Search Results (32,731)

Diversion is defined as the practice of providing an alternative outcome for children who have engaged in offending behaviour, which keeps them away from the formal criminal justice system. Diversion is a significant element of the Child First approach, and is widely implemented across England and Wales. The increase in use of diversion in recent years has contributed to reductions in First Time Entrant rates; however, evidence regarding whether these measures reduce reoffending is limited. Diversion practices vary significantly both nationally and internationally. Hence, much could be learnt from reviewing the international literature to establish what could be implemented in England and Wales. Therefore, this systematic review aims to explore the effect of different types of diversion measures on reoffending in First Time Entrants. To do this, a comprehensive search of 10 electronic databases was undertaken to systematically identify literature relating to youth justice diversion. A systematic screening procedure was followed to identify studies that met inclusion criteria, data on key information was extracted and studies were assessed using a quality assessment tool. Results were synthesised using the EMMIE framework, to increase applicability to practice. A total of 12 distinct studies were included in the review, with both experimental and quasi-experimental design. One study was conducted in Norway, one in the Netherlands and the rest in the United States of America. Findings were varied but generally suggested diversion leads to lower rates of recorded reoffending than formal processing. When comparing between types of diversion, often there was no difference in reoffending but generally, the least intensive intervention showed the best results. However, findings from one study that considered self-reported offending prompts consideration of whether diversion genuinely affects behaviour or simply influences the detection of offences. This review indicates promising results for diversion interventions but highlights the need for further research to provide conclusive evidence regarding which measures are most effective. Full article

Meningiomas are the most common central nervous system tumour and are associated with significant morbidity. Mounting evidence implicates the role of exogenous hormones in meningioma development and growth. This has led to increasing pressure on healthcare professionals to understand the risk profile of different hormonal compounds with regards to meningioma incidence and growth. This is particularly relevant when managing patients with pre-existing meningioma tumours or with one or more risk factors for meningioma formation. The aim of this review was to summarise existing evidence from clinical studies (cohort and case–control) concerning the risk of meningioma associated with different types of exogenous hormones and the associated meningioma characteristics. The literature review identified over 30 cohort and case–control studies published between 2003 and 2026. Studies demonstrated a mixed risk profile of broadly defined hormonal replacement therapy and hormonal contraceptives; however, many of these studies did not capture specific information about duration, dose or medication type. Risk associated with synthetic progestin-containing compounds such as depot medroxyprogesterone and desogestrel contraceptives was higher and related to duration of use. Highly potent synthetic progestins including cyproterone acetate (CPA) carried the strongest risk profile and showed a strong association with multiple meningiomas and anterior/middle skull base location. In conclusion, there is strong evidence for a link between meningioma incidence and highly potent synthetic progestins such as CPA, but further evidence is needed regarding menopausal hormone therapy and broadly defined oral contraceptives, as well as the doses and durations that are associated with clinically relevant risk. There is a space for translational research in this area to better understand the molecular basis underlying the relationship between hormones and meningioma growth. Full article

Migrant agricultural workers (MAWs), predominantly individuals from countries in the Global South, play a vital role in maintaining Canadian food security. Employed in low-income positions across the country, they often face workplace hazards and numerous occupational health and safety (OHS) challenges related to long working hours, limited access to OHS information, gaps in knowledge, structural power imbalances with employers, and language and cultural barriers. This pilot study explored the knowledge, attitudes, and perceptions of OHS issues among MAWs in Southern and Eastern Ontario during the COVID-19 pandemic. Participants completed survey questions on working conditions, OHS hazards, and living conditions. A total of 93 questionnaires were completed, 55 by Spanish-speaking and 38 by English-speaking individuals, with 91% of respondents identifying as male. Several participants reported awareness of positive COVID-19 cases in their workplaces, and some indicated having experienced OHS-related illnesses or injuries but felt uncomfortable reporting them to supervisors. Knowledge of OHS rights varied, with a notable minority uncertain about their entitlement to sick leave. The findings indicate a need for further research and targeted interventions to strengthen health and safety practices among MAWs and to ensure they are informed, protected, and supported in exercising their workplace rights. Full article

