Awareness, acceptance, and impact of undetectable equals untransmittable (U = U) among people living with HIV across Canada

Undetectable equals Untransmittable (U = U) is a pivotal tool for HIV prevention, stigma reduction, and improving quality of life for people living with HIV. This study examined awareness, acceptance, and impact of U = U among people living with HIV across Canada, and explored differences across sociodemographic characteristics. From 2018–2024, 1,083 participants were recruited in-person and online using snowball sampling. Peer researchers conducted interviews, initially in person and later mostly online due to COVID-19. Demographic data and U = U outcomes were collected and analyzed using multivariate logistic regression. Overall, 72% of participants had heard of U = U, 67% strongly accepted it, and 51% had discussed it with a healthcare provider. Awareness and acceptance were lower among heterosexual and bisexual participants. Cis-women and participants who were unemployed were less likely to report positive impacts from U = U. Black-identifying participants were more likely to report benefits, while Indigenous participants were more likely to believe U = U could reduce stigma and shift public opinion. Older participants were less likely to discuss U = U with a healthcare provider. Findings highlight U = U’s potential to reduce stigma, but gaps remain in awareness, acceptance, and provider communication. Tailored strategies are needed to engage diverse communities and support healthcare providers in confidently sharing the zero-risk message.

Socio-economic determinants of engaging in a relationship with a Blesser

Transactional sexual relationships are a key driver of adverse sexual and reproductive health outcomes among adolescent girls and young women (AGYW) in South Africa. A prominent subtype, the “Blessed” relationship, involves older, relatively wealthier men (Blessers) who exchange material support for sexual relationships. While motivations within these partnerships have been studied, limited attention has been paid to the structural and economic factors shaping AGYW’s engagement in such relationships. This study explored the socio-economic conditions influencing involvement with Blessers, amongst 5025 AGYW, aged 15–24, across eight South African provinces in 2024. Key socio-economic indicators included household wealth, food insecurity, education, employment, and orphanhood. AGYW from the wealthiest households were significantly less likely to report involvement with a Blesser than those from the poorest households, underscoring the role of poverty in shaping transactional partnerships. Food insecurity further amplified vulnerability, with participants who reported going without food multiple times, substantially more likely to have a Blesser. Education appeared protective: school attendance and completion of secondary education were both associated with a reduced likelihood of involvement with a Blesser. Findings underscore the role of structural inequality, poverty, and disrupted education in shaping AGYW’s relationship choices.

Comparing optimisation strategies of building design students and expert practitioners across subtasks

Optimisation techniques are increasingly used in building design. However, little is known about how optimisation strategies vary during a computational design session. Given that knowledge of optimisation is specialised, the experience level of a designer might significantly influence their strategy, since mental effort required to process information across optimisation subtasks relates to overall strategy. General differences between novice and expert designers are well documented, but little work has explored differences between students and experts while formulating and interacting with a design space using optimisation. In response, a study tasked graduate students from architecture and architectural engineering and expert practitioners to design an atrium using optimisation tools. Key optimisation events were identified to characterise strategies by the timing and frequency of these events. Eye tracking was used to approximate cognitive load via the Index of Cognitive Activity, fixation counts, and fixation durations. Experts exhibited more diverse design strategies and lower average values for the eye metrics, which could indicate an advantage in processing information due to expertise. The proxy metrics for cognitive load were relatively highest during initial parametric modelling and when reviewing optimisation results. These results can encourage emphasis on design space setup and interpretation of results while teaching optimisation.

