John R Horne

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This review examined the needs of children and young adults who care for a family member with dementia. Young carers often do not know what support is available, face barriers in education and careers, and experience social isolation, yet the support they receive from family, schools, and health services is inconsistent. Research has rarely distinguished between younger children and older young adults despite their different needs, leaving a major gap in understanding how to help these caregivers.

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A pilot study tested whether people with mitochondrial disease — a condition causing severe fatigue and exercise intolerance — could follow a home exercise program supported by a smartphone app and smartwatch. Most participants who enrolled attended the majority of virtual check-ins and wore the smartwatch consistently, but adherence to the actual exercise sessions was low and daily step targets were rarely met. People who already exercised before the study did far better, suggesting the approach works best for those with some exercise history.

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Researchers tested whether having prosthetists screen patients with leg amputations for common health problems — such as depression, nerve damage, and poor circulation — was practical and useful. The screening was feasible and well accepted, and patients rated their prosthetist as more attentive to their concerns when screening was included. While it did not change overall satisfaction scores or clinic time, it encouraged patients to seek additional medical care, suggesting a meaningful role for prosthetists in broader health management.

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UK orthotic professionals reached formal agreement on best-practice guidelines for delivering brace and splint care to stroke survivors. Across two rounds of expert voting, 64 out of 65 proposed standards were approved with at least 75% agreement. These are the first nationally agreed standards of this kind in the UK, giving clinicians a clear framework for consistent, high-quality orthotic stroke rehabilitation.

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A case series reported on two patients who had a specific type of above-knee amputation called a Gritti-Stokes amputation, which leaves a longer residual limb. Both patients were fitted with preparatory prostheses using a suction-based suspension system, wore them successfully for over six months, and returned to work before receiving their final prostheses. The findings suggest this suspension approach is viable for this amputation type and can support strong functional recovery.

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A study evaluated whether Raman spectroscopy — a light-based technique for identifying chemicals — could accurately measure trace impurities in a pharmaceutical product using a transmission detection setup rather than the conventional backscatter approach. The method successfully quantified a contaminant at low concentrations across multiple testing days, operators, and batches of silver nanoparticles. The results show that transmission-mode SERS can reliably detect pharmaceutical impurities in complex mixtures.

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Researchers identified that a protein called paratox, carried by viruses that live inside the strep throat bacterium, does more than just suppress bacterial communication — it also binds to multiple proteins involved in gene regulation. A crystal structure showed that paratox grips its partner proteins using a shared structural feature, a docking helix, though some partners use a different binding mode. This suggests paratox helps the virus maintain its foothold in the bacterium by broadly disrupting the bacterium's regulatory networks.

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A 20-year clinical trial compared two types of plastic liners used in hip replacement surgery: a standard type and a newer, more durable cross-linked version. The standard liner wore down at more than five times the rate of the cross-linked liner, and patients with standard liners needed revision surgery at three times the rate. This is the longest randomized trial of its kind and confirms that the cross-linked liner substantially reduces implant failure over decades.

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Using a computer model of Earth's early chemistry, researchers investigated why the rise of oxygen in Earth's atmosphere happened 2.4 billion years ago — long after photosynthesis first evolved. Counterintuitively, they found that the earlier oxygen-producing life appeared, the longer it took for atmospheric oxygen to build up, because low phosphorus availability kept biological productivity too limited to generate a lasting oxygen surplus. Phosphorus supply, not the timing of photosynthesis itself, was the key bottleneck controlling when Earth's atmosphere finally became oxygen-rich.

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Surveys of cancer patients and healthcare professionals in the UK found widespread problems with access to biomarker tests — the molecular analyses that guide which targeted cancer treatments a patient receives. The main barriers were too few trained staff, long waiting times, and outdated ordering systems. Improving training for nurses and other clinicians, and providing better information to patients, were identified as priority steps.

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This study developed a mathematical formula to more accurately calculate the energy cost of electrostatic interactions in chains of charged molecules (polyelectrolytes). It showed that previous calculations overlooked a significant correction that arises near the ends of finite-length chains. The corrected formulas improve predictions of how polyelectrolyte solutions behave, which matters for designing materials like gels, drug delivery systems, and coatings.

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A cadaver study mapped the internal structure of human lips and found that each lip is divided into 24 distinct compartments separated by thin tissue walls. The compartments are consistent across sex and race, with larger volumes in the center and smaller volumes toward the corners. This anatomy has direct implications for cosmetic filler injections, suggesting that respecting compartment boundaries may produce more natural-looking results.

