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Dissecting the dynamics of virus-derived DNA of dengue virus 2 (DENV-2) in Aedes mosquitoes

Dengue is one of the neglected tropical diseases (NTDs) transmitted by Aedes mosquitoes and continues to spread globally. When mosquitoes are infected with dengue virus (DENV), virus-derived DNA (vDNA) is generated in mosquitoes, which subsequently contributes to their immune response. We traced the generation and presence of dengue virus type 2 (DENV-2) vDNA in experimentally infected cultured mosquito cells and Aedes mosquitoes, and notably, in wild mosquitoes collected in Burkina Faso. Detection of vDNA was achieved using a method incorporating loop-mediated isothermal amplification (LAMP), specifically, a LAMP-based vDNA detection method (vDNA-LAMP). The LAMP reaction, using primers targeting a segment of the NS5 region of DENV-2, detected vDNA from crude DNA extracted from experimentally infected cultured cells and Aedes mosquitoes. Detection revealed that the amount of DENV-2 vDNA generated in infected cells was relatively low; nevertheless, vDNA-LAMP enabled successful detection. The timing and quantity of vDNA generation in cultured cells were associated with the initial number of viral particles introduced during infection. Furthermore, vDNA-LAMP was applied to detect dengue virus vDNA in wild mosquitoes in dengue-endemic regions. This resulted in the successful detection of DENV-2 vDNA in field-collected mosquitoes, indicating that a proportion of wild mosquitoes in Burkina Faso harbored DENV-2 vDNA. Mapping these vDNA-positive mosquitoes allowed the identification of areas where infected mosquitoes and/or their progeny were likely present. These findings provide insights into the dynamics of DENV-2 vDNA in natural environments and underscore the potential of vDNA-LAMP as a tool for tracing vDNA in wild mosquitoes, which are responsible for transmitting viral infections.

Why we launched Denmark’s second Young Academy (and what’s different about it)

How facemasks shape trust in social interactions

Face coverings can potentially impact how trustworthy someone appears through two channels: by hiding important facial cues associated with trust; or by signalling the wearer’s intentions or personal characteristics. The facemasks widely adopted during the COVID-19 pandemic both obscured the face and were associated with pro-social attitudes or intentions. The goal of this paper is to investigate how facemasks impact judgments about the trustworthiness of the wearer, and whether this would affect interactions with others. We report three experiments. Experiments 1 and 2 examined decisions in a two-player trust game when participants interacted with a single masked or unmasked counterpart. Experiment 3 explored whether participants were more likely to trust a masked or an unmasked person in a straight choice between them. In all experiments, masked faces were judged more trustworthy than unmasked ones. While in Experiments 1 and 2 this was not reflected in trust behaviour, in Experiment 3 over 70% of participants chose to trust the masked person, a decision predicted by the difference in perceived trustworthiness between the masked and unmasked counterparts. This suggests that in settings where facemasks or similar trust related cues are more salient, such as in joint evaluation, they can lead to enhanced trust.

Daily briefing: The most- and least-improved countries for chronic disease

Correction: Variants in the CETP gene affect levels of HDL cholesterol by reducing the amount, and not the specific lipid transfer activity, of secreted CETP

Trends and inequalities in full immunization coverage among two-year-olds in Sierra Leone, 2008–2019

Background Immunization is a cornerstone of public health, preventing numerous vaccine-preventable diseases. However, disparities in immunization coverage persist globally, particularly in low-income countries like Sierra Leone. This study aims to examine the trends and socioeconomic and geographic inequalities in full immunization coverage among two-year-olds in Sierra Leone between 2008 and 2019. Methods This study utilised data from the Sierra Leone Demographic Health Surveys conducted in 2008, 2013, and 2019. The Health Equity Assessment Toolkit software developed by the World Health Organisation was used to calculate various inequality measures, including Difference, Ratio, Population-Attributable Risk, and Population-Attributable Fraction. An assessment of inequality was conducted across six stratifiers: maternal age, maternal economic status, maternal education level, place of residence, child sex, and sub-national province. Results Between 2008 and 2013, the coverage of full immunization coverage among two-year-olds in Sierra Leone increased from 41.1% in 2008 to 73.1% in 2013; however, the coverage decreased to 50.4% in 2019. The inequality associated with maternal age, sex of the child, and sub-national level increased between 2008 and 2019. However, the results were not statistically significant for maternal age and sex of the child. Similarly, inequalities existed with economic status, education, and place of residence steadily decreased over the same period, but the results were also not statistically significant. Conclusion The study’s findings highlight the need for sustained efforts to improve immunization coverage in Sierra Leone. While there was progress between 2008 and 2013, the subsequent decline emphasizes the importance of maintaining vital immunization programs. Addressing the significant regional disparities, particularly the gap between the southern and northern regions, is recommended. This requires targeted interventions to improve access to immunization services, strengthen health systems, and address the northern region’s underlying social and economic factors. Additionally, ongoing monitoring and evaluation are essential to identify and address emerging challenges and ensure equitable access to immunization for all children in Sierra Leone.

