Conectar
Engagement with the arts is advocated to reduce stigma and to increase the social inclusion of people living with dementia since the arts powerfully support non-verbal communication, affect and the opportunity to participate in activities that are meaningful to self and others. An example is Sharing Dance Older Adults (SDOA), an innovative, community dance programme that is offered by Canada’s National Ballet School (NBS) intended to support social inclusion by making dance accessible to older adults with a range of physical and cognitive abilities, including people living with dementia. Despite the benefits that SDOA offers people living with dementia and their carers, individuals from historically excluded populations, and more specifically those from racialised groups, have had only limited engagement with the programme. This study thus aims to co-develop with dance artists in the three largest racialised communities in Canada (Black, Chinese and South Asian) culturally relevant SDOA-informed dance opportunities for people living with dementia.
This 3-year study (2024–2027) is a multiple-case and intrinsic-case study design informed by critical participatory action research and the Critical Realism and the Arts Research Utilisation Model. For each of the three racialised communities, implementation and data collection will develop across five phases (preimplementation of professional development for dance artists; implementation of professional development for dance artists; postimplementation of professional development for dance artists; implementation of dance programming; and postimplementation of dance programming). Drawing on organisational partnerships in two Canadian provinces for three racialised communities, we plan to recruit older adults living with/without dementia who will attend the dance programming (n=90), formal/informal carers such as nurses and family (n=30), site managers such as directors of care (n=15), dance artists from the case communities (n=15) and NBS dance trainers who teach SDOA (n=2). Data collection strategies include: semistructured e-diary entries; active interviews; and video recordings of dance classes. All e-diary entries, transcriptions of interviews and video clips selected for full verbatim transcription will be analysed concurrently and recursively, using standard thematic analysis techniques.
All five phases of this study have been approved by the Clinical Trials Ontario (CTO Project ID: 4997, 11 June 2026), which is a streamlined ethics review system for multisite studies. All participants will provide written informed consent before taking part in the study. The outcomes will be shared through articles published in journals, presentations at academic and professional conferences, arts-based community events and other knowledge mobilisation forums that include all partners and collaborators.
by Kyungsup Kwon, Choi Young Jang, Woori Kim, JuYeon Son, Euijin Chang, Sung-Han Kim
BackgroundThe post‑acute sequelae of SARS‑CoV‑2 infection (PASC, “Long COVID”) remain difficult to evaluate because standardized diagnostic tools are limited. We applied the recently proposed PASC index (score ≥ 12) to describe the 12‑month trajectory of Long COVID symptoms.
MethodsIn this prospective cohort, adults with laboratory‑confirmed COVID‑19 were consecutively enrolled from November 2022 to February 2025. Long COVID was defined by a PASC index of ≥12 across 12 symptom domains persisting for at least 30 days post-infection. Symptom questionnaires were completed at 1, 3, 6 and 12 months after infection.
ResultsAmong 183 participants, 48 (26.2%) met Long COVID criteria. Symptom assessments indicated that the proportion of participants meeting the Long COVID threshold declined from 27% at 1 month to 18% at 12 months, although this change was not statistically significant (p = 0.16). Participants classified as having Long COVID had consistently higher PASC index values across follow-up, while pairwise within-person comparisons showed no significant temporal changes in either the Long COVID or non-Long COVID group. These findings suggest that the overall symptom burden remained relatively stable over time, despite fluctuations in threshold status.
ConclusionDuring 12 months of follow-up, approximately one quarter of participants met the PASC index threshold at least once. Among participants with repeated assessments, PASC index scores showed limited within-person change, although differential non-response limits the interpretation of temporal prevalence estimates.
To examine the association between sleep quality and psychological resilience in a Chinese community-based cohort and assess the consistency of this association across two sleep measures.
Cross-sectional analysis of baseline data.
Community-based cohort in Hangzhou, China (2016–2019).
10 268 adults aged 18–80 years enrolled via quota sampling stratified by sex and age group. After excluding participants with missing data, analytic samples were 9781 (single-item measure) and 9780 (Pittsburgh Sleep Quality Index (PSQI)), owing to one additional missing response.
