Ergosterol, the principal sterol in fungal cell membranes, is the natural precursor of vitamin D₂. Ultraviolet exposure opens the molecule’s B-ring to form previtamin D₂, which then undergoes thermal isomerization to vitamin D₂. This mechanism allows mushrooms to become a controllable, non-animal source of the vitamin, but exposure must be managed carefully. Continued or excessive irradiation can generate lumisterol₂, tachysterol₂, vitamin D₄ and other photoproducts rather than improving the desired fraction. Reported vitamin D₂ concentrations consequently depend not only on ergosterol abundance but also on wavelength, dose, irradiance, exposure time, moisture, temperature, particle size, matrix structure and the geometry of the irradiated material.

The feedstock is itself highly variable. Species, strain, developmental stage, anatomical part, cultivation conditions, light exposure, storage and drying can all change ergosterol content and extractability. Processing can also leave a substantial residue: non-marketable caps, stipes, trimmings and irregular fruiting bodies may account for up to 30% of production mass. These materials retain ergosterol and offer a possible alternative to using edible mushrooms specifically for nutrient production. Their composition nevertheless varies, and the chitin-, β-glucan- and protein-rich cell wall can restrict solvent penetration. Drying, milling, steaming, ultrasound, microwave, enzymatic and other pretreatments can improve access to membrane-associated sterols, but the benefits depend on the species and the extraction process that follows.

Conventional Soxhlet, maceration and heat-assisted extraction remain useful benchmarks because they are established, although they may require hours of heating, substantial solvent and several downstream steps. Their weakness is not necessarily poor recovery, but the combined burden of long treatment, thermal exposure, solvent evaporation and purification. Ultrasound-assisted extraction can shorten the process and improve mass transfer through cavitation. In one study of industrial button-mushroom stalks, ultrasound at 25 °C increased ergosterol extraction by as much as roughly twofold relative to mechanical agitation, while 96% ethanol produced about twice the yield of 70% ethanol. This illustrates a recurring feature of intensified extraction: physical treatment and solvent composition cannot be optimized independently.

Microwave-assisted extraction offers another rapid route. In button-mushroom processing by-products, approximately 19.4 minutes at 132.8 °C and 1.6 grams of dry biomass per liter produced 556.1 milligrams of ergosterol per 100 grams, comparable to conventional recovery in much less time. Pressurized liquid extraction can likewise use short cycles and food-grade ethanol, although it demands pressure-rated equipment and controlled depressurization. Supercritical CO₂ extraction is particularly useful for separating lipophilic sterols from mushroom matrices. In one optimized button-mushroom process, the point that maximized ergosterol purity did not coincide with the point that maximized recovery, demonstrating that a high total extract yield can come at the cost of co-extracted material and more demanding downstream separation.

Enzymatic pretreatment may be particularly useful with supercritical CO₂. In a comparative study, chitinase increased the ergosterol concentration in a shiitake extract to 337.53 milligrams per gram, outperforming the effects of microwave and ultrasound pretreatments under the tested conditions. Deep eutectic solvents and natural deep eutectic solvents offer another route because their properties can be tailored and reused. A proline–levulinic acid system was recycled for seven shiitake-stem extraction cycles without a significant loss in extraction efficiency, while a menthol-based system supported ultrasound-assisted ergosterol recovery, ultraviolet conversion and stabilization in the same medium. The integrated system achieved 85.41% ergosterol extraction efficiency and a 4.08% vitamin D₂ yield, but these findings remain laboratory results rather than commercial performance.

Process integration also changes how irradiation must be controlled. Irradiating whole mushrooms before extraction avoids solvent handling but can be restricted by poor light penetration, whereas irradiation of an extract improves precursor accessibility yet adds solvent-dependent photochemistry and separation steps. Studies of mushroom extracts indicate that 254-nanometre light can convert ergosterol more effectively than 365-nanometre light, although broader spectra may act faster while producing more unwanted isomers. Intense pulsed light increased vitamin D₂ in shiitake powder from 4.18 to 100.82 micrograms per gram under the most intensive reported condition. Particle size must also be optimized rather than minimized without limit: one button-mushroom powder preparation achieved a 2.59% vitamin D₂ yield at a median particle size of 130–140 micrometres, reflecting a balance among surface area, porosity, light shielding and optical penetration.

Scale-up is the principal gap identified by the review. Increasing the size of a batch can alter acoustic-field distribution, electromagnetic heating, solvent flow, heat and mass transfer, pressure drop and irradiation geometry. A larger supercritical-CO₂ system for shiitake, using a six-liter vessel and two 1.6-liter separators, produced a lower overall extraction yield than smaller systems under similar conditions but generated fractions in which ergosterol accounted for as much as about 53% of the extract. The larger apparatus also separated sterol-rich fractions of different compositions. Such results show why yield, enrichment, productivity and fractionation must all be monitored during enlargement. Larger ultrasound systems also require careful control of power density and energy distribution, and flow-through configurations are often more practical than simply scaling a laboratory batch.

Environmental and economic assessments expose further constraints. A cradle-to-gate life-cycle assessment of an ergosterol-rich extract from mushroom residues attributed roughly 31–32% of potential damage to ultrasound-assisted ethanol extraction, 31–32% to evaporation and 19–20% to lyophilization, with electricity contributing as much as 70–85% of impacts under some allocation approaches. Locally generated photovoltaic electricity reduced impacts by up to about 50% in the assessed scenario, whereas osmotic dehydration before lyophilization produced a much smaller reduction of around 9%. A separate laboratory-based economic assessment estimated production costs of €2.43 per gram for an ergosterol-rich extract and €8.28 per gram for a vitamin D₂-rich extract; ethanol recovery reduced those estimates by about 47% and 39%, respectively, with the vitamin D₂-rich figure falling to €5.04 per gram. These are process-specific estimates, not validated industrial prices, but they identify solvent recovery, electricity, purification and the extra conversion step as decisive variables.

Patent activity suggests that commercial concepts are developing faster than public pilot-scale evidence. The targeted search identified 50 patents directly related to mushroom ergosterol or vitamin D₂ processing, plus eight downstream-use applications. Early inventions centered on ultraviolet treatment of dried shiitake, while later patents addressed fresh mushrooms, controlled humidity and temperature, conveyors, vibrating beds, pulsed light and irradiation integrated into drying systems. More recent approaches combine extraction with conversion, including ethanol extraction followed by ultraviolet treatment, vegetable-oil extraction of irradiated mushrooms, supercritical-CO₂ purification and direct irradiation of natural deep eutectic solvent extracts. The next essential step is not another isolated demonstration of extraction yield, but pilot-scale validation of complete process chains with standardized mass and energy balances, product-stability testing, solvent accounting and simultaneous techno-economic and life-cycle assessment.

Subject of Research: Process intensification and scale-up of ergosterol and vitamin D2 recovery from mushrooms

Article Title: Advanced recovery of ergosterol- and vitamin D2-rich fractions from mushrooms: process intensification and scale-up challenges

Article References: Pastor, K., Vladic, J., & Nastić, N. (2026). Advanced recovery of ergosterol- and vitamin D2-rich fractions from mushrooms: process intensification and scale-up challenges. Frontiers in Nutrition, 13, Article 1987834. https://doi.org/10.3389/fnut.2026.1987834

Image Credits: AI Generated

DOI: 10.3389/fnut.2026.1987834

Keywords: mushrooms, ergosterol, vitamin D2, UV photoconversion, process intensification, supercritical CO2 extraction, deep eutectic solvents, ultrasound extraction, scale-up, life-cycle assessment, Advanced, recovery

Ohinau Island is a roughly 43 ha island about 5 km off the east coast of New Zealand’s Coromandel Peninsula. It is owned by Ngāti Hei and co-managed with the Department of Conservation. Kiore, or Pacific rats, and European rabbits were eradicated in 2005. The island supports 12 flesh-footed shearwater colonies, five of which have been monitored since April 2016, with visits generally occurring during egg-laying and incubation in December and January and during chick-rearing and fledging in April and May.

