The mental health and wellbeing of the dental team is of paramount importance in ensuring the delivery of oral healthcare. This perspective emphasises the importance of developing mechanisms of supporting the oral healthcare team. We propose a tripartite approach: a practitioner support network; a mechanism for support of members of the dental team who are referred to the General Dental Council; and crisis support for those facing severe mental health challenges. A practitioner support network would build on the known efficacy of mutual support in addressing the ongoing stress of delivering patient care. Referral to the General Dental Council has been identified as a major source of stress, and a support mechanism providing guidance and realistic discussion of likely outcomes would be of great benefit. Finally, as with all professions, some individuals will need more intense support as a result of mental health crises. We suggest that these three approaches could build on and co-ordinate existing initiatives to support the wellbeing of the dental care team.

In commercial pig production, many important traits are recorded as binary phenotypes. For such traits, threshold models offer an appropriate framework but are computationally intensive. Thus, linear models are widely used to obtain genomic estimated breeding values (GEBV); however, these are on the observed scale (phenotypic). This creates the need for a robust method to approximate GEBV from linear models to the liability scale. A recently proposed approximation showed good concordance for low-prevalence traits (<5%) but has not yet been tested for a wider range of prevalence values and for models with more than one random effect. We aimed to evaluate the performance of this approximation for pig binary traits with prevalences ranging from <5% to >86%, in both animal and maternal animal models. Data were available for five fitness traits (FT1-FT5), with up to 233k animals with phenotypes, of which 204k animals were genotyped with a 25k SNP array. Variance component estimates were obtained using threshold models. Classical animal models were used for FT1-FT3, and maternal animal models for FT4 and FT5. Variance components on the observed scale were then obtained by multiplying estimates from a threshold model by the square of the height of the standard normal density evaluated at the threshold. GEBV were predicted using single-step genomic best linear unbiased prediction under both linear and threshold models. The approximation tested involved scaling the GEBV using the height of the ordinate of the standard normal distribution evaluated at the threshold as a scaling factor. The agreement between GEBV from the scaled linear model and the threshold model on the probability scale was evaluated using Pearson and Spearman correlations, mean squared error (MSE), regression parameters, overlapping coefficient (OVL), distribution overlap, and classification accuracy (CACC). Correlations between linear and threshold GEBV ranged from 0.94 (low-prevalence traits) to 0.99 (high-prevalence traits) for the direct GEBV and were 0.99 for the maternal GEBV. MSE were close to zero. The OVL exceeded 0.83 for all traits. CACC ranged from 95.10% to 98.33% for the direct GEBV and from 92.54% to 97.42% for the maternal GEBV. Regardless of model and trait prevalence, this approximation yielded GEBV that are highly consistent with threshold model GEBV, providing a reliable, practical approach for large-scale pig genetic evaluations for binary traits using linear models.

The Cox proportional hazards (PH) model is widely used in time-to-event research, but its validity depends on the PH assumption, which can be violated in child mortality studies where hazards vary with age. Piecewise exponential models (PEMs) relax this assumption by partitioning follow-up time into intervals. However, standard formulations impose constant hazards within each interval and typically ignore spatial heterogeneity, limiting their usefulness for public health analyses in which geographical variation in risk is important. Existing extensions address non-proportional hazards or spatial dependence separately, but rarely combine a smooth baseline hazard, interval-level temporal heterogeneity, and structured spatial frailty within a single, computationally tractable Bayesian framework. This study proposes and applies such a framework to under-five mortality (U5M) in Nigeria.

Regarding air quality, modern hospitals include both 'protected' and 'unprotected' areas. Although recommendations exist for maintaining good air quality in protected zones, guidance for unprotected areas remains limited. This gap poses a significant risk, particularly for immunocompromised patients, who are more susceptible to acquiring potentially life-threatening healthcare-associated infections (HAIs) transmitted through the air in these settings. The aim of this review was to review existing evidence on indoor air quality in unprotected (IAQ-U) hospital areas and identify current knowledge gaps. Additionally, some proposals for assessing and maintaining optimal indoor air quality (IAQ) in these settings are presented. A narrative review of the literature on IAQ was conducted, covering the period from 2015 to 2025, and selected available recommendations on IAQ in the healthcare setting were examined. The paper is structured in two sections. The first section reviews the existing evidence on IAQ, while the second presents perspectives and proposals. Specifically, the European Society of Clinical Microbiology and Infectious Diseases could co-ordinate a pilot multi-centre study among selected European hospitals to develop guidelines for assessing IAQ-U hospital areas. Implementation of these proposals could reduce the incidence and associated costs of air-transmitted HAIs and strengthen preparedness for future pandemics.