Background: Optimising medication for Attention Deficit Hyperactivity Disorder (ADHD) is often hindered by the lack of practical physiological indicators that can inform treatment effects. Electrooculography (EOG) has been suggested as a low-burden marker of neurophysiological processes relevant to ADHD, but its responsiveness to medication within routine clinical settings is not well established. Methods: We analysed anonymised clinical records from adults with ADHD receiving stable, ongoing medication who underwent closed-eye EOG recordings immediately before and after taking their scheduled dose during standard consultations. Recordings were obtained using clinical EEG equipment. Heart rate and blood pressure, measured after each EOG session, were included as contextual indices of physiological state. Pre–post changes were assessed using paired t-tests and binomial tests, with effect sizes and confidence intervals reported for the main pre–post comparisons, with Pearson correlations used to evaluate associations between EOG and cardiovascular measures. Results: Both mean and peak EOG power showed consistent within-session reductions, with the majority of individuals exhibiting a decrease across measures. Cardiovascular parameters showed no systematic pre–post change, and differences in cardiovascular measures did not correlate with changes in EOG activity. Conclusions: Closed-eye EOG showed systematic within-session modulation in adults with ADHD on stable treatment. These preliminary findings suggest that EOG is sensitive to short-latency physiological changes occurring within a clinical timeframe. However, the present design does not establish pharmacological specificity, and further controlled studies are needed to determine whether such changes are specifically medication related and whether they have relevance for treatment monitoring and titration. Full article

Climate change poses significant environmental and socio-economic challenges for Small Island Developing States (SIDS), including Timor-Leste. This systematic review aimed to synthesise evidence on climate change impacts, vulnerabilities, adaptation pathways, and research gaps in Timor-Leste. Following PRISMA 2020 guidelines, literature searches were conducted in Web of Science, Scopus, and Google Scholar through May 2025. Eligible sources included peer-reviewed studies, technical reports, policy documents, and institutional publications. Source quality was assessed based on relevance, methodological consistency, credibility, and thematic contribution, and evidence was synthesised using a qualitative meta-synthesis approach. A total of 79 peer-reviewed studies and 8 international reports met the eligibility criteria, resulting in a final corpus of 87 documents. The evidence indicates a warming trend of 0.16 °C/decade and a sea-level rise of 5.5 mm/year with significant implications for agriculture, food security, water resources, and coastal systems. Approximately 70% of the population depends on climate-sensitive livelihoods, increasing exposure to climate-related risks. Evidence remains limited by data scarcity and methodological heterogeneity. Overall, Timor-Leste faces substantial climate vulnerability, highlighting the need for strengthened adaptation planning, improved climate information systems, and targeted policy interventions. Full article

Background/Objectives: Human trafficking is the use of force, fraud, or coercion to compel a person to provide labor or sex and has become a public health crisis. This scoping review aimed to identify known risk factors for trafficking among North American Indigenous women and to synthesize the complexities of trafficking and its related health outcomes. Methods: Following the PRISMA-ScR checklist, a comprehensive literature search of seven electronic databases (CINAHL, Embase, PubMed, SCOPUS, PsycINFO, Cochrane Library, and Google Scholar) was conducted in March 2022 and updated in September 2023. English language research reports, literature reviews, dissertations and theses, commentaries, and government reports that focused on human trafficking in North American Indigenous women aged 18 years and older from the United States and Canada were identified using key terms. Results: Fifteen articles were included, revealing three themes: structurally produced vulnerabilities and other contributors to human trafficking, the long-term effects of human trafficking, and the need for collaboration of key stakeholders to mitigate human trafficking. Risk factors of human trafficking for Indigenous women include personal factors, historical trauma, and inadequate systems to identify and support victims. The needs of this population are complex. However, a multidisciplinary approach can be effective in combatting human trafficking. Conclusions: This review substantiates key risk factors and complexities unique to the trafficking experienced by North American Indigenous women, while also revealing a persistent gap in the research. These findings advance nursing knowledge by informing culturally responsive, trauma-informed care approaches while supporting targeted educational and research initiatives to improve health outcomes among these women. Full article

