Low-dimensional representation and clustering of network data are tasks of great interest across various fields. Latent position models are routinely used for this purpose by assuming that each node has a location in a low-dimensional latent space and by enabling node clustering. However, these models fall short through their inability to simultaneously determine the latent space dimension and number of clusters. Here we introduce the latent shrinkage position cluster model (LSPCM), which addresses this limitation. The LSPCM posits an infinite-dimensional latent space and assumes a Bayesian nonparametric shrinkage prior on the latent positions’ variance parameters resulting in higher dimensions having increasingly smaller variances, aiding the identification of dimensions with non-negligible variance. Further, the LSPCM assumes the latent positions follow a sparse finite Gaussian mixture model, allowing for automatic inference on the number of clusters related to non-empty mixture components. As a result, the LSPCM simultaneously infers the effective dimension of the latent space and the number of clusters, eliminating the need to fit and compare multiple models. The performance of the LSPCM is assessed via simulation studies and demonstrated through application to two real Twitter network datasets from sporting and political contexts. Open-source software is available to facilitate widespread use of the LSPCM.

Creatine is a vital bioenergetic compound that remains largely overlooked within food systems despite its well-established role in human health and performance. Unlike creatinine – a downstream breakdown product of creatine metabolism commonly measured as a biomarker of kidney function – creatine functions as an energy buffer, facilitating the rapid regeneration of ATP in tissues with high metabolic demands such as skeletal muscle, brain and heart. Although a portion of daily creatine requirements is met through endogenous synthesis, dietary intake – primarily from animal-source foods – remains essential to maintain optimal physiological levels. Emerging evidence indicates that suboptimal creatine status, or creatine insufficiency, may be widespread, particularly among vegetarians, vegans, older adults, individuals with chronic illness and those with increased energy needs. This paper examines the evolving role of creatine across four domains: its natural occurrence in foods, incorporation into fortified food products, use as a dietary supplement and potential future classification as a pharmaceutical agent. Special emphasis is placed on differences in regulatory status, intended use, dosage, labelling and public health implications. In light of mounting evidence that creatine insufficiency may contribute to adverse outcomes – including impaired cognition, reduced muscular performance and vulnerability to stressors – integrating creatine into food policy and nutrition strategies represents a promising, scalable and preventive approach to improve population health.

Rural primary care providers report increasing rates of professional burnout, which can further exacerbate rural provider shortages and health disparities. From 2023 to 2025, the Project ECHO team at Penn State University developed and delivered an educational rural health telementoring program, collaboratively with stakeholders, to disseminate guideline-concordant care to rural primary care clinicians. The program focused on key rural topics and created a professional learning community aimed at decreasing participant burnout. Self-reported results of the pilot program’s participants (n = 106) demonstrate increased knowledge (p < .001) and reduced professional isolation. Future programing will expand data collection to explore longer-term impact.

This study evaluated the effect of different medium-chain to long-chain fatty acid (MCFA:LCFA, M:L) ratios on growth performance, intestinal function, antioxidant capacity and gut microbiota in piglets. A total of 250 piglets were randomly assigned to five groups with five replicates, each containing ten pigs. The diets, containing varying amounts of MCFA-rich coconut oil and LCFA-rich soyabean oil, resulted in M:L ratios of 0, 2·1, 4·2, 8·8 and 33·8 %. Results showed that both final body weight and average daily weight gain increased as the M:L ratio increased (P < 0·05), while the 8·8 % M:L ratio diet exhibited the lowest feed:gain ratio (P < 0·05). As the M:L ratio increased, the contents of superoxide dismutase and glutathione peroxidase were increased, and MDA was decreased in serum (P < 0·05). The 8·8 and 33·8 % M:L diets improved ileal and jejunal morphology (P < 0·05), as indicated by greater villus height and villus height:crypt depth ratios. Furthermore, increasing M:L ratios from 0 to 33·8 % increased expression of tight junction proteins occludin and ZO-1 in the jejunum (P < 0·05). The 33·8 % M:L ratio reduced microbial α-diversity (P < 0·05), while 8·8 % M:L diet significantly increased the abundance of beneficial bacteria (e.g. Lactobacilli, Prevotella) and decreased harmful bacteria (e.g. Escherichia-Shigella, Enterococcus) in the cecum (P < 0·05). In summary, our study found that 8·8 % of dietary M:L ratios significantly improved growth performance, likely through modulating intestinal function, antioxidant activity and gut microbial composition.