Perceptions over biologics for psoriasis after 5 years of access in Brazil: a cross-sectional study

Biologic therapies have transformed psoriasis management, and their incorporation into Brazil’s public healthcare system (SUS) in 2019 expanded access nationwide. However, real-world utilization and perceptions remain incompletely understood. To evaluate perceptions, barriers, and prescription patterns regarding biologic therapy among Brazilian dermatologists and patients five years after universal incorporation, while quantifying the prevalence of undertreatment. We conducted two independent cross-sectional online surveys throughout 2024 among dermatologists ( n  = 225) and patients with psoriasis or psoriatic arthritis ( n  = 1,001). Data on demographics, clinical characteristics, and perceived barriers were analyzed. Overall, 64.9% of dermatologists prescribed biologics, with higher prescribing rates among younger physicians ( p  = 0.022), those with fewer years of practice ( p  = 0.013), higher patient volumes ( p  < 0.001), and practice in tertiary centers ( p  = 0.001). Only 25.5% of patients were receiving biologics, strongly associated with psoriatic arthritis ( p  < 0.001), with no difference between public and private care. Key barriers included perceptions that conventional therapies are sufficient (59.5%), insufficient training (38.0%), and administrative burden (45.5%), while patients mainly reported safety (45.7%) and cost (30.9%) concerns. Undertreatment was prevalent, affecting over 50% of patients with moderate-to-severe disease. While 71.3% of non-users were willing to start biologics, only 28.0% had received a medical recommendation. Persistent educational and structural barriers continue to limit optimal biologic use despite formal availability, highlighting the need for targeted education, streamlined care pathways, and improved physician–patient communication to achieve equitable outcomes.

Healthcare resource use of patients with mild-moderate psoriasis on systemic treatments: a UK single-center longitudinal retrospective cohort study

Healthcare resource utilization (HCRU) costs in those on conventional systemics for mild-moderate psoriasis are poorly described. This study aimed to describe HRCU, disease severity and health-related quality of life in patients with mild-moderate psoriasis requiring systemic therapy. UK single-center retrospective longitudinal cohort study including adults with mild-moderate psoriasis (PASI < 10, no historical PASI ≥ 10, no prior biologics) on conventional systemic therapy with 3-year data capture from first PASI recording (2014–2019, pre-COVID). Patients discontinued due to reaching PASI ≥ 10, starting biologics or being lost to follow-up. The median annual HCRU cost was £1923 (mean £3361), largely driven by visit costs. A total of 50.8% patients achieved a PASI ≤ 2 and 30.6% achieved PASI ≤ 2 and DLQI ≤ 5 during follow-up. The difference between the maximum and minimum PASI for a patient and follow-up time were statistically significant predictors of total costs ( p  < 0.05). Despite high healthcare costs, nearly half of the patients did not achieve clear/nearly clear skin. These data, in the context of reducing costs for biosimilars, may provide a basis to challenge care pathways and access criteria for ‘high-cost’ treatments.

Exploring mental health and violence narratives on X: insights from social media data

Social media platforms offer a dynamic space for monitoring public discourse on societal issues, including mental health and violence (MHV). The purpose of this study is to examine how MHV is framed in public conversations on X in the Norwegian context over a ten-year period. We collected 5,468 unique Norwegian-language tweets from 2,500 authors using 103 search terms related to MHV (January 2015–May 2024). Tweets were retrieved with twarc , and BERTopic was used to generate topic embeddings, identifying 21 topics. To increase keyword diversity, maximal marginal relevance and KeyBERT was used to identify extract representative terms. Topics were grouped and interpreted through qualitative thematic analysis. The analyses revealed that 33% of tweets explicitly discussed the association between MHV. These discussions were predominantly event-driven, with activity spiking following high-profile incidents involving individuals with mental health conditions. A small group of highly active users dominated, emphasizing systemic failures over individual blame and maintaining a constructive tone. Stigmatizing language appeared in political contexts, where MHV terms served to delegitimize opponents. This study highlights discourse on MHV and underscores the need for advocacy groups to use platforms like X to counter stigma, provide accurate information, and promote nuanced conversations.

