Proceedings of the Royal Society B: Biological Sciences

Japanese encephalitis virus (JEV) is a leading cause of viral encephalitis in humans in Asia. Prior to 2021, only sporadic outbreaks had been detected in Australia's tropical northern extremes. However, during 2021-23, JEV infection was identified in 45 people and in more than 85 piggeries, together with many detections in feral pigs, mosquitoes, and other livestock across Australia, including in the temperate far south. Here we estimated the spatial extent of virus transmission during the outbreak (the realised niche) and the area environmentally suitable for transmission (the potential niche). We collated a national dataset of JEV surveillance and detection in humans, mosquitoes, domestic pigs, feral pigs, and sentinel chickens from 2021-23. We combined these data with (1) previously published predictions of habitat suitability for vertebrate host and vector species, and (2) estimated densities of humans, domestic pigs, and feral pigs, in a multipart assessment of spatial risk. Our model projected broad potential environmental suitability over much of northern and eastern Australia during the outbreak period, but floodplain wetland areas in the north and the inland east of Australia had both the highest estimated environmental suitability for transmission, and the strongest evidence for virus circulation.

Vegetation plays a critical role in shaping fine-scale tick density by structuring local microclimates, habitat resources, and host interactions that largely determine tick survival and activity, with implications for tick-borne disease transmission. Tick burden in the United States continues to increase, with annual reported tick-borne disease cases more than doubling from 2004 through 2019. These trends call for a broader scope of tick-mitigation strategies that go beyond traditional prevention measures that focus on personal protection; and there is an opportunity to inform habitat-level interventions. Here, we quantify fine-scale vegetation structure across 48 subplots at tick surveillance sites in Western Massachusetts to assess local habitat features associated with Ixodes scapularis density and potential for human-tick contact risk. In assessing understory and overstory vegetation attributes, this study identified life stage-specific differences in predicted tick density, with higher adult densities in areas with deeper leaf litter and presence of invasive plant species and nymphs associated with high presence of ferns. Both adult and nymphal Ix. scapularis were predicted at higher densities in relatively low basal area forests (18.9 to 26.9 m2/hectare). This study design provides a simple, low-cost framework for organizations looking to incorporate tick-informed forest measurement ecology into their public health tick surveillance protocols with minimal training.

Background Interruptions are common in hospital outpatient departments (OPDs) and are linked to error. Many are clinically necessary, so the aim is to regulate them. Most interventions target the individual clinician. Little is known about how doctors manage interruptions in practice or what makes their strategies work. Methods Qualitative study using focus groups and interviews with 42 doctors working in UK National Health Service OPDs (19 sessions, September to November 2025). Participants were purposively sampled by clinical experience and self-reported patient complexity. Data were analysed using Framework Analysis, informed by Cognitive Load Theory and Social Identity Theory. Results We developed four themes. (1) Pre-emptive protection of attention. Doctors withdrew, signalled unavailability and set thresholds for interrupting. These depended on colleagues learning and sharing the norm, which staff rotation eroded. (2) Sharing the burden through team coordination. Designated roles and time-limited rotas moved interruptions to colleagues with capacity set aside for them and made interrupting legitimate. (3) Real-time cognitive repair. Doctors asked interrupters to wait while they secured the task, and rebuilt the consultation on return, sometimes with the patient's help. Asking a colleague to wait depended on seniority or team membership; some trainees described difficulty doing this with senior colleagues. (4) Organisational recognition as the precondition for sustainable regulation. Where supervision was built into job plans, the interruptions it generated were expected and doctors held capacity in reserve for them. Advice, vetting and telephone queries were rarely counted as work. Conclusions Each strategy served a cognitive purpose, and social and organisational conditions decided whether it was perceived to work. Interventions could make norms shared and roles explicit, count interruption work in job plans and keep routes open for junior staff to raise concerns. Evaluations should ask who is able to use them.