One hundred captive-reared wētā were released at a southern site in November 2007, comprising 44 males and 56 females at least 1.5 cm in body length. Tracking-tunnel surveys in 2011 and 2012 found that the population had dispersed only 60–100 m from the release site. The new observations, covering nine to 16 years after translocation, show a different pattern: wētā were found in monitored colonies across a broad section of the island, with one recorded approximately 830 m from the release site at a temporary research camp in 2020.

The researchers encountered the insects during nocturnal searches of seabird colonies and connecting tracks, and during daytime investigations of burrows. In 2016, wētā were frequently seen only at the southernmost colony and were encountered on few occasions at a central colony, with apparent density decreasing toward the northern end of the southern colony. Sightings farther from the release site became more frequent from 2017. In 2018, researchers recorded wētā at the westernmost colony, on the track linking that colony with the southernmost one, and occasionally at all monitored colonies except the northernmost.

Distribution records extended farther north in 2020, when a single wētā was observed at the temporary camp, about 830 m from the release site. During 2022 and 2023, wētā were encountered more frequently at the camp and within the northernmost monitored colony, while they continued to be found regularly at the other monitored colonies. The authors therefore interpret the observations as evidence of slow initial dispersal followed by more rapid northward expansion and say that the population has likely recolonized the whole island. The southern part of Ohinau Island was not searched, however, so complete island-wide occupation was not directly demonstrated.

Field workers also repeatedly observed M. isolata scavenging on the carcasses of dead seabird chicks in May 2019, primarily flesh-footed shearwater chicks and occasionally grey-faced petrel chicks. The authors state that scavenging had not previously been reported in this species, although it had been proposed as a possible dietary behavior. M. isolata is regarded as an opportunistic carnivore that primarily eats insects, including smaller members of its own species. These observations establish carrion feeding at a monitored colony but do not quantify the contribution of seabird carcasses to the diet or show that carrion enabled establishment.

A severe drought affected the North Island during the 2019–2020 austral summer, and extensive sections of Ohinau Island’s māhoe forest died off. The monitoring team was on the island for six weeks, from 3 to 27 January and 10 to 28 February 2020, without recorded precipitation. Nightly colony searches produced fewer wētā sightings as January progressed into February, and no wētā were seen on the forest floor during the final weeks of February, including around the release site. The observations do not establish the effect of the drought on survival. Wētā were seen in subsequent years and continued to expand, suggesting that some individuals may have remained inactive during the dry period and persisted once conditions improved.

Several features of the island may be associated with establishment. Ohinau lacks tuatara and little spotted kiwi, while morepork are detected infrequently and at low numbers. Duvaucel’s gecko is present at high densities and may prey on the wētā. Burrowing seabirds also modify colony soils and create underground chambers that the wētā use as daytime retreats or in which they excavate galleries. The authors suggest that seabird colonies may have helped the early expansion, but the opportunistic observations cannot establish causal relationships involving predation, habitat conditions, carrion availability or population growth.

The findings come from sightings concentrated around monitored seabird colonies and their tracks, with no systematic measurement of population size, reproductive success or occupancy across the entire island. The authors interpret the expansion as potentially density dependent, in which rapid dispersal begins after a population threshold is reached, but that mechanism was not tested. They recommend standardized surveys on Ohinau and the other islands receiving translocated M. isolata to corroborate the reported range expansion and assess the long-term fate of the populations.

Subject of Research: Range expansion of translocated Mercury Islands tusked wētā on Ohinau Island

Article Title: Recovery and range expansion of the once critically endangered Mercury Islands tusked wētā ( Motuweta isolata ) on Ohinau Island, New Zealand, 16-years post-translocation

Article References: Lamb, S., Olsthoorn, M., Burgin, D., Ray, S., Bell, M., & Crowe, P. (2026). Recovery and range expansion of the once critically endangered Mercury Islands tusked wētā (Motuweta isolata) on Ohinau Island, New Zealand, 16-years post-translocation. Journal of Orthoptera Research, 35(1), 33-40. https://doi.org/10.3897/jor.35.131747

Image Credits: AI Generated

DOI: 10.3897/jor.35.131747

Keywords: Mercury Islands tusked wētā, Motuweta isolata, Ohinau Island, wildlife translocation, range expansion, seabird colonies, drought response, conservation monitoring, New Zealand, Recovery, range, expansion

The substudy was conducted at two Swedish anaesthesia departments, Linköping University Hospital and Ryhov County Hospital in Jönköping. Eligible participants were adults aged 18 years or older with a confirmed cancer diagnosis who were scheduled for port implantation. They were allocated in a 1:1 ratio to local anaesthesia alone or local anaesthesia combined with patient-controlled sedation using propofol and alfentanil. The parent trial’s primary endpoint was maximal intraprocedural pain, while the primary outcome of this substudy was the difference in postoperative total QoR-15 scores between groups.

The QoR-15 is a validated patient-reported measure covering pain, physical comfort, physical independence, psychological support and emotional state. Scores range from 0 for very poor recovery to 150 for excellent recovery, and the published minimal clinically important difference used in the analysis was 6 points. The questionnaire was administered before surgery, after the procedure but before discharge, and by telephone on postoperative day 1. Secondary outcomes included changes in QoR-15 domains and individual items, postoperative pain and analgesic consumption.

The trial was unblinded, and the repeated-measures analysis used available observations from randomised participants within the intention-to-treat population. Of 340 patients randomised, six were excluded after investigators identified that they met exclusion criteria. The final population comprised 334 patients: 168 received local anaesthesia alone and 166 received local anaesthesia plus patient-controlled sedation. One patient in the local-anaesthesia group had an unsuccessful implantation and lacked primary outcome data. Postoperative day 1 follow-up was incomplete for 16 patients, or 9.6%, in each group. A complete-case sensitivity analysis was consistent with the primary analysis.

Preoperative mean QoR-15 scores were 122.4 with a standard deviation of 19.3 in the local-anaesthesia group and 119.9 with a standard deviation of 21.6 in the sedation group. There was no overall difference in total postoperative QoR-15 scores between groups (P = 0.61). Before discharge, the between-group mean difference was 1.9 points (95% confidence interval −0.6 to 4.4; P = 0.14), and on postoperative day 1 it was −2.4 points (95% confidence interval −5.1 to 0.2; P = 0.07). These comparisons did not show a statistically significant between-group difference at either postoperative assessment.

Total QoR-15 scores changed significantly over time in both groups (P < 0.001), with a significant group-by-time interaction (P = 0.02). By postoperative day 1, mean scores had increased from baseline by 2.9 points in the local-anaesthesia group and by 3.1 points in the sedation group, with P = 0.02 for both changes. Neither increase exceeded the published minimal clinically important difference of 6 points. The sedation group recorded its largest within-group increase before discharge: 5.6 points (95% confidence interval 3.1 to 8.1; P < 0.001), also below that threshold.

The emotional-state and psychological-support domains changed significantly over time, and their patterns differed between treatment groups. Both domains reached their highest scores before discharge in the sedation group but not in the local-anaesthesia group. Individual-item analyses identified differences over time for support from hospital staff, feeling sad or depressed, and ability to breathe easily. These domain and item findings were exploratory because the analysis did not adjust for multiple comparisons, so the authors cautioned that isolated statistically significant results could reflect chance findings. The transient pattern was not a demonstrated causal effect of sedation; the authors noted that relief after completing the procedure and support from the healthcare team might also have contributed.

Postoperative pain remained common. The pain domain was the only QoR-15 domain to decline significantly from baseline in both groups on postoperative day 1. Maximum pain that day had a median numerical rating scale score of 3, with an interquartile range of 2 to 5, in both groups (P = 0.86). Ratings of at least 4 were reported by 74 of 151 evaluable patients in the local-anaesthesia group, or 49.0%, and by 71 of 148 in the sedation group, or 48.0% (odds ratio 1.042, 95% confidence interval 0.66 to 1.64; P = 0.86).