Whole blood RNA profiling in cats dissects the host immunological response during recovery from feline infectious peritonitis

Feline infectious peritonitis (FIP) is caused by infection with the feline coronavirus (FCoV) and is fatal if left untreated. In most cats, FCoV primarily infects the gastrointestinal tract and remains asymptomatic or causes only mild enteritis, with only a small proportion of infected cats developing FIP. An excessive and harmful immune response leading to characteristic (pyo)granulomatous phlebitis is believed to play a key role in the development of FIP, along with complex interactions between host and viral factors. Our research group recently demonstrated successful treatment of cats with naturally occurring FIP using the antiviral nucleoside analogue GS-441524. Treatment led to complete recovery without any relapses for a follow-up period of one year, demonstrating both a short- and long-term cure. To investigate differential gene expression and corresponding molecular pathways in cats with FIP before, during, and after antiviral treatment, RNA sequencing was performed on full blood samples of 18 cats treated successfully in a prospective study. Samples were analyzed before treatment, at different timepoints while on treatment with GS-441524 and after completion of treatment. Additionally, gene expression profiles were compared to 12 healthy FCoV-infected control cats and 5 healthy uninfected control cats. The results revealed both a widespread dysregulation of the blood RNA signature in cats with FIP as well as its rapid normalization within the first week of treatment. Significant changes were already apparent within the first two days of treatment. The results of the present study suggest that elimination of the virus from the blood leads to rapid control and subsequent normalization of the damaging immune response, a finding that corresponds well to the clinical response to treatment. This study illustrates the host response to treatment at the molecular level and provides further evidence that a shorter treatment duration than the 84 days predominantly practiced is sufficient.

A multi-group path analysis of medication documentation quality using cross-sectional survey data: Impact of leadership, job satisfaction, patient-related burnout, and patient safety culture

Medication-related adverse events are a major problem for patient safety and quality of care. This study explored the effects of leadership, job satisfaction, patient-related burnout and patient safety culture, measured through surveys of frontline workers, on documentation quality. Perceptions of physicians and nurses were surveyed using established instruments including the Transformational Leadership Inventory, the Copenhagen Psychosocial Questionnaire, the Copenhagen Burnout Inventory, and the Hospital Survey on Patient Safety Culture. Documentation quality was evaluated using retrospective review of patient records with the MediDoq instrument. Data from 24 departments, covering 282 physicians, 417 nurses, and 802 patient records, were analysed through a multi-group (physicians and nurses) path analysis to evaluate the theoretical model. The theoretical model revealed satisfactory fit, explaining about 76–80% of the variance in Documentation Quality for physicians and nurses. Perceived Patient Safety had a significant effect on Documentation Quality only for nurses. The analyses revealed differences between professional groups. Based on these results, (i) medication documentation quality may be affected by various organizational factors; (ii) perceived Patient Safety reported by the nurses may mediate some of these effects; (iii) the effects of various organizational factors on documentation quality may vary significantly across professional groups.

New frontiers in radiologic interpretation: evaluating the effectiveness of large language models in pneumothorax diagnosis

Background This study evaluates the diagnostic performance of three multimodal large language models (LLMs)—ChatGPT-4o, Gemini 2.0, and Claude 3.5—in identifying pneumothorax from chest radiographs. Methods In this retrospective analysis, 172 pneumothorax cases (148 patients aged >12 years, 24 patients aged ≤12 years) with both chest radiographs and confirmatory thoracic CT were included from a tertiary emergency department. Patients were categorized by age and pneumothorax size (small/large). Each radiograph was presented to all three LLMs accompanied by basic symptoms (dyspnea or chest pain), with each model analyzing each image three times. Diagnostic accuracy was evaluated using overall accuracy (all three responses correct), strict accuracy (≥2 responses correct), and ideal accuracy (≥1 response correct), alongside response consistency assessment using Fleiss’ Kappa. Results In patients older than 12 years, ChatGPT-4o demonstrated the highest overall accuracy (69.6%), followed by Claude 3.5 (64.9%) and Gemini 2.0 (57.4%). Performance was significantly poorer in pediatric patients across all models (20.8%, 12.5%, and 20.8%, respectively). For large pneumothorax in adults, ChatGPT-4o showed significantly higher accuracy compared to small pneumothorax (81.6% vs. 42.2%; p < 0.001). Regarding consistency, Gemini 2.0 demonstrated excellent reliability for large pneumothorax (Kappa = 1.00), while Claude 3.5 showed moderate consistency across both pneumothorax sizes. Conclusion This study, the first to evaluate these three current multimodal LLMs in pneumothorax identification across different age groups, demonstrates promising results for potential clinical applications, particularly for adult patients with large pneumothorax. However, performance limitations in pediatric cases and with small pneumothoraces highlight the need for further validation before clinical implementation.