Brazil experienced its worst dengue epidemic in 2024, with an increase in severe outcomes among elderly individuals, highlighting the need for vaccination strategies informed by population immunity. We reconstructed state- and age-specific immune profiles by fitting an age-structured catalytic model to dengue surveillance data from 2000-2025. This inferred immune profile was incorporated into an SIR-type transmission model to project disease burden and to evaluate the public health impact of vaccine allocation strategies. We observed substantial spatial heterogeneity in accumulated immunity, which was closely associated with projected burden and optimal allocation. Strategies prioritizing states with lower historical incidence and larger susceptible populations yielded greater benefits. Under limited vaccine supply, targeting children resulted in the greatest reductions in DALYs, whereas targeting elderly populations achieved smaller DALY reductions but larger reductions in mortality. We further showed that accelerated vaccine supply markedly increased impact, while allocation choices remained critical when availability was constrained.

Health inequalities are often examined through single axes such as class or ethnicity, obscuring how these dimensions interlock. This study applies a longitudinal intersectional approach to examine physical and mental health trajectories across five generations in the UK. We analysed 14 waves of the UK Household Longitudinal Study (2009-2024) using longitudinal Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA). We modelled SF-12 physical and mental health trajectories for 398 intersectional strata defined by gender, ethnicity, occupational class, and generation. Physical health inequalities widened with age, consistent with cumulative disadvantage, while mental health inequalities were more evident among later-born cohorts. The 'Boomer' generation exhibited a relatively flat mental health trajectory across its observed age range. In contrast, 'Generation Z' had lower predicted mental health, particularly among White British women with no work history - a group with poorer predicted trajectories than their South Asian peers. Our study shows how health inequalities are structurally differentiated by cohort and intersectional position. Policy responses should support proportionate universalism, combining broad population-level support with intensified action for groups showing poorer health.

Introduction Despite the significant burden of Shigellosis, routine surveillance systems in resource-limited settings lack predictive capabilities to guide proactive public health responses. Consequently, we developed and evaluated the accuracy, uncertainty and computational cost of multi-horizon forecasting models for Shigella incidence among children <5 years in rural western Kenya using 16-year longitudinal incidence time-series. Methods We estimated monthly Shigella incidence using data from three pediatric enteric studies (2008-2024), supplemented with Kenya Health Information System during inter-study gaps. Incidence estimates incorporated sampling, healthcare-seeking, stool-testing, and pathogen-specific weights, with bootstrap-derived 95% confidence intervals. Predictors included Google Trends health-related indicators, climate, temporal trends, and seasonality. Forecasts at 1-, 3-, and 6-month horizons were evaluated using rolling-origin validation. Following horizon-specific predictor selection using Boruta, 14 state-space, machine-learning, and hybrid models were compared using point-forecast and probabilistic metrics, bootstrap confidence intervals, and Model Confidence Sets. Adaptive conformal prediction recalibrated prediction intervals, while Shapley Additive exPlanations assessed predictor contributions. Results Mean monthly Shigella incidence was 2.51 per 100 child-years (standard deviation=1.85). Shigella dynamics in Kenya can be forecast beyond seasonal persistence alone for up to six months reducing absolute errors by ~ 33%. However, optimal model architectures and predictor sets shift systematically across forecasting horizons. Temporal trend and recent incidence were the dominant predictors, while predictor importance shifted with forecast horizon toward syndromic, pharmaceutical, seasonal, and lagged environmental signals. Extreme Gradient Boosting performed best at 1 month (Root mean squared error [RMSE]=1.86), remained competitive at 3 months (RMSE=1.89), whereas exponential smoothing (ETS) performed best at 6 months (RMSE=2.05). Forecast accuracy declined with increasing horizon. ETS and TBATS provided the best-calibrated prediction intervals, whereas machine-learning models generally under-covered. Model Confidence Sets demonstrated horizon-dependent model distinguishability. Conclusion Horizon-specific model selection balancing predictive accuracy, uncertainty calibration, and computational feasibility could strengthen operational early warning systems for shigellosis.