Low psychological resilience, defined by a median split on a 9-item scale adapted from the Brief Resilience Scale and Connor–Davidson Resilience Scale.
Poor sleep quality was associated with higher odds of low resilience across both measures (single-item measure, adjusted OR=1.5, 95% CI 1.3 to 1.6; PSQI, adjusted OR=1.5, 95% CI 1.4 to 1.7), after adjustment for demographic factors, socio-economic factors, mental health indicators and health behaviours. Interaction tests showed no evidence of effect modification by sex, age group, loneliness or depression history for the single-item measure (p>0.05). For the PSQI, the association differed by loneliness (p<0.05), with a larger magnitude of association among lonely participants (adjusted OR=2.1, 95% CI 1.6 to 2.7) than non-lonely participants (adjusted OR=1.5, 95% CI 1.3 to 1.6).
Poor sleep quality was consistently associated with low resilience across both measures. Because the design was cross-sectional, temporal direction cannot be established. Longitudinal and interventional studies are needed to establish temporal ordering, and intervention studies are needed to determine whether improving sleep increases resilience.
To evaluate the association between cataract surgery and the incidence and progression of diabetic retinopathy (DR) in a population-based cohort of patients with diabetes.
A nationwide population-based retrospective cohort study.
A nationwide administrative claims database in Taiwan covering more than 99% of the population, with longitudinal follow-up from 2010 to 2021.
Adult patients (≥20 years) with diabetes mellitus and cataract were identified. Patients with prior cataract surgery before the first recorded cataract diagnosis were excluded. A total of 15 360 patients who underwent first-time cataract surgery and 15 846 patients without surgery were included. After two-stage matching (1:2 age-matching and sex-matching followed by 1:1 propensity score matching), 7837 matched pairs were analysed.
Not applicable.
The primary outcomes were (1) incident DR and (2) DR progression within 6 months and 1 year after the index date. Incident DR was defined as new-onset non-proliferative DR (NPDR) or proliferative DR (PDR). DR progression was defined as transition from no DR to NPDR/PDR or from NPDR to PDR. Outcomes were identified using diagnostic codes recorded at least twice in outpatient visits or once during hospitalisation.
Cataract surgery was associated with higher risks of both incident DR and DR progression within 1 year. In the 1:2 matched cohort, the adjusted ORs were 3.40 (95% CI 2.65 to 4.36) for incident DR and 3.11 (95% CI 2.47 to 3.92) for DR progression. Similar findings were observed in the 1:1 propensity score-matched analysis. Absolute event rates at 1 year showed DR progression in approximately 3.1% of patients undergoing surgery compared with 1% in the non-surgical group. Increased risk was also associated with more intensive antidiabetic treatment.
Cataract surgery in patients with diabetes was associated with an increased risk of incident DR and disease progression, particularly within the first postoperative year. These findings support the consideration of cataract surgery as a clinically relevant risk window for enhanced retinal monitoring. Incorporating surgical history into DR risk stratification and screening strategies may improve early detection and inform postoperative care pathways.
by Hung-Chih Yeh, Chia-An Ho, En-Yu Chang, Hei-Tung Lau, Chih-Wen Hsu, Hsin-Yu Tu, Pei-Hsuan Wang, Chin-Shan Ho
The isometric mid-thigh pull (IMTP) is a reliable method for assessing whole-body maximal isometric strength; however, the influence of lifting straps on IMTP performance remains unclear, particularly in sports such as judo that rely heavily on grip strength. This study recruited 30 male participants, including 15 judo athletes and 15 recreationally resistance-trained undergraduates, who completed IMTP tests under strapped and non-strapped conditions in a randomized order. Peak force (PF), rate of force development (RFD), and impulse (IP) were measured using a 1000 Hz force plate, and a two-way mixed ANOVA was used to examine the effects of group and strap condition. The results showed no significant interaction between group and condition. However, significant main effects of both group and strap condition were observed for most variables (p < 0.05), with higher PF, RFD, and IP recorded under the strapped condition. Judo athletes also demonstrated greater grip strength (51.3 ± 3.4 kg) than the resistance-trained group (44.7 ± 3.3 kg, p < 0.01). These findings suggest that the use of lifting straps enhances IMTP performance and may reduce the influence of grip strength limitations on maximal force expression. Therefore, when the purpose of IMTP testing is to assess maximal force production, the use of lifting straps may be considered to minimize the potential influence of grip-related limitations and to standardize testing procedures across athletes.There has been considerable attention placed on ‘failures’ of maternity care in high-income countries, with little focus on the drivers of ‘high-quality’ care delivered at the organisational level. We conducted a realist review with this central focus and report on the first phase, initial programme theories (IPTs) generated from the literature, where a future phase will ‘test’ the IPTs.