Albumin-corrected anion gap as a predictive marker for mortality in critically Ill cirrhosis patients: an analysis based on the MIMIC-IV database

Background The prognostic value of Albumin-Corrected Anion Gap (ACAG) has been extensively examined across a range of diseases; however, its relationship with short- and long-term survival in critically ill cirrhotic patients remains poorly understood. This study aims to investigate and elucidate the association between ACAG levels and mortality risk in this patient population. Methods Initial analysis involved a univariate assessment of 30-day mortality outcomes, followed by stratification of patient data using X-tile software. Multivariate modeling was employed to identify independent risk factors for mortality. Survival outcomes associated with ACAG levels were analyzed using Kaplan-Meier (K-M) survival curves, while diagnostic accuracy was evaluated through Receiver Operating Characteristic (ROC) curve analysis. Additionally, Restricted Cubic Spline (RCS) regression was utilized to investigate potential non-linear relationships between ACAG levels and mortality risk. Subgroup analyses further validated the interactions between ACAG levels and mortality outcomes in the context of liver cirrhosis. Result This study analyzed 2,826 participants, stratifying them into elevated (>20) and normal (≤20) ACAG groups based on X-tile-derived optimal cutoff. Elevated ACAG significantly correlated with higher mortality at 30, 90, 180, and 365 days (P < 0.05). Cox regression confirmed ACAG as an independent mortality predictor, supported by consistent hazard ratios (P < 0.05). K-M analysis revealed worse survival in the elevated ACAG group (P < 0.05). ROC curves indicated fair predictive value for cirrhosis mortality, while RCS analysis showed a linear ACAG mortality relationship. Subgroup analyses revealed no significant interaction effects between ACAG and demographic or clinical variables. Conclusion ACAG stands out as a reliable prognostic indicator, showing a meaningful link to mortality rates among critically ill patients with cirrhosis.

Effect of sensory-motor intervention associated with skin-to-skin contact on neuromotor and clinical outcomes of preterm newborns: A randomized controlled trial

Objective To examine the effects of a physical therapy sensory-motor intervention combined with kangaroo skin-to-skin contact in clinically stable preterm newborns. Design, setting, and participants This randomized controlled trial included two parallel and balanced groups. Thirty-four preterm newborns (≤34 weeks gestation and low birth weight) who were hospitalized in a neonatal intermediate care unit were randomly assigned to either the experimental (EG) or control (CG) group. Only newborns with a poor repertoire, as determined by the Prechtl General Movements Assessment (GMA), were included. Interventions The intervention consisted of 10 sessions of 15-minute sensory-motor physical therapy followed by 60 minutes of skin-to-skin contact (EG), or 60 minutes of skin-to-skin contact only (CG). Outcome measures The primary outcome was the quality of general movements (GMs), assessed by the GMA during the writhing movements (WM) and fidgety movements (FM) phases. Secondary outcomes included weight gain, posture and muscle tone, behavioral state, length of hospital stay, and establishment and maintenance of breastfeeding. Vital signs and signs of respiratory distress were also monitored. Results Newborns gained weight, showed no signs of respiratory distress, and maintained stable vital signs during the interventions. Both groups exhibited similar proportions of normal and abnormal GMs at both the WM and FM phases. However, the EG group showed improved scores for popliteal angle and leg recoil after the intervention compared to the control group. Conclusions The neonatal physical therapy intervention was a clinically safe technique for stable preterm newborns. This technique may be recommended to promote the development of physiological flexor tone in the lower limbs, but it does not appear to provide advantages in improving the quality of GMs compared to skin-to-skin contact. Due to the non-confirmatory findings, this study should be considered a pilot. Trial registration REBEC identifier RBR-4wx7wp. Trial registered in the Brazilian Clinical Trials Registry (ReBec). ReBec is a Primary Registry in the WHO Registry Network. Trial nº. RBR-5n82tv. URL: http://www.ensaiosclinicos.gov.br/rg/RBR-5n82tv/