PURPOSE: Women with metastatic breast cancer (MBC) are at risk of developing financial toxicity due to prolonged treatment. Resilience has been identified as a key protective factor associated with better quality of life among cancer populations. However, it is unknown if resilience is associated with financial toxicity. We sought to examine the relationship between resilience and financial toxicity among women with MBC and explore whether socioeconomic factors moderate this association. PATIENTS AND METHODS: Our sample included 209 women with MBC who completed self-reported questionnaires of the Resilience Scale Specific to Cancer (RS-SC) and the Comprehensive Score for Financial Toxicity (COST). Participants (n=2) with missing data were excluded from analysis. We conducted multiple linear regression to examine the association of resilience with financial toxicity. Interaction terms were used to test moderating effects of age (18-39, 40-64 and > =65 years), race, education, health insurance, household income and employment status. RESULTS: Of the sample, 56.5% were aged 40-64 years, 76.6% were White, and 79.9% had a college or master degree or above. Women reported moderately high resilience with mean RS-SC score of 34.49 (SD = 6.67), and moderate financial toxicity (mean COST score =21.01 [SD = 10.51]). Adjusting for covariates, higher resilience was linked to better financial well-being (b = 0.37, SE= 0.11, 95% CI [0.14, 0.59], P < 0.01). Age, education and health insurance moderated this relationship, with resilience more strongly associated with better financial well-being among those aged 40-64 years, with college/master degree or above and private insurance. Race, household income, and employment status did not moderate the association between resilience and financial toxicity. CONCLUSION: Women with MBC who reported higher resilience are more likely to experience better financial well-being, but the strength of this association varied by socioeconomic factors. Further research is needed to confirm these findings. Our results have important implications for incorporating resilience into financial toxicity interventions and tailoring such interventions based on individual socioeconomic characteristics.

OBJECTIVE: To describe (1) US emergency department-treated pickleball injury burden and the injury-to-participation measure among total players, with burden among adults aged 60 to 79 years as a descriptive subgroup, and (2) determine whether general internet search interest for 'pickleball' is also associated with total pickleball-related injuries. DESIGN: Ecological time series study, United States, 2014 to 2023. DATA SOURCES: National Electronic Injury Surveillance System (NEISS) emergency department microdata yielded 1,738 adjudicated pickleball cases, 921 of them orthopedic, weighted to an estimated 101,450 injuries nationally. Google Trends, English Wikipedia pageviews, and GDELT news volume served as general pickleball attention signals, with the Trends index for 'sourdough' as a negative control. Sports and Fitness Industry Association (SFIA) participation estimates supplied a total player denominator. MAIN OUTCOME MEASURES: Annual national injury estimates with design-based 95 percent confidence intervals; injury-to-participation measures; and correlations between total pickleball-related injuries and general pickleball attention signals before and after removing trend and seasonality. RESULTS: Estimated emergency department-treated pickleball injuries rose 17.5-fold, from 1,391 in 2014 (highly unstable) to 24,294 in 2023. 70 percent of adjudicated cases involved adults aged 60 to 79. During 2017-2023, injury estimates rose 4.0-fold and participation rose about 4.4-fold. No temporal trend was detected in the injury-to-participation measure (P=0.59). Search interest looked like an excellent proxy: in annual levels it correlated with total pickleball-related injuries at R=0.96, and Pickleball Wikipedia pageviews at R=0.98. However, so did searches for "sourdough", at R=0.76. Removing trend and seasonality left little (monthly residual R=0.084; year-on-year R=0.28 over 96 months, 2015-2023), and the seasons ran opposite, with injuries peaking in February and searches in July, such that, on 12-month mean profiles, the sourdough negative control fitted the injury season (R=0.96) while pickleball ran against it (R=-0.40). General pickleball search interest and pickleball news coverage remained correlated in year-on-year changes in 2017-2023 (R=0.64), whereas their corresponding correlations with total pickleball-related injuries in 2017-2023 were 0.25 and 0.20. CONCLUSIONS: The absolute burden of emergency department-treated pickleball injury has grown substantially, but the available surveillance data cannot resolve whether the sport has become more hazardous per participant. The observed rise is consistent with growth in exposure alone. The strong correlation between search interest and injury counts was not specific, the association was substantially attenuated after detrending, and the seasonal patterns were opposed. These descriptive results do not establish that search interest can substitute for injury surveillance, and series that rise together should not be assumed to be related.