Children undergoing cancer treatment face repeated, prolonged hospitalisations carrying substantial risks of psychological distress, social isolation, and impaired development. Volunteers offering structured non-medical activities are widely employed to complement professional psychosocial care in paediatric oncology settings, yet empirical evidence examining their role specifically—as distinct from professionally delivered psychosocial interventions—remains sparse. This narrative review, conducted in accordance with SANRA criteria and drawing on a structured search of PubMed, PsycINFO, and Google Scholar (2000–2025), supplemented by a targeted verification search in July 2026, synthesises the theoretical and preliminary empirical basis for volunteer involvement, critically evaluates associated clinical risks, and proposes evidence-informed recommendations for paediatric oncology clinical practice. Three theoretical frameworks provide the conceptual grounding for volunteer activities: developmental psychological models (Piaget; Erikson), stress and coping theory (Lazarus and Folkman), and the biopsychosocial model (Engel). Indirect empirical evidence—derived predominantly from professionally delivered interventions—supports short-term benefits of structured distraction, play, and social activities on procedural anxiety, pain experience, and sense of social inclusion; the sole study examining volunteer-facilitated activities specifically in paediatric oncology reported meaningful reductions in distress and high family satisfaction. Eight categories of clinical risk are identified, including physical and psychological overload, erosion of child autonomy, suppression of authentic emotional expression, and inadequate coordination with healthcare staff. Six practice recommendations are proposed, centred on a working definition of the volunteer role, mandatory pre-access training, genuine individualisation including cultural adaptation, multidisciplinary-team-led coordination, and structured programme evaluation. Volunteer involvement can meaningfully complement professional psychosocial care when delivered within a structured, supervised, and multidisciplinary-team-coordinated framework. The paediatric oncology team occupies a pivotal role in realising the potential benefits while safeguarding children from associated risks. Prospective research employing standardised volunteer programme definitions and validated child-reported outcome measures is urgently needed to build an evidence base commensurate with the clinical importance of this practice. Full article

Supply chain traceability often fails in practice because relevant records are scattered across production, warehouse, transport, laboratory, and document systems. When a recall or audit is needed, firms must manually collect and reconcile evidence from many sources. Existing standards and blockchain platforms address parts of this problem, but prior work still reports recurring weaknesses in governance, confidentiality management, interoperability, and performance measurement. This paper presents a governance-aware, privacy-preserving, event-driven conceptual model for supply chain traceability. The model uses five event types—Create, Transform, Transfer, Verify, and Recall—linked through explicit lineage. It stores compact signed event headers on-ledger and anchors detailed off-ledger payloads and governance policy text through hashes. It also links data-sharing choices to consortium governance, defines validation invariants, embeds key performance indicators, and produces two regulator-ready outputs: a product passport and an audit pack. The contribution is a standards-informed conceptual artifact that integrates event semantics, provenance reconstruction, selective disclosure, governance, validation, performance measurement, and regulator-ready outputs in one cross-sector traceability model. Full article

Background/Objectives: Active surveillance (AS) is the recommended management strategy for localized, early-stage prostate cancer. Despite promising cancer-specific outcomes, up to one-third of men discontinue AS and undergo radical prostatectomy without evidence of disease progression, often because of stress, anxiety, uncertainty, and unmet supportive care needs. Evidence-based psychosocial interventions tailored to men on AS are lacking. We aimed to: (1) adapt the Stress Management and Resilience Training (SMART) program to address the unique psychosocial and supportive care needs of men with prostate cancer on AS (SMART-AS), and (2) evaluate the feasibility and acceptability of SMART-AS. Methods: Following the Assessment, Decision, Adaptation, Production, Topical Experts, Integration, Training, Testing (ADAPT-ITT) framework, we adapted SMART for men with prostate cancer on AS (SMART-AS) informed by our prior qualitative study and expert input. Next, we conducted a single-arm pilot feasibility study at one large urban academic medical center. Participants attended eight weekly 90-minute telehealth group SMART-AS sessions. Feasibility and acceptability were evaluated one-week post-intervention. Results: Based on our prior qualitative study and expert input, core SMART-AS components included content targeting stress, anxiety, communication, and self-management. In total, 30 participants were enrolled in the pilot feasibility study and completed baseline assessments (mean age = 71 years, standard deviation = 8.3); 26/30 (86.7%) completed six out of eight SMART-AS sessions, and 17/30 (56.7%) completed post-intervention assessments. Nearly all (16/17, 94.1%) reported that they would recommend SMART-AS to others. Most agreed that SMART-AS helped them talk to clinicians (13/17, 76.5%), reduced anxiety (13/17, 76.5%), enhanced coping skills for AS challenges (15/17, 88.2%), and supported self-care (15/17, 88.2%). Nearly two-thirds (11/17, 64.7%) reported SMART-AS helped them continue AS as a management strategy. Conclusions: This pilot study provides preliminary evidence supporting the feasibility and acceptability of SMART-AS among men with prostate cancer on AS. Participants reported perceived improvements in anxiety, coping, communication with clinicians, and self-management. Findings support further evaluation in a randomized controlled trial. Full article