Functional referral systems are critical to primary health care and universal health coverage. Referral and counter-referral are key relational mechanisms to link communities to the care they need and primary care to secondary and multi-sectoral services. Many referral systems are fragmented, leading to inefficiencies, coverage gaps, and compromised continuity and quality of care. In June 2024, we conducted a scoping review of PubMed, Global Index Medicus and WHO publication databases to identify referral coordination and process initiatives at national, subnational, and local levels.

We classified reports from 181 papers into non-exclusive categories based on referral system design, operational elements, service delivery platform, and/or user group. Initiatives targeting referral system design included modelling, organization and assessment methodologies. Initiatives focusing on operational elements included networks and linkages, pathways and algorithms, e-referral systems and platforms, digital processes and tools, and facility-level processes and tools.

When classified by service delivery platform, community-level initiatives emphasized improved recognition, screening, diagnosis, and communication by community health workers and use of SMS text messaging or mHealth apps. At initiating facilities, reports focused on standardizing referral criteria and protocols and optimizing communication with referral facilities, including for real-time clinical decision-making to improve timely referral and to reduce under- and over-referral. Structured algorithms and pathways were key to minimize the time between referral, diagnosis, and treatment for time-sensitive conditions. At receiving facilities, actions included supporting initiating facility clinical decision-making prior to referral, prioritizing urgent cases, and consistent counter-referral and/or onward referral.

Findings are informing WHO guidance on two-way referral systems.

Dieting is a global emerging trend in recent years as more people strive to adhere to food restriction plans for weight management in obese people and to achieve desired slim body. This strategy may have unforeseen repercussions in females that may affect reproductive potential. Therefore, we aimed to investigate the impact of dietary stress on reproductive hormone levels, histoarchitecture of the ovary, autophagy and apoptosis markers in the rat ovary. Data suggest that dietary stress caused due to food deprivation decreased body weight and ovary weight, luteinising hormone, follicular-stimulating hormone and estradiol-17β levels. The dietary stress reduced the number of primary follicles, altered the histoarchitecture of the ovary, increased number of fragmented and irregularly shaped oocytes. Dietary stress induced autophagy signalling by inhibiting mammalian target of rapamycin and increasing Lamp-1, LC-3 and Beclin-1 in the ovarian follicles. In addition, dietary stress induced proapoptotic signalling pathway by decreasing Bcl-2 and increasing Bax as well as cytochrome-c expressions in the ovary. Taken together, these findings suggest that dietary stress caused due to food deprivation reduced reproductive hormones levels, induced autophagy and apoptotic signalling pathways that affected histoarchitecture of the ovary, ovarian function, oocyte quality and thereby reproductive potential.

The high incidence of new cases of anxiety disorders highlights the need for scalable preventive interventions, which can be achieved through information and communication technologies. To our knowledge, no meta-analysis has been conducted to evaluate purely digital preventive interventions for anxiety in all types of populations. The aim of this study was to assess the effectiveness of digital interventions for the prevention of anxiety disorders. Systematic searches were conducted in six electronic databases (PubMed, PsycINFO, EMBASE, Web of Science, OpenGrey, and CENTRAL) from inception to December 12, 2024. Inclusion criteria for the studies were as follows: (1) randomized controlled trials (RCTs), (2) psychological or psychoeducational digital interventions to prevent anxiety, and (3) all types of populations without anxiety at baseline of the study. A total of 15 studies (19 comparisons; 6093 participants) were included in the systematic review. One study was identified as an outlier and was therefore excluded from the meta-analysis. The pooled analysis showed a small effect in favor of preventive interventions among non-anxious and varied populations (standardized mean difference = −0.32, 95% confidence interval: −0.44 to −0.20; p < 0.001). Sensitivity analyses supported the robustness of this finding. We found no evidence of publication bias. Heterogeneity was high, however, a meta-regression that included one variable (country, the Netherlands) explained 100% of the variance. All RCTs, except two, had a high risk of bias, and the quality of the evidence, according to Grading of Recommendations Assessment, Development, and Evaluation, was very low. There is a need to develop and evaluate new digital preventive interventions with a rigorous methodology.

