Background/Objectives: Chronic aortic regurgitation (AR) can remain asymptomatic despite progressive myocardial damage. While current surgical guidelines rely heavily on left ventricular ejection fraction (LVEF) and symptoms, these measures may fail to detect subclinical myocardial dysfunction. Global longitudinal strain (GLS), a sensitive echocardiographic marker, has emerged as a potential early biomarker in valvular disease. Therefore, this systematic review aims to assess whether impaired GLS is significantly associated with adverse clinical outcomes including symptom onset, reduced LVEF, and the need for aortic valve intervention among patients with asymptomatic moderate to severe AR and preserved LVEF. Methods: This systematic review and meta-analysis followed PRISMA guidelines and was registered with PROSPERO (CRD42024579540). Comprehensive searches of PubMed, Embase, and the Cochrane Library were completed on November 28, 2024. Screening, deduplication, and blinding were conducted using Rayyan. Eligible studies included adults with chronic, asymptomatic moderate to severe AR and preserved LVEF who underwent GLS measurement. Risk of bias was assessed using the National Heart, Lung, and Blood Institute (NHLBI) tool. A random-effects meta-analysis was performed on studies reporting multivariate hazard ratios (HRs) and 95% confidence intervals. Results: Twelve studies (N = 3278) were included in the systematic review, and four studies (n = 1125) were eligible for meta-analysis. Impaired GLS was significantly associated with adverse outcomes, yielding a pooled HR of 1.359 (95% CI: 1.106–1.668; p = 0.003). Heterogeneity was substantial (I² = 77%), and the 95% prediction interval ranged from 0.553 to 3.340, indicating potential variability in future settings. Conclusions: GLS is a promising prognostic biomarker for identifying subclinical cardiac dysfunction in asymptomatic moderate to severe AR with preserved LVEF. Its use may enhance early risk stratification and optimize timing for surgical intervention. Larger prospective studies are needed to validate specific GLS thresholds for clinical decision-making.

Diabetes mellitus is characterized by impaired glucose regulation, predisposing patients to both hyperglycemia and hypoglycemia. Hypoglycemia, particularly frequent in insulin-treated individuals, remains a serious but underrecognized complication. Remote patient monitoring (RPM) technologies, such as continuous glucose monitors, smartphone apps, and hybrid closed-loop systems with remote monitoring capabilities, have emerged as promising tools to improve glycemic control and prevent hypoglycemia in nonclinical settings. Evidence examining the use of RPM technologies has expanded rapidly; however, the scope, characteristics, and reported outcomes of these interventions remain fragmented across modalities and settings. This scoping review aims to systematically map and describe the extent, range, and characteristics of published evidence on RPM interventions for glycemic management among adults with type 1 and type 2 diabetes in nonclinical settings. The review will follow the Joanna Briggs Institute scoping review methodology and adhere to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) reporting guidelines. The population, concept, and context framework defines the population as adults with type 1 or type 2 diabetes who experience or are at risk for hypoglycemia; the concept as RPM techniques (continuous glucose monitors, hybrid closed-loop systems with remote monitoring capabilities, telemedicine, and smartphone apps); and the context as nonclinical environments. The PubMed, Embase, and Scopus databases will be searched, supplemented by gray literature. Eligible studies will include clinical trials, observational studies, and cohort studies; reviews, case studies, and non-English articles will be excluded. Two independent reviewers will conduct screening, data extraction, and summarization. Findings will be synthesized descriptively in tabular and narrative formats. At the time of submission, the protocol has been registered, and the formal search strategy is being finalized. As of March 2026, the formal database search has been completed, and screening of studies is scheduled to begin in April 2026. This protocol outlines a structured approach to mapping the current landscape of RPM interventions for glycemic management in nonclinical settings. The completed review will synthesize reported intervention characteristics and outcomes to clarify existing evidence and identify areas for future investigation. OSF Registries 10.17605/OSF.IO/XNBWF; https://osf.io/xnbwf/overview. PRR1-10.2196/88197.

Daylight Saving Time (DST) creates abrupt, externally imposed circadian disruptions that can impair sleep regulation, hormonal balance, cognitive performance, and emotional stability. Although these effects are known in the general population, individuals with chronic mental illness, whose circadian systems are often intrinsically dysregulated, may face increased neuropsychological consequences. This comprehensive review synthesizes evidence from chronobiology, psychiatry, neuroscience, and population health to examine how DST-related circadian misalignment impacts cognitive functioning, mood regulation, suicidality risk, and symptom exacerbation across psychological disorders such as depression, anxiety disorders, bipolar disorder, post-traumatic stress disorder, attention-deficit/hyperactivity disorder, and psychotic disorders. Following the Scale for the Assessment of Narrative Review Articles (SANRA) guidelines, a search of PubMed, PsycINFO, Scopus, and Google Scholar was conducted to identify studies published from 2000–2026 examining DST, circadian rhythm disruption, neuropsychological outcomes, and chronic mental illness. Empirical, theoretical, and mechanistic studies were included to ensure comprehensive synthesis. Across conditions, DST, particularly spring forward transitions, is associated with increased sleep disturbance, impaired executive functioning, reduced attention and working memory, heightened emotional reactivity, increased depressive symptoms, elevated risk of manic episodes, and short-term increases in suicidality. Neurobiological mechanisms include altered melatonin secretion, cortisol dysregulation, Hypothalamus Pituitary Axis (HPA-axis) activation, and clock-gene desynchrony. DST may function as a modifiable negative environmental influence capable of affecting neuropsychological functioning in vulnerable populations. These findings underscore the need for clinical awareness, preventive strategies, and policy reconsiderations, including calls to eliminate seasonal time changes. Standardizing DST-related research outcomes and expanding longitudinal, multi-site studies will be essential for advancing this emerging field.