A realist review methodology was employed, an interpretative, theory-driven approach designed to explore ‘what works, for whom, in what circumstances’ using context, mechanism and outcome (CMO) propositions.
The search strategy used a purposive database (MEDLINE) and hand searches, including peer-reviewed journals, grey literature and policy reports, to identify literature rich and relevant to the research question.
As per realist review approaches, we included any English-language literature from peer-reviewed journals, grey literature, policy reports, service guidance and public or professional commentary, from high-income countries, that provided explanatory insights to the operationalisation of ‘high-quality’ maternity care at the organisational level. Using an a priori definition, high-quality maternity care was defined based on four outcome criteria: higher service user and staff well-being, lower prevalence of complications/adverse outcomes and optimal use of resources.
Data extraction configured evidence using the ‘If, Then, Leading to’ CMO heuristic. The IPTs were iteratively developed from the synthesised data and refined through consultation with a diverse 26-member core stakeholder group.
The iterative search process included 17 index papers, which were a mix of systematic reviews, primary research studies, commissioned reports, evaluations and commentaries. These papers generated 292 initial CMO hypotheses, which were refined into 11 IPTs focusing on organisational-level mechanisms. The IPTs reflect a ‘both-and’ philosophy, balancing clinical excellence (safety) and values-based relational care (personalisation and staff environment). Key themes include visible and supportive leadership, responsiveness to workload assessments, ensuring operational fitness (system and workplace environment support) and broadening the definition of safety beyond physical safety to include psychological, emotional and cultural safety. The IPT related to ‘A culture of equitable care’ was identified as critical in underpinning all maternity service provision.
The 11 IPTs offer crucial insights into the context and mechanisms that may produce desired outcomes in high-quality maternity care. Learning from high-quality services (safety II) provides a novel approach compared with focusing only on failings. These globally relevant IPTs can be applied to high-income contexts as a foundation for designing future improvement programmes.
CRD420251104996.
The limited efficacy and tolerability of interferon (IFN)-based therapies make refining patient selection a critical step towards achieving a functional cure in chronic hepatitis B (CHB). The novel GOLDEN model, based on sequential changes in quantitative HBsAg (qHBsAg), accurately predicts hepatitis B surface antigen (HBsAg) loss in patients with CHB receiving nucleos(t)ide analogue (NA) therapy. However, it remains unvalidated in patients receiving sequential pegylated IFN α-2b (Peg-IFN α-2b)-based therapy. We aim to validate the GOLDEN model and the optimised cut-off value for the predictive index (Pi) to prospectively identify optimal candidates for clinical cure among patients receiving sequential Peg-IFN α-2b therapy using pre-IFN treatment qHBsAg kinetics across multiple centres.
This prospective multicentre observational cohort study will enrol 300 NA-experienced patients with CHB from 22 centres in China. Patients, stratified by the Pi calculated from pre-treatment qHBsAg dynamics, will be classified into two groups: favourable (Pi>0.15, n=150) and unfavourable candidates (Pi≤0.15, n=150). All patients will receive 48 weeks of combination therapy with Peg-IFN α-2b plus ongoing NAs. The primary endpoint is the HBsAg clearance rate at week 48, with clearance defined as HBsAg loss at any time during the treatment period. Secondary endpoints include HBsAg seroconversion and sustained clearance rates. The sample size provides 80% power to detect a significant difference between the assumed clearance rates (35% vs 20%, favourable vs unfavourable group). Between-group comparisons will be performed using the 2 or Fisher’s exact test. Long-term follow-up studies are warranted to assess sustained HBsAg clearance and its impact on clinical outcomes. Concurrently, we will explore establishing novel predictive models using this framework alongside other baseline indicators. Future research could focus on analysing serial inflammatory cytokine profiles from stored blood samples to elucidate the immunological mechanisms driving treatment response.
