Uterine fibroids represent the most common benign gynecological tumors globally, yet management pathways differ substantially across health systems. Observational evidence demonstrates marked divergence between the United Kingdom (UK) and Sub-Saharan Africa (SSA), particularly Nigeria, in treatment access, surgical thresholds, and fertility-preserving strategies. To synthesize biological, structural, and health-system determinants underpinning divergent fibroid management pathways between the UK and SSA, and to construct a multi-domain explanatory framework with equity implications. A comparative narrative analysis was conducted using SANRA quality standards to guide critical appraisal and reporting. Elements of the PRISMA 2020 checklist informed transparent reporting of the search strategy. Databases were searched for epidemiological, clinical, policy, and systems-level literature comparing fibroid prevalence, genetic predisposition, treatment modalities, and institutional frameworks across regions. SSA populations demonstrate earlier age of onset, larger tumor burden at presentation, and higher surgical rates. In contrast, UK management is characterized by guideline-directed conservative pathways, wider access to MRI, uterine artery embolization, minimally invasive surgery, and fertility-preserving pharmacotherapy. Determinants of divergence include genetic susceptibility, delayed presentation, financing constraints, imaging availability, workforce distribution, and national guideline enforcement. The review identifies an emerging pattern of reverse reproductive medical tourism, wherein UK-resident African-ancestry women seek cross-border surgical intervention due to system-level unmet need. Divergent fibroid management reflects not merely biological variation but structural inequities embedded within health systems. Addressing disparities requires integrated policy reform, workforce investment, patient-stratified clinical decision-making, and context-adapted guideline implementation. Future prospective comparative studies are warranted to quantify outcome differentials and inform equity-driven global gynecological practice.
The payload of the Interstellar Mapping and Acceleration Probe (IMAP) includes sophisticated in situ instruments to measure solar wind plasma and magnetic fields, suprathermal and energetic particles at 1 au as well as unprecedented remote sensing instruments to observe the energetic neutral atoms (ENAs) in the outer heliosphere and the ultraviolet glow of the interstellar neutral H interacting with the three-dimensional solar wind. This unique combination of sensors on a single platform allows connections to be made between the inner and outer heliosphere to an extent never before possible. This article focuses on the scientific theme of connecting the physics of particle acceleration and transport throughout the heliosphere. Such studies enabled by IMAP are organized into three broad categories: i) fundamental particle acceleration and transport processes, ii) heliospheric variability that affects those processes, and iii) inner heliospheric science.
This study aimed to develop the Psychological Abuse in Intimate Relationships Scale (PAIRS), a psychometrically sound measure capturing the multifaceted nature of psychological abuse, and to examine its dimensions and associations with trauma-related psychological outcomes. An initial item pool was created by reviewing 16 existing scales in the psychological abuse literature. Seventy-one items were generated and tested in a pilot study (n = 337). In the second phase, data were collected online from 1,012 ever-partnered women. Exploratory factor analysis (EFA) with Promax rotation examined the dimensional structure of PAIRS. ANOVAs compared women exposed to psychological abuse alone versus those also exposed to physical and/or sexual violence. Hierarchical regressions examined the associations between psychological abuse and peri-trauma distress and PTSD. The PAIRS demonstrated excellent internal consistency (Cronbach’s α = 0.98), and its subscales showed high reliability (Cronbach’s α = 0.80–0.95). EFA revealed a dominant unrotated factor, indicating a coherent psychological abuse construct. The rotated solution yielded eight interrelated factors, reflecting its multifaceted structure. Psychological abuse explained the largest proportion of variance in peri-trauma distress and PTSD. While psychological abuse alone was significantly associated with peri- and post-trauma outcomes, the severity of impairment was substantially amplified when it co-occurred with physical and/or sexual violence, consistent with cumulative and multiplicative effects. The PAIRS is a reliable and valid tool for capturing the multidimensional nature of psychological abuse. It offers important clinical and research utility by identifying specific abusive behavior patterns. Future research should validate the PAIRS in more diverse populations.
We present the first Event Horizon Telescope 1.3 mm observations of the supermassive binary black hole candidate OJ 287. The observations achieved an unprecedented angular resolution of 18 μas and reveal significant structural and polarization variability over just five days, marking the shortest timescale on which such changes have been directly imaged in this source. The inner jet exhibits a twisted ridgeline structure, with features displaying apparent superluminal motions up to about 22 c. The linear polarization maps reveal three main polarized features whose electric-vector position angles (EVPAs) change substantially over the time span of our observations, including a component with a radial polarization consistent with being produced by a recollimation shock. Most notably, we directly resolved two innermost jet components whose EVPAs rotate in opposite directions. The faster component, moving at 2.4 ± 0.9 μas/day (17.4 ± 6.5 c), exhibits counterclockwise EVPA swings of roughly 3.7° per day, while the slower component, with a proper motion of 1.4 ± 0.3 μas/day (10.2 ± 2.2 c), rotates clockwise at approximately 2.5° per day. Previous studies inferred helical magnetic fields in AGN jets from time-resolved or integrated polarization variability but lacked the angular resolution to directly image this effect. Our results provide spatially resolved evidence that a helical magnetic field threads the jet’s collimation and acceleration zone, ruling out models based on the superposition of unresolved components. Our analysis suggests that propagating shocks interact with a Kelvin–Helmholtz plasma instability, illuminating different phases of the helical magnetic field and producing the observed polarization spatial and temporal variability. Moreover, our model naturally accounts for the more rapid polarization rotation observed in the faster moving component. Our model predicts even more rapid swings in polarization, which could be tested with future observations featuring a more densely sampled time coverage.
Chiropractic care often exists outside of national healthcare systems, with exceptions in some national settings. This situation has led to suboptimal interprofessional communication and referral, with implications for the provision of appropriate and efficient care. To find solutions, the attitudes and perceptions of other professions must be better understood. We conducted a systematic review to assess other healthcare professionals’ perceptions and attitudes towards chiropractors and chiropractic care. The review was registered with PROSPERO (CRD42023403381). Reporting was guided by the PRISMA statement. A search was carried out on PubMed, CINAHL, AMED, Index of Chiropractic Literature (ICL) and MEDLINE in Jan 2021 and updated on Jan 2022, February 2023 and June 2024. We included qualitative and quantitative study designs, focusing on healthcare professionals’ attitudes toward and perceptions of chiropractic. Methodological quality was assessed using the Centre for Evidence Based Medicine tools for qualitative and cross-sectional survey studies. The search retrieved 245 articles, of which 43 were included for review. Studies had been conducted across multiple national jurisdictions A total of 10,108 participants were included across the studies, including primary and secondary healthcare professionals as well as healthcare students. Issues identified with influencing opinions of chiropractic practice included participants’ knowledge of chiropractic methods, scope of practice, interprofessional communication, research base, and education. While some participants reported a perception of positive clinical outcomes associated with chiropractic care, communication between healthcare professionals and chiropractors was often lacking. Attitudes towards chiropractic varied, with factors like knowledge, patient interest, and referrals influencing perceptions. To improve interprofessional attitudes and perceptions, the chiropractic profession might prioritise increased communication and information access concerning contemporary chiropractic care with other health care professions including educational interventions. Mitigation of a persistent lack of reliable information may improve how the profession is perceived in general, reduce misinformation and increase the likelihood that patients receive the joined-up care they need.
