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Psychometric validation of a culturally adapted health belief model scale for breast cancer screening in Chinese women

This study aimed to validate a culturally adapted Health Belief Model (HBM) questionnaire for assessing breast cancer screening beliefs among Chinese women and to evaluate its structural validity and measurement invariance. A cross-sectional survey was conducted with 314 women aged 18–70 in Guizhou Province, China, using multistage sampling. The original HBM questionnaire underwent cultural adaptation and expert content review. Exploratory and confirmatory factor analyses were conducted to examine the factor structure, and measurement invariance was tested across residential settings and age groups. A seven-factor solution was identified, encompassing all six core HBM constructs, with self-efficacy splitting into two empirically distinct dimensions. The final 41-item model demonstrated strong model fit (CFI = 0.914, TLI = 0.906, RMSEA = 0.059, SRMR = 0.060), high internal consistency (ω ≥ 0.88), and full invariance across subgroups. Convergent validity and inter-construct correlations aligned with theoretical expectations. In particular, strong positive associations were observed among self-efficacy, perceived benefits, and cues to action, while perceived barriers showed inverse relationships with perceived severity and risk perception. These findings offer empirical justification for both single-construct and multi-construct intervention strategies. The validated scale provides a psychometrically sound and culturally grounded tool for identifying psychological barriers to screening among Chinese women. It may guide the design of theory-informed public health interventions that address individual belief profiles and promote screening uptake.

An adaptive simulation intervention decreases emergency physician physiologic stress while caring for patients during COVID-19: A randomized clinical trial

Background Stressful work environments and burnout in emergency medicine (EM) physicians adversely impact patient care quality. The future EM workforce will need to prioritize clinician well-being to ensure optimal patient care. Methods This prospective, randomized, controlled study aimed to determine whether an adaptive simulation intervention, COVID-19 Responsive Intervention: Systems Improvement Simulations (CRI:SIS), decreased physiologic stress as measured by heart rate variability (HRV) in front-line EM physicians during the COVID-19 pandemic. HRV was measured with smart shirts and self-reported State-Trait Anxiety Inventory (STAI) were collected at baseline and during four 8-hour clinical shifts for all participants. The intervention group (n = 40) received a 3-hour virtual educational simulation intervention consisting of four simulation scenarios (CRI:SIS). The control group (n = 41) received no simulation intervention. Results There were no significant differences in demographics between groups. HRV data collected from 81 physicians across a total of 324 clinical shifts showed an increase in HRV (decrease in physiologic stress) in shifts immediately following CRI:SIS in the intervention group as measured by a root mean square standard deviation (RMSSD) difference of 11.55 ms (95% CI, −19.90 to −3.20; P = 0.007) compared to the control group. Post-intervention STAI did not significantly differ between intervention and control. Conclusion An adaptive simulation-based educational intervention led to decreased physiologic stress (increased HRV) among emergency physicians who received a simulation education intervention. Reduced physiologic stress generated by adaptive simulation interventions may improve both patient safety and clinician well-being.

Before the wave: Exploring early perspectives on COVID-19 self-testing among African Americans in Eastern North Carolina

Introduction In the first year of the COVID-19 pandemic, African Americans in rural communities faced disproportionate rates of hospitalizations and deaths. The emergence of the omicron variant further exacerbated these disparities, with African American adults approximately four times more likely to be hospitalized for COVID-19 compared to their White counterparts. To curb the transmission of the virus, public health professionals advocated COVID-19 mitigation strategies, including testing. However, barriers such as limited testing sites, long wait times, and privacy concerns hindered testing accessibility in rural areas. This study characterizes the early perceptions and acceptability of COVID-19 self-testing among African Americans in eastern North Carolina. Method We conducted semi-structured, small group discussions in November 2021 with participants representing three age groups (youth, adults, and older adults) from Eastern North Carolina. Data were analyzed thematically using deductive and inductive approaches. Results Findings indicate that, while self-testing was a novel concept for many participants, there was a high acceptability of COVID-19 self-testing. Barriers included low self-efficacy, concerns about test accuracy, and perceived costs. Participants emphasized the convenience and comfort of self-testing, recommending clear instructions, video demonstrations, and a toll-free number for help. Conclusions These insights offer valuable guidance for improving emergency testing strategies and protocols in response to future viral outbreaks and pandemic threats. Clear, user-friendly instructions and video demonstrations can enhance the accessibility of self-testing kits. Moreover, addressing concerns related to cost and test accuracy is crucial for widespread adoption. Public health campaigns should prioritize affordability, user-friendliness, and community-specific needs to foster resilience and equity in healthcare responses.

