the-loser design, while lowering the maximum sample size relative to running a traditional MAMS trial or multiple separate trials.

Mathematics