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Evidence-informed practice is crucial to perform safe and efficient health interventions. In recent years, the evidence base of acupuncture continuously increased leading to the integration of acupuncture into clinical guidelines by various leading medical associations worldwide. At the same time, recent studies showed that licensed acupuncturists are rarely utilizing scientific research to inform their practice. This descriptive study using an online survey assessed the role of evidence-informed practice of acupuncturists in Austria, Germany, the United States of America, Australia, and New Zealand and aimed to determine critical factors relevant for promoting research literacy including demographical data, data about the clinical practice patterns, and the role and value of different information sources of traditional, complementary and integrative medicine (TCIM) practitioners. In total, 404 acupuncturists completed the online survey that included questions about demographic characteristics, the role and value of research in clinical practice, and details about the amount and type of continuing professional education. Univariate and multivariate analysis was used to determine significant predictors of the outcome variable \"importance of research in clinical practice\" (numerical rating scale, 0 to 100). The results showed that the majority of acupuncturists use certified courses as primary source of continuing professional education and value experts' opinions as the most reliable source of information. Multivariate analysis showed that the importance of research is dependent on the interest in research, an interdisciplinary learning environment, and positive experiences with research including if an acupuncture study ever changed the clinical practice of practitioners. Future educational programs should therefore focus on an interactive format aiming to promote skills to critically assess the value and practical use of research studies to improve the general practice of acupuncture.

Background Acupuncture is a popular treatment for women’s health. Several trials and meta-analysis have been published in recent years on key women’s health conditions but it is unclear if this has led to any changes in clinical practice or referrals from other health professionals. The aim of this survey was to explore if, how, and why, aspects of acupuncture practice have changed since our survey in 2013. Method An online cross-sectional survey of registered acupuncturists and Chinese Medicine practitioners in Australia and New Zealand. Questions covered the practitioner demographics and training, women’s health conditions commonly treated, modalities used, sources of information and continuing education (CE) (e.g. webinars), changes in clinical practice, and referral networks. Results One hundred and seventy registered practitioners responded to this survey, with 93% reporting treating women’s health in the last 12 months. The majority of respondents were from Australia (60%), held a bachelors level qualification (60%), and used a traditional Chinese medicine framework (86%). Most practitioners incorporated other modalities in addition to acupuncture. Most practitioners’ referral networks were predominantly based on word of mouth for menstrual, fertility and pregnancy related conditions, with referrals from medical practitioners being much less common. More than half (57%) reported having changed their women’s health practice in the past 12 months; just over a quarter of those who changed treatment (27%) reported it was due to research findings. The most commonly used sources of information/CE used to inform treatment were webinars and conferences, while peer-reviewed journal articles were the least commonly used source. Conclusion Acupuncture practitioners in Australia and New Zealand commonly treat women’s health conditions, but this is usually the result of women seeking them out, rather than being referred from a medical practitioner. The majority of practitioners did report changing their women’s health practice, but peer reviewed academic articles alone are not an ideal medium to convey this information since practitioners favour knowledge obtained from webinars and conferences. Academics and other clinician researchers should consider alternative means of disseminating knowledge beyond traditional academic publications and conferences, special interest groups may assist in this and also help improve research literacy.

Polycystic ovary syndrome (PCOS) affects 13% of women of reproductive age and is characterised by endocrine and metabolic disturbances. Current treatments include lifestyle changes and pharmacological options, but patient dissatisfaction with medications is high due to side effects. Women with PCOS appear to favour complementary approaches such as Chinese herbal medicine (CHM). This paper reviews the evidence for CHM in the management of PCOS, which typically includes multiherb prescriptions like Gui Zhi Fu Ling Wan and Cang Fu Dao Tan Tang as well as individual herbs such as Coptis chinensis (Huang Lian). CHM has shown potential in improving reproductive outcomes and metabolic health as well as for reducing inflammation through mechanisms like hormone regulation and modulation of gut microbiota. However, the methodological quality of CHM research is often low, and barriers to effective implementation of research findings remain. Future research should focus on improving methodological rigor, enhancing generalisability and conductance of pragmatic RCTs comparing real-world interventions. Addressing these challenges can help to further integrate CHM into clinical practice for managing PCOS to improve patient choice and potentially improve health outcomes for this population.