Leveraging the potential of social media: Unveiling the influence of customer-generated photos on customer behavior

Recent research shows that social media has enormous potential for customers and enterprises, but this potential has been largely untapped. This study investigates the influence of customer-generated photos on social media to drive customer visit intentions via the argument quality of online reviews, including perceived informativeness and persuasiveness, by integrating the direct and moderating effects of brand social media visual communication and controlling customer demographics such as gender, age, and income in the context of restaurants. This study collected 1,137 responses from different customers through an online survey. After carefully filtering data, 980 customer responses were analyzed using structural equation modeling. This study discovered that customer-generated photos significantly influenced perceived informativeness, persuasiveness, and customer visit intentions. Likewise, perceived informativeness and persuasiveness directly and indirectly contributed to increased customer visit intentions. In addition, brand social media visual communication directly influences to drive customer visit intentions toward restaurants. This study offers fresh insights for restaurant marketers to devise innovative marketing strategies to influence customer behavior toward eateries. Employing a social media ecosystem, this study contributes to the heuristic-systematic and elaboration likelihood models by examining consumer behavior in the hospitality industry.

Effect of plastic and seaweed shelters on the skin microbiome of lumpfish Cyclopterus lumpus used as cleaner fish in aquaculture pens

Atlantic salmon ( Salmo salar ) aquaculture is a major industry in several countries worldwide and a growing enterprise in others. One of the main challenges the industry faces is infestations with the parasitic copepod Lepeoptheirus salmonis , or salmon lice. Several different chemical and mechanical methods are available for alleviating the problem, but often at cost to salmon welfare and/or the environment. In some regions cleaner fish have been introduced to farming facilities as an environmentally and salmon welfare friendly option for reducing sea lice infestations. In some North Atlantic countries, lumpfish ( Cyclopterus lumpus ) are being used as cleaner fish. However, poor welfare and high mortality rates of lumpfish in salmon farming are frequent issues, and the need to improve lumpfish welfare is great. One adaptation for salmon farms is to provide the lumpfish with shelters to meet their need to rest and hide. Plastic shelters are the most widely used form, but seaweed shelters have more recently also been applied as a more natural solution. This project investigated the potential effect of seaweed and plastic shelters on the skin and gill microbiome of lumpfish and any potential correlation to their welfare. In an experimental setup in a commercial salmon farming facility, lumpfish from pens with either plastic or seaweed shelters were sampled over a period of approximately three months. The results showed that the bacterial communities on the two shelter types were significantly different and fewer potentially pathogenic bacteria dominated the skin microbiome of lumpfish living with seaweed shelters than of those living with plastic shelters. No differences were detected in the welfare of the lumpfish and further investigations are needed to clarify any potential implications of the differences detected in the skin microbiome of lumpfish including responses to stressful conditions.

Cadinapyridine sesquiterpene alkaloids from Artemisia annua and in vitro cytotoxicity and antiplasmodial activities

Artemisia annua L. (A. annua) is a medicinal herb that has been used for the last two millennia to treat various diseases. In African countries, teas prepared from cultivated A. annua have been used to treat malaria for the past three decades. In another work, our team investigated the antiplasmodial efficacy of these traditional preparations using a Liquid-Chromatography-Mass Spectrometry metabolomic approach on various teas prepared from different batches of A. annua collected in Benin and in France and highlighted an original nitrogenous compound. The present work aimed to isolate and characterize its structure. Therefore we describe the fractionation of an alkaloid extract from a Beninese sample of the plant’s aerial parts led to the isolation of two previously undescribed alkaloids, annuanine A (1) and annuanine B (2) along with the known fabianine (3), all possessing a very unusual skeleton. Their structures were determined through NMR and MS data analyses. The structure of 1 was further confirmed by single-crystal X-ray structural analysis. Compounds 1 and 2 were evaluated for cell-growth inhibition on Caco-2, VERO, and Thp1 cells, as well as on the Plasmodium falciparum FcB1 strain. Unfortunately, the two compounds 1 and 2 were inactive in these in vitro models. Comparison of LC-HRMS data between annuanine B and A. annua tea allowed us to identify it as the nitrogenous compound highlighted by our previous study. These results enhance the chemical knowledge of this well-known ethnopharmacological herb and highlight a very rare alkaloid skeleton that may have formed from the degradation of artemisinin during plant storage.

