Establishing causality in nutritional science is difficult. Human diets are complex, and individuals vary substantially in how they respond to dietary exposures. The nutrition literature mostly relies on observational studies, which are vulnerable to confounding and measurement error. Twin-based randomized controlled trials (RCTs), especially the co-twin control design, offer a compelling methodological solution to many of these challenges. This design enables researchers to distinguish genetic from environmental influences on health outcomes. The present scoping review was conducted to systematically map twin RCTs in nutrition science, evaluate their methodological approaches, and identify gaps and opportunities for future research. A comprehensive search across clinical trial registries and electronic databases yielded only 13 eligible studies, demonstrating that co-twin randomized dietary interventions remain rare relative to standard study designs using nontwins or twins assigned to the same arm. The interventions used in these eligible RCTs could be classified into four groups: dietary pattern interventions, nutrient- or supplement-based interventions, dietary component modification, and behavioral or multimodal interventions. This limited number of studies may be explained by recruitment challenges and concerns about generalizability. Greater international collaboration, standardized trial protocols, and integration of emerging technologies could expand the utility of twin designs in nutrition science.

In an effort to conceptually replicate prior work on persuasion and campaign effects, we conducted three randomized survey experiments to evaluate the persuasive effects of political advertisements during the 2025 Canadian federal election. We tested a total of 15 campaign advertisements on 3,346 respondents. Our results are consistent with what seems to be three robust findings about the effects of campaign advertising: (1) they can change candidate evaluations and vote intentions, but (2) the effects are very small, and most importantly, (3) persuasive treatment effects seem to be mostly homogeneous. We offer new empirical evidence that strengthens previous findings on the homogeneity of persuasive treatment effects of political advertising in Canada that challenges the extent to which microtargeting improves candidates and advocacy groups’ ability to sway public opinion.

This paper investigates the conditions under which women are more likely to represent interest groups in parliamentary hearings, shifting attention from the content of advocacy to the identity of advocates. While existing research has focused on how interest groups gain access to legislative venues, it has largely overlooked who delivers these messages and how messenger characteristics shape political representation. Drawing on theories of gender representation, interest group advocacy, and source effects, we develop a framework that distinguishes between structural and strategic representation and examine whether gender is deployed as a symbolic and relational resource in legislative settings. Using an original dataset covering all interest group appearances in the Spanish Parliament from 1996 to 2023, and hierarchical logistic regression models with Bayesian inference, we analyze how organizational, institutional, and contextual factors shape gendered representation. The findings show that citizen groups are significantly more likely than economic organizations to be represented by women, and that female representation increases with the proportion of women MPs on parliamentary committees. Gendered patterns also vary across policy domains and hearing characteristics. Importantly, the results provide evidence consistent with strategic adaptation: interest groups appear more likely to select female representatives in gender-diverse institutional environments, suggesting that gender functions as a form of strategic signaling rather than solely reflecting internal organizational structures. These findings contribute to research on interest groups and political representation by highlighting how identity operates as a political resource, with implications that extend beyond parliamentary lobbying to broader debates on descriptive and substantive representation.

There is limited research into the experiences and impact on wellbeing, of laypersons informally supporting people seeking asylum (PSA) within the United Kingdom. This study addresses this topic within the context of the Bibby Stockholm barge. An interpretivist philosophical paradigm and qualitative strategy were employed. A combination of purposive and snowball sampling was utilized in recruiting nine participants aged 50–80, six male and three female, and all of Caucasian ethnic origin. Data were collected using semi-structured one-to-one interviews and analyzed using Thematic Analysis. Three themes emerged. First, Participants situated their motivations to volunteer within the context of social justice, informed by previous life experiences, personal morals and a reaction to the sociopolitical context PSA are forced to navigate. Second, volunteers’ experiences reflected the interactions of community. To this end, community is considered as an ever-changing “machine” where processes such as welcoming, loss and belonging form the cogs, which drive its evolution. Finally, volunteers described the way their experience affected their wellbeing—the wellbeing equation. Overall, volunteers described an overwhelmingly positive experience and provide accounts of experiencing increased wellbeing. However, volunteers also faced challenges damaging to wellbeing, employing protective mechanisms to mitigate these. This relationship between volunteering with PSA and wellbeing is summarized in the development of a revised conceptual framework contextualizing the effects of volunteering on volunteer health and wellbeing. The future application of this framework across different voluntary fields may improve understanding of what it means to volunteer and thus universal volunteer retention and outcomes.