Correction: Fibrinogen and colorectal cancer: A study of the Chinese population

Analytical approach of synchronous and asynchronous update schemes applied to solving biological Boolean networks

Characterizing the minimum, necessary and sufficient components to generate the dynamics of a biological system has always been a priority to understand its functioning. In this sense, the canonical form of biological systems modeled by Boolean networks accurately defines the components in charge of controlling the dynamics of such systems. However, the calculation of the canonical form might be complicated in mathematical terms. In addition, computing the canonical form does not consider the dynamical properties found when using the synchronous and asynchronous update schemes to solve Boolean networks. Here, we analyze both update schemes and their connection with the canonical form of Boolean networks. We found that the synchronous scheme can be expressed by the Chapman-Kolmogorov equation, being a particular case of Markov chains. We also discovered that the canonical form of any Boolean network can be easily obtained by solving this matrix equation. Finally, we found that, the update order of the asynchronous scheme generates a set of functions that, when composed together, produce characteristic properties of this scheme, such as the conservation of fixed-point attractors or the variability in the basins of attraction. We concluded that the canonical form of Boolean networks can only be obtained for systems that use the synchronous update scheme, which opens up new possibilities for study.

Unmasking the effects of E-leadership on virtual team effectiveness by an integrated fsQCA and NCA method

Together with unstoppable trend of business going digitally global in recent years and the worldwide spread-out of COVID-19 since 2020, virtual teams have gradually garnered considerable attention in academia. Yet, the question of how to boost virtual team effectiveness remains underexplored. This study adopts a leadership perspective to examine the role of E-leadership in enhancing virtual team effectiveness. Gathered survey data from 74 virtual teams of Chinese manufacturing firms and employed an integrated fsQCA and NCA method, this study unravels two primary results. First, Fuzzy-set Qualitative Comparative Analysis (fsQCA) identified the sufficient combinations of E-leadership dimensions to promote virtual team effectiveness. Second, Necessary Condition Analysis (NCA) specifies the quantitative thresholds a E-leadership dimension’s value must be to render different levels of virtual team effectiveness. The conclusions of this research offer valuable insights into the theoretical and managerial implications of E-leadership in virtual teams.

FloralArea: AI-powered algorithm for automated calculation of floral area from flower images to support plant and pollinator research

Floral area is a major predictor of the attractiveness of a flowering plant for pollinators, yet the measurement of floral area is time-consuming and inconsistent across studies. Here, we developed an AI-powered algorithm, FloralArea, to automate floral area measurement from an image. The FloralArea algorithm has two main components: an object segmentation module and an area estimation module. The object segmentation module extracts the pixels of flowers and the reference object in an image. The area estimation module predicts floral area based on the ratio between flower and reference object pixels. We fine-tuned two YOLOv8 segmentation models for flower and reference object segmentation. The flower segmentation model achieved moderate precision, recall, mAP0.5, and mAP0.5-0.95 of 0.794, 0.68, 0.741, and 0.455 on the test dataset, while the reference object model achieved an impressive performance of 0.907, 0.940, 0.933, and 0.832. We evaluated FloralArea using 75 images of flowering plants. We used ImageJ to calculate the actual floral area for all the images and compared them with the predicted floral area from FloralArea. The predicted floral area correlated well with the measured floral area with a coefficient of determination (R2) of 0.93 and a root mean square error of 20.58 cm2. The FloralArea algorithm reduced the time it takes to calculate floral area from an image by 99.24% compared with traditional methods with image processing tools like ImageJ. By streamlining floral area estimation, the FloralArea algorithm provides a scalable, efficient, consistent, and accessible tool for researchers, particularly to aid in assessing plant attractiveness to different pollinator groups.