Autologous fat grafting is widely used in reconstructive and aesthetic surgery because it is easy to harvest, well tolerated by the host, and produces natural-looking results. However, unpredictable graft resorption-with reported volume retention ranging from 30% to 80%-remains a major obstacle. To overcome this, two cell-based approaches have been developed: the stromal vascular fraction (SVF), a freshly isolated mixture containing approximately 1%-10% adipose-derived stem/stromal cells (ADSCs) plus other cell types, and culture-expanded ADSCs, a more homogeneous population obtained under Good Manufacturing Practice conditions. Meta-analyses show that while SVF increases fat retention by a modest margin, expanded ADSCs can achieve substantially greater improvements, highlighting important biological and regulatory differences between the two preparations. ADSCs support graft survival not only through classic growth factor secretion but also via immunomodulation, intercellular mitochondrial transfer, and exosomal microRNAs that co-ordinate angiogenesis, inflammation, and fibrosis. This review summarises current clinical evidence for ADSC- and SVF-enriched fat grafting in breast reconstruction, facial rejuvenation, scar management, chronic wounds, hair restoration, and paediatric as well as elderly populations. We also critically assess adjunctive strategies, including platelet-rich plasma, exosome-based acellular therapies, decellularized adipose matrices, engineered hydrogels, and nanofat grafting, and discuss the role of mitochondrial transfer enhancement. Standardised summary tables of clinical studies and emerging technologies are provided to facilitate evidence synthesis. Persistent challenges-such as the frequent conflation of SVF with ADSCs in the literature, the lack of standardised preparation and potency assays, and unresolved long-term oncological safety concerns-are examined, and priority areas for future research are proposed.

Though modern contraceptive prevalence has increased significantly across all wealth quintiles, a substantial gap in the utilisation of modern reversible contraceptives persists among women in lower socioeconomic groups. Nevertheless, very few studies have explored the same. This study assesses the magnitude and underlying factors of wealth-based inequalities in the utilisation of MRC. The study included 202,954 currently married women who are not currently pregnant, are not sterilised, and need family planning, from the fifth round of the National Family Health Survey, 2019-21. To address the study objectives, descriptive statistics, bivariate chi-square significance test, and Erreygers concentration index were employed. The results demonstrate that the level of MRC use varies from 41.93% among the poorest to 56.86% among the richest. Particularly, a pro-rich inequality was found in the utilisation of MRC (CI = 0.113), with the pro-rich pattern being more pronounced for short-acting (CI = 0.093) than for long-acting (CI = 0.020) reversible contraceptives. Additionally, pro-rich inequality in MRC is attributed to no media exposure (31.80%), the east region (16.71%), urban residence (14.39%), higher education level (13.15%), ≥ 3 children (8.64%), and the ≥ 35 age group (3.50%). Hence, the study findings endorse scaling up media exposure and strengthening outreach programmes, as well as informed choices through community support in the eastern region, as pivotal for achieving equity in reproductive health.

Growth is a complex trait, influenced by numerous genes and environmental factors that transect various physiological pathways. This study sought to characterise the relationship between neurobehavioural development genes and growth in dusky kob juveniles. Five candidate neurobehavioural genes were identified from the literature and assessed for gene sequence variants. Thirteen SNPs in two genes, Brain-derived neurotrophic factor (bdnf) and Early growth response 1 (egr1), were identified. Case-control association analyses were conducted applying two methods of correcting for family structure: (1) categorical, based on family identity; and (2) quantitative, based on co-ordinate analysis eigenvalues. The eigenvalue-corrected association analysis outperformed the categorical analysis in both model adherence and estimates of effect sizes. Six significantly associated SNPs were identified, three in each gene. Linkage disequilibrium was significant within both genes, with the formation of haplotype -GA- in egr1 associated with increased growth and haplotype -CG- in bdnf associated with decreased growth. A non-synonymous mutation (Serine > Proline) was identified in bdnf, and protein modelling suggests significant disruption of protein structure in small individuals that likely explains the functional mechanism of action. This study has identified novel SNPs and haplotypes in neurobehavioural development genes, which highlight the impact of neurological and behavioural pathways on growth in dusky kob.