Tick-borne disease risk reflects the combined influence of vector abundance, pathogen prevalence, human exposure, and seasonal activity, yet these components are rarely integrated at the county level. We developed species-specific ecological risk scores for three medically important tick species (Acari: Ixodidae): Amblyomma americanum (L.), Dermacentor variabilis (Say), and Ixodes scapularis Say, across all 102 Illinois counties using data from 2019 to 2022. County-level predicted tick abundance and pathogen prevalence were scaled and combined using equal weights to generate primary vector-level risk scores. Robustness to the equal-weight assumption was evaluated by systematically varying the relative weights assigned to abundance and pathogen prevalence, while a separate sensitivity analysis incorporated reported tick-bite incidence where available. Associations with human disease were evaluated using negative binomial regression of tick-borne disease case counts on the corresponding risk scores, with county population included as an offset. Monthly phenology indicators were constructed by integrating human disease cases, reported tick bites, and sampled tick abundance and were evaluated in relation to temperature and precipitation. Seasonal risk was estimated by combining county-level vector risk with species-specific monthly phenology, generating monthly risk surfaces that were deployed through an interactive R Shiny application. Higher risk scores were significantly associated with greater disease case rates for each tick species. County rankings were highly stable under moderate changes in abundance and prevalence weighting. Seasonal activity differed among species, with A. americanum and D. variabilis showing concentrated warm-season risk and I. scapularis exhibiting a broader seasonal profile. These county-level seasonal risk maps identify where and when relative tick-borne disease risk is elevated in Illinois, supporting targeted prevention, surveillance, and clinical awareness.

Objectives: Health professions students often receive limited training on how to adjust their communication for patients whose first language is not English (LX), despite the risks for diagnosis, treatment, and patient trust. Based on Communication Accommodation Theory, we developed a brief module to improve students' awareness and knowledge of strategic communication adjustments for LX patients. Methods: We tested feasibility in a single-group, pre-post pilot study guided by the Kirkpatrick framework with undergraduate (n=22) and graduate (n=41) speech-language pathology and psychology students in Massachusetts and North Carolina. The module included instructional content, video and audio examples, interactive activities, and a podcast. Learning was assessed with knowledge checks, and self-reported facilitative and resistant accommodation with the Communication Accommodation Behavior Scale (CABS). After training, students rated their confidence and likelihood of using accommodation strategies. Results: At both sites, facilitative accommodation increased and resistant accommodation decreased significantly, with a larger decrease at the undergraduate site. Knowledge-check accuracy was high at both time points, suggesting a ceiling effect. Students reported moderate- to-high confidence in adapting their speech and high likelihood of using a learned strategy in future clinical encounters. Conclusions: A brief module can be feasibly delivered across institutions and is associated with short-term improvements in self-reported communication accommodation. Practice implications: We recommend future work evaluate whether these changes translate into clinical behavior long-term and refine knowledge-check items to better capture learning gains.

Background: Commercial spaceflight now carries civilians on short missions, yet their stress-axis physiology is poorly described. Earlier shuttle data suggest that sympathetic responses predominate after short flights and glucocorticoid responses after long ones. The neutrophil-to-lymphocyte ratio (NLR) is a low-cost readout of both. Methods: Preregistered secondary analysis of open clinical laboratory data (NASA Open Science Data Repository OSD-569 and OSD-575) from the four Inspiration4 crew members, each sampled seven times: three draws before launch, one the day after return (R+1) and three during recovery (R+45 to R+194). Log-transformed NLR was modelled with a linear mixed model with a random intercept per crew member and Kenward-Roger inference. Lymphocyte and eosinophil counts and C-reactive protein were secondary outcomes with false discovery rate correction. Results: All 28 draws were analysed. NLR at R+1 did not differ from pre-flight (fold change 1.04; 95% CI 0.81 to 1.34; p = 0.73); two crew members increased (+25% and +46%) and two decreased (-27% and -11%). During recovery NLR was 23% lower than pre-flight (fold change 0.77; 95% CI 0.64 to 0.92; p = 0.005). No secondary outcome changed after correction; lymphocytes were 18% lower at R+1 (95% CI -35% to +4%; q = 0.31). Between-person differences explained 58% of the variance. An ordinary regression ignoring repeated measures missed the recovery effect (p = 0.08). Conclusions: A 3-day orbital flight produced no consistent leukocyte stress signature one day after return. The lower NLR during recovery suggests that pre-flight values, not recovery values, deviate from the resting state, which has implications for how baselines are defined in short-duration spaceflight studies.