The menopausal subject at work: gendered embodiment and neoliberal management in the UK

In this paper, we examine five key UK policy documents that aim, inter alia, to address the concerns of ageing women in the workplace at a time when an estimated 900,000 women in the UK have left their jobs due to symptoms associated with menopause. Our analysis reveals that menopause has become a key site through which the contemporary struggle over how we (should) perceive gendered embodiment is being played out. This is evident in how these documents expand the menopausal subject: from exclusively cisgendered women to include trans, intersex and genderqueer people. Examining two key tensions that emerge—the invocation of menopause as natural and biological alongside a more inclusive menopausal subject, and the perceived naturalness of menopause alongside the construal of menopausal symptoms as abnormal , we maintain that expanding the menopausal subject is linked to a neoliberal managerial desire to address the challenges of all employees who experience menopause. Our findings thus point to a striking conjuncture between feminist and LGBTQI+ struggles to debunk binary understandings of sex and gender and the neoliberal State’s desire to keep all older people experiencing menopause in the workforce, contributing to our understanding of the increase in menopause talk.

Before gender: lost stories from trans history, 1850-1950 Before gender: lost stories from trans history, 1850–1950, by Eli Erlick, Boston, MA, Beacon Press/Manchester, Manchester University Press, 2025, 268 pp., £20.00 (hardback), ISBN 978 1 5261 9271 4

Navigating the complexities of supervising challenging students in clinical education: perspectives of physiotherapy educators and departmental managers

Physiotherapy clinical educators report that supervising students who are underperforming, struggling and/or challenging is one of the most difficult aspects of their role. These situations impact the individual educator and may also have negative effects on other students, staff, and the workplace. The aim of this project was to explore the attitudes and opinions of physiotherapy clinical educators and departmental managers regarding the impact of supervising challenging students and document their needs for support/training. This study was a cross-sectional design employing qualitative and quantitative methods of data analysis. Participants were Australian physiotherapy clinical educators and departmental managers. There were 209 completed surveys returned (educators n  = 166, managers n  = 43), Overall response rate was 60%. Most respondents indicated that they had supervised (87% of educators) or worked with (93% of managers), a student they perceived to be challenging. Supervising challenging students often had a negative impact on physiotherapy clinical educators and their workplaces. It was perceived by both educators and departmental managers that these difficult situations resulted in an increased workload, additional stress, and often adversely influenced willingness to engage in further student clinical education. A need for more training and face-to-face support to assist in the management of challenging student situations was widely reported and particularly highlighted by novice educators. Challenging students have a considerable impact on physiotherapy clinical educators and their workplace. Better pre-placement student preparation and improved support and training are vital to enhance educator job satisfaction, contribute to a positive workplace culture around student supervision and maintain capacity to provide high-quality physiotherapy clinical placements.

Poor upper limb performance despite the absence of notable upper limb motor impairment in adults with acute stroke – the influence of cognitive deficits

Introduction: To assess the impact of cognitive impairment, upper limb apraxia, and spatial neglect on upper limb performance in adults with stroke. Methods: This prospective cross-sectional study evaluated upper limb performance dependency in adults with acute/early subacute stroke. The Upper Limb (UL)-LIMOS assessed upper limb performance; while upper limb motor impairment was evaluated with the Fugl Meyer Assessment-Upper Extremity (FMA-UE), general cognitive function with the Montreal Cognitive Assessment, spatial neglect with the Catherine Bergego Scale, and upper limb apraxia with the Apraxia Screen of TULIA. Results: We recruited 407 adults with stroke. Minimal or no upper limb motor impairments were present in 270 out of 407 (66.3%) adults, among whom 38.5% still exhibited poor upper limb performance. There were weak to moderate correlations between UL-LIMOS and MoCA (r = .213), spatial neglect (r = −.415), and apraxia (r = .190). General cognition, spatial neglect strongly predicted upper limb performance (R2 = 0.34). Conclusion: Almost 40% of adults with acute stroke, who do display minimal upper limb impairments, demonstrate poor performance in upper limb tasks, attributed to impaired general cognition, spatial neglect, and/or, to a lesser extent, upper limb apraxia. Hence, there is need for cognitive-motor therapies to be integrated into early rehabilitation settings to address these challenges effectively.