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An international survey of 223 long-term care facilities across 13 countries found that facilities with more pre-pandemic infection control training were better prepared for COVID-19, while residents' feelings of loneliness and depression were among the most common harms. Providing psychological support to both residents and staff was associated with fewer behavioral problems and less work-life imbalance. The findings argue for investing in preparedness and mental health support before the next pandemic or outbreak.

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A small qualitative study explored whether an online dance class could support the mental and physical health of unpaid caregivers in the UK. Six female carers reported perceived benefits to both their physical and mental wellbeing, and found the classes satisfying, though caring duties sometimes made participation difficult. The study supports the feasibility of this approach but calls for larger trials with more diverse carer groups.

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Half of older adults with leg amputations seen at a specialized clinic were prescribed at least one medication considered potentially inappropriate for older patients, including risky pain drugs. Inappropriate prescribing was most common in patients with phantom limb pain, stomach problems, and multiple medications. The findings highlight that medication review — especially for pain management — should be a routine part of post-amputation care in older adults.

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This article reviews the ethical and legal challenges of conducting forensic research using human biological samples in South Africa, particularly under the country's data protection law. The authors call for a standardized code of conduct developed jointly by forensic scientists and the Academy of Science of South Africa, and emphasize the need for a diverse DNA database and strict informed consent practices. They argue that aligning national laws and ethical standards is essential for credible, rights-respecting forensic science.

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This commentary describes outreach programs in Southern Africa aimed at narrowing the gap between academic forensic science training and real-world practice. Initiatives include student mentoring, collaborative mixer exercises between students and practitioners, and efforts to correct media-driven misconceptions about forensic science. The authors propose establishing a standing committee within the regional forensic science forum to sustain and coordinate these efforts.

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Researchers developed two super-resolution fluorescence microscopy techniques that work at very low temperatures, enabling precise 3D localization of specific proteins inside frozen cells before high-resolution electron microscopy imaging. These tools address a critical gap in correlative light and electron microscopy (cryo-CLEM), where standard fluorescence provides insufficient resolution to guide the electron microscope to the right location. Applying these methods to bacterial and mammalian cells demonstrates their potential to link functional protein labels to detailed structural images.

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This letter argues that African forensic science communities need to more actively engage with debates about laboratory quality standards, accreditation systems, and ethical conduct. It highlights gaps in quality management and cognitive competency training in the African context, and calls for the forensic community there to adopt the principles of the Sydney Declaration and work toward internationally recognized standards. The authors urge urgent dialogue and reform to improve the reliability of forensic evidence produced in the region.

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This study showed that a protein called Prkd1 is essential for bone-sensing cells called osteocytes to repair small tears in their cell membranes that occur during physical loading, and that this repair process drives new bone formation. Mice lacking Prkd1 in osteocytes had a weaker bone-building response to exercise and lost more osteocytes after mechanical stress. A membrane-sealing drug partially rescued the bone density response but suppressed bone growth in other ways, highlighting the complexity of targeting this pathway.

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An international survey of over 2,000 healthcare workers in long-term care facilities examined whether organizational psychological support could help staff who experienced social discrimination stay in their jobs during the COVID-19 pandemic. About 37% of workers reported discrimination, and those who did were less likely to intend to stay. Psychological support from the organization significantly buffered this effect, reducing the impact of discrimination on retention.

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Researchers used a quality-by-design approach to optimize the microwave-assisted synthesis of silver nanoparticles used in Raman spectroscopy tests. By systematically varying reaction time, temperature, and stirring speed, they identified conditions that produce nanoparticles with consistent size and strong, reproducible spectroscopy signals. The optimized process reduced batch-to-batch variability to under 15%, addressing a key obstacle to using SERS in routine laboratory testing.

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The study investigated why some lung cancer cells with a BRAF mutation stop responding to a standard two-drug treatment over time. Early resistant cells were vulnerable to ferroptosis — a type of iron-dependent cell death — while cells that developed full resistance switched to a different antioxidant strategy and became susceptible to HDAC inhibitor drugs instead. These findings map specific drug vulnerabilities to distinct stages of resistance, pointing toward sequential or combination treatment strategies.

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Researchers determined how a helper protein called SurA hands off unfolded bacterial outer membrane proteins to the BAM complex, the machine responsible for inserting them into the bacterial cell wall. Using engineered molecular traps and cryo-electron microscopy, they captured the complex in action and found that SurA docks at a specific domain of BAM, likely triggering shape changes that transfer the cargo. Disrupting this handoff cripples membrane assembly, confirming SurA's essential role and identifying a potential target for new antibiotics.