Polycystic ovary syndrome (PCOS) affects 11–13% of women globally, thus presenting a sizable health and economic burden. Characterized by irregular menstrual cycles, hyperandrogenism, and polycystic ovaries, PCOS is also linked to insulin resistance, infertility, type 2 diabetes, and cardiovascular disease. Dissatisfaction with conventional symptom management drives women to seek complementary therapies such as acupuncture. This paper synthesizes current evidence supporting the use of acupuncture for PCOS symptom management, examining the mechanisms, dosage, and point selection rationale based on both research and clinical practice. Acupuncture demonstrates potential for regulating menstrual cycles, improving insulin sensitivity, and enhancing quality of life. Mechanistically, acupuncture may influence neuroendocrine and reproductive functions, with manual acupuncture and electroacupuncture affecting steroid hormone receptors and the endogenous opioid system, respectively. These mechanisms can improve glucose tolerance, insulin sensitivity, and hormone regulation. Commonly used acupuncture points include SP6 (sanyinjiao), ST29 (guilai), CV6 (qihai), LI4 (hegu), and CV4 (guanyuan), strategically selected based on principles of traditional Chinese medicine (TCM) and supported by clinical research. Refining research methodologies and leveraging clinical expertise and real-world clinical data can enhance the applicability of research outcomes. In turn, this will support the integration of acupuncture and TCM as components of holistic PCOS treatment strategies, thereby improving patient outcomes.

Abstract Context Insulin resistance is common in women with polycystic ovary syndrome (PCOS). Inositol may have insulin sensitizing effects; however, its efficacy in the management of PCOS remains indeterminate. Objective To inform the 2023 international evidence-based guidelines in PCOS, this systematic review and meta-analysis evaluated the efficacy of inositol, alone or in combination with other therapies, in the management of PCOS. Data Sources Medline, PsycInfo, EMBASE, All EBM, and CINAHL from inception until August 2022. Study Selection Thirty trials (n = 2230; 1093 intervention, 1137 control), with 19 pooled in meta-analyses were included. Data Extraction Data were extracted for hormonal, metabolic, lipids, psychological, anthropometric, reproductive outcomes, and adverse effects by 1 reviewer, independently verified by a second. Data Synthesis Thirteen comparisons were assessed, with 3 in meta-analyses. Evidence suggests benefits for myo-inositol or D-chiro-inositol (DCI) for some metabolic measures and potential benefits from DCI for ovulation, but inositol may have no effect on other outcomes. Metformin may improve waist-hip ratio and hirsutism compared to inositol, but there is likely no difference for reproductive outcomes, and the evidence is very uncertain for body mass indexI. Myo-inositol likely causes fewer gastrointestinal adverse events compared with metformin; however, these are typically mild and self-limited. Conclusion The evidence supporting the use of inositol in the management of PCOS is limited and inconclusive. Clinicians and their patients should consider the uncertainty of the evidence together with individual values and preferences when engaging in shared decision-making regarding the use of inositol for PCOS.

Polycystic ovary syndrome (PCOS) is a prevalent endocrine disorder impacting women’s health and quality of life. This scoping review explores the use of the Internet of Things (IoT) in PCOS management. Results were grouped into six domains of the IoT: mobile apps, social media, wearables, machine learning, websites, and phone-based. A further domain was created to capture participants’ perspectives on using the IoT in PCOS management. Mobile apps appear to be useful for menstrual cycle tracking, symptom recording, and education. Despite concerns regarding the quality and reliability of social media content, these platforms may play an important role in disseminating PCOS-related information. Wearables facilitate detailed symptom monitoring and improve communication with healthcare providers. Machine learning algorithms show promising results in PCOS diagnosis accuracy, risk prediction, and app development. Although abundant, PCOS-related content on websites may lack quality and cultural considerations. While patients express concerns about online misinformation, they consider online forums valuable for peer connection. Using text messages and phone calls to provide feedback and support to PCOS patients may help them improve lifestyle behaviors and self-management skills. Advancing evidence-based, culturally sensitive, and accessible IoT solutions can enhance their potential to transform PCOS care, address misinformation, and empower women to better manage their symptoms.

Nutrient enrichment of soils and water will intensify in the future and has the potential to alter fundamental ecosystem processes, such as litter decomposition. We tested the direct (via water nutrient enrichment) and indirect (via changes in leaf chemistry) effects of nutrient enrichment on microbial activity and decomposability of Quercus robur L. (oak) leaves in laboratory microcosms simulating streams. Senescent leaves of oak trees grown without and with fertilization were incubated under ambient and elevated water nutrient [nitrogen (N) and phosphorus (P)] concentrations for 60 days. Soil fertilization led to an increase in leaf (3.4×) and leaf litter (2.3×) N concentration. Increased water-dissolved nutrients concentrations stimulated microbial activity (N uptake, microbial respiration, fungal biomass buildup and conidia production by aquatic hyphomycetes) that translated into accelerated litter decomposition (2.1× for unfertilized and 1.6× for fertilized trees). Leaves from fertilized trees had higher microbial activity and decomposition rates than leaves from unfertilized trees only at low dissolved nutrient availability. When both litter and water nutrients concentration increased, microbial activity and leaf decomposition were stimulated, but the effects were additive and direct effects from increased dissolved nutrient availability were stronger than those mediated by increases in litter N concentration (indirect effects). Our results suggest that increases in water nutrient availability (within the range used in this study) may exert a stronger control on microbial activity and litter decomposition than litter nutrient enrichment.