Additional pain medication was taken by 98 patients, or 64.9%, in the local-anaesthesia group and 108 patients, or 73%, in the sedation group; paracetamol was the most commonly used analgesic in both groups. The findings have important limitations. Approximately one-third of those who declined participation wanted sedation, potentially limiting generalisability to patients most likely to seek it. The lack of blinding may have affected subjective patient-reported outcomes, and incomplete day 1 follow-up further constrained the repeated-measures analysis. Because the recovery analysis was a prespecified secondary analysis and domain and item tests were not adjusted for multiple comparisons, the authors classified the findings as exploratory.

Subject of Research: Postoperative recovery after patient-controlled sedation during venous port implantation in adults with cancer

Article Title: Quality of recovery (QoR-15) after patient-controlled sedation during venous port implantation: A prespecified substudy of the PACSPI-2 randomised clinical trial

Article References: Seifert, S., Nilsson, A., Azman, J., Eriksson, O., Chew, M. S., Hammarskjöld, F., & Taxbro, K. (2026). Quality of recovery (QoR-15) after patient-controlled sedation during venous port implantation: A prespecified substudy of the PACSPI-2 randomised clinical trial. PLOS One, 21(10), e0360479. https://doi.org/10.1371/journal.pone.0360479

Image Credits: AI Generated

DOI: 10.1371/journal.pone.0360479

Keywords: patient-controlled sedation, venous port implantation, Quality of Recovery-15, postoperative recovery, cancer care, local anaesthesia, postoperative pain, randomised clinical trial, Quality, recovery, QoR-15, patient-controlled

Sub-ice-shelf bathymetry is a major boundary condition for models of Antarctic ice sheets and the ocean cavities beneath them. The shape of the seabed helps determine where relatively warm, salty ocean water can enter a cavity, how currents are steered across the basin, and where deep troughs may permit dense water to penetrate toward grounded ice. Bathymetric roughness also influences turbulence in the cavity and the transfer of heat to the ice. Direct observations remain rare because the cavities are difficult for ships and other platforms to access, leaving gravity inversion as an important tool for estimating hidden terrain between scattered measurements.

The approach works because the large density contrast between rock and seawater leaves a measurable imprint on Earth’s gravitational field. Airborne surveys can recover broad features of a sub-ice-shelf basin, typically at wavelengths of about 5 kilometres and above. Geological complications make the calculation less straightforward. Lateral variations in crustal thickness, rocks with different densities, and other subsurface structures can distort the measured anomaly. Earlier inversions addressed some of these issues by tying reconstructed topography to known elevations, but the new analysis indicates that this can be insufficient when a large, deep basin lacks centrally positioned tie points.

New observations collected beneath the Dotson and Crosson ice shelves revealed the scale of the problem. Autonomous underwater vehicles Ran and Autosub Long Range surveyed the ocean-facing margin during the RV Nathaniel B. Palmer expedition in January and March 2022. Ran collected multibeam profiles with a Kongsberg EM2040 system, supported by Doppler velocity log and inertial navigation; comparisons with shipborne swaths indicated an absolute horizontal positional error below 40 metres and a relative error below 10 metres. Autosub Long Range followed three routes extending 2, 16 and 39 kilometres inboard from the ice-shelf margin with a single-beam depth sounder whose local depth accuracy was below 1 metre. Three profiling floats and seismic measurements from 27 active shot points added observations farther across the cavity.

Comparison of these observations with the earlier gravity-derived model showed that parts of the Dotson basin had been estimated as too shallow by at least 400 metres. The discrepancies were most systematic at wavelengths longer than 30 kilometres, whereas the previous inversion reproduced much of the observed variation at intermediate scales of 10 to 30 kilometres. Differences below 10 kilometres were also expected because the airborne gravity data had been filtered at a 5-kilometre wavelength and collected with line spacing of 7.5 to 10 kilometres. The long-wavelength mismatch pointed to a systematic regional bias rather than merely unresolved small-scale terrain or scattered measurement errors.

The study’s explanation is that glacial excavation removes mass from the crust and prompts an upward adjustment of the Mohorovičić discontinuity, the boundary between less-dense crust and denser mantle. This isostatic compensation brings dense mantle material closer to the surface beneath a deep basin. Its positive gravitational contribution can offset part of the negative anomaly produced when excavated rock is replaced by water, causing the basin to appear shallower than it is. The method therefore calculates a model of the compensating gravity field and subtracts it from the original free-air anomaly before the bathymetric inversion. The researchers describe it as a pseudo-isostatic correction because its initial topography is inferred from gravity rather than directly observed.

For the calculation, the team used an Airy isostatic model, which assumes that the crust has no lateral strength. They adopted a reference Mohorovičić depth of 30 kilometres, crustal density of 2,670 kilograms per cubic metre, and mantle density of 3,330 kilograms per cubic metre. The chosen reference depth was deeper than some local seismic estimates, but the authors considered it a reasonable global average given uncertainty in the crustal and upper-mantle density structure. The Airy model generates the maximum local Moho deflection and therefore the largest correction among models with different crustal strengths. The researchers also calculated the compensation while treating excavated material as having displaced air rather than water, amplifying the modelled Moho topography by 1.6 times. This selected treatment produced a good fit with the direct observations beneath the ice shelf.

After subtracting the modelled isostatic gravity effect, the adjusted anomaly was converted into an initial topographic surface using a rearranged Bouguer-slab equation. The researchers then modelled the gravity field of that surface using prisms, calculated the residual against the adjusted observations, and iteratively updated the topography. Two further iterations brought the residual below about 1 milligal across most of the survey area. Where direct observations were available, the difference between the reconstructed surface and measured elevation was interpolated into a correction field. Subtracting that field from the gravity-derived estimate produced a model that followed the observations while retaining the regional shape supplied by gravity. The inversion was also run without the sub-ice-shelf observations as an independent test of the isostatic correction.

Against the longest Autosub Long Range profile, the isostatically corrected inversion reduced the mean error from 195 to 3.2 metres and the standard deviation from 105 to 70 metres. Comparison with float observations produced a smaller improvement in the mean error, from 313 to 135 metres, while the standard deviation remained 187 metres. The researchers attributed the difference partly to the floats following the steep coast of Bear Island, where an approximately one-kilometre topographic step falls from coastal terrain of about 300 metres to adjacent depths near 700 metres below sea level. That feature is not recoverable using gravity data filtered at wavelengths above 5 kilometres. Float navigation also had horizontal uncertainty of about 1 kilometre or more, which could make measured depths appear displaced from the model. The vehicle profile lay closer to the centre of the basin and away from the steep fjord wall, making it a more favourable test of the method.

The revised method changed the regional picture most strongly beneath Dotson and Crosson, where the basin is deep and direct constraints are sparse. The final model combined the corrected inversion with the new observations and was slightly deeper in places than the unconstrained, isostatically corrected result. The authors said this version should provide the best bathymetric estimate currently available for the area given the available data. They also cautioned that the 70-metre standard deviation along the main vehicle profile is location-specific: it incorporates unresolved short-wavelength topography, errors of about 1.67 milligals in the gravity observations, local geological variability, and navigation uncertainty. Unknown geology remains difficult to quantify, while thick sediment layers could create a different, negative gravity effect that the model does not explicitly resolve.

Beyond the study area, the results show that gravity-derived bathymetry can contain regional errors of several hundred metres when isostatic compensation is ignored. Such errors may affect simulations of ocean circulation beneath ice shelves and assessments of grounded-ice vulnerability to warming oceans, because a modelled seabed raised above a sill can artificially restrict the entry of warm water. The correction is likely to matter most for small or poorly explored ice shelves containing broad erosional basins and few direct measurements, rather than the much larger Ross or Ronne-Filchner ice shelves. Its influence was smaller near Thwaites Glacier, where the predicted compensation field had a low-amplitude, approximately uniform gradient, so interpolation between observations on either side of the data gap could provide a reasonable result. The study therefore indicates that direct observations remain essential, while a physically informed isostatic correction can make gravity inversion substantially more reliable for recovering regional bathymetry beneath Antarctic ice shelves.

