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461 papers

Understanding Multi-Victimization: Identifying Socioecological Supports Among Adolescents.

Smith EK et al. · Jul 1, 2026

Background Transgender and gender-diverse adolescents (TGDA) experience multiple victimization types (i.e., multi-victimization) more often than their cisgender peers. While greater socioecological supports are associated with reduced victimization, their role in protecting TGDA against multi-victimization is underexplored. Methods We conducted a cross-sectional analysis of health risk behavior survey data from students (N = 4207) across 13 high schools in a mid-sized U.S. city. We compared victimization rates and socioecological support levels (i.e., parental monitoring, perceived social support, food and housing security) and associations between socioecological support and victimization, accounting for between-school differences. We included two-way interactions between gender and socioecological supports. Results TGDA reported more frequent multi-victimization and lower socioecological support than cisgender adolescents. Across all groups, greater socioecological support was associated with experiencing fewer victimization types. Food security was more protective for cisgender girls than cisgender boys. Implications for school health policy, practice, and equity Enhancing socioecological support may reduce multi-victimization for all youth, with TGDA having the greatest need. Schools' advocacy and innovative efforts to bolster socioecological support are critical to TGDA wellbeing. Conclusions Modifiable socioecological supports may reduce adolescent multi-victimization. TGDA have lower support rates and higher multi-victimization rates, suggesting the need for tailored interventions.

Psychology

Dual-scan conformal cone-beam CT for targeted image-quality improvement using dynamic collimation.

Liu Y et al. · Jul 1, 2026

Background Cone-beam computed tomography (CBCT) is routinely used for image guidance in radiation therapy, but conventional full-field CBCT acquisition may expose anatomically irrelevant regions and generate substantial scatter, which degrades soft-tissue contrast and limits the accuracy of target localization and adaptive radiotherapy workflows. A clinically practical imaging strategy should improve image quality in the region of clinical interest while preserving sufficient full-field anatomical information for patient setup and dose-related assessment. Purpose To improve image quality within clinically relevant regions without increasing the total imaging dose, this study developed a dual-scan conformal cone-beam CT method using dynamic collimation. Methods A dual-scan conformal acquisition strategy using dynamic collimation was designed. Dynamic collimation was defined as angle-dependent shaping of the X-ray field around a preplanned target region; it was implemented with a multi-leaf collimator model in the digital phantom and patient-data simulations and with the movable kV collimator in the physical phantom measurement. Collimator positions were calculated from forward projections of the target region, and a target-region-based intensity-optimization model was used to allocate more photons to projection angles and detector regions contributing to the target region. The dual-scan protocol, consisting of a low-dose full-field-of-view (FOV) scan and a higher-dose conformal scan, was reconstructed using a regularized weighted least-squares algorithm with anisotropic total-variation regularization. The method was evaluated using a FORBILD head phantom, patient planning CT datasets, and an anthropomorphic head phantom measured on a Varian Edge on-board imaging system. Results The proposed method achieved the best overall image quality among the compared methods. In the FORBILD phantom, for target region 1 (VOI1), SSIM increased from 0.702 to 0.855, CNR increased from 0.514 to 1.463, and SNR1/SNR2 increased from 33.8/32.8 to 113.1/114.6 compared with conventional FDK reconstruction. In the prostate cancer case, CNR increased from 0.44 to 1.94, and SNR1/SNR2 increased from 25.6/23.3 to 74.6/82.4. In the measured anthropomorphic head phantom, CNR improved from 1.036 to 2.379, and SNR1/SNR2 improved from 42.8/50.1 to 89.8/98.0. Conclusion The proposed dual-scan conformal CBCT strategy using dynamic collimation improves local image quality in the clinically relevant target region while maintaining full-FOV information through the two-scan protocol. This method may provide a practical route toward patient-specific CBCT guidance for adaptive radiotherapy.

Physics and Astronomy

Health, Social and Recidivism Outcomes Among People Who Have Been Incarcerated in New South Wales, Australia: Study Protocol and Cohort Profile for the Prison Outcomes STudy (POST).