Background/Objectives: Persistent inequities in healthcare experiences and outcomes among marginalized racial/ethnic groups and sexual and gender minority (SGM) populations have been well documented. However, disparities in perceptions of discrimination and bias between patients and health providers remain insufficiently understood. This review synthesizes the current evidence on how these groups differently perceive discrimination, how bias manifests in clinical encounters, and how intersecting identities shape healthcare experiences. Methods: A comprehensive review using SANRA guidelines examined racial/ethnic discrimination, SGM-related bias, provider implicit attitudes, minority stress processes, and structural determinants of inequity in healthcare settings. Articles were identified through systematic search strategies across major databases, and their conceptual, methodological, and theoretical contributions were analyzed. Results: Across studies, marginalized patients consistently reported discrimination, stigma, and mistrust in healthcare, whereas providers often underestimated the prevalence and impact of these experiences. Evidence indicates that implicit pro-White biases among providers influence communication quality, clinical decision-making, and patient comfort. Structural racism and intersecting minority statuses further compound disparities, contributing to delayed care, unmet health needs, and poorer outcomes. Limited alignment between patient and provider perceptions suggests a gap in recognition of inequitable treatment and its drivers. Conclusions: Healthcare inequities arise from interconnected, interpersonal, and structural mechanisms. Addressing these disparities requires multilevel interventions targeting provider training, institutional policy reform, and system-level barriers. Integrating both patient and provider perspectives is essential for developing equitable, affirming models of care and improving health outcomes for racial/ethnic and SGM populations.

BACKGROUND Dog bites represent a significant global public health concern, particularly among children and adolescents. Approximately 330,000 emergency department visits occur annually in the United States alone due to dog bite injuries, with pediatric populations bearing a disproportionate burden. Despite this, existing systematic reviews remain fragmented, focusing on isolated aspects such as breed-specific risk, educational interventions, or legislative measures without comprehensively addressing the global incidence, prevalence, and multifactorial risk profile in pediatric cohorts. OBJECTIVE This protocol describes a planned systematic review aimed at synthesizing international evidence on the incidence and prevalence of dog bites in pediatric populations (aged ≤18 years), with concurrent analysis of demographic, behavioral, and environmental risk and protective factors. METHODS A comprehensive search of PubMed, Embase, and Web of Science will be conducted, with no date restrictions, limited to English-language observational studies (cross-sectional, case-control, cohort) and population-based surveys. The PECOS framework will guide inclusion and exclusion criteria. Two independent reviewers will screen records and extract data using a standardized codebook, with discrepancies resolved by consensus or a third reviewer. Study quality will be assessed using validated tools appropriate to each study design. Findings will be synthesized narratively with descriptive statistics; meta-analysis will be pursued where sufficient homogeneity exists. RESULTS This review is anticipated to be the first comprehensive global synthesis of pediatric dog bite burden, stratified by age group (newborns through adolescents), geographic region (developed vs developing countries), sex, and socioeconomic context. It will identify critical gaps in the evidence base and provide actionable evidence to inform targeted prevention strategies, clinical pathways, and public health policy. CONCLUSIONS By aggregating data across diverse populations and settings, this systematic review will deliver the most comprehensive global assessment of pediatric dog bite epidemiology to date, with direct implications for reducing the burden of these preventable injuries worldwide. CLINICALTRIAL Trial Registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251129292

BACKGROUND Labor pain is among the most intense forms of pain, and neuraxial anesthesia including epidural, spinal, and combined spinal-epidural techniques is considered the gold standard for its management. Despite its effectiveness, persistent misconceptions, cultural barriers, and disparities in awareness contribute to underutilization among certain populations. Educational interventions have been developed to address these gaps, yet a comprehensive synthesis of such efforts within the United States is lacking. OBJECTIVE This scoping review aims to map the extent, range, and nature of educational interventions designed to improve knowledge, awareness, and acceptance of neuraxial anesthesia during labor among pregnant women. METHODS Following the PRISMA-ScR framework, peer-reviewed studies published in English were identified through PubMed, Embase, and Scopus up to August 2025. Eligible studies included pregnant women eligible for neuraxial anesthesia, with interventions delivered during prenatal or perinatal care. Extracted data included study design, intervention type, delivery method, timing, and outcomes related to knowledge acquisition, awareness, acceptance, satisfaction, and uptake. Data will be summarized descriptively, supported by tables, charts, and narrative synthesis. RESULTS Findings are expected to demonstrate that culturally sensitive, multimodal interventions particularly when delivered prenatally enhance knowledge retention, reduce anxiety, and increase epidural uptake, especially in historically underserved populations. Digital interventions such as mobile apps and videos are emerging, though accessibility remains a challenge. Gaps in long-term outcome data and limited attention to diverse racial and rural populations are anticipated. CONCLUSIONS This review will inform the development of standardized, scalable, and culturally relevant educational strategies to promote informed decision-making, patient autonomy, and equitable access to neuraxial labor analgesia.