The study protocol has been reviewed, and ethical approval has been obtained from the ethics committee of Tangdu Hospital, Fourth Military Medical University (approval no. K202509-69). Approval has also been secured from 21 additional participating centres.
ChiCTR2500095819.
by Wenyi Qin, Jiajun Huo, Xiongsheng Xiao, Siyi Li, Haiqing Luo, Yongkang Wu, Weijie Chen, Zhuoting Chen, Changwei Zheng, Muge Liu, Baibei Li, Guiping Zhou, Zhibin Huang, Xuemeng Li, Jinquan Li, Zhi Zhang, Jian Ye
BackgroundThe changes of intestinal flora and thyroid hormone levels before and after operation for papillary thyroid cancer (PTC) and their relationship are not clear. It may interfere with the intestinal thyroid axis, change the systemic thyroid hormone regulation and exogenous treatment response. It is recognized that this microbial involvement is clinically related to long-term metabolic outcomes, and future strategies for microbial targeted adjuvant therapy are suggested. This study aims to provide direct evidence and a comprehensive understanding of the relationship between intestinal flora and thyroid hormone levels before and after surgical treatment of papillary thyroid cancer through metagenomic analysis.
MethodsAs a paired before and after observation study, 20 patients diagnosed with papillary thyroid cancer were included in the study. Fecal samples and thyroid hormone levels were collected within 3 days before operation and 72 hours after operation. First, the intestinal microbiota of these 20 patients was analyzed for metagenomic differences, such as α and β diversity analysis, PCoA, ANOSIM, Spearman correlation analysis, FDR correction, KEGG pathway enrichment and correlation network analysis. Subsequently, the changes of hormone levels were examined in combination with the collected intestinal microbiota.
ResultsThere were significant differences in the diversity and composition of the gut microbiota in patients with papillary thyroid cancer before and after surgery. At the species level, the eight most significantly different groups identified were Bacteroides sp., Clostridium sp., Bacteroides fragilis, Alistipes sp., Parabacteroides sp., Bacteroides thetaiotaomicron, Phocaeicola dorei, and Oscillibacter sp. Notably, Clostridium sp. higher abundance in the pre-operative group, whereas Bacteroides sp., Bacteroides fragilis, Alistipes sp., Parabacteroides sp., Phocaeicola sp., and Bacteroides thetaiotaomicron were more prevalent in the post-operative group. After operation, FT4 showed an upward trend, while TSH, PTH and HTG showed a downward trend. The primary differential pathways associated with these changes pertained to iron uptake and regulation, polysaccharide utilization and transport, as well as metabolism and stress response. The pre-operative group was predominantly involved in ribosome biosynthesis, along with amino acid synthesis for valine and leucine. In contrast, the post-operative group primarily engaged in lipoic acid metabolism, glycosaminoglycan degradation, and bacterial secretion systems.
ConclusionThis study found that the composition, diversity and function of intestinal flora changed in patients with papillary thyroid cancer after operation. Specific microbial taxa may be associated with fluctuations in thyroid hormone levels. In the future, regulating intestinal flora can be used as an adjuvant therapy for hormone regulation in patients undergoing PTC surgery.