Subject of Research: Gravity-based recovery of bathymetry beneath the Dotson and Crosson ice shelves using an isostatic correction

Article Title: Improved recovery of sub-ice shelf bathymetry from gravity data using an isostatic correction: a case study from the Dotson and Crosson ice shelves, West Antarctica

Article References: Jordan, T. A., Heywood, K. J., Wåhlin, A., Hall, R. A., Muto, A., Dutrieux, P., Hogan, K., Girton, J., Alley, K. E., & Pettit, E. (2026). Improved recovery of sub-ice shelf bathymetry from gravity data using an isostatic correction: a case study from the Dotson and Crosson ice shelves, West Antarctica. Solid Earth, 17(10), 1187-1199. https://doi.org/10.5194/se-17-1187-2026

Image Credits: AI Generated

DOI: 10.5194/se-17-1187-2026

Keywords: Antarctica, ice-shelf bathymetry, gravity inversion, isostatic compensation, Dotson Ice Shelf, Crosson Ice Shelf, glacial erosion, seabed mapping, autonomous underwater vehicles, West Antarctica, Improved, recovery

The research team, led by Jie Yang and Li Jiang of Shanghai Jiao Tong University School of Medicine, recruited 160 young and middle-aged adults who underwent minimally invasive lung cancer surgery at a tertiary hospital in Shanghai between June and December 2024. Before discharge, each participant completed a battery of validated assessments measuring three dimensions of early recovery: the quality of their in-hospital recovery, their confidence in managing their own cancer care, and the level of social support they perceived around them. One month after surgery, the researchers assessed whether participants had returned to work and, crucially, at what stage of readiness they stood.

The headline result is striking: 88 of the 160 participants, or 55 percent, had already returned to work within a single month of undergoing lung cancer surgery. This is a remarkably rapid reintegration for a population recovering from a cancer diagnosis and a thoracic operation. Yet the study also revealed a sobering nuance. Of those who had resumed work, 53 were categorized in the uncertain maintenance stage of return to work, meaning they had gone back to their jobs but remained unsure whether they could sustain it. Only 35 had reached the proactive maintenance stage, in which they felt confident and in control of their working lives again.

The remaining 72 participants, 45 percent of the cohort, had not yet returned to work at one month. The researchers mapped these individuals across the stages of the Readiness for Return-to-Work model, a framework originally developed for patients with musculoskeletal disorders and adapted here for cancer survivors. Nine were in the precontemplation stage, not yet thinking about resuming work. Fifteen were in the contemplation stage, aware of the need but not yet committed. Twenty-two stood in the prepared for action self-evaluative stage, weighing whether they were ready, while 26 had reached the prepared for action behavioural stage, actively making plans to go back.

Using binary logistic regression, the team examined which baseline factors predicted early return to work. Three variables emerged as significantly associated with a greater likelihood of resuming employment within one month: higher quality of in-hospital recovery, greater cancer self-management self-efficacy, and stronger perceived social support. In other words, patients who recovered better during their hospital stay, who felt more capable of managing symptoms, medications, and follow-up care on their own, and who perceived more support from family, friends, and their community were more likely to be back at their desks or workplaces within weeks of the operation.

The measurement of in-hospital recovery relied on the Quality of Recovery-15 scale, or QoR-15, a psychometrically validated instrument developed by anaesthesiology researchers to capture the multidimensional nature of postoperative recovery, including physical comfort, emotional state, psychological support, and independence. The self-efficacy dimension was assessed with the Strategies Used by People to Promote Health scale, rooted in Bandura’s social cognitive theory, which holds that a person’s belief in their own capability is a central determinant of whether they will attempt and sustain a behaviour. Perceived social support was measured with a Chinese version of the Perceived Social Support Scale, capturing the support patients feel from significant others, family, and friends.

The theoretical scaffolding of the study draws on the biopsychosocial model of health, which argues that outcomes after illness and treatment cannot be understood through biology alone but must incorporate psychological and social dimensions. This perspective has gained traction in return-to-work research across orthopaedic trauma, hand injuries, and cardiovascular disease, and the Shanghai team extended it to the specific and understudied context of lung cancer surgery in working-age adults. Lung cancer is among the most common malignancies in China, and a substantial proportion of patients are diagnosed at ages when they remain economically active, making the question of work reintegration both a clinical and a societal concern.

The study’s clinical implications are considerable. Rehabilitation nursing, the authors note, plays a critical role in supporting postoperative functional recovery and facilitating reintegration into daily life and work. If the quality of recovery during the hospital stay is already associated with return to work one month later, then interventions delivered in the immediate perioperative period, consistent with enhanced recovery after surgery protocols for lung surgery, may have downstream effects on employment outcomes. Similarly, if self-efficacy and perceived social support predict early return, then nursing programmes that build patients’ confidence in self-managing their cancer care and that mobilize family and community resources could be designed with return to work as an explicit goal.

However, the authors and the broader literature caution that early return is not the same as sustainable return. The fact that most patients who resumed work within a month remained in the uncertain maintenance stage suggests that many were pushing themselves back to employment before they felt fully confident they could stay there. Prior research on cancer survivors has documented work withdrawal behaviour, fear of failure at work, financial toxicity, and the mediating role of self-efficacy between social support and work outcomes. The Shanghai findings align with a growing body of evidence from colorectal, kidney, breast, and head and neck cancer survivors showing that psychological readiness and social resources are as important as physical recovery in determining whether patients return to work and remain there.

The study also contributes to a wider conversation about what work means after cancer. Recent grounded theory research has argued that survivors often reconceive the purpose of work following a diagnosis, sometimes abandoning conventional career ambitions in favour of work that feels meaningful or manageable. The Shanghai cohort’s distribution across readiness stages captures this psychological complexity: even among those who had not yet returned, many were actively evaluating their capacity or making concrete plans. For clinicians, the message is that return to work should be assessed not as a binary event but as a staged process, and that tailored support, whether building self-management skills, strengthening social networks, or optimizing perioperative recovery, may help patients move through those stages more confidently. For working-age lung cancer patients facing surgery, the evidence now suggests that the journey back to the workplace is shaped as much by what happens in the hospital and in the mind as by what happens in the operating room.

Subject of Research: Associations of in-hospital recovery, cancer self-management self-efficacy, and perceived social support with early return to work in young and middle-aged patients undergoing lung cancer surgery: a prospective cohort study

Article Title: Associations of in-hospital recovery, cancer self-management self-efficacy, and perceived social support with early return to work in young and middle-aged patients undergoing lung cancer surgery: a prospective cohort study

Article References: Yang, J., Jiang, L., Ge, L., Shi, Y., Ju, X.-X., & Liu, X.-X. (2026). Associations of in-hospital recovery, cancer self-management self-efficacy, and perceived social support with early return to work in young and middle-aged patients undergoing lung cancer surgery: a prospective cohort study. Supportive Care in Cancer, 34(11), Article 1107. https://doi.org/10.1007/s00520-026-11305-6

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11305-6

Keywords: Associations, in-hospital, recovery, cancer, self-management, self-efficacy, perceived, social, support, early, return, work

Honeybee hives have long been recognised as rich sources of environmental nucleic acids, or eNA, encompassing both DNA and RNA from a wide range of taxonomic origins. Bees forage across landscapes, collecting pollen and nectar from flowering plants while simultaneously picking up microbial spores, fungal fragments, and viral particles. Genetic material from these sources accumulates within the hive, where it can be extracted and analysed to reveal the surrounding vegetation, detect plant pathogens, and assess honeybee health through the identification of pests and pathogens. Previous studies have used hive samples to monitor plant biodiversity, identify weed incursions, detect honeydew-producing insects, and even determine the regional provenance of honeys being sold commercially. However, the collection of internal hive samples such as honey, pollen, and bees requires specialists to open and handle hives, is seasonally dependent, and can weaken colonies over time if long-term monitoring is undertaken. Opening hives during colder months to collect samples can also risk colony survival.