The relationship between prenatal heat exposure and birth outcomes: How much does the heat metric matter?

The impact of prenatal heat exposure on birth outcomes is well-established, but what is it about heat drives this relationship? Is it exposure to extreme temperatures, to moderate heat, or the confluence of heat and humidity? Despite the large body of research on heat exposure and birth outcomes, the literature lacks consistent measurement. This means we cannot extract practical recommendations around which heat conditions pose the greatest risk, and hence should be avoided during pregnancy. It also means we cannot predict the implications of climate change on neonatal health and healthcare needs at a population level. This paper has two goals: first, to demonstrate that our conclusions around the existence and magnitude of the impact of heat exposure vary dramatically with the choice of heat exposure metric, and second, to make general recommendations for how heat exposure should be measured in future. We present analysis from Australia’s Northern Territory — a region spanning tropical and arid climates. We compare commonly used heat exposure metrics, alongside additional metrics supported by theory. We find that a metric based on ‘bands’ of exposure and incorporating daily minimum as well as maximum measures provides the best fit; this is consistent with our theoretical understanding that both moderate and extreme heat affect fetal development in different ways. Estimates based on our preferred heat metric suggest that the impact of prenatal heat exposure on preterm birth is orders of magnitude larger than what would be implied by some metrics commonly used in the literature. Our findings underscore the importance of getting the measure of heat right, particularly in tropical climates.

Power and sample size for reversible linear mixed models with clustering and longitudinality: GLIMMPSE Version 3

GLIMMPSE Version 3 is a free, web-based, open-source software tool, which calculates power and sample size for general linear mixed models with Gaussian errors. The software permits power calculations for clinical trials, randomized experiments, and observational studies with clustering, repeated measures, and both, and almost any testable hypothesis. The software has been supported by five United States National Institutes of Health (NIH) grants, is used for more than 14,000 power or sample size calculations per year, has been cited in almost 500 peer-reviewed manuscripts, and used to design more than 200 million dollars in NIH-funded studies. This release provides several new features. The back end has been refactored in Python. The interface has been simplified, requiring user decisions about only one topic per screen. A new menu improves specification of both between-participant and within-participant hypotheses. A recursive algorithm permits computing covariances for up to ten levels of clustering. An updated Monte Carlo simulation using five new examples with clustering, longitudinality, or both, shows accuracy of the power approximations to within 0.01. Five new examples demonstrate power or sample size calculations for 1) a cluster-randomized trial, 2) a longitudinal study with repeated measures, 3) a multilevel study with a multivariate outcome, 4) a multilevel and longitudinal study, and 5) a complex study with a subgroup factor, repeated measures, and intervention-by-location interaction.

Minimizing Urban Carbon Emissions and Heat Island Intensity: A theoretical study

Cities exhibit both beneficial and detrimental characteristics, many of which stem from agglomeration effects and are, to a first approximation, influenced by population size. However, urban density also plays a critical role. For example, cities with similar population sizes but higher densities tend to emit less carbon, while simultaneously exhibiting a more pronounced urban heat island (UHI) effect. This trade-off highlights the need for a balanced approach that simultaneously minimizes both carbon emissions and the urban heat island (UHI) effect. To address this challenge, we examine how both carbon emissions and UHI intensity are influenced by the population size and spatial extent of the cities. As objective function we define the some of both quantities where city population and area are variables. Considering the scaling relation between area and population as constraint, we derive a theoretical expression leading to an optimal city size. To validate our approach, we analyze carbon emissions data from cities in Germany and consider UHI parameters from the literature. We find that, in the specific case of German cities, achieving an optimal city size that simultaneously minimizes both carbon emissions and UHI intensity is not physically feasible. From a methodological perspective, only the UHI intensity parameters, together with the exponent of the relationship between population and area, determine whether an optimum exists or not. We argue that instead, the scaling relation between population and area itself should be understood as an optimum.