Aim To explore associations of cerebrospinal fluid biomarkers of neurodegeneration and amyloidosis with caregiver burden, cognition and functionality in dementia with Lewy bodies (DLB) paired with late-onset Alzheimer’s disease (AD) and healthy older people. Methods Consecutive outpatients with DLB were matched with outpatients with AD according to sex, cognitive scores and dementia stage, and with cognitively healthy controls according to age and sex to investigate associations of cerebrospinal fluid amyloid-β (Aβ 42 ,Aβ 40 ,Aβ 38 ), tau , phospho- tau Thr 181 , ubiquitin, α-synuclein and neurofilament light with caregiver burden, functionality, reverse digit span, a clock drawing test, Mini-Mental State Examination (MMSE) and Severe MMSE, adjusted for sex, age, education, dementia duration and APOE -ε4 alleles. Results Overall, 27 patients with DLB (78.98 ± 9.0 years-old; eleven APOE -ε4 +) were paired with 27 patients with AD (81.50 ± 5.8 years-old; twelve APOE -ε4 +) and 27 controls (78.98 ± 8.7 years-old; four APOE -ε4 +); two-thirds were women. In AD, Aβ 42 /Aβ 38 and Aβ 42 were lower, while tau /Aβ 42 and phospho- tau Thr 181 /Aβ 42 were higher; α-synuclein/Aβ 42 was lower in DLB and higher in AD. The following corrected associations remained significant: in DLB, instrumental functionality was inversely associated with tau /phospho- tau Thr 181 and tau /Aβ 42 , and reverse digit span associated with α-synuclein; in AD, instrumental functionality was inversely associated with neurofilament light, clock drawing test scores inversely associated with phospho- tau Thr 181 /Aβ 42 and α-synuclein/Aβ 42 , and Severe MMSE inversely associated with tau /Aβ 42 and tau /phospho- tau Thr 181 . Conclusions Cerebrospinal fluid phospho- tau Thr 181 in DLB was similar to AD, but not Aβ 42 . In associations with test scores, biomarker ratios were superior to isolated biomarkers, while worse functionality was associated with axonal degeneration only in AD.

Clinical distinction between dementia with Lewy bodies (DLB) and late-onset Alzheimer’s disease (AD) is difficult, while several features might affect the analyses of biomarkers. This study aimed to verify associations of anthropometric and demographic features with cerebrospinal fluid biomarkers, their ratios, and restructured traditional regression formulas in patients with DLB and AD, as well as in cognitively healthy controls. Consecutive outpatients with DLB were paired with outpatients with AD according to sex, dementia stage, and cognitive status, and with controls according to sex and age to investigate associations of sex, age, dementia duration, total sleep time, body mass index, alcohol use, smoking, sanitation, and APOE-ε4 alleles on the measurement of cerebrospinal fluid α-synuclein, biomarker ratios, and restructured traditional regression formulas involving amyloid-β (Aβ42,Aβ40,Aβ38), tau, and phospho-tau Thr181. Overall, 81 participants were included with DLB (n = 27;11 APOE-ε4 +) or AD (n = 27;12 APOE-ε4 +), and controls (n = 27;4 APOE-ε4 +); two thirds were women. Cerebrospinal fluid evidence of amyloidosis and tauopathy was more prevalent among women with AD, while Aβ42/Aβ38 could also discriminate men with DLB from men with AD. Restructured traditional regression formulas had higher diagnostic accuracy for women with AD. Aging, higher body mass index, and APOE-ε4 alleles were associated with amyloidosis in DLB, while only in AD were higher body mass index associated with lower tau pathology load, and more alcohol use associated with higher phospho-tau Thr181/Aβ42. These findings confirm the effects of anthropometric and demographic features on cerebrospinal fluid biomarkers, and also differences in aberrant amyloidosis and tauopathy between DLB and AD.

Temperature influences biological systems ranging from biochemical reactions to ecosystem processes. Some traits such as growth, development, and body size are related to temperature. Here, we ask the question whether the size of trichopteran changes along a ~ 1200 elevation gradient, as a predictor of temperature. Additionally, we measured in laboratory growth rates of the caddisfly Schizopelex festiva under three temperature regimes. Specimens of Hydropsyche ambigua, Hydropsyche siltalai, and Rhyacophila adjuncta were smaller at low than at high elevations. For each increase in 2 °C (downwards 400 m in the mountain), there was a 6.6 ± 2.3% decrease in size. Under laboratory conditions, specimens of Schizopelex festiva grew faster at 20 °C (34.7 ± 6.5 µg mg−1 day−1) than at 15 and 10 °C (18.9 ± 4.1 and 16.7 ± 2.3 µg mg−1 day−1, respectively). We conclude that caddisflies are sensitive to temperature along elevation gradients; we predict that ongoing global warming may affect aquatic insects body size and other related parameters such as survival and fitness.