Phytochemical profiling and bioactivity validation of Moringa oleifera leaves: Antimicrobial, antidiarrheal, analgesic, and in silico insights

The increasing threat of antimicrobial resistance and the need for new medicines have renewed interest in medicinal plants like Moringa oleifera Lam., a fast-growing tree from the Moringaceae family that can survive in dry conditions. It is easily recognized by its compound leaves and long seed pods. Traditionally, it has been widely used in Ayurvedic medicine and as a nutrient-rich food source, with its leaves, pods, and seeds employed for treating malnutrition, inflammation, and over 300 ailments across South Asia and Africa. A methanolic leaf extract was prepared and analyzed via GC-MS/MS for phytoconstituents. Antimicrobial activity was tested against Gram-positive, Gram-negative bacteria, and fungi using disc diffusion (100 µg/disc), compared to standard antibiotics (30 µg/disc). Antidiarrheal (castor oil-induced model) and analgesic (acetic acid-induced writhing) effects were assessed at 200 and 400 mg/kg doses, with Loperamide and Diclofenac as standards, respectively. Molecular docking analyzed interactions of key compounds with therapeutic targets (URO, EGFR, DHFR, etc.). GC-MS/MS revealed 79 bioactive compounds including 4,5-dimethoxy-2-biphenylcarboxylic acid (14.32%), gamma-sitosterol (3.83%) and stigmasterol (0.81%). The extract showed broad-spectrum antibacterial activity, with strongest inhibition against Pseudomonas aeruginosa (19 mm) and Salmonella typhi (19 mm), though 30–50% less potent than standard antibiotics. In antidiarrheal testing, 400 mg/kg dose reduced diarrheal episodes by 58.06% compared to control, while in analgesic assay it decreased writhing by 59.18%. Molecular docking demonstrated superior binding of compounds 57, 65 and 61 to molecular targets, with compound 57 showing strongest affinity to URO (−6.7 kcal/mol) and compound 65 to EGFR (−9.6 kcal/mol). ADME/T analysis revealed compounds C57, C59 and C61 possessed optimal drug-likeness (log P 1.33–3.02), high GI absorption, and no predicted toxicity – contrasting with poorly absorbed compounds (C13, C28; TPSA>150). Moringa oleifera methanolic leaves extract demonstrated broad-spectrum bioactivity, validating its traditional uses. While less potent than synthetic drugs, its multi-target mechanisms and bioactive diversity highlight its potential as an adjunct therapy. Further studies should isolate active compounds and optimize formulations for clinical applications.

Combining ability and heterosis analysis for mineral content in the leafy vegetable Gynandropsis gynandra (L.) Briq.

Spider plant (Gynandropsis gynandra) is a leafy vegetable rich in micronutrients, including minerals, vitamins, and secondary metabolites, making it a valuable opportunity crop for combating hidden hunger and promoting human health. However, knowledge of the inheritance of mineral content is limited, which hinders the development of improved cultivars for wider cultivation. To address this, 118 F1 experimental hybrids involving 26 parental lines were generated from a North Carolina mating design II. The F1s and their parents were evaluated across two years (2019 and 2020) for gene action, combining ability effects and heterosis of leaf mineral (zinc, copper, manganese, calcium, magnesium, sodium, phosphorus, and potassium) content. Significant differences (p < 0.001) were observed among and between hybrids and parents for iron, zinc, copper, manganese, calcium, magnesium, sodium, phosphorus, and potassium contents. The genotype × year interaction was also significant, with variance greater than the genotypic variance. Significant general and specific combining ability effects, together with variance components analysis, revealed that both additive and nonadditive gene action controlled mineral content, with a predominance of nonadditive gene action. Mid- and best-parent heterosis ranged from -80.4% to 389.5% for mineral content. Parents with good general combining ability were identified, as well as crosses with high specific combining ability and heterosis. There were significant and moderate to strong correlations between mean hybrid performance, specific combining ability effects, and heterosis levels, and low to moderate correlations between general combining ability and the performance of the mean parents. We conclude that hybridization in G. gynandra contributes to improving the mineral content. G. gynandra can be used as a model crop to study the genetic mechanism underlying heterosis in leafy vegetables.

Eculizumab and ravulizumab clinical trial and real-world pharmacovigilance of meningococcal infections across indications