Post cancer treatment, many young people often live with ongoing emotional, social, and physical difficulties, but support is not always accessed when it is needed. This study aimed to co-produce a conceptual model of support-seeking after cancer treatment with young people with lived experience of cancer, to better understand the triggers, timing, and pathways influencing engagement with support. This co-design work, informed by Bird et al.’s generative framework for co-production, built upon a prior study involving interviews and co-design workshops with young people and healthcare/allied health professionals, and informed a preliminary model of support-seeking. The current work involved two further co-production stages through an online survey and workshop to refine this model. Data were analysed using a thematic approach to support conceptual model development. Four interconnected themes shaped support-seeking: (1) readiness to engage: recognition, emotional readiness, and relational safety; (2) access and appraisal of support: visibility, fit, feasibility, and burden; (3) pathways to support: multi-modal, layered, and non-linear engagement; and (4) support trajectory: changing needs and recurrent engagement. Engagement in support-seeking depended on the alignment of readiness, recognition of need, and relational safety. This model offers a framework to improve how post-treatment support is designed and delivered in practice. Full article

Background/Objectives: Children with congenital long QT syndrome (cLQTS) are at extremely high risk of torsades de pointes (TdP) and sudden cardiac death (SCD). Although the implantable cardioverter-defibrillator (ICD) is a cornerstone in SCD prevention, traditional transvenous ICDs are associated with venous access occupation, lead wear or fracture due to somatic growth, and difficulties with long-term lead revision or extraction. The extravascular ICD, which places the lead in the substernal extravascular space, has the potential to circumvent these lead-related complications. We report the experience of successful extravascular ICD implantation in a young child with drug-refractory cLQTS type 2 (cLQTS2). Methods: The clinical data of a 9-year-old boy with cLQTS2 were retrospectively analyzed. The patient carried a heterozygous KCNH2 variant (c.1810G>A, p.Gly604Ser) and had been on long-term oral propranolol and mexiletine. He presented with a cardiac arrest out of hospital during nocturnal sleep, was transferred to our hospital after successful cardiopulmonary resuscitation, and had TdP captured on ambulatory monitoring. Following multidisciplinary discussion, preoperative chest computed tomography (CT) assessment of the substernal anatomy, and informed consent, extravascular ICD implantation was performed on hospital day 11. The procedure involved the creation of a substernal tunnel via a subxiphoid incision, placement of the defibrillation lead in the anterior mediastinum with lead slack reserved for growth, and positioning of the pulse generator in a left axillary subcutaneous pocket. Intraoperative defibrillation testing succeeded with a single 30 J shock. Results: The postoperative recovery was uneventful without procedure-related complications. At the 2-month follow-up, device parameters were satisfactory and no inappropriate shocks had occurred. The corrected QT interval (QTc) decreased from 563 ms on admission to 522 ms. Ambulatory monitoring detected asymptomatic episodes of non-sustained ventricular tachycardia, but no ventricular fibrillation or syncope was observed. Venous access was fully preserved. Conclusions: In children with drug-refractory cLQTS2, the extravascular ICD provides defibrillation and antitachycardia pacing (ATP) while avoiding transvenous lead complications and preserving venous access. This case shows that with precise preoperative planning and lead redundancy, the device appears feasible and can be implanted without short-term complications in young children. Larger studies with longer follow-up are needed to evaluate long-term device performance. Full article