Forecasting and analysing global average temperature trends based on LSTM and ARIMA models

Previous studies have demonstrated a significant correlation between global average temperature change trends and greenhouse gases, and employed various prediction models. However, the potential of the combination of the LSTM and ARIMA models for temperature forecasting has not been fully explored, especially in terms of enhancing prediction accuracy. Based on the hypothesis that COVID-19 has affected the global average temperature, this study utilizes global average temperature data from 1880 to 2022. We combine the LSTM model, which excels at capturing long-term dependencies, with the ARIMA model, known for its effectiveness in handling linear time series data, to predict the global mean temperature. This combination compensated for the limitations of individual models, providing a more accurate and comprehensive temperature forecast. Our findings reveal that the early trend of global temperature rise is significant, yet the implementation delay leads to severe issues. Moreover, COVID-19 has indirectly reduced greenhouse gas emissions, slowing global warming. Additionally, we find that the correlation between longitude and mean temperature is weak, while the correlation between latitude and temperature is strongly negative. This study offers valuable insights and provides a reliable prediction method for ecological environment governance and the formulation of economic construction policies.

An integrated blockchain and IPFS-based solution for secure and efficient source code repository hosting using middleman approach

Centralized version control systems (VCS) are vital for software development but pose risks of data loss and ownership disputes. While blockchain offers a decentralized alternative, existing solutions are often hindered by high latency, compromising the real-time collaboration essential for modern workflows. This study introduces a novel hybrid architecture combining the security of the Ethereum blockchain and the InterPlanetary File System (IPFS) with two key contributions: 1) Shamir’s Secret Sharing (SSS) to create a trust-minimized model for key distribution, and 2) an authoritative-first, optimistic-fallback retrieval protocol utilizing a temporary middleware to decouple the user experience from blockchain confirmation delays. We implemented a full prototype and conducted a comprehensive performance evaluation on the public Sepolia testnet. Our results demonstrate that this architecture not only provides a secure, auditable, and resilient platform for source code hosting but also achieves highly competitive user-perceived performance. Our user-perceived push time reduces submission latency by up to 49% compared to a standard git push for common repository sizes, proving that a well-designed decentralized VCS can balance the core tenets of security and decentralization with the practical need for speed and efficiency.

Survival of dental implants in irradiated head and neck cancer patients compared to non-irradiated patients: An umbrella review

Background: There is an increasing demand for oral rehabilitation in patients undergoing irradiation for head and neck cancer treatment. Although radiotherapy appears to adversely affect implanted oral rehabilitation, the evidence provided by previous systematic reviews in the field remains controversial. Thus, this umbrella review aimed to evaluate the survival of dental implants installed before and/or after radiotherapy in patients with head and neck cancer compared to those not irradiated. Methods: A comprehensive search of electronic databases was performed in the PubMed, Cochrane Library, Embase, Web of Science, and Google Scholar databases, including manual searches, from inception to February, 2024, with no language or date restrictions. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2020 guidelines were followed. Survival percentage of dental implants was the primary outcome. A Measurement Tool to Assess systematic Reviews (AMSTAR) 2 was used as a critical appraisal tool for the included studies. The protocol for this review has been registered with PROSPERO (CRD42023406059). Results: Of the 1,811 articles screened, 11 articles that evaluated 73,674 implants were included. Quantitative analyses showed 2,674 failures out of 14,471 implants installed in irradiated bone and 1,825 failures out of 34,092 implants in non-irradiated bone. The survival rate was 81.52% for irradiated implants and 94.64% for non-irradiated implants. A significant difference in survival in favor of implants in non-irradiated bone is supported by 11 meta-analyses. The included systematic reviews showed critically low methodological quality. Conclusions: Although the included studies had low methodological quality, the findings indicate a higher failure rate of implants in irradiated patients. Further well-designed clinical studies are warranted.