The research team, working at sites in the Australian Capital Territory, set out to compare the effectiveness of non-invasive hive entrance swabbing with seven commonly used sample types. At a former pastoral property surrounded by grassland nature reserves and residential areas, they collected hive entrance swabs, hive debris swabs, honey, internal pollen, pollen trap samples, return forager bees, and top box bees across three sampling days in January 2023. Each hive entrance was swabbed using a sterile nylon FLOQSwab dipped in deionised water, rubbed across the entire length of the entrance four times while twisting to reach a range of depths inside the hive. Three consecutive swabs were collected per hive, along with the more invasive samples. All samples were immediately placed on ice in the field and stored at minus 80 degrees Celsius until DNA and RNA extraction, with no storage buffers used.

For DNA metabarcoding, the researchers amplified four genetic markers targeting bacterial 16S, animal COI, fungal ITS1, and plant ITS2 regions. The animal COI reactions included a peptide nucleic acid clamp specifically developed for this study to reduce amplification of honeybee DNA, allowing non-honeybee animal taxa to be detected more effectively. After quality control and filtering, over 5.2 million metabarcoding reads were obtained across the four markers. The results were striking: hive entrance swabs and hive debris swabs consistently recovered the highest number of taxa for bacteria, animals, and fungi. For the fungal ITS1 marker, hive entrance swabs detected 232 of the 309 total fungal taxa observed in the dataset, along with the highest total reads and average reads per sample. For bacteria, both swab types recovered 33 unique taxa each out of 35 total observed, while pollen trap samples produced the lowest number of total reads and unique taxa.

Plant detections told a slightly different story. Honey samples produced the highest average number of unique plant taxa per sample, closely followed by swab samples, with no significant differences observed between these sample types. Internal pollen samples, despite returning the highest total reads for the plant marker, yielded the lowest average number of unique taxa per sample. Return forager bees, which might be expected to carry the freshest plant genetic material, identified only 33 of the 62 total plant taxa detected. The researchers suggest this unexpected pattern may reflect the dynamic foraging behaviour of bees, which varies with the colony’s nutritional needs. Pollen is typically consumed more quickly than honey stores, meaning honey likely provides a cumulative record of the local environment while pollen samples give a more contemporary view of recent flowering activity.

For RNA virus detection, the team used metatranscriptomic sequencing on a subset of sample types collected in April 2024 from a separate apiary bordering Black Mountain and the Australian National Botanic Gardens. After quality control, 67 viruses were identified from a combined total of 17 million reads assigned to contigs. Honey samples had the highest observed number of viruses across all sample types, with an average of 23 viruses per replicate, followed by hive entrance swabs with 16 and top box bee samples with 14. Internal pollen samples contained the lowest observed number of viruses with an average of 7.73. All four sample types detected fungal and plant viruses, though honey samples comprised the highest number of plant viruses with 23 detected, followed by hive entrance swabs and top box bees with 10 each. Fungal viruses were most abundant in swab samples, with 10 detected. Honeybee-specific viruses were most abundant in bee samples, followed by honey and hive entrance swabs.

Five of the top 10 viruses detected across all sample types were associated with the plant genus Camellia, all detected in each sample type. The remaining five included two fungi-associated viruses, two viruses associated with clovers, and the honeybee virus black queen cell virus. The researchers note that the lack of honeybee and other insect viruses detected in pollen samples was surprising, given multiple other studies report success in detecting honeybee viruses using pollen. They attribute this result to the small number of hives sampled and a general low prevalence of honeybee viruses in these hives at the time of sampling. The trade-offs between the number of viruses detected and the depth and completeness of viral sequences emphasise that the most suitable sample type depends on the specific virus surveillance goal.

Replication analysis revealed important guidance for optimising sampling effort. When comparing the number of unique taxa collected from each swab replicate, a downward trend was observed following subsequent swabbing of the same area. For bacteria, only one additional unique taxon was detected from a second swab replicate, with no new taxa detected on the third. For fungi, however, swabbing replicates continued to detect additional unique taxa across each replicate, with 31 and 19 additional taxa detected in replicates two and three of the hive entrance swabs. Based on species accumulation curves, replication was sufficient for bacterial and animal communities, but further replication would be needed to recover additional fungal and plant diversity. The researchers recommend collecting two swab replicates per hive as sufficient for capturing taxonomic diversity from hive eDNA metabarcoding, while noting that sampling from additional hives is likely more beneficial than collecting more swab replicates from a single hive.

The effectiveness of hive entrance swabbing likely stems from the accumulation and persistence of eNA across the hive entrance and base. Hive debris typically accumulates at the base as a result of routine colony activities such as brood rearing and food storage. High bee traffic through the hive entrance facilitates the deposition of pollen, microbial spores, and other biological material from returning foragers, while passive air flow can draw eNA from the surrounding area into hives. The comparable and often better recovery of eNA from swabs over more direct sample types was somewhat surprising to the researchers, given that individual bees carry only a fraction of the total eNA and represent a narrower time window compared to honey and hive debris, which accumulate genetic material over longer periods. Each sample type captures a distinct temporal and ecological snapshot of the hive environment.

The study represents the most comprehensive comparison of hive eNA sample types to date and provides an improved sampling protocol that can be implemented for a range of biosecurity surveillance activities. Hive entrance swabbing offers clear logistical advantages: it is simple enough for non-specialists to collect, non-invasive for the ongoing persistence of hives, suitable for year-round sampling without seasonal constraints, and does not weaken colonies over time. The researchers suggest that leveraging established hive networks with this approach offers a highly scalable strategy for detecting honeybee pests and pathogens, plant pathogens, and surrounding vegetation across diverse landscapes. Engaging with beekeepers to capture hive eNA across urban and agricultural landscapes presents an exciting opportunity to support both hive health and environmental monitoring, one that can be strengthened through collaboration with citizen scientists and scaled across broad geographic areas with minimal impact on the hives themselves.

Subject of Research: Surface swabs outperform most traditional honeybee (Apis mellifera) hive samples for recovery of eDNA and eRNA

Article Title: Surface swabs outperform most traditional honeybee ( Apis mellifera ) hive samples for recovery of eDNA and eRNA

Article References: Hill, E., Milla, L., Encinas-Viso, F., O'Dwyer, J., Gooden, B., Hopper, M., & Roberts, J. (2025). Surface swabs outperform most traditional honeybee (Apis mellifera) hive samples for recovery of eDNA and eRNA. Metabarcoding and Metagenomics, 9, Article e165436. https://doi.org/10.3897/mbmg.9.165436

Image Credits: AI Generated

DOI: 10.3897/mbmg.9.165436

Keywords: Surface, swabs, outperform, most, traditional, honeybee, Apis, mellifera, hive, samples, recovery, eDNA

The headline finding is deceptively simple. Hurricanes cause economic losses equivalent to about two days of typical sales in affected areas. That is a real hit, but it is a far cry from the weeks-long shutdowns that dominate public perception after catastrophic storms. Even more notable is the speed of the rebound: local economies recover to pre-hurricane levels within roughly ten days. The study, led by Sumit Agarwal of the National University of Singapore together with Smarajit Paul Choudhury of the Mastercard Economics Institute, Mingxuan Fan of the National University of Singapore, and Leora Klapper of the World Bank, provides some of the first systematic real-time evidence on how local economies adjust to hurricanes as they happen.

The technical achievement behind these numbers lies in the data infrastructure. The researchers used aggregated and anonymized transaction data, provided under controlled access by the Mastercard Economics Institute, to measure merchant sales and consumer spending at daily frequency across thousands of ZIP codes. This granularity matters enormously. Traditional economic damage assessments rely on surveys, insurance claims, or official statistics that arrive weeks or months after the event, by which time the recovery has already occurred and the dynamics of disruption have been lost. Daily transaction data, by contrast, capture the economic pulse of a community as the storm approaches, makes landfall, and passes, allowing researchers to watch the disruption unfold hour by hour and day by day.

One of the study’s most consequential findings concerns what economists call substitution. In theory, when a hurricane shuts down businesses in one location, consumers might simply shift their spending to neighboring areas that escaped the worst of the storm, or they might move purchases across channels, buying online instead of from flooded storefronts. If such substitution were widespread, the aggregate economic damage of a hurricane would be much smaller than the local damage suggests. But the researchers found limited offsetting substitution across locations and channels. The losses in hit areas are not meaningfully recouped by gains elsewhere, meaning the disruption represents a genuine net loss to the economy rather than a mere reshuffling of economic activity.