This Perspective article addresses the issue of recovery in mental health research, policy and practice from a service user/survivor perspective. In doing so, it brings to bear a fundamentally different viewpoint to that which has dominated psychiatric history, one based on lived experience rather than the ideological allegiances of its founders. The article addresses the modern history of Western mental health provision, its over dependence on medicalised individual understandings of wellbeing, the limitations this has imposed and the challenges it has been subjected to. The issue of recovery is examined in its historical context, exploring its strengths and weaknesses. The latter weaknesses have been magnified by the association of recovery by different governments, nationally and internationally, with pressing mental health service users and others experiencing distress into employment; this is often poor quality and unsupported employment. The article puts this in the broader context of a number of values and principles underpinning both the developing psychiatric system survivor movement and the emerging international interest in Mad Studies. In doing so, the article offers a basis for the radical reform of both understandings of madness and mental distress, recognition of their holistic relations and more helpful routes to offering support and engaging with the lived experience and experiential knowledge of mental health service users.

Research participants should be informed of genetic test results that could impact their health, particularly when they have expressed interest in receiving such information. Furthermore, the return of genetic test results is essential to improve trust, transparency, and health equity. However, investigators often encounter barriers in returning genetic test results to research participants. We examined genomic research at a large, research-intensive medical school and found less than 6% of protocols included plans to return results to participants. This study describes our development of protocols for returning primary and secondary genetic test results and implementation of a Genomic Return of Results (gROR) service. This arose through a collaboration with experts in community engagement, genetics, and pathology to consider consent adequacy, analytical/clinical validity, and clinical utility when returning results. The gROR service reduces investigator burden and provides participants with genetic information and guidance to address any potential health risks. Genetic results are returned by a genetic counselor at no cost to participants or their family. Investigator costs are subsidized to incentivize the delivery of actionable genetic test results to research participants. Our approach prioritizes transparency, accessibility, and informed decision-making, thereby promoting equitable sharing of genetic knowledge and personalized healthcare interventions.

Intrinsic capacity, introduced by the WHO, represents a shift in focus from treating disease to maintaining physical and mental capacities individuals as they age. It encompasses five interrelated domains: vitality, sensory, cognition, psychology, and locomotion. Vitality refers to the body’s physiological reserve and is shaped by processes such as energy metabolism, immune function, and neuromuscular integrity. By definition, vitality is closely linked to nutritional status, which plays a central role in maintaining resilience and health in older adults. However, integrating nutritional status into the vitality domain presents several challenges due to inconsistent definitions and varied measurement approaches. This review examines these challenges and explores possibilities for integrating nutritional status in the vitality domain. The absence of standardised nutrition-related indicators limits comparability across studies and constrains the practical application of intrinsic capacity in both research and clinical contexts. To strengthen the role of intrinsic capacity in nutritional monitoring, it is essential to reach consensus on which nutritional indicators to include and how to score them consistently. Addressing these methodological challenges will support the use of intrinsic capacity in identifying early signs of nutritional decline and guiding timely interventions to promote healthy ageing.

This study aimed to investigate the effects of caffeic acid (CA) on the inflammatory response induced by hydrogen peroxide (H2O2) in porcine small intestinal epithelial cells (IPEC-J2 cells) and to elucidate the potential molecular mechanisms involved. Firstly, we treated IPEC-J2 cells with different concentrations of H2O2 to establish the inflammation model caused by oxidative stress. Subsequently, we treated IPEC-J2 cells with CA and/or H2O2 to investigate the effect of CA on the inflammatory response of IPEC-J2 cells induced by H2O2. In addition, IPEC-J2 cells were treated with a nuclear factor kappa-B (NF-κB) inhibitor and a Nucleotide-binding Oligomerization Domain (NOD)-like receptor thermal protein domain associated protein 3 (NLRP3) inhibitor, so as to investigate the molecular mechanism by which CA alleviates H2O2-induced damage in porcine intestinal epithelial cells. The changes in cell morphology, intestinal epithelial cell damage and the expression of genes related to the NF-κB/NLRP3 signalling axis were examined. The results showed that CA attenuated H2O2-induced intestinal epithelial cell injury, and the mechanism may be related to the inhibition of NF-κB-mediated NLRP3 inflammasome activation. These findings were expected to provide a theoretical basis for more reasonable and effective application of CA, and provide new ideas for nutritional regulation measures to alleviate intestinal inflammation in piglets.