Background/Objectives: Hypertensive disorders of pregnancy, particularly preeclampsia and eclampsia, are associated with high maternal and fetal morbidity and mortality, with maternal obesity representing a major, modifiable risk factor. This study aimed to estimate the association between obesity and preeclampsia/eclampsia (PEC) in obstetric hospitalizations in the state of São Paulo, Brazil, and to examine risk trends across maternal age groups and between two distinct temporal cohorts. Methods: This population-based observational study analyzed 2,338,934 obstetric hospitalizations using data from the Hospital Information System of the Unified Health System (SIH/SUS). PEC and obesity diagnoses were coded according to the International Classification of Diseases, 10th Revision (ICD-10). Logistic regression models were applied to estimate associations adjusted for maternal age, complemented by adjusted marginal predictions. Results: PEC occurred more than twice as often among women with obesity than without (5.4% vs. 2.2%; OR 2.13, 95% CI 1.84–2.47) and was associated with longer hospital stays (3.52 vs. 2.70 days) and higher costs (R$797.91 vs. R$602.69). The absolute risk difference between obese and non-obese women declined from 24.7% to 13.6% at age 20 between the 2017–2019 and 2023–2025 cohorts, while the relative risk gradient remained stable across all ages. Conclusions: Obesity is strongly associated with increased PEC risk, longer hospitalization, and higher costs. The observed attenuation in absolute risk differences in the most recent cohort reinforces the need for preventive interventions, nutritional surveillance, and public health policies aimed at reducing hypertensive complications during pregnancy for both obese and non-obese women. Full article

We present a unifying thesis which posits that the biological resolution of uncertainty is a fundamental adaptation to entropy’s negative impact on the highly ordered molecular structures required to maintain the living state. These molecular biological adaptations are highly conserved and play a critical role in the survival of the earliest multicellular organisms and the vertebrates thereafter. The imperative to reduce cognitive uncertainty is effected through the dopaminergic Medial Forebrain Bundle (MFB) Reward Prediction Error (RPE) mechanism, or its homologous equivalents, to compute a biological valuation of information. This hypothesis is supported by the central role of the MFB seeking system as the neural substrate of exploratory behavior that leads to the reduction of uncertainty when information is apprehended and cognitively assimilated. We define the human experience of intellectual beauty as the subjective emotional reward that is activated by the MFB seeking system. Accordingly, humans experience intellectual beauty when a high-entropy state of confusion is suddenly resolved into a low-entropy state of insight. In humans, the neuroanatomical substrates of inductive reasoning, inquiry, and the intellectual beauty to which they lead are present at birth. What develops postnatally is synaptic plasticity in the connections among these neurons that is activated in the loving didactic relationship that is established between mother and child during infancy. This dynamic is critically dependent on observational learning on the part of the child. It is supported by the joyful engagement and emotional support of the mother. This provides a paradigm of joy in learning that we propose is the developmental origin of intellectual beauty. This is the reinforcement that maintains inquiring behavior in the search for information that is needed to resist the adverse effects of entropy on life. This paper traces the continuous thread of uncertainty resolution from its phylogenetic origins in associative learning to the intuitive science of early childhood, and ultimately to the highest levels of human inquiry in science, as well as literary, musical and visual arts. The intuitive scientific method gives rise to the collective intelligence of groups, an evolved trait that likely contributed to the success of our hominin ancestors. At the societal level, this collective intelligence scales into the institutional working of markets, driving the macroeconomic price discovery of new information to counter entropy. Importantly, we compare the cost of information across the disparate domains of pharmaceutical drug discovery and the contemporary art market to demonstrate that the imperative to reduce uncertainty manifests as a universal, falsifiable mechanism for the “price discovery” of information. Full article