Perhaps the most counterintuitive result is that storm category alone is a poor predictor of short-run economic impacts. A Category 4 storm that makes landfall in a sparsely populated area with robust infrastructure may cause less economic disruption than a weaker storm that strikes a densely populated urban corridor with fragile power grids. Instead, the study found that economic disruption increases with physical damage, evacuation restrictions, and infrastructure outages. These are the variables that actually matter for the economic pulse of a community. Evacuation orders, by emptying towns of consumers, can shut down sales even before the storm arrives. Power outages, by disabling payment systems and refrigeration, can keep businesses closed after the skies have cleared. Physical damage to buildings and roads determines how quickly commerce can resume.

The disruption and recovery patterns also vary significantly across industries, merchant types, and sales channels. Restaurants, which depend on foot traffic and perishable inventory, likely experience different disruption dynamics than hardware stores, which may see surges in demand as residents prepare for and repair after storms. Online merchants may weather the disruption differently than brick-and-mortar establishments. These differences matter for policymakers trying to target relief efforts and for businesses trying to anticipate how a storm will affect their operations. The study’s industry-level breakdown provides a granular map of economic vulnerability that could inform everything from emergency lending programs to supply chain planning.

The findings arrive at a moment of growing urgency. Climate projections indicate substantial increases in hurricane activity under continued warming, meaning the economic exposure of coastal communities is set to grow in the decades ahead. Understanding the short-run dynamics of disruption and recovery is therefore not merely an academic exercise. It helps identify the conditions under which short-run economic disruption is most severe, which in turn can guide the design of evacuation policies, infrastructure hardening, and emergency financial support. If power outages and evacuation restrictions are the key drivers of economic pain, then investments in grid resilience and communication systems may yield outsized economic benefits relative to their cost.

The research also carries implications for how economists and policymakers measure the cost of natural disasters. Official damage estimates typically focus on physical destruction, the value of destroyed property and infrastructure. But the study suggests that the short-run economic disruption, the lost sales and interrupted commerce, represents a distinct and measurable component of hurricane costs. Because the disruption is brief, it may be systematically underestimated in traditional assessments that arrive too late to capture it. Real-time transaction data offer a way to fill this gap, providing a running tally of economic damage as the storm unfolds rather than a retrospective estimate after the fact.

The study was supported financially by the World Bank Research Support Budget, and the authors are careful to note that the findings, interpretations, and conclusions expressed in the paper are entirely those of the authors and do not necessarily represent the views of Mastercard, the World Bank, or the governments they represent. Mastercard provided data access for academic research purposes only and had no role in study design, analysis, interpretation, or the decision to publish. These safeguards matter for a study that relies on proprietary financial data, and they help establish the credibility of the results for a research community that has long called for better real-time economic monitoring of natural disasters.

As warming oceans continue to fuel more intense Atlantic hurricane seasons, the ability to watch local economies stumble and recover in real time may become one of the most valuable tools in the climate adaptation toolkit. The study’s message is ultimately one of measured reassurance mixed with caution: local economies are more resilient in the short run than the aftermath of catastrophic storms might suggest, bouncing back within ten days, but the depth of disruption depends on factors that are within human control, the robustness of infrastructure, the design of evacuation policies, and the speed of physical repairs. In the race between warming and adaptation, real-time economic data may prove to be the compass that shows which investments actually keep communities economically alive when the next storm makes landfall.

Subject of Research: Real-time measurement of economic disruption and recovery in US ZIP codes affected by Atlantic hurricanes using daily transaction data

Article Title: Real-time economic disruption and recovery from Atlantic hurricanes across the US

Article References: Agarwal, S., Choudhury, S. P., Fan, M., & Klapper, L. (2026). Real-time economic disruption and recovery from Atlantic hurricanes across the US. Nature Communications. https://doi.org/10.1038/s41467-026-78686-4

Image Credits: AI Generated

DOI: 10.1038/s41467-026-78686-4

Keywords: hurricanes, economic disruption, recovery, transaction data, ZIP codes, substitution, infrastructure outages, evacuation, storm category, climate change impacts, environmental economics, Nature Communications

The study, known as the NuTra trial, was conducted at a Level I trauma center in Tübingen and published in BMC Geriatrics. Researchers led by Carolina Vogel and Mika F. Rollmann enrolled 218 patients aged 70 or older who had been admitted with fragility fractures — breaks caused by low-energy falls in bones already weakened by age. The participants had a mean age of 81.8 years, and nearly three-quarters were women, reflecting the demographic reality of fragility fractures. Every patient was screened for nutritional risk using two validated instruments: the Nutritional Risk Screening 2002, which weighs weight loss, food intake, and disease severity, and the Mini Nutritional Assessment, which captures broader markers of dietary vulnerability in older adults.

The results of that screening were striking. Nearly half of the patients — 45.9 percent, or 100 of the 218 — screened positive in at least one tool and were classified as being at nutritional risk. These patients were then randomized to receive either a protein-enriched diet targeting 1.5 to 2.0 grams of protein per kilogram of body weight per day, or a standard hospital diet. The remaining 118 patients, who screened negative on both instruments, served as an observational reference group without nutritional risk. This design allowed the team to compare not just the effect of the intervention, but also the baseline consequences of being at nutritional risk in the first place.

Even before any intervention began, the differences between the groups told a clear story. Patients at nutritional risk carried heavier comorbidity burdens, had higher scores on the American Society of Anesthesiologists physical status classification, and were markedly frailer than their well-nourished counterparts. This clustering is not incidental. In geriatric medicine, malnutrition, frailty, and multimorbidity are increasingly understood as overlapping expressions of the same underlying physiological decline — sarcopenia, chronic inflammation, and reduced physiological reserve. The NuTra data reinforce that picture: nutritional risk rarely appears in isolation in this population.

The trial’s primary outcomes were in-hospital medical complications, surgical site infections, and functional mobility at discharge. Medical complications occurred in 45.0 percent of patients overall, a figure that underscores how fragile this population is even under modern trauma care. Yet there were no significant differences between the protein-enriched group and the standard diet group. Serum albumin, a key marker of protein status, decreased during hospitalization in all groups, while C-reactive protein, an indicator of systemic inflammation, increased — and neither trajectory differed between the intervention and control arms. The extra protein, in other words, did not bend the biological curves of the acute hospital stay.

Secondary outcomes told a similar story. Length of hospital stay, in-hospital mortality, and discharge destination showed no measurable benefit from the protein-enriched diet. What did matter was nutritional risk status itself. Patients in the reference group without nutritional risk were more often independently mobile at discharge and more frequently returned home, whereas patients at nutritional risk — whether they received the enriched diet or not — more often required institutional care after leaving the hospital. In multivariable analysis, a higher age-adjusted Charlson Comorbidity Index was independently associated with discharge destination, but the nutritional intervention itself showed no independent effect.

Why did a biologically plausible intervention fail? The authors point to the deeper entanglement of nutritional risk with overall vulnerability. A hospital stay is short — often just days to a couple of weeks — while the physiological deficits that define malnutrition in older adults took years to develop. Reversing them with a few weeks of extra protein at the bedside may simply be asking too much of too brief an intervention. Bone healing, immune competence, and muscle rebuilding all operate on timescales of months, not days. The NuTra trial suggests that the acute in-hospital phase may be the wrong window to expect measurable returns from nutritional therapy alone, even when the therapy is well targeted.

There are also technical considerations worth weighing. The trial was single-center, and the intervention was delivered during the hospital stay only, without structured follow-up supplementation after discharge. The screening tools, while validated, may capture a heterogeneous mix of patients — some with reversible acute deficits, others with entrenched chronic malnutrition. And the primary outcomes, focused on the short term, may not have been sensitive to benefits that could emerge later in rehabilitation. The study was retrospectively registered at ClinicalTrials.gov, and the authors themselves frame the findings as hypothesis-shaping rather than practice-defining.