A scoping review of innovations that promote interprofessional collaboration (IPC) in primary care for older adults living with age-related chronic disease in rural areas

Background and objectives An aging population and associated multi-morbid chronic diseases (CDs) require comprehensive health care across multiple disciplines. Literature suggests interprofessional collaboration (IPC) in primary care is effective for CD models of care. However, IPC requires innovative implementation, particularly in rural and remote areas where access to health care services and providers is often limited. Our main objective was to identify and synthesize the available research evidence on innovations that promote IPC in primary care for older rural adults with CD, identify gaps in the literature, and provide recommendations for future research. Methods Comprehensive and systematic searches were conducted across four scientific databases for peer-reviewed, original research published in English since 1990, resulting in 9,343 records. Following elimination of duplicates, screening, and evaluation, 38 studies were included for synthesis. All studies were described and illustrated by frequency distribution, and findings were grouped thematically. Results Most innovations involved case management and focused on diabetes (n = 15), dementia (n = 12), and hypertension (n = 10). Rural challenges were more prevalent than benefits and mainly involved limited services and resources, while strengths were mainly related to close-knit connections and familiarity with one another. Three main themes regarding benefits of the innovations were: 1) enhanced availability/accessibility, 2) earlier detection/management/support, and 3) improved care. Subthemes included: 2a) education/support, 2b) CD or risk factor outcomes, 3a) care continuity, and 3b) care coordination. Five main gaps in the literature included few studies with age-related CDs other than diabetes, dementia, and hypertension; conducted outside of United States and Canada; randomized controlled trial (RCT) and longitudinal studies; that involved virtual or technology-assisted innovations; and that considered sex and gender in the analysis. Conclusions Several main areas were highlighted including rural strengths and challenges that impacted the innovations, key innovation benefits, and gaps in the literature. Recommendations for future research were made.

Smartphone use on the toilet and the risk of hemorrhoids

Smartphones are ubiquitous in daily life, with many people now using them while sitting on the toilet. Despite anecdotal evidence that length of time spent on the toilet is a risk factor for hemorrhoids, a multivariate analysis of smartphone use has not been performed. This study examines the correlation between smartphone use on the toilet and prevalence of hemorrhoids. A cross-sectional study was conducted among adult patients undergoing screening colonoscopy at Beth Israel Deaconess Medical Center. Participants completed survey questions regarding their smartphone habits while using the toilet, Rome IV questionnaires, and additional behaviors including straining, fiber intake and levels of physical activity. Presence of hemorrhoids were evaluated endoscopically and independently rated by two blinded endoscopists. Categorical variables were analyzed using chi-square tests and linear variables with regression analysis. A total of 125 adult participants completed the survey and 43% had hemorrhoids visualized on colonoscopy. Participants who used smartphones on the toilet were younger than non-users (mean ages 55.4 vs. 62.1, p = 0.001). Of all respondents, 66% used smartphones while on the toilet. Participants who used smartphones on the toilet spent significantly more time there than those who did not, with 37.3% of smartphone users spending more than five minutes per visit on the toilet, compared to 7.1% of non-smartphone users (p = 0.006). Furthermore, in a multivariate logistic regression, smartphone use on the toilet was associated with a 46% increased risk of hemorrhoids (p = 0.044) after adjusting for age, sex, BMI, exercise activity, straining and fiber intake. The most common activity performed while on the toilet was reading “news” (54.3%), followed by “social media” (44.4%). The study suggests that prolonged engagement with smartphones while using the toilet may be associated with an increased prevalence of hemorrhoids.

Correction: Perceived barriers to physical activity and their predictors among adults in the Central Region in Saudi Arabia: Gender differences and cultural aspects

Assessing the burden of severe nausea and vomiting of pregnancy or hyperemesis gravidarum and the associated use and experiences of medication treatments: An Australian consumer survey

Background There is little data on contemporary patterns of antiemetic use or women’s experiences when using such agents in the treatment of severe nausea and vomiting of pregnancy (NVP) or hyperemesis gravidarum (HG). Methods Online, national survey of Australian women who were currently or had previously experienced severe NVP or HG, distributed through the HG consumer group, Hyperemesis Australia between July and September 2020. Results There were a total of 289 respondents with a mean age of 33 years, of which 38% were currently pregnant. More than 50% of respondents reported “major impacts” of the condition on areas such as social life, ability to undertake daily chores, ability to eat or drink, effects on work, taking care of pre-existing children and sleep. This resulted in 62% of respondents reporting ‘often’ or ‘always’ experiencing feelings of depression or anxiety as a result of their HG symptoms, with 54% reporting considering terminating their pregnancy, and 90% having considered having no more children. The most commonly used anti-emetic was ondansetron (91%), followed by pyridoxine (62%), doxylamine (62%), and metoclopramide (61%). Nearly all (95%) women who reported using ondansetron commenced it within the first trimester, with 55% reporting use as a first-line therapy. Most women reported one or more side effects to anti-emetics such as headache, constipation, sedation or impaired cognition, with 31% stopping metoclopramide because of side effects, compared with 14% for ondansetron and 10% for doxylamine. Ondansetron, doxylamine and corticosteroids had the greatest perceived effectiveness, with more than 50% rating them as “effective” or “very effective”. Half (50%) reported use of acid suppressive therapy, with 51% reporting using complementary or alternative therapies in addition to conventional treatments. Conclusions The study findings demonstrate large variability in antiemetic use and outcomes, highlighting the need for individualised care and treatment approaches during pregnancy.