Background: Substance use disorders (SUDs) disproportionately affect pregnant and parenting persons in the United States. Long term residential programs (RTPs) provide comprehensive, structured care that improves pregnancy and neonatal outcomes. However, shared living environments that include young children increase vulnerability to respiratory virus transmission, and evidence to guide infection prevention and control (IPC) in RTPs is limited. In December 2024, an RTP in the northeastern United States housing 13 parenting persons with 15 children experienced an outbreak of respiratory syncytial virus among children, resulting in 14 symptomatic cases, 7 laboratory-confirmed infections, and 5 hospitalizations. This study aimed to identify barriers to and enablers of IPC practices among RTP residents and staff to inform interventions tailored to this unique setting. Methods: In November 2025, we conducted six focus groups at the RTP: three with residents and three with staff. Due to Institutional Review Board restrictions, sessions were not audio-recorded; instead, a trained scribe captured detailed field notes. Data were analyzed using conventional thematic analysis, guided by the Capability, Opportunity, Motivation, and Behavior (COM-B) model. Results: Thirteen of 14 residents and 18 of 25 staff participated. Three overarching themes were identified. First, IPC capability was fragmented. Both residents and staff recognized the role of IPC in reducing respiratory virus transmission. However, residents primarily relied on social media and internet sources for information, while staff relied on guidance from healthcare professionals. Misunderstanding and absence of standardized, facility-level IPC policies led to confusion regarding appropriate cleaning/disinfecting practices and adherence to isolation/quarantine criteria. Second, IPC opportunity was constrained by contextual and structural barriers. Residents entered the program from diverse living situations, resulting in divergent interpretations of IPC norms, including hand hygiene and environmental cleaning. Shared spaces, reliance on resident-performed cleaning without consistent supervision or accountability, lack of commercial cleaning services, and inconsistent enforcement of cleaning and isolation procedures limited effective IPC implementation. Third, IPC motivations were misaligned. Staff viewed IPC practices as opportunities for life-skills development, whereas residents often perceived cleaning and isolation measures as stigmatizing or punitive, negatively affecting symptom disclosure and IPC practice adherence. Conclusions: Although IPC practices in RTPs aim to prevent illness among residents and children, implementation is hindered by knowledge gaps, structural constraints, perceived stigma, and misaligned motivations. These findings underscore the need for clear, standardized policies and trauma-informed, public health–focused IPC strategies. IPC professional societies are well positioned to develop context-specific guidance for this understudied residential setting.

Wing shape is integrally related to flight performance and function in extant animals. Analyzing this relationship in pterosaurs is complicated by the fragmentary nature of the fossil record and because the flight dimensions of wing membranes do not preserve. In the absence of fully extended pterosaur wing fossils, scientific reconstruction of the pterosaur Bauplan presents the clearest alternative for analysis. However, these wing shapes are subject to multiple conflicting scientific opinions and the artistic styles of the researchers and illustrators reconstructing them. Here we test the functional ramifications of different wing-shape reconstructions. We use theoretical morphospace analysis to establish whether modern reconstructions of pterosaur wings exhibit the diversification and functional performance expected of living animals. Pterosaur wing reconstructions show little by way of taxonomic separation either in shapespace or functional performance, with all pterosaur groups overlapping independent of time, size or proposed niche. This suggests that published pterosaur reconstructions underestimate the diversity of wing shapes expected of such a diverse group and are not reflective of flying animals. Stylistic approaches have little effect on the occupation and diversity of pterosaur reconstructions, suggesting that the underpinning issues lie in the lack of scientific consensus on the shape and structure of the wings, rather than how they are reconstructed.

