Evidence for inclusion strategies in the workplace is limited. In our previous research we identified challenges for newly qualified racially minoritized physiotherapy staff within a large UK urban NHS Trust. In this study we evaluated the impact of strategies co-created to facilitate their inclusion. A process and outcomes evaluation approach was used with our previous work to co-create and implement inclusion strategies. Mixed methods of data collection included a staff survey, workplace guidelines, proforma usage, and interviews with key protagonists which were informed by a theory of change. Six months after the project was implemented, we found that newly qualified staff responded more positively to statements about feeling included. There was little improvement in socializing or connecting on a personal level with colleagues, despite a greater variety and frequency of social events. Even though participants were unchanged in their perception of space for inclusive conversations, more agreed they were able to converse about race albeit with ambivalence about whether action would be taken. We noted a small increase in proportions of newly qualified staff feeling vulnerable and unable to bring their authentic self to work. This study implemented a proactive co-design approach for inclusion in physiotherapy with partial success. The findings at 6-months show some change in raising awareness, fostering dialogue and improving perceptions. However, a limitation of the process employed is that it may have surfaced deeper racial and intersectional tensions that require sustained and complex local and organizational action, which is an ongoing and iterative endeavor.

Philosophy of medicine has drawn its richest account of suffering from a broadly Christian lineage, in which affliction can be borne with meaning and the sufferer retains an inviolable dignity. That lineage is not the only one, and it was not the first. This paper sets out the conceptions of suffering developed in the Stoic and Epicurean schools, in Buddhist thought, in Schopenhauer and Nietzsche, and in the phenomenological and existential reflection of Scheler, Weil, Levinas, Ricoeur, and Frankl, and asks what each contributes to the goals of medicine. The traditions disagree sharply. The Hellenistic schools locate suffering in judgment and counsel its dissolution through a discipline of the mind. Buddhist thought treats unsatisfactoriness as a structural feature of conditioned existence rather than a contingent defect. Schopenhauer reads suffering as the truth of the will, while Nietzsche makes it a condition of growth and meaning. The phenomenological tradition recovers suffering as the affliction of an embodied person and divides over whether it can be redeemed at all. Read together, these accounts test the assumption, common in clinical ethics, that suffering is either a problem to be solved or a meaning to be found. They suggest a medicine that can relieve what can be relieved, accompany what cannot, and decline to impose any single meaning on the person who suffers. The argument is illustrated through chronic pain, palliative care, and the care of the frail aged, where these traditions have already entered clinical practice through acceptance-based and meaning-centered interventions.

Cognitive aging is shaped by genetic variation, environmental factors, and health-related conditions. Until now, it is largely unclear why some individuals maintain their cognitive function, and others show progressive cognitive decline. This study uncovered determinants of distinct cognitive aging trajectories in the older population. To approach the inter-individual variability in cognitive aging, we clustered n = 696 dementia-free individuals from the prospective TREND study based on their longitudinal changes in comprehensive cognitive testing every 2 years over 13 years on average. Identified subgroups of cognitive aging were tested for differences in general physical health, motor function, mental and neuropsychological health, personality, lifestyle, diet, and genetic and biofluid markers as observed at the phenotypes' initial records. Comparing the best- and lowest-performing subgroups of cognitive aging, we found that individuals who maintain high cognitive function compared to those with low baseline and progressive cognitive decline showed significant faster gait speed, higher health-related quality of life, did sports and cognitive stimulating activities more frequently, and reported higher plant-based foods intake. Although there are fewer phenotypic differences involving the intermediate subgroups of cognitive aging, the best-performing subgroup compared to all other subgroups showed higher plant-based foods intake. Overall, this study identifies distinct, data-driven subgroups of long-term cognitive aging trajectories and reveals factors associated with these divergent paths using deeply phenotyped data. The findings highlight the substantial heterogeneity of cognitive aging and suggest that favorable trajectories are linked to modifiable behavioral and health-related characteristics, providing a foundation for future multidisciplinary strategies to promote healthy cognitive aging.

College students remain at increased risk for acquiring human papillomavirus (HPV), yet HPV vaccination coverage remains suboptimal despite the availability of a safe and effective vaccine. This study examined predictors of HPV vaccination and HPV- and HPV vaccine-related knowledge, beliefs, and hesitancy among undergraduate students at a southern United States university. An online cross-sectional survey was administered to undergraduate students aged 18-26 years in November 2024. Descriptive statistics summarized participant characteristics, vaccination status, and HPV-related measures. Multinomial logistic regression models were used to examine factors associated with HPV vaccination status while estimating adjusted odds ratios (ORs) and 95% confidence intervals (CIs). Among 1,127 respondents (mean age, 20.1 years), most were female (74.1%), White (74.9%), and insured (90.4%). Overall, 48.4% reported receiving at least one dose of the HPV vaccine, with only 21.7% completion. More than 30% were unsure of their HPV vaccination status. HPV knowledge, HPV vaccine knowledge and beliefs, and vaccine hesitancy were all independently associated with vaccination status (all p < 0.001). Participants with stronger positive HPV vaccine beliefs and lower vaccine hesitancy had significantly greater odds of reporting HPV vaccination. In secondary analyses, both provider and parental recommendation were significantly associated with younger age at initiation. HPV vaccination initiation and completion remain low among college students, with substantial gaps in knowledge, awareness, and confidence. College campuses represent an important setting for interventions that improve HPV-related knowledge, strengthen vaccine confidence, increase awareness of personal vaccination status, and promote vaccination to reduce future HPV-associated cancers.