The clinical implications are nonetheless significant. For geriatric trauma units, the message is not that nutrition does not matter — it is that nutrition alone, delivered in isolation during a brief hospitalization, is unlikely to move the needle on complications, mobility, or discharge destination. The authors argue that nutritional risk should be considered within the broader context of overall vulnerability, and that nutritional care may need to be embedded in comprehensive longitudinal rehabilitation strategies extending well beyond the acute in-hospital phase. That could mean structured supplementation programs that continue through weeks of outpatient rehabilitation, combined with resistance exercise, geriatric assessment, and social support.

For a field that has long hoped a simple dietary fix could rescue the frailest fracture patients, the NuTra trial is a humbling but clarifying result. It redirects attention from the hospital tray to the longer arc of recovery — and toward integrated models of care that treat malnutrition not as an isolated deficiency to be topped up, but as one thread in the larger fabric of aging. The trial’s findings, published as open access research, are likely to spark renewed debate about how, when, and for whom protein supplementation should be deployed in geriatric trauma care.

Subject of Research: Impact of malnutrition and protein-enriched oral nutrition on early recovery after fragility fractures in older adults: the NuTra trial

Article Title: Impact of malnutrition and protein-enriched oral nutrition on early recovery after fragility fractures in older adults: the NuTra trial

Article References: Vogel, C., Heyl, M., Vollmer, L., Schuhmacher, J., Demissie, J., Haas, D., Braun, B. J., Herath, S. C., Histing, T., & Rollmann, M. F. (2026). Impact of malnutrition and protein-enriched oral nutrition on early recovery after fragility fractures in older adults: the NuTra trial. BMC Geriatrics. https://doi.org/10.1186/s12877-026-08247-3

Image Credits: AI Generated

DOI: 10.1186/s12877-026-08247-3

Keywords: Impact, malnutrition, protein-enriched, oral, nutrition, early, recovery, fragility, fractures, older, adults, NuTra

The review team, led by Becky Watts of the University of Sheffield alongside Samuel Chawner, Gareth Burchell and John Fox, searched four major databases, PsycINFO, MEDLINE, Scopus and CINAHL, for peer-reviewed qualitative studies of autistic adults with lived experience of eating disorders or disordered eating. From 424 initial records, thirteen studies survived full-text screening. Each was appraised with the Critical Appraisal Skills Programme qualitative checklist, and the findings were combined using thematic synthesis, a three-stage method that codes participant quotations and author interpretations line by line, groups the codes into descriptive themes, and then distils higher-order analytical themes that cut across individual studies. Eleven of the thirteen studies were rated high quality, and the review was registered prospectively on PROSPERO.

Three analytical themes emerged, and together they amount to a quiet revolution in how the intersection of autism and eating disorders might be understood. The first is that eating disorder experiences cannot be understood independently of autistic ways of processing the world. The second is that recovery is enabled through developing self-understanding and integrating autism into personal identity. The third is that recovery is facilitated when support aligns with autistic needs rather than neurotypical assumptions. Each theme is anchored in vivid first-person testimony, and each carries direct implications for how clinicians assess, formulate and treat eating disorders in this population.

The sensory thread runs through nearly every account. Participants described food choices driven by texture, smell and temperature rather than calories or body shape. One person explained that a salad was terrifying because its components were mixed together. Another described restricting food after weight gain not because of how their stomach looked but because they disliked the sensation of how it felt. A third traced the onset of restriction to the school canteen, a space of overwhelming noise, crowds and social demands. For some, the sensory experience of clothing or of their own skin was itself aversive, one participant describing her body as a cage she decorated with tattoos. These are not the classic mechanisms of anorexia nervosa as taught in textbooks, and the review argues that sensory-driven restriction was frequently experienced entirely independently of body image concerns.

Interoception, the brain’s perception of internal bodily states, emerged as a second crucial mechanism. Many participants reported profound difficulty recognising hunger, fullness, thirst and satiety. One described being able to identify dizziness, stomach pain or a dry mouth without ever connecting those signals to hunger. Another said they could binge or miss meals very easily because they did not fully understand their thirst and hunger responses. In the context of binge eating disorder, neurodivergent participants described eating as a form of sensory seeking or emotional regulation, with one noting that recognising they wanted sensory input rather than food helped them choose vegetables instead. These accounts suggest that both restriction and bingeing can arise from the same underlying difference: an unreliable channel of information between body and brain.

The third mechanism is cognitive. A preference for routine, predictability and rule-based thinking appeared repeatedly, both as a driver of rigid eating patterns and, paradoxically, as a resource for recovery. Participants described self-imposed food rules that felt impossible to break, and eating routines so entrenched that travel or social occasions became untenable. Yet the same preference for structure meant that predictable, planned approaches to eating, such as meal plans agreed in advance, reduced anxiety and supported engagement with treatment. One participant noted that the containment and structure of an inpatient ward was genuinely helpful, precisely because it removed the burden of self-organisation.

Perhaps the most striking finding concerns identity. Many participants received an autism diagnosis only in adulthood, often after years of eating disorder treatment that never addressed what they felt was the real cause. One woman summarised the experience bluntly: for her, the anorexia was just a symptom, and the cause was the autism. Receiving a diagnosis frequently acted as a turning point, allowing people to reinterpret decades of struggle not as personal failure but as the predictable consequence of navigating a neurotypical world with a differently wired nervous system. Participants described greater self-compassion, a re-storying of their lives, and connection with others who shared the dual experience. The review notes, however, that this process could also carry grief, as people mourned the years in which their needs went unrecognised.

Against this backdrop, conventional treatment often fell short. Participants reported being told off in hospital for autistic behaviours such as walking on tiptoes, which staff interpreted as calorie-burning. Others described clinicians who insisted on body image work even when patients said their difficulties had nothing to do with weight or shape, an approach one person found humiliating and condescending. Some were discharged from services because their cases were deemed too complex. In contrast, support that worked was individualised and collaborative: therapists who provided written summaries and goal setting, services that gave advance notice of changes and allowed comforting sensory items, families who respected a person’s refusal of intolerable foods without pressure. The behaviours of autism and the behaviours of an eating disorder can look identical, participants stressed, but their causes, and therefore their treatments, can be entirely different.

These findings have conceptual consequences that reach beyond the clinic. The review highlights a potential overlap with avoidant/restrictive food intake disorder, or ARFID, a diagnosis characterised by sensory-based food avoidance without body image concern. Because the evidence base is dominated by anorexia nervosa, the authors caution that some autistic people with primarily sensory-driven restriction may historically have been misclassified, and they argue that whether such presentations constitute ARFID, or simply eating behaviours embedded within autistic experience, remains an open question. They suggest the field may need a paradigm shift, from treating autism and eating disorders as co-occurring conditions toward a model rooted in lived phenomenological experience, in which autistic characteristics such as sensory processing, interoceptive differences and a preference for predictability are understood as mechanisms that shape how eating disorders develop, persist and resolve.

The authors are careful about limitations. Only thirteen studies met the criteria, most focused on anorexia nervosa, most participants were women, and all included research was published in English, leaving bulimia nervosa, binge eating disorder, ARFID, men and non-English-speaking populations underrepresented. Reflexivity was the most common methodological weakness in the primary studies. The review itself was conducted by a non-autistic researcher without lived experience of an eating disorder, a position the authors acknowledge and address through explicit reflexive consideration. Even so, the synthesis represents the most comprehensive attempt yet to centre autistic voices in this literature, and its message is unambiguous. When autistic adults say their eating difficulties are about the way food feels rather than the way their body looks, clinicians should listen, because recovery, the evidence suggests, begins when treatment is built around autistic needs rather than neurotypical assumptions.