Degenhardt L et al. · Jul 1, 2026

Introduction We have been funded to examine post-incarceration health and social outcomes for all people incarcerated in New South Wales, Australia, 2000-2022; assess treatment and services for drug dependence and serious mental illness; and project the impact of expanding intervention coverage. We will use a linked cohort, the Prison Outcomes STudy (POST), which we also describe. Methods The POST cohort was established using linked administrative data for all adults (≥ 18 years) admitted to full-time custody in New South Wales, 2000-2022. Custody records were probabilistically linked to 18 health, justice and mortality datasets. We report baseline sociodemographic and custody characteristics and the frequency of key post-release events. Results 200,486 adults, 15% women (n = 30,698), were incarcerated, with 2,282,367 person-years of follow-up and 11% (257,545 person-years) of follow-up spent in custody. First Nations people comprised 27% of the cohort. Half (48%) of the cohort (n = 95,563) had at least one contact with community mental health services, and 27% (n = 54,100) had received alcohol and other drug treatment. POST will provide population-wide evidence on health and social outcomes after custody, including the effects of treatment for drug dependence and serious mental illness. We will compare across subgroups and the outcomes of post-release service engagement. Mathematical modelling will test the impact of expanding access to care in prison and post-release on outcomes in the community. Discussion and conclusions POST will inform policy and service responses across justice, health and community settings to reduce harms among people who experience incarceration.

Social Sciences

Effect of Structured Training on ICU Nurses' Knowledge-Based Competence in Ventilator-Associated Pneumonia Prevention in a Resource-Limited Setting: An Explanatory Sequential Mixed-Methods Study.

Yakubu YH et al. · Jul 1, 2026

Aim To evaluate the effect of a structured training intervention on ICU nurses' knowledge-based competence in VAP prevention in a resource-limited setting and identify personal, environmental and organisational barriers to implementation. Design An explanatory sequential mixed-methods design was employed, integrating a single-group quasi-experimental pre-test-post-test quantitative strand with a qualitative interview strand. Because participant responses were not linked across assessment points, findings represent group-level improvements rather than within-individual change. Methods ICU nurses completed pre-test (n = 57) and post-test (n = 56) assessments using an adapted eight-item VAP prevention knowledge questionnaire. A structured 3-h workshop on VAP prevention bundles, infection control and airway management was delivered between tests; the post-test occurred within 2 weeks. Group differences were analysed using an independent-samples t-test and chi-square tests. Qualitative interview data (n = 8) were analysed thematically to explain and contextualise the quantitative findings. Results Mean knowledge scores increased from 3.63 (SD 1.57) to 5.29 (SD 1.57) out of 8 (t(111) = -5.61, p 2 (2) = 22.43, p Conclusions A brief, context-specific training workshop significantly improved ICU nurses' knowledge-based competence in VAP prevention. However, systemic barriers-equipment shortages, absent protocols, limited supervision and workload pressures-constrain the translation of knowledge gains into consistent bedside practice. Sustainable improvement requires embedding education within broader quality improvement efforts. No patient or public contribution No patient or public contribution.

Medicine

Polygenic Risk Scores for Incident Dementia in the Multi-Ethnic Study of Atherosclerosis.

Xue D et al. · Jul 1, 2026

Over 75 Alzheimer's disease (AD) and dementia-associated variants have been identified through genome-wide association studies, but the utility of polygenic risk scores (PRS) for predicting AD and dementia in diverse and admixed populations remains unclear. We compared how PRS approaches differing in p-value thresholds, variant weights, and source ancestry perform in predicting dementia in 6338 African American, Chinese, Hispanic, and White individuals from the Multi-Ethnic Study of Atherosclerosis. We tested clumping and thresholding (C+T) methods with varying parameters against Bayesian approaches (PRS-CS, PRS-CSx). We compared the ability of each method to predict incident dementia in all participants and in groups stratified by self-reported race/ethnicity. We additionally analyzed performance across groups stratified by estimated proportion of non-Finnish European (NFE)-like ancestry. Including more variants does not improve performance. We found comparable associations between dementia and PRS when comparing a C+T method with only 15 SNPs and PRS derived from Bayesian models that include > 800,000 SNPs (HR 5e-08 = 1.18, 95% CI: 1.08-1.28; HR CSx = 1.17, 95% CI: 1.07-1.27). The p lowNFE _ 5e-08 = 1.27, 95% CI: 1.08-1.50; HR lowNFE _ CSx = 1.12, 95% CI: 0.94-1.33). More selective PRS models using genome-wide significant SNPs may be preferable for dementia prediction in diverse populations.