Financial well-being (FWB) encompasses objective and subjective financial status and may influence health. We developed and validated a parsimonious FWB index using data from 23,006 Health and Retirement Study (HRS) participants aged 50 years and older from 2006 to 2022. The FWB-5 Index was derived using correlated two-factor confirmatory factor analysis accounting for household clustering. Indicators included household wealth, household income-to-poverty ratio, monthly financial strain, satisfaction with one's financial situation, and perceived financial mastery. We assessed convergent and discriminant validity using the Consumer Financial Protection Bureau Financial Well-Being (CFPB-FWB) Scale and Satisfaction with Life Scale, respectively. Associations with pre-baseline socioeconomic factors and subsequent depressive symptoms and health conditions were examined to assess construct and predictive validity. Model fit indices supported the two-factor structure (robust comparative fit index = 0.99; robust root mean square error of approximation = 0.05). Correlations were stronger with the CFPB-FWB Scale (Spearman P = 0.80) than with life satisfaction (Spearman P = 0.43). Associations with socioeconomic factors and subsequent health outcomes were in the hypothesized directions. These findings support the FWB-5 Index as a parsimonious measure for examining financial well-being and its associations with health across HRS waves, including those predating the CFPB-FWB Scale.

Wolbachia-based interventions were less effective in achieving introgression in Rio de Janeiro than other settings. Reduced introgression occurred in locations where dengue was historically high, raising concerns of inequity. We examined factors affecting Wolbachia introgression in Rio through trajectory modeling, spatiotemporal Bayesian models, and Ae. aegypti abundance estimation. During the intervention (2017-2020), Wolbachia introgression was 26% (median; IQR,14-44%), with four distinct trajectories. Despite receiving more releases, densely populated areas with low socioeconomic status had lower introgression. In spatiotemporally explicit multivariable regressions, higher Ae. aegypti abundance, temperature, population density and lower socioeconomic status were associated with reduced introgression. Improved characterization of Ae. aegypti abundance and other structural/environmental predictors of introgression could be used to calibrate release doses to ensure equitable benefits from Wolbachia interventions.

Objective. Temperature readings are routinely stratified by race and ethnicity, though significant group differences may reflect physiology, instrument noise, or categorization rather than biology. This study tests whether these categories partition facial infrared thermography measurements beyond individual variation and baseline device noise. Approach. A secondary analysis of thermography data (n = 951 adults) compares inner-canthus maximum (TCEmax) and full-face maximum (Tmax) temperatures across five administrative categories via one-way analysis of variance (ANOVA), mixed-effects modeling, Bland-Altman analysis against oral reference, and Monte Carlo sensitivity analysis. Main results. ANOVA returns significant group differences (p < 0.001; eta-squared = 0.04 for TCEmax, 0.03 for Tmax), but the total spread (0.2 to 0.3 degrees Celsius) is comparable to device accuracy and within-subject variability. Individual variation accounts for 95% of TCEmax variance, and adding simulated Gaussian noise to participant-level temperatures (sigma = 0.10 to 0.30 degrees Celsius) preserves the complete group-mean rank order in as few as 37.5% of iterations. Significance. Testing whether a group difference survives perturbation at the scale of instrument accuracy offers a check against treating significance alone as evidence of physiology. Here, observed group differences are small relative to measurement variability, and their physiological interpretation remains uncertain, with implications for clinical tools that treat administrative categories as biologically meaningful.

We develop an age- and immunity-structured COVID-19 model with setting-specific contacts, calibrated to Ontario incidence and hospital admissions before Omicron. We simulate counterfactual vaccination strategies and contact restrictions in schools, workplaces, and other community settings, evaluating projected severe-case demand against an illustrative healthcare-capacity benchmark. Vaccination combined with workplace and community contact restrictions keeps simulated demand within capacity. In contrast, relaxing restrictions in either setting produces large surges and repeated capacity threats, even when school restrictions remain. School-only changes produce smaller effects on severe disease. These findings highlight the value of vaccination and setting-specific contact restrictions that prioritize workplace and community settings for pathogens with adult-concentrated severe outcomes.