Validity of the German version of the Stay Independent Questionnaire applied by telephone interview: A diagnostic accuracy study

Background Mobility limitations are among the most common functional problems in older people. Repeated falls can lead to injuries and fractures, trigger or intensify concerns of falling, and contribute to subsequent functional decline and loss of independence. Various questionnaires have been developed, both nationally and internationally, to identify older people at increased risk of falling. Data for evaluation against standard tests from the geriatric mobility assessment are scarce. Methods In a German project evaluating home emergency call systems, the Stay Independent Questionnaire (SIQ) from the American prevention program STEADI (Stopping Elderly Accidents, Deaths, and Injuries) was used for the identification of community-dwelling seniors aged 70 and older at risk of falling. The original questionnaire was translated by professional translators using the typical forward and backward translation process, and a final version was established after discussion involving a bilingual scientist. The diagnostic performance of the questionnaire (diagnostic test) was tested against the mobility assessment Short Physical Performance Battery (SPPB, gold standard). To describe the test performance, typical statistical measures are used, i.e., sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios, each with the corresponding 95% confidence interval (95% CI). Results Data from a total of 190 participants (143 women, 75.3%; average age 80.5 years ± 5.5 years standard deviation) were included in the analysis. According to existing comorbidities and functional abilities, between 30% and 40% suffered of advanced comorbidity and/or functional impairment. The questionnaire identified 148 individuals (77.9%) as at risk of falling. According to SPPB, 81 participants had an objectively measurable impairment of standing and walking balance. The test performance measures for SIQ as a diagnostic test are: sensitivity 95.1% 95% CI [88.0%; 98.1%], specificity 34.9% [26.6%; 44.2%], positive and negative predictive value 52.0% [44.0%; 59.9%] and 90.5% [77.9%; 96.2%], respectively, and positive and negative likelihood ratio 1.46 [1.26; 1.69] and 0.14 [0.05; 0.38]. In receiver-operating characteristic (ROC) analysis, the unadjusted area under the curve for SIQ was 65.0% [57.3%; 72.7%], after adjustment for sex and age 71.0% [63.8%; 78.2%]. Conclusions The German version of the Stay Independent Questionnaire is capable of identifying community-dwelling seniors aged 70 and older without impairment in standing and walking balance. The high sensitivity of the test allows excluding test-negative individuals from further investigation. A limitation of the questionnaire is the high proportion of false positives, resulting from the low specificity of the test. Scientific evaluation will show to what extent the use of the questionnaire may improve the identification and medical care of community-dwelling seniors at risk of falling in terms of fall prevention.

Virtual Reality in Awake brain Surgery (VIRAS) stage I: Proof of concept and tolerance validation during scheduled orthopedic surgery