Biochemistry, Genetics and Molecular Biology

Ectonucleotidases CD39 and CD73 expression levels are independent and inverse predictors of survival in muscle-invasive bladder cancer.

Ledderose S et al. · Jul 1, 2026

Bladder cancer is one of the leading causes of cancer-related mortality worldwide. Long-term survival is particularly poor in patients with muscle-invasive bladder cancer (MIBC). Modulation of purinergic signaling through the ectonucleotidases CD39 and CD73 has emerged as a promising therapeutic strategy in cancer medicine. Altered expression patterns of these molecules have been linked to prognosis in various malignancies. In this study, we assessed the value of CD39 and CD73 expression as prognostic markers and potential therapeutic targets in MIBC. CD39 and CD73 expression was determined by immunohistochemistry using tissue microarrays from 180 patients with MIBC. Associations between tumoral and stromal expression and clinicopathological variables, including overall survival (OS), tumor-specific survival (TSS) and disease-free survival (DFS), were analyzed. Tumor cells did not express CD39. High stromal CD39 expression was significantly associated with a lower T category and UICC stage as well as prolonged median OS, TSS, and DFS. High CD73 expression by tumor cells was significantly associated with poorer OS and TSS. Stromal CD73 expression was not significantly correlated with survival outcomes. Our findings indicate distinct and compartment-specific roles for CD39 and CD73 in MIBC. They suggest that high CD73 expression in tumor cells and low CD39 expression in stromal cells are negative prognostic indicators and potential therapeutic targets in MIBC.

Biochemistry, Genetics and Molecular Biology

Caveats on Using Firth's Penalization in the Model-Based Regression Standardization for Rare Diseases.

Hashibe S et al. · Jul 1, 2026

Model-based regression standardization, also known as the parametric g-formula, is widely used to estimate marginal effect measures. However, in rare disease settings, the small number of observed events relative to the number of covariates can lead to (quasi-)complete separation, resulting in non-convergent estimates in the regression models. Firth's penalized likelihood estimates are a common solution to this issue, ensuring finite parameter estimates even for separated data. While effective for estimating regression coefficients, Firth's method introduces bias into model-based regression standardization because of its tendency to shrink the predicted probabilities to 0.5, leading to discrepancies between the predicted and observed event rates. We examined the implications of applying Firth's method to model-based regression standardization, illustrating its potential bias through an empirical study on surgical site infections (SSI) in orthopedic surgeries. We also proposed two ad hoc corrections (i.e., Firth's logistic regression with intercept correction and added covariate) to mitigate this bias and evaluated these methods via simulation studies, comparing them with propensity score-based approaches. Finally, we applied the proposed method to assess the association between SSI, a rare disease, and smoking status in a clinical database of orthopedic surgeries.

Mathematics

Comparative Cochlear-Vestibular Aging Reveals Age-Aligned Mitochondrial Ultrastructural Burden, Mitophagy-Autophagy Remodeling, Synaptic Uncoupling, and Sensory Functional Decline.