Introduction Complement component 5 inhibitor therapies (C5ITs) for rare hematological, renal, and neurological diseases are associated with increased meningococcal infection risk. Robust risk mitigation measures include vaccination, drug safety programs, patient safety cards, and antibiotic prophylaxis initiation when starting C5ITs. Here we describe the exposure-adjusted meningococcal infection and mortality rates in eculizumab- or ravulizumab-treated patients based on clinical trial and real-world pharmacovigilance data. Methods Global clinical trial and real-world safety data regarding eculizumab and ravulizumab use across indications were recorded in the Alexion pharmacovigilance database. Data for eculizumab (March 2007-October 2024) and ravulizumab (December 2018-December 2024) were searched based on the Medical Dictionary for Regulatory Activities (versions 26.1, 27.0, and 27.1) High-Level Term of Neisseria infection. Only cases associated with Neisseria meningitidis were included. Reporting rates were calculated cumulatively per 100 patient-years (PY). Results At the time of analysis, cumulative exposure across clinical trial and real-world settings were 2457 and 91,052 PY, respectively, for eculizumab and 3287 and 34,582 PY, respectively, for ravulizumab. The cumulative meningococcal infection rate in clinical trials was 0.28 and 0.18 per 100 PY for eculizumab and ravulizumab, respectively. Real-world cumulative meningococcal infection rates in patients treated with eculizumab have decreased since 2007 (0.25 per 100 PY in 2024). In patients treated with ravulizumab, the real-world cumulative rate of meningococcal infection remains low (0.10 per 100 PY in 2024). The rates of meningococcal-associated mortality were ≤0.03 per 100 PY in both eculizumab- and ravulizumab-treated patients in clinical trials and real-world settings. Conclusions Meningococcal infection and mortality reporting rates have remained stable despite increasing cumulative eculizumab and ravulizumab exposure over time across indications, including rare neurological indications. Infection awareness, existing risk mitigation strategies, and availability of vaccines have effectively reduced the risk of meningococcal infections in C5IT-treated patients, underlining the importance of adhering to those measures.

A novel sialylation pathway mediated by extracellular vesicles in aggressive prostate cancer

Altered cell surface glycosylation is a hallmark of cancer; among aberrant glycan structures, hypersialylated proteins contribute to disease progression. The enzyme ST6 β-galactoside α2,6-sialyltransferase 1 (ST6GAL1) mediates α2,6-linked sialylation of N-glycosylated proteins and is upregulated in many cancers, including prostate cancer (PrCa). We propose that ST6GAL1 may be released by cancer cells in small extracellular vesicles (sEVs) in the PrCa tumor microenvironment to potentially modulate cell surface sialylation in recipient cells. We isolated sEVs from PrCa cells by density gradient separation and characterized them by nanoparticle tracking analysis using ZetaView and immunoblotting analysis. We identified ST6GAL1 in both its membrane-bound and soluble forms, both active, in circulating sEVs from healthy donors and patients with PrCa. ST6GAL1 is also expressed in human PrCa cells (PC3, DU145, and C4-2B), and in murine cells (TRAMP-C2 and RM1) at different levels, which correlate with aggressive cell phenotypes. In addition to classic sEV markers, such as CD9, TSG101 and Syntenin, sEVs isolated from PrCa cell lines express PDL1, an immune checkpoint ligand. The soluble ST6GAL1 form is present in the sEVs released from DU145 and PC3 cells and can be transferred via sEVs to recipient PrCa cells. This transfer is prevented by expression of Nogo-66 receptor homolog 2 (NgR2) and β3 integrin, which are elevated in the aggressive neuroendocrine phenotype of the disease. The soluble form is absent in the sEVs released from the bone metastatic line C4-2B, which only contains the membrane-bound form. Our results suggest that ST6GAL1 in sEVs derived from PrCa cells may potentially play a role in promoting bone metastasis by facilitating the formation of the pre-metastatic niche.

Surgeon interpretation of patient-reported outcome measures in upper extremity osteoarthritis

Purpose Measures that quantify levels of pain intensity, incapability, symptoms of distress, and unhelpful thinking were designed as research tools. We studied how surgeons interpret and act on these scores in the care of individual patients. Methods In an online experiment, 67 upper limb specialists from the Science of Variation Group reviewed 10 fictious patient scenarios of trapeziometacarpal, wrist and elbow osteoarthritis (OA) and randomized elements of radiographic severity, levels of discomfort and incapability, deprivation index score (social health), and levels of distress and unhelpful thinking (mental health). Multilevel mixed-effects linear regression identified patient factors associated with surgeon concern, enthusiasm to offer surgery, motivation to discuss mental health and social circumstances, and likelihood to refer for mental/social health care. Results Higher levels of discomfort, incapability, distress, unhelpful thinking, and deprivation were associated with greater surgeon concern, increased motivation to discuss or refer for mental and social health, and greater motivation to refer for mental/social health. Greater likelihood to offer surgery was associated with greater discomfort and incapability, greater radiographic severity, wrist and elbow OA, and greater distress/unhelpful thinking. Conclusions Measures that quantify the subjective aspects of illness draw surgeon attention to mental and social health, and can be used to inform comprehensive, biopsychosocial diagnostic and treatment strategies.