Recent industry surveys have reported widespread concern about mental health, working conditions, and harassment in the UK film and television industry, but no peer-reviewed empirical study has examined the determinants of occupational burnout in this workforce. The present study tested whether physical health, mental wellbeing, perceived public stigma, intrinsic job quality, and sexual harassment exposure predict burnout in industry professionals. A cross-sectional online survey was completed by 415 individuals across more than 100 job titles, with 286 also completing an optional harassment module. Mental wellbeing sat well below population norms, with 68% scoring in the range indicative of probable depressive symptoms and 82% in the high-exhaustion range on the Maslach Burnout Inventory General Survey. Mental wellbeing and intrinsic job quality were the strongest predictors of burnout (R2 = .56), with meaningfulness accounting for most of the job-quality effect. Working hours independently predicted emotional exhaustion. Harassment exposure was associated with burnout in women but not men, approximately 30% mediated by mental wellbeing; sexist behaviour directly predicted exhaustion in women. Workers with a disability reported higher stigma. Burnout was strongly associated with intent to leave, and the findings collectively indicate an industry-wide occupational health concern requiring structural rather than individual-level intervention.

Background. Nigeria's reported Lassa fever case fatality ratio (CFR) rose from 18.9% at week 23 of 2025 to 25.0% in 2026, prompting concerns over failing clinical care. Because surveillance artefacts can also alter CFRs, candidate mechanisms that published data can resolve were identified and evaluated. Methods. This ecological study extracted weekly state-level counts from 474 Nigeria Centre for Disease Control and Prevention situation reports (2017-2026). Per a pre-specified plan, years were compared at phase-matched points, year-on-year CFR changes were decomposed into within-state and between-state components, and tipping-point ascertainment shifts calculated. Weekly incident and cumulative published totals were compared post hoc. Findings. Of 11 candidate mechanisms, 2 could be evaluated fully and 5 in part. On weekly incident counts, 2026 did not differ from 2025 at the phase-matched midpoint (+0.3 percentage points, 95% CI -5.0 to 7.6); within-state (-1.1, 95% CI -4.7 to 3.0) and between-state (+0.5, -2.0 to 2.9) components spanned zero. Conversely, the published cumulative CFR was 5.4 to 6.2 percentage points higher because 70 deaths were added retrospectively by week 36 outside weekly reports. Reconciling cumulative figures would require 279 missed survivors (6% of suspected cases not confirmed). Interpretation. The 2026 CFR rise came from deaths added to cumulative totals outside the weekly counts, and published data cannot attribute it to care. Endemic zoonotic CFRs cannot serve as clinical outcome measures unless testing volumes, deaths added late, and post-mortem sampling are published alongside case counts. Funding. US NSF-NIH-NIFA EEID; UK BBSRC; Birgitta Sintring Fellowship (Uppsala University).

Purpose: To compare the performance of three large language models (LLMs), ChatGPT-o1, Grok 3, and Gemini 2.0 Pro, on the American College of Prosthodontists' National Prosthodontic Resident Examination (NPRE). Materials and Methods: Official NPRE examinations from years 2015-2024 were retrieved from the American College of Prosthodontists website and used to prompt each LLM. Paid access tiers and advanced reasoning were enabled. Responses from LLMs were recorded and compared against the official answer keys for accuracy, variability across years, and consistency of responses. Duplicate questions were retained for the primary analysis and removed in a sensitivity analysis. Accuracy (percent correct) was compared using generalized estimating equations binary logistic regression (primary); Cochran's Q with Bonferroni-adjusted McNemar tests (sensitivity). Year-to-year variability (SD of annual accuracy) was compared using weighted Levene tests. Consistency across duplicate items was quantified as the percentage of perfect matches and compared using Cochran's Q with Bonferroni-adjusted McNemar tests. Results: Across 1,487 questions, overall accuracy differed among models (global P < 0.001). ChatGPT-o1 achieved 78.4% correct, Grok 3 76.4%, and Gemini 2.0 Pro 73.2%; ChatGPT-o1 and Grok 3's accuracy significantly exceeded Gemini 2.0 Pro (both P [&le;] 0.016), with no significant difference between ChatGPT-o1 and Grok 3 (P = 0.099). After removing duplicates (n = 1,200), results were similar: ChatGPT-o1, Grok 3, and Gemini 2.0 Pro were 77.1%, 76.6%, and 71.5% correct, respectively; ChatGPT-o1 and Grok 3's accuracy was significantly higher than Gemini 2.0 Pro (both P < 0.001). Variability across years did not differ significantly (P [&ge;] 0.097). Grok 3 showed significantly higher perfect-match consistency (79.2%) than ChatGPT-o1 (69.4%) and Gemini 2.0 Pro (64.5%) (P [&le;] 0.010). Conclusions: Contemporary LLMs showed 70-80% accuracy on postgraduate prosthodontic multiple-choice content. While promising for educational support, residual error and inconsistency warrant human oversight and transparent methods reporting before curricular adoption.