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A review and meta-analysis examined whether physical activity levels are linked to academic performance in university students. Students with higher physical activity were three times more likely to be high academic performers than students with low activity, though this finding came from only six studies and carries low confidence. Half of all reviewed studies found no significant association, meaning the relationship remains uncertain and warrants more rigorous research.

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Medical educators at Northwestern described how they integrated digital tools — including recorded lectures, online discussion boards, audience response systems, and interactive classrooms — into the preclinical pulmonary medicine curriculum. The article shares lessons learned and a practical framework for combining asynchronous content with active in-person learning. It serves as a guide for other medical schools looking to modernize how they teach lung disease to students before clinical rotations.

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Researchers adapted a simulation-based training checklist used to evaluate individual paramedic performance so that it could instead assess teams of two paramedics working with a physician in pediatric emergency scenarios. After two rounds of refinement with multiple raters, the modified tool achieved strong agreement (80% or above) for overall performance scoring across three emergency case types. The tool can now be used to identify team-level safety gaps in prehospital pediatric care.

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Among adults with chronic pain after leg amputation, those with heightened sensitivity to pressure at the amputation site also showed increased pain sensitivity throughout the rest of the body — a pattern suggesting the nervous system has become broadly sensitized, not just locally affected. However, self-reported pain questionnaire scores were similar between sensitive and non-sensitive groups, meaning standard symptom surveys may not capture this underlying physiological difference. Objective pressure testing may be needed to identify patients with centrally driven pain.

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A study of 126 adults with leg amputations identified physical activity level, balance confidence, prosthesis use, and absence of nerve damage as the four strongest predictors of how well people reintegrate into community life. Together these four factors explained half the variation in community participation scores. Because all four are potentially modifiable, they represent concrete rehabilitation targets for improving life after amputation.

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This article proposes a framework called "resilient prescribing" for using psychiatric medications in military personnel deployed to operational environments. The approach emphasizes keeping service members engaged in their own recovery, setting realistic expectations about what medication can do, and avoiding a passive patient role that undermines mission readiness. The authors argue these principles can amplify the benefits of mental health treatment while preserving the sense of agency that is critical in combat settings.

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A systematic review of 33 published case reports found that long-term complications of mechanical fallopian tube blocking devices — used for permanent contraception — are rare but serious, most often involving the device migrating out of its original position and sometimes causing infection. No single imaging method was clearly superior for diagnosis, and definitive treatment required surgically removing the device. Clinicians should consider these delayed complications in patients presenting with pelvic symptoms years after the procedure.

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This earlier study used EPR spectroscopy and cryo-electron microscopy to show that the antibiotic darobactin B locks the BAM complex — a bacterial protein assembly machine — into a specific inactive shape inside E. coli cells. The work established that BAM normally adopts a range of conformations in its native membrane environment, and that darobactin B narrows this flexibility. These findings explained the antibiotic's mechanism of action at atomic resolution.

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Adults with leg amputations who were largely sedentary showed measurable weakness in the deep back muscles of the lumbar spine, and this weakness was independently associated with slower walking speed, worse balance, and reduced mobility. Both the activity of the multifidi muscles and trunk extensor endurance contributed to physical performance beyond other known factors. Trunk muscle rehabilitation may be an overlooked but important component of post-amputation recovery.

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Genetic analysis of Hawaiian hawksbill sea turtles — a critically small population — revealed that turtles from different nesting beaches on the same island rarely interbreed. Both males and females tend to return to the beach where they were born, leading to genetically distinct groups separated by just tens of kilometers. This demographic isolation has important implications for conservation, as it means losing a local nesting group could eliminate a genetically unique subpopulation.

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Researchers used a systematic quality-by-design approach to find the key factors controlling how silver nanoparticles form in a chemical reduction reaction used for SERS testing. Among five variables studied, the concentration of the reducing agent, the pH, and the reaction time had the biggest impact on particle quality. Identifying these critical parameters is the first step toward producing consistent, reliable nanoparticles for quantitative analytical testing.

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A study of 763 patients who had surgery for esophageal cancer after chemotherapy found that how much residual cancer remained in the lymph nodes was a strong predictor of survival — as strong as tumor response itself. Patients with complete lymph node clearance had less than half the mortality risk of those with persistent disease. The authors recommend that lymph node response be routinely reported after esophageal cancer surgery, not just tumor response.

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This review identified building design features that influence whether SARS-CoV-2 spreads indoors, including temperature, humidity, ventilation, room layout, and air conditioning systems. The paper synthesizes research showing how each factor affects the survival and movement of the virus in enclosed spaces. Understanding these parameters allows architects, engineers, and facility managers to design or adapt buildings to reduce infection risk.