Xie J et al. · Jul 1, 2026

Age-related hearing loss and balance decline are prevalent features of organismal aging, yet how the cochlea and vestibular organs converge on shared cellular liabilities remains insufficiently resolved. In particular, whether mitochondrial ultrastructural injury and mitochondrial quality-control programs co-vary with synaptic vulnerability and sensory functional decline across these systems within an age-resolved framework has not been clearly delineated. Here, we compared cochlear and vestibular aging in SAMP8 mice of different ages using integrated functional assays, region-resolved quantification of hair cells and CtBP2/GluA2 synapses, cochlear NF200+ fiber area fraction, transmission electron microscopy, and targeted qPCR of mitophagy/autophagy-lysosome genes. The results show that ABR thresholds rose progressively across 5.6-32 kHz. VsEP exhibited age-dependent threshold shifts and prolonged P-wave latency. Relative to the magnitude of synaptic and functional changes, cochlear hair-cell numbers were broadly preserved, although regional OHC loss was observed in middle-to-basal turns, whereas vestibular macular hair-cell density declined with age. Ultrastructurally, the proportion of pathological mitochondria increased with age, featuring electron-lucent matrix, disrupted cristae organization, and rounded/swollen profiles. What's more, guided by an adult-versus-aged transcriptomic screen nominating the Ca 2+ extrusion gene Atp2b4, we derived z-scored molecular indices, including a flux-burden signature (z(p62)-z(Lc3b)) and a TFEB-lysosome module. Descriptive coupling across age-group means indicated that mitochondrial pathology burden aligned closely with high-frequency ABR loss and basal synaptic uncoupling, and tracked the flux-burden signature more consistently than the TFEB-lysosome module. Together, these findings support age-aligned associations among mitochondrial ultrastructural injury, molecular remodeling, synaptic vulnerability, and progressive sensory decline across cochlear and vestibular systems.

Neuroscience

Paediatric Practitioners' Acceptance of the National Paediatric Early Warning System (PEWS).

Kaye LK et al. · Jul 1, 2026

Early detection of deterioration in children in hospital is essential for improving patient outcomes, prompting NHS England to introduce a digital National Paediatric Early Warning System (PEWS) in November 2023. Our service evaluation examined a locally delivered digital version of the PEWS system, introduced in July 2025 to explore paediatric staffs' acceptance before and after implementation, measured by the Technology Integration Evaluation Resource (TIER), based on the Technology Integration Model. Online surveys were completed pre- and post-implementation. Acceptance did not significantly change over time. However, user motivation, agency and perceived cost-benefit as well as perceptions of PEWS as an extension of self, were positively associated with acceptance, highlighting key psychological factors influencing digital health adoption.

Medicine

Effects of Sedation, TEmperature and Pressure After Cardiac Arrest and REsuscitation on Major Adverse Kidney Events (STEPCARE-MAKE): A Protocol for a Pre-Planned Sub-Study of a Randomized Clinical Trial.

M KK et al. · Jul 1, 2026

Background Acute kidney injury (AKI) is a common and serious complication after cardiac arrest, affecting more than 30% of initially successfully resuscitated patients, with around 10% receiving Kidney Replacement Therapy (KRT). Currently, treatment options to prevent renal complications are limited. In this predefined sub-study of the Sedation, TEmperature and Pressure after Cardiac Arrest and REsuscitation (STEPCARE) trial, we evaluate the effects of sedation depth, fever management strategies, and mean arterial pressure (MAP) targets on the risk of major adverse kidney events (MAKE) in post-cardiac arrest patients. Methods STEPCARE-MAKE is a predefined prospective sub-study of the international, randomized clinical STEPCARE trial. The main trial will enroll 3500 patients and employs a 2 × 2 × 2 factorial design, randomizing participants across three interventions: (1) deep sedation for 36 h or minimal sedation, (2) fever management with or without a feedback-controlled device, and (3) MAP target ≥ 65 mmHg or ≥ 85 mmHg. The primary outcome is the composite outcome MAKE, which includes death from any cause by day 30, initiation of KRT, or persistent renal dysfunction, defined as the final creatinine value ≥ 200% of the baseline at the time of discharge from the primary hospital or at day 30, whichever occurs first. Differences between baseline and the highest in-hospital creatinine, baseline and the last measured in-hospital creatinine, baseline and 72-h creatinine, and baseline and the highest creatinine within 72 h will be reported as secondary outcomes. Conclusion The findings of this sub-study will provide new evidence on the renal effects of the STEPCARE trial interventions and may inform the future of individualized kidney-protective treatment approaches.

Medicine