Adoptive cellular therapies may expand treatment options for pediatric brain tumors by focusing activity on tumor antigens and limiting off-tumor effects. We systematically reviewed preclinical and clinical evidence for CAR T cells, TCR-engineered T cells, and NK or γδ T-cell platforms directed against HER2, B7-H3 (CD276), EGFR806-reactive EGFR, GD2, IL13Rα2, and EphA2 or EphA3, with attention to delivery route, safety, persistence, and combination strategies. Following PRISMA, we searched PubMed, Embase, and Scopus from inception through September 17, 2025, restricted to English. The search yielded 324 records; 103 duplicates were removed; 221 titles and abstracts were screened; 180 full texts were reviewed; and 34 studies were extracted by two independent reviewers. We captured design, tumor and molecular features, product engineering, route and schedule, lymphodepletion, toxicities including cytokine release syndrome, immune effector cell associated neurotoxicity, and tumor inflammation associated neurotoxicity, radiographic or clinical response, survival, and correlatives such as persistence or trafficking in blood, cerebrospinal fluid, or tumor tissue, cytokines, and antigen dynamics. In vivo studies showed reproducible antitumor activity for HER2 in medulloblastoma, GD2 in diffuse midline glioma, and multi-antigen constructs incorporating IL13Rα2 and EphA2 in medulloblastoma and ependymoma, with significant survival advantages compared with controls. γδ T cells targeting the EphA axis selectively killed medulloblastoma with neural sparing; GD2 CAR NK-92 inhibited diffuse intrinsic pontine glioma growth. In early clinical programs, route shaped safety and pharmacodynamics. For GD2, low-dose intravenous induction followed by repeated intraventricular dosing produced objective radiographic regressions and manageable tumor inflammation associated neurotoxicity, while dose-limiting cytokine release syndrome was confined to higher intravenous doses. Intraventricular B7-H3 CAR T cells, given without lymphodepletion, enabled multi-cycle dosing with mainly grade 1 to 2 events and cerebrospinal fluid localized persistence. Weekly intracranial EGFR806 CAR T cells were feasible and well tolerated, with stable disease as the best response in a small cohort. Across trials, persistence and immune activation were most evident in cerebrospinal fluid, supporting cerebrospinal fluid centered pharmacodynamic monitoring. Mechanism-based combinations, including IGF-axis inhibition in diffuse midline glioma and epigenetic priming of GD2 with an integrated safety switch in medulloblastoma, enhanced activity. The evidence supports pediatric-centric antigen selection and a CNS-first, locoregional dosing approach to increase on-tumor exposure and reduce systemic toxicity. Priorities include multi-antigen strategies to prevent escape, incorporation of safety switches, earlier deployment when tumor burden is low, and prospective cerebrospinal fluid pharmacodynamics in multisite phase II studies.

Cancer-associated venous thromboembolism (VTE) is a common and life-threatening complication in patients with colorectal cancer (CRC) following surgery. This study aims to develop and validate a nomogram for accurately predicting the risk of VTE in CRC patients undergoing postoperative chemotherapy. This study included a total of 1,397 CRC patients who received postoperative chemotherapy at Chongqing University Cancer Hospital. The patients were randomly divided into training cohort and validation cohort in a 7:3 ratio. LASSO regression and multiple logistic regression were employed to identify independent risk factors for VTE and construct a nomogram. The model performance was evaluated using receiver operating characteristic (ROC) curves, area under the curve (AUC), calibration curves and decision curve analysis (DCA). Among the patients, 116 cases (8.30%) developed VTE. Six independent predictors included: Age, Karnofsky performance status (KPS), Surgical level, leukocyte count (WBC), lymphocyte count (LYM), and D-dimer levels. The nomogram demonstrated excellent discriminative ability, with AUCs of 0.868 (95% CI: 0.820-0.915) and 0.831 (95% CI: 0.748-0.914) in the training and validation cohorts, respectively. Calibration curves showed strong agreement between predicted and actual probabilities in both cohorts. DCA confirmed the model's clinical net benefit across a wide range of threshold probabilities. We developed and validated a nomogram incorporating six available clinical variables, which accurately assesses the risk of VTE in CRC patients undergoing postoperative chemotherapy, while demonstrating significant clinical value.