Purpose To assess whether follow-up MRI, biopsy status, and timing of cribriform disease detection predict active surveillance (AS) failure in a contemporary transatlantic cohort. Materials and Methods. Retrospective MRI-driven AS cohort of 619 men at two academic centers (UK/USA), 2012-2024. Primary outcome: AS failure (disease-specific mortality, metastasis, grade group [GG] [&ge;]4 progression, or post-treatment biochemical recurrence). Key exposures: final MRI and biopsy status, timing of cribriform [&ge;]GG2 detection. Cumulative incidence was derived; independent predictors used multivariable Fine-Gray models. Results. Over median follow-up of 6.4 years, 39/619 men (6%) experienced AS failure. Cribriform [&ge;]GG2 was detected in 82/619 (13%) on follow-up biopsy versus 24/619 (4%) at baseline, comparably in baseline GG1 (10%) and non-cribriform GG2 (9%), and only in MRI-visible tumors. Three-year AS failure after final biopsy was 31% in men with cribriform [&ge;]GG2 versus 0-2% with stable or non-cribriform disease; 44% of failures had stable MRI. On Fine-Gray analysis, cribriform [&ge;]GG2 was the only independent predictor of AS failure in re-biopsied men (SHR 30; 95% CI 5.2-167; P<0.001); no type of MRI progression category was independently predictive. Among 595 men cribriform-negative at baseline, 6-year AS failure after a second biopsy was 34% if cribriform [&ge;]GG2 was detected versus 7% if still cribriform-negative. Conclusions. Cribriform status at follow-up biopsy independently predicts AS failure, whereas MRI progression does not. The three-fold higher cribriform prevalence at follow-up likely reflects baseline sampling error. Because newly detected cribriform tumours were exclusively MRI-visible, early repeat biopsy of patients with MRI-visible disease may considerably improve risk stratification.

Background: Workplace discrimination and violence against health workers including sexual harassment is a societal problem worldwide. We aimed to assess the frequency, predictive factors, and effects of sexual harassment using a nationwide survey of physicians working in Switzerland. Materials and Methods: We conducted a self-administered questionnaire survey of physicians working in Swiss healthcare institutions. The questionnaire assessed experiences of sexual harassment at work, including frequency, types, and sources of harassment. It also asked about the impact of sexual harassment, whether incidents were reported, and what actions were taken following a report. Results: Among the 1837 physicians that participated in the survey, 575 (31.3%) had experienced sexual harassment at least once during their career. Among those reporting sexual harassment, 39.1% of women and 13.2% of men had experienced harassment at least once in their job. Women reported more verbal harassment, while men reported more physical harassment. Women were also more likely to face both forms combined. The main sources of harassment were colleagues of the same profession (46.7%), patients (42.3%), and superiors (41.0%). The most frequently reported impacts included stress (60.1%), emotional exhaustion (34.7%), reduced motivation at work (30%), and considering leaving the job (7.5%). Gender-men was associated with a lower likelihood of experiencing harassment 0.24 (0.18 to 0.31), whereas working in the German-speaking region was associated with a slightly higher likelihood of having experienced sexual harassment at least once (OR 1.35, 95% CI:1.02-1.81). Conclusions: Sexual harassment is common among physicians in Swiss healthcare institutions. It adversely affects the mental health and career trajectories of both men and women yet remains widely underreported due to fears of reprisals and inaction. Institutions should effectively intervene to ensure that reported incidents result in appropriate actions, and that those who report them receive adequate protection from reprisals.