Mpox remains an important public health threat in several African countries, with recurrent outbreaks highlighting the need for decentralized and scalable diagnostic systems. During the 2024–2025 Mpox outbreak in Burundi, reliance on a single National Reference Laboratory limited timely diagnosis, reduced surveillance efficiency, and delayed outbreak response activities. This study describes and evaluates the implementation of a national strategy for decentralizing and expanding Mpox diagnostic capacity across Burundi. A descriptive implementation study was conducted between August 2024 and July 2025. Burundi implemented a four-phase diagnostic scale-up strategy that expanded Mpox testing services from one centralized laboratory to 56 decentralized GeneXpert-equipped laboratories, including mobile laboratory units. The implementation phases comprised strategic planning and risk mapping, pilot deployment at the national level, regional expansion, and extension to peripheral district laboratories. Key interventions included healthcare workforce training, strengthening laboratory supply chains, deployment of mobile diagnostic units, and integration of laboratory information into the national surveillance system. Program performance was assessed using indicators of laboratory network expansion, testing coverage, diagnostic turnaround time, and confirmed case detection. Following implementation, the number of operational Mpox diagnostic sites increased from 1 to 56, representing a 5500% expansion in testing capacity. National testing coverage approached 100%, substantially improving geographical access to diagnostic services. Weekly confirmed Mpox case detection increased by 496%, reflecting enhanced surveillance sensitivity and improved case identification. Diagnostic turnaround time decreased from 24–72 h under the centralized model to 2–4 h following decentralization. The expanded diagnostic network facilitated earlier case confirmation, more rapid isolation of infected individuals, strengthened surveillance activities, and accelerated implementation of outbreak control measures. The phased decentralization of Mpox diagnostics using existing GeneXpert infrastructure and mobile laboratories substantially improved testing access, reduced diagnostic delays, and strengthened outbreak response capacity in Burundi. This approach demonstrates a practical, scalable, and cost-effective model for enhancing epidemic preparedness and building resilient diagnostic systems in resource-constrained settings. Similar strategies could support improved detection and control of Mpox and other emerging infectious diseases across Africa and comparable low-resource environments. Full article

Objective: This multicenter retrospective real-world data study aimed to evaluate whether the use of a preparation containing polyphenol, vitamin D3, vitamin C, and zinc in addition to antiviral therapy was associated with symptom duration and severity, time to fever resolution, and functional recovery in children diagnosed with influenza. Materials and Methods: This was a five-center, multicenter, retrospective, comparative real-world data analysis. A total of 128 patients aged 4–10 years with a clinical diagnosis of influenza were classified into a control group receiving antiviral therapy alone (n = 64) and a combined polyphenol group receiving, in addition to antiviral therapy, a preparation containing polyphenol, vitamin D3, vitamin C, and zinc (n = 64). Clinical data were obtained from electronic patient records and parent-reported information. Symptom severity (0–3 ordinal score), recovery time, and functional outcomes were assessed on Days 0, 3, 5, and 7. Continuous variables were compared using the independent-samples t test, categorical variables using the chi-square or Fisher exact test, and changes over time using a repeated-measures general linear model. Statistical significance was accepted as a two-sided p value of <0.05. Results: In this study including 128 pediatric patients, there were no significant differences between the combined polyphenol and control groups in demographic or baseline clinical characteristics (p > 0.05). During follow-up, all symptom scores improved more rapidly and markedly in the combined polyphenol group than in the control group. By Day 3, significant differences were observed between groups in fever, cough, rhinorrhea, sore throat, fatigue, general condition, and physical activity scores (p < 0.001 for all parameters). By Day 5, almost complete resolution of symptoms (score 0) was observed in the combined polyphenol group, whereas symptoms persisted to a substantial extent in the control group (p < 0.001). The time to fever resolution was significantly shorter in the combined polyphenol group (1.84 ± 0.72 days vs. 4.5 ± 1.36 days; p < 0.001). Similarly, time to return to school (3.21 ± 0.9 days vs. 5.8 ± 1.91 days; p < 0.001) and time for parents to return to work were significantly shorter in the combined polyphenol group (p < 0.001). The need for additional healthcare visits and antipyretic use was markedly lower in the combined polyphenol group (Day 3: 20.3% vs. 53.1%; Day 5: 0% vs. 15.6%; p < 0.001 for both comparisons). Repeated-measures analyses showed a significant time-by-group interaction, indicating that the reduction in symptom scores occurred more rapidly and prominently in the combined polyphenol group (p < 0.001). Treatment was generally well tolerated in the combined polyphenol group; no serious adverse events were reported, and parent-reported tolerability was high (9.39 ± 0.7). Conclusions: This multicenter retrospective real-world data study suggests that the use of a preparation containing polyphenol, vitamin D3, vitamin C, and zinc in addition to antiviral therapy was associated with shorter symptom duration, lower symptom severity scores, and faster functional recovery in children diagnosed with influenza. These findings suggest that this combination may represent a promising and well-tolerated adjunctive approach in the management of pediatric influenza. Full article