Introduction The VIRAS (Virtual Reality in Awake Surgery) project is a two-stage, adaptive study. Its goal is to demonstrate the tolerance of the virtual reality (VR) headset for performing cognitive neuro-monitoring during awake brain surgery. Awake surgery involves operating on patients who remain conscious during the procedure and is most commonly employed in interventions such as tumor resections and epilepsy treatments. This approach allows surgeons to monitor and preserve critical brain functions by engaging the patient in real-time assessments of motor, sensory, and cognitive capabilities. The use of immersive distractions such as VR can help reduce anxiety and discomfort during awake craniotomy. We present the results of the first stage of the study, conducted in patients undergoing scheduled orthopedic surgery under regional anesthesia, aimed at validating the tolerance and safety of using the VR headset in the operating room. Materials and methods Eligibility required a minimum predicted surgery duration of one hour. All participants received standardized training in the use of VR headset the day before surgery. Investigators supervised intraoperative neurofunctional testing delivered through the VR system. Tolerance and safety were evaluated using VAS scores, the Simulator Sickness Questionnaire (SSQ), and the State-Trait Anxiety Inventory (STAI). Acceptability was assessed among healthcare providers. The primary outcome was defined as successful maintenance of the VR headset and completion of neurofunctional testing for at least one hour. Data analysis employed the Sequential Probability Ratio Test (SPRT) with predefined thresholds (P₀ = 0.6, P₁ = 0.8; Nmin = 10, Nmax = 50). Result The first 10 patients completed the procedure successfully, meeting the primary endpoint and leading to early study termination per SPRT design. The VR headset was well tolerated in all cases, with no adverse events reported. Median VAS tolerance scores were high (training: 9.0; intraoperative: 10.0). SSQ scores indicated minimal cybersickness. All participants completed neurofunctional tests during surgery and expressed willingness to reuse the device. Acceptance among healthcare providers was excellent (median VAS: 10). Conclusion The initial phase of the VIRAS study demonstrated excellent overall tolerance of the VR headset by both participants and the healthcare professionals involved in orthopedic surgery.

Plastispheres as reservoirs of antimicrobial resistance: Insights from metagenomic analyses across aquatic environments

Evidence suggests that plastic particles from various environments can accumulate harmful microorganisms and carry bacteria with antimicrobial resistance genes (ARGs). The so-called “plastisphere” might facilitate the spread of pathogens and antimicrobial resistance across environments, posing risks to human and animal health. This study aimed to analyze the diversity and abundance of ARGs found in plastispheres from various aquatic environments, identify clinically relevant pathogenic species, and ascertain bacterial hosts carrying ARGs. We present data from 36 metagenomes collected from plastispheres in different environments (freshwater, raw wastewater, and treated wastewater). The diversity and abundance of ARGs in the resistome of the plastispheres were analyzed through metagenomic methods. A total of 537 high-quality metagenomic-assembled genomes (MAGs) were constructed to identify clinically relevant pathogens and to link the detected ARGs to their bacterial hosts. The results show that the environment has the greatest influence on the abundance and diversity of ARGs in the plastispheres resistome, with the wastewater plastisphere containing a resistome with the highest diversity of ARGs. Resistance to beta-lactams, aminoglycosides, and tetracyclines were the most abundant resistance mechanisms detected in the different plastispheres. The construction of MAGs identified potential pathogens and environmental bacteria that confer resistance to one or several drug classes, with beta-lactams being the most pervasive form of AMR detected. This work enhances our understanding of the plastisphere’s role in antimicrobial resistance dissemination and its ecological and public health risks.

Metagenomic profiling of the insect-specific virome in non-urban mosquitoes (Culicidae: Culicinae) from Colombia’s Northern inter-Andean valleys

Hematophagous mosquitoes are major vectors of diverse pathogens and serve as bioindicators in tropical ecosystems, yet their virome in non-urban Neotropical regions remains poorly characterized. We analyzed the virome of 147 mosquitoes from two natural ecosystems in Colombia using a hybrid viral identification approach, combining high-confidence and less stringent methods. Most high-confidence viral contigs remained unclassified or unknown, as expected for metagenomic surveys in novel ecosystems. However, members for the Magrovirales and Ortervirales, and other six orders were detected at lower abundance. Using a complementary, less stringent approach, we identified 168 viral species from 68 genera and 22 families across four mosquito tribes (Aedini, Culicini, Orthopodomyiini, Sabethini), with dominance of Metaviridae, Retroviridae, Iridoviridae, and Poxviridae, though many sequences could not be taxonomically assigned. Insect-specific viruses predominated, while no medically relevant arboviruses were detected. Both methods consistently identified Trichoplusia ni TED virus, Cladosporium fulvum T-1 virus, Lymphocystis disease viruses, and Oryctes rhinoceros nudivirus among the most abundant and frequently detected taxa across samples. Alpha diversity indices revealed the highest virome diversity in Sabethini, followed by Orthopodmyiini, and substantially lower richness and diversity in Aedini and Culicini. These results provide a baseline for virome characterization in sylvatic mosquitoes from Colombia and highlight the need for further research on the ecological roles of the mosquito virome in pathogen transmission and microbiome evolution.