Background: Environmental hygiene (EH) plays a critical role in reducing healthcare-associated infection (HAI) risk, yet significant variability persists in hospital patient room cleaning and disinfection. While discharge cleaning compliance is frequently studied, real-world practices during daily occupied patient room cleaning remain poorly characterized. Furthermore, the time to complete Environmental Services (EVS) tasks is rarely reported in published literature, despite being linked to budget, facility throughput, and patient and employee satisfaction. Researchers conducted a multi-hospital, observational study about environmental cleaning processes. Methods: Across 3 large (<500 beds) teaching hospitals in 3 distinct US regions, researchers shadowed EVS technicians during daily and discharge patient room cleaning across diverse ward types. Direct practice observations documented total turnover time, time to complete tasks such as cleaning the patient and bathroom room surfaces, floor mopping and non-disinfection tasks using a standardized data collection tool (Figure 1). Cleaning compliance was also measured via visual assessment, defined as wiping a surface with a disinfectant wipe or cloth. Results: A total of 638 daily and 91 discharge cleans were evaluated. The average occupied daily room turnover time was 9 minutes. However, square footage, isolation needs, in-room equipment and EVS expectations varied across unit types and individual facilities. For daily occupied room cleaning, on average, more time was spent on non-disinfection tasks like removing waste, refilling consumables and patient engagement (see Table 1). High-touch surface (HTS) cleaning compliance during daily cleans was low (38–48%), whereas floor mopping occurred in <90% of rooms. Site Z spent approximately twice the average time performing a daily room clean compared to Sites X and Y, however, did not achieve greater than 50% HTS cleaning compliance. Discharge cleaning demonstrated markedly higher HTS compliance (87–92%) and longer average duration (Table 2). Conclusion: To date, EH research has been focused on cleaning compliance measured by fluorescent marking, ATP swabbing and/or environmental culturing. Less research, however, is available regarding daily occupied patient room cleaning and the time and resources needed to do it successfully. Our research revealed that EVS technicians across 3 large hospitals spent an average of 9 minutes on daily room cleaning and only a third of that time spent using a disinfectant. Many healthcare disinfectants used by EVS have a contact time of 5 minutes or more. Healthcare leadership should have realistic expectations of what can be accomplished in budgeted cleaning time and the impact of time on disinfectant efficacy, regulatory compliance and infection prevention.

Background: Central line-associated bloodstream infections (CLABSIs) remain a significant source of preventable harm in hospitalized patients, often resulting from missed dressing changes and mislabeled tubing. Research indicates that most CLABSIs occur more than five days after catheter insertion, highlighting the importance of maintenance practices. This project, conducted at Atrium Health Union/Union West, aimed to reduce CLABSI rates by improving adherence to central line care protocols through innovative use of secure chat photography. Methods: Using the Plan-Do-Study-Act (PDSA) framework, the team identified procedural gaps in dressing changes and tubing labeling. A novel intervention was implemented: frontline nurses sent secure chat photos of central line dressings and tubing labels to leadership at each shift change via the electronic medical record (EMR). This real-time visual verification system enhanced compliance monitoring and accountability. Stakeholder engagement was prioritized through shared governance, pilot testing, and feedback loops. Pre- and post-intervention audits measured compliance, and statistical analysis validated the impact. Results: Pre-intervention compliance with central line maintenance protocols was 83%. Post-intervention, compliance improved to a range of 92.4% to 100% across seven units, averaging 95.5% with sustained results for a year thus far. This improvement correlated with a reduction in CLABSI rates, contributing to better patient outcomes and potential cost savings, as each CLABSI can cost between $16,000 and $45,000. The project is on track to meet its goal of ≥99% compliance, supported by ongoing audits, leadership feedback, and integration of the secure photo process into standard workflows. Conclusion: This initiative successfully leveraged digital tools to address a persistent clinical challenge. Secure photo documentation via EMR messaging proved to be an effective, scalable, and low-cost strategy for improving central line care compliance. The intervention not only enhanced patient safety and reduced infection risk but also promoted health equity by standardizing care across units. Its replicability across other healthcare settings makes it a valuable model for broader dissemination. The project demonstrates how technology-driven solutions can transform infection prevention practices and support institutional goals of safety, quality, and equity in care delivery.