Subject of Research: Lived experiences of eating disorders in autistic adults

Article Title: A systematic review of qualitative research of eating disorders in autistic adults: convergent and divergent experiences

Article References: Watts, B., Chawner, S. J. R. A., Burchell, G., & Fox, J. R. E. (2026). A systematic review of qualitative research of eating disorders in autistic adults: convergent and divergent experiences. Frontiers in Psychiatry, 17, Article 1953234. https://doi.org/10.3389/fpsyt.2026.1953234

Image Credits: AI Generated

DOI: 10.3389/fpsyt.2026.1953234

Keywords: autism, eating disorders, anorexia nervosa, ARFID, sensory sensitivities, interoception, qualitative research, systematic review, thematic synthesis, neurodiversity, mental health, recovery

Participants from three Kaiser Permanente regions who underwent cystectomy with either ileal conduit or neobladder diversion between 2013 and 2015 completed surveys at 6 and 18 months post-surgery. Items were derived from prior qualitative research and clinician input. Multivariable linear and negative binomial regressions were used to examine associations between surgery type and patient characteristics and challenges.

Among 269 respondents at 6 months and 201 at 18 months, 80% and 68% reported at least one challenge, respectively. Common issues included accidents/leaks, sleep disturbances, and managing necessary urinary diversion supplies. Patients with ileal conduits reported more body habitus-related challenges, which increased over time. At 18 months, younger age, male sex, and advanced AJCC stage were associated with a higher number of challenges. Surgery type and complications were not significantly associated with challenge burden.

Recovery from cystectomy and urinary diversion is marked by persistent challenges which vary by diversion type and patient characteristics. These findings highlight the extent to which challenges continue over time, and may help inform the development and future evaluation of tailored supportive interventions for bladder cancer survivors.

Radical cystectomy, the surgical removal of the bladder, remains one of the most demanding operations in urologic oncology. Because the bladder stores and expels urine, its removal requires the creation of a new pathway for urine to leave the body, a procedure known as urinary diversion. The two most common options are the ileal conduit, in which a short segment of intestine is used to channel urine to an opening on the abdominal wall where it drains into an external appliance, and the orthotopic neobladder, in which a reservoir constructed from bowel tissue is connected to the urethra so that patients can theoretically void in a more natural manner. Both approaches are effective at controlling the cancer, but each imposes a distinct set of physical, practical, and psychological demands on patients during the months and years that follow surgery.

Much of the existing literature on recovery after cystectomy has focused on objectively measurable outcomes such as surgical complications, hospital readmissions, and survival. Studies of readmission patterns, for example, have shown that a meaningful proportion of patients return to the hospital in the first weeks and months after the operation, and large multi-institutional analyses have compared ninety-day morbidity between the two diversion types. Health-related quality of life has also been examined, including in randomized trials comparing robotic-assisted with open surgical techniques. What has been less well characterized is the day-to-day experience of patients themselves: how often they encounter specific problems such as leakage, disturbed sleep, or difficulty obtaining supplies, and which patients are most likely to struggle. The new survey-based study addresses this gap by quantifying the prevalence of these challenges and identifying the characteristics associated with a heavier burden.

The study drew on the integrated health care delivery setting of Kaiser Permanente, recruiting patients from three geographic regions who had undergone cystectomy between 2013 and 2015. This kind of population-based approach has an important advantage over single-surgeon or single-center series, because it captures a broader cross-section of patients, including those who might not be treated at high-volume academic centers. Prior work comparing Kaiser Permanente members with the general population suggests that findings from such systems can be reasonably generalizable, although integrated delivery systems may differ somewhat from fragmented care environments in how supportive services are organized and delivered.

The survey instruments themselves were grounded in earlier qualitative work. The research team had previously conducted focus groups and interviews with patients recovering from cystectomy, and those conversations generated the concrete, patient-centered items that appear in the current questionnaires. This lineage matters, because challenges reported in surveys can otherwise reflect clinician assumptions rather than the issues patients actually consider most troublesome. By building the measurement tools from patient narratives and refining them with clinician input, the investigators aimed to capture recovery difficulties as patients experience them, from leaks and accidents around the diversion to sleep disruption and the logistical burden of managing supplies.

The headline finding is striking: four out of five patients reported at least one challenge six months after surgery, and more than two-thirds still reported challenges a full year and a half later. This persistence is clinically meaningful. It suggests that recovery after cystectomy is not a short-term process that resolves within the first few months, but rather an extended adaptation period during which patients continue to confront practical and physical obstacles. The most frequently reported problems, accidents and leaks, sleep disturbances, and supply management, are precisely the kinds of issues that may not surface during routine oncology follow-up visits, which tend to prioritize surveillance for cancer recurrence. Patients may also hesitate to raise such concerns, viewing them as embarrassing or as an expected price of survival.

The divergence between diversion types is one of the more nuanced results. Patients with ileal conduits reported more challenges related to body habitus, meaning concerns about the appearance and physical presence of the urostomy appliance on the abdomen, and these concerns grew rather than faded over time. This pattern may reflect the ongoing visibility of an external appliance in daily life, clothing choices, intimacy, and self-image. Notably, however, when the investigators examined the overall number of challenges, surgery type itself was not significantly associated with burden, nor were postoperative complications. This suggests that the total volume of difficulties patients face is shaped less by which diversion they received or by whether they experienced surgical complications, and more by who they are as individuals.

The demographic and clinical predictors identified at eighteen months deserve particular attention. Younger patients reported more challenges, a finding that may seem counterintuitive but is consistent with a broader literature on cancer survivorship in which younger age is often associated with greater disruption, possibly because younger patients have longer expected lifespans during which they must live with the diversion, higher expectations for physical function and social participation, and active work and family roles that make practical difficulties more consequential. Male sex was also associated with a higher number of challenges, and advanced American Joint Committee on Cancer stage predicted greater burden, plausibly reflecting more extensive disease, more aggressive treatment pathways, and possibly more complex surgeries.

These findings arrive amid growing recognition that bladder cancer survivors carry substantial unmet informational and supportive care needs. Systematic reviews have documented gaps in the support available to patients with muscle-invasive bladder cancer across the illness trajectory, and consensus efforts within the urologic community have emphasized improving the patient journey and quality of care. Prior studies have also examined how unmet needs vary by age, sex, and treatment choice, and how self-efficacy and quality of life can be bolstered through enhanced nursing care for patients living with a urostomy. Digital resources designed specifically for bladder cancer survivors and their caregivers represent one avenue for addressing informational needs at scale.

For clinicians, the practical implication is that supportive care after cystectomy should be planned as a longitudinal endeavor rather than a perioperative afterthought. The persistence of challenges at eighteen months argues for structured follow-up that extends well beyond the early recovery window, with attention to stoma and appliance issues, sleep, and the practical logistics of supply management. The identification of younger men with advanced-stage disease as a higher-burden group offers a starting point for risk stratification, allowing care teams to target education, ostomy nursing support, and peer connections toward patients most likely to need them.

For researchers, the study illustrates the value of measuring patient-reported challenges with instruments grounded in qualitative patient input, and of following patients long enough to observe how burdens evolve. The finding that body habitus concerns increased over time among ileal conduit patients suggests that some difficulties may emerge or intensify after the initial recovery period, underscoring the need for assessments at multiple time points. Future intervention studies can build on this foundation by testing whether tailored supportive programs, whether delivered through specialized nursing, digital tools, or peer support, reduce the prevalence and severity of these persistent challenges and improve the day-to-day lives of bladder cancer survivors.

Subject of Research: Recovery challenges and unmet supportive care needs after cystectomy and urinary diversion for bladder cancer

Article Title: Recovery after cystectomy and urinary diversion: patient experiences and challenges

Article References: Bulkley, J. E., O’Keeffe-Rosetti, M., Leo, M. C., Gilbert, S. M., Harrison, T. N., Kwan, M. L., Danforth, K. N., & McMullen, C. K. (2026). Recovery after cystectomy and urinary diversion: patient experiences and challenges. Supportive Care in Cancer, 34(11), Article 1113. https://doi.org/10.1007/s00520-026-11342-1

Image Credits: AI Generated

DOI: 10.1007/s00520-026-11342-1

Keywords: bladder cancer, cystectomy, urinary diversion, cancer survivorship, supportive care, quality of life, Recovery, urinary, diversion, patient, experiences, challenges