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Among adults with leg amputations seen at a limb loss clinic, clinical examination revealed that more than half of those with nerve damage and nearly 9 in 10 with poor circulation had not reported these conditions themselves. People with non-diabetic amputations were especially likely to be unaware of nerve damage. The results show that self-reported health histories miss the majority of these serious conditions, making routine clinical screening essential in this population.

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A study of 83 adults with leg amputations found that 36% reported falling repeatedly in the past year, and those with pain in the lower back and both limbs had more than six times the odds of being recurrent fallers. Lower balance confidence, worse self-reported mobility, and reduced reaching distance on the prosthetic side were all independently associated with fall risk. These factors are modifiable through rehabilitation, making them practical targets for fall prevention programs.

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Researchers used electron spin resonance spectroscopy to study the shape-shifting behavior of the BAM complex — a bacterial protein machine — directly inside living bacterial cells, rather than in isolated test conditions. In the presence of the antibiotic darobactin B, BAM's movement became restricted to a single locked conformation, explaining how the drug blocks the machine. Cryo-electron microscopy images confirmed these findings, providing a structural basis for how darobactin B kills bacteria.

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Hip muscle strength on both the amputated and intact sides distinguished between adults with below-knee amputations who were sedentary and those who were more physically active. Specific strength cutoffs were identified that, combined into a composite score, estimated more than twice the odds of being sedentary for each additional deficit. Measuring hip strength during clinical visits could help identify patients at risk of inactivity and guide prosthesis prescription decisions.

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This case report describes a young, otherwise healthy man who developed a severe disseminated Coccidioides fungal infection involving the lungs, spine, and pelvis after visiting Arizona. An unusually high blood IgE level alongside the travel history prompted early antifungal treatment before laboratory cultures confirmed the diagnosis. The case highlights how combining travel history with a simple blood marker can guide life-saving treatment decisions before definitive results are available.

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This commentary explains newly published structural work revealing how bacteria fold proteins into their outer membrane using a molecular machine called BAM. The new structures and experiments show that BAM harnesses the natural tension of the membrane to complete the folding of barrel-shaped proteins, resolving a long-standing puzzle about how this energy-demanding process works without a conventional fuel source.

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Biology educators redesigned an introductory lab course to repeatedly teach and test three basic calculation skills — unit conversion, molar concentration, and dilution — throughout the semester using quizzes, worksheets, and videos. Students showed statistically significant improvement on all three skills, and the gains continued increasing even in the second half of the semester after direct instruction had ended. The sustained assessment approach proved especially effective for the most difficult skill, suggesting repeated testing itself drives learning.

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A private practice tracked how hip and knee replacement surgeries shifted from hospital settings to outpatient surgery centers between 2013 and 2019, and how adding a long-acting local anesthetic (liposomal bupivacaine) to their pain management protocol affected outcomes. Adding the drug raised same-day discharge rates from 4% to 32% early on, ultimately reaching 96-100% same-day discharge with low opioid use. The results show this pain management approach enables safe outpatient joint replacement with minimal complications.

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A machine learning tool called the Cardiac Comorbidity Risk Score was developed and validated to predict which patients undergoing hip or knee replacement surgery are at risk of serious heart complications within four weeks. Using only existing electronic health record data — no extra tests or blood draws — the tool achieved 80% accuracy, substantially outperforming the standard clinical scoring system. The tool can flag high-risk patients without adding any burden to clinical workflows.

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This review summarized recent machine learning methods designed to predict how a change in a protein's building blocks — a mutation — will affect its function. It covered approaches ranging from convolutional and graph neural networks to language models trained on protein sequences. These tools are accelerating protein engineering for medicines, industrial enzymes, and other applications by reducing the need for expensive laboratory experiments.

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This case report describes a 48-year-old woman who developed a severe MRSA infection that spread from her bloodstream to both eyes, her heart valves, bones, and joints simultaneously. Despite emergency surgery on both eyes and aggressive antibiotic treatment, she did not recover her vision. The case illustrates the catastrophic potential of bloodstream MRSA and the need for rapid, coordinated care across multiple specialties.

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A detailed process evaluation of a falls prevention program in six care homes found that context mattered enormously — the same program worked differently depending on staff attitudes, management stability, and prior practices in each home. In some settings, staff training alone reduced falls without formal assessments being completed. The findings suggest that falls prevention programs should be tailored to individual care home circumstances rather than applied uniformly.