Background: Almost a decade has passed since the inaugural Core Elements of Outpatient Antibiotic Stewardship from the Centers for Disease Control and Prevention. Recognizing that outpatient prescribing accounts for upwards to 90% of antibiotic use, with 30% of those prescriptions deemed inappropriate, four core elements (commitment, action, tracking, education) guide the identification and monitoring of stewardship activities. We aimed to examine infection preventionist (IP) perceptions of outpatient stewardship programs. Methods: Members and non-members of the Association for Professionals in Infection Prevention (APIC) were invited to participate in the quinquennial electronic survey of IPs between June 6 and July 31, 2025, through email, QR codes, and social media campaigns. Data were collected on nine outpatient antimicrobial stewardship program (ASP) characteristics, including structure, leadership, and educational resources. Descriptive statistics were used to summarize the data. Result: Responses were received from 199 IPs who selected outpatient settings as their primary work location. Among these, 58% (n=115) reported the presence of an ASP, while 10% (n=19) were unsure. IPs reported that most ASPs were led by either clinical pharmacists (38.5%, n=37), infectious disease physicians (24%, n=23), or infectious disease pharmacists (19%, n=18), although 13% of IPs (n=15) could not identify the program leader. Nearly one-quarter of respondents (27%) indicated that they had access to an infectious diseases pharmacist. Over 75% (79%, n=86) reported the use of up-to-date treatment recommendations for infections; however, 24.8% (n=27) were unsure whether education on appropriate antibiotic prescribing was offered. Participation in multidisciplinary ASP rounding was evenly divided: yes (31%, n=34); no (35.8%, n=39); and do not know (33%, n=36). Over a third (35.3%) of IPs attended rounds. Conclusion: Although most outpatient stewardship programs are led by frontline clinical pharmacists, this survey found they were frequently supported by infectious diseases experts. This likely reflects the perception that these programs operate in hospital systems where IPs are present. Surprisingly, multidisciplinary rounding was reported even in outpatient environments, challenging assumptions that such practices are limited to inpatient stewardship. While education is a core component of stewardship, multidisciplinary educational efforts are necessary to make resources more visible and accessible across disciplines.

Background: Antibiotic allergies are frequently reported in children, yet most reactions are mild and should not preclude first-line therapy. Inaccurate allergy labels contribute to increased healthcare costs, Clostridioides difficile infection, and suboptimal or unnecessary antibiotic use. We aimed to characterize the incidence and features of inpatient antibiotic-associated allergic reactions, including serious events, and to determine the proportion of antibiotic regimens that were inappropriately modified in response to reported allergies. Methods: We conducted a retrospective study of patients ≤18 years admitted to Severance Children’s Hospital (Republic of Korea) during 2022–2024 who received oral or intravenous antibacterials and had an antibiotic-related adverse drug reaction (ADR) documented as “allergy” in the electronic health record. ADRs to antiviral, antifungal, or antiparasitic agents and reactions occurring in outpatient or emergency settings were excluded. Each discrete sign or symptom attributed to an antibiotic was counted as one allergic-reaction event. Management was considered appropriate if first-line therapy was continued for mild reactions, discontinued when unnecessary, aligned with international or national guidelines, or reflected pediatric infectious diseases expert opinion. Results: Among 31,164 admissions, 17,614 (56.0%) patients received antibiotics. A total of 215 antibiotic-related ADRs (0.92%) were documented, including 161 allergic-reaction events in 122 patients (0.7%) associated with 143 antibiotic prescriptions. Males accounted for 59.0% of cases; median age was 7.8 years (IQR, 2.8–12.4). The most common indications were surgical prophylaxis (34.3%), systemic febrile illness (14.0%), and pneumonia (11.2%). Frequent manifestations included nausea/vomiting (32.3%), urticaria (23.6%), and non-urticarial rash (18.1%). ?-lactams accounted for 67.3% of implicated agents; the most frequent drugs were ceftriaxone (26.8%), vancomycin (15.7%), and ampicillin/sulbactam (5.9%). Anaphylaxis occurred in 6 patients (5.0% of reactions; 0.002% of antibiotic prescriptions). Overall, 28.7% of allergy-labeled reactions were managed inappropriately, and 8.4% resulted in unnecessary escalation to broader-spectrum antibiotics (Table 1). Surgical prophylaxis was associated with reduced odds of inappropriate management compared with therapeutic use (OR, 0.46; 95% CI, 0.22–0.99; P Conclusion: True antibiotic allergy in hospitalized children is uncommon, yet nearly one third of reported allergies led to suboptimal or inappropriate antibiotic use. With the recent launch of the national antimicrobial stewardship pilot program in Korea (November 2024), we plan to develop an evidence-based clinical pathway for antibiotic allergy management and incorporate de-labeling strategies into the hospital electronic system to optimize antibiotic selection.