One of the ways in which healthcare's climate impact can be reduced is by taking greenhouse gas emissions into account when deciding which treatments are reimbursed and/or included in clinical guidelines. In a report for the Minister of Health, Welfare, and Sports in the Netherlands, we explored how this idea could be put into practice. We developed a set of two criteria: greenhouse gas emissions per patient (which can be compared to, for example, QALYs gained), and total amount of greenhouse gas emissions for all patients undergoing the intervention (which can be compared to, e.g., healthcare's remaining carbon budget). In the coming three years, the National Health Care Institute will use these criteria in an experimental setting, to gain practical experience and to assess whether there is sufficient support among policy makers, practitioners, and patients for taking into account climate impact regularly.

Freshwater fish biodiversity is undergoing a rapid decline worldwide due to habitat fragmentation, climate change, invasive species, overexploitation and pollution. Yet, for many regions, including biodiversity-rich but underrepresented areas such as Türkiye, large-scale assessments of species diversity and distribution remain limited. Environmental DNA (eDNA) metabarcoding offers a powerful, non-invasive and scalable tool for biodiversity assessment, capable of detecting both common and cryptic taxa. Here, we present the first nationwide, basin-scale eDNA metabarcoding survey of freshwater fishes across Türkiye's major river systems, spanning a transect of more than 6000 km and encompassing 29 sampling sites across seven principal basins. Triplicate water samples were analysed using high-throughput sequencing of the mitochondrial 12S ribosomal RNA (rRNA) gene, generating 351,392 high-quality reads (after filtration) and detecting 52 fish species, including native, invasive and several taxa previously unrecorded in their respective basins. The Eastern Mediterranean basin exhibited the highest species richness (28 species) and diversity (H' = 2.35; 1 - D = 0.88), whereas beta-diversity analyses revealed marked spatial structuring among basins (Jaccard similarity 0.17-0.58) and a clear biogeographic separation in principal co-ordinates analysis (PCoA) ordination. Importantly, eDNA metabarcoding uncovered cryptic and low-abundance taxa not detected by conventional surveys, demonstrating its complementary value and sensitivity. By providing the first comprehensive molecular baseline of Turkish freshwater ichthyofauna, this study illustrates the potential of large-scale eDNA approaches to transform biodiversity monitoring, inform conservation strategies and support management decisions in freshwater ecosystems facing accelerating environmental change.

Objective.Contemporary particle accelerators allow for the generation of a narrow pencil beam of electrons which can be scanned to deliver a clinical dose distribution at an ultra-high (FLASH) dose rate. This study develops a radiotherapy beam model and discrete ordinates Boltzmann solver for such an accelerator and then applies the method to treatment planning for superficial brain metastases.Approach.Beam profiles for the quasi-monoenergetic 17.5 MeV electron beam from the Photo Injector Test facility at Deutsches Elektronen-Synchrotron laboratory in Zeuthen (PITZ) were measured at various depths in a water tank using radiochromic film. The incident radiation was modelled as a Gaussian source and the electron distribution in the patient was modelled using classical observations with continuous slowing down approximation (CSDA). This distribution then formed the fixed source component in a discrete ordinates Boltzmann solver. The dose calculation method was then applied to a retrospective study of six patients with superficial brain metastases. The dose due to scanned electrons was compared with that from a single passively scattered proton beam at ultra-high dose rate (UHDR), a proton arc, and a robotic photon treatment.Main results.The calculated dose distribution in a homogeneous water phantom agreed with the measured data to within the 3% experimental uncertainty at all depths. Scanned electron beams were able to provide dose distributions for superficial brain metastases that had a better conformity index than either passively scattered protons or robotic photon treatment (1.02 ± 0.13 versus 1.54 ± 0.13 and 1.35 ± 0.26 respectively; median ± hemi-range; p < 0.05). Brain V12Gyand skin dose were acceptable for all treatments.Significance.The dose calculation provides a fast and efficient method for inverse planning in the potential clinical application of a scanned electron beam at UHDR. The results show that such an approach could be useful in the treatment of superficial target volumes.