by Chengjun Wang, Junyi Li, Qing Liu, Chang Zhao, Yuliang Li, Yanqiu Zhao
Three-dimensional point clouds can accurately represent the spatial geometric information of industrial product surfaces, offering significant value in small-target defect segmentation tasks. To address the scarcity of high-quality datasets in existing research on industrial defect point cloud segmentation, as well as the challenges posed by the small scale, sparse distribution, and complex morphology of wire rope surface defects, this paper constructs a wire rope defect point cloud dataset, WireRope3D, covering three typical types of defects: wear, wire protrusion, and broken wire. Furthermore, we propose a point cloud segmentation method named WireGC-Former (Wire Rope Graph Convolution Transformer), which integrates a graph convolutional network with a Transformer. The method enhances the model’s ability to perceive local geometric structures and defect boundaries through an edge feature extraction module; improves the representation of local spatial relationships by incorporating a spatial attention module that fuses absolute coordinate information with relative positional encoding; integrates multi‑level local and global features via a feature fusion module; and models long‑range dependencies with a feature attention module, thereby achieving precise segmentation of small‑target defects on wire rope surfaces. Experimental results show that WireGC-Former achieves a mean Intersection over Union (mIoU) of 80.32% on the WireRope3D dataset, demonstrating the effectiveness of the proposed method for small‑target defect segmentation on wire rope surfaces. The presented method can provide a reliable data foundation and technical support for refined detection and subsequent quantitative analysis of wire rope surface defects, and serve as a reference for point cloud semantic segmentation research in complex industrial scenarios.by LeTian Lv, Changxu Chen, Xuyang Liu, Huayang Liu, PanWen Wu
BackgroundRest interval duration is a key variable in exercise prescription, influencing both performance and physiological responses. Traditional training typically employs fixed rest intervals; however, this approach may not adequately reflect individual variability in recovery needs. Recently, self-selected rest intervals—based on individual perception—have gained attention as a potential strategy for more precise load regulation. Nevertheless, current evidence regarding their effects on exercise performance, heart rate, and blood lactate remains inconsistent.
MethodsThis study followed PRISMA guidelines and conducted a systematic search of Web of Science, PubMed, Cochrane Library, and Embase from database inception to March 20, 2026. Acute experimental studies comparing self-selected and fixed rest intervals were included. A three-level random-effects meta-analysis was performed to account for dependency among multiple effect sizes. Subgroup analyses, meta-regression, and sensitivity analyses were conducted to explore potential moderators and assess robustness.
ResultsSixteen studies (k = 16) involving 281 participants were included. No significant overall difference was observed between self-selected and fixed rest intervals for exercise performance (g = 0.27, 95% CI [−0.14, 0.69], p = 0.29), with substantial between-study heterogeneity. After removing outliers, a small but significant effect favoring self-selected rest intervals was identified (g = 0.20, 95% CI [0.08, 0.33], p Conclusion
Self-selected and fixed rest intervals produce comparable effects on exercise performance and physiological responses. However, self-selected rest intervals may confer a small advantage in maintaining performance under specific conditions. These findings should be interpreted with caution due to sensitivity to outliers and study heterogeneity.
To identify latent profiles of job demands, job resources and personal resources among hospital nurses based on the Job Demands-Resources model, and to examine whether these profiles differed in multidimensional work fatigue and demographic and occupational characteristics.
A cross-sectional survey study.
An online survey was conducted with clinical nurses in tertiary public hospitals in Jiangsu Province, China, between February and April 2024. Latent profile analysis was performed using seven standardised Job Demands–Resources indicators. Overall, physical, mental and emotional work fatigue were compared across profiles. Multinomial logistic regression was used to explore demographic and occupational correlates of profile membership. The study was reported in accordance with the STROBE guideline for cross-sectional studies.
Among 1804 nurses, three profiles were identified: Balanced Neutrals, Strained Survivors and Resilient Achievers. Strained Survivors were characterised by higher non-clinical work stress and work-to-family conflict, together with lower organisational identification, work-to-family facilitation, work-related meaning and self-efficacy. This profile reported the highest overall, physical, mental and emotional fatigue. Resilient Achievers showed the most favourable demand–resource configuration and the lowest fatigue, while Balanced Neutrals showed intermediate patterns. Profile membership was associated with employment type, age, gender, professional title, managerial role and clinical department.
Hospital nurses experience distinct demand–resource configurations that correspond to meaningful differences in multidimensional work fatigue. A person-centred Job Demands–Resources approach can support more targeted identification of fatigue risk.
Profile-informed strategies may help create healthier nursing work environments by identifying nurses who require demand reduction, work–family support, resource rebuilding or preventive monitoring.
This study addresses the tendency to treat nurses' work fatigue risk as uniform. The findings show that fatigue aligns with distinct configurations of job demands, job resources and personal resources, supporting profile-informed rather than one-size-fits-all healthy work environment strategies.
Reported in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology guideline.
This study did not include patient or public involvement in its design, conduct or reporting.
To investigate the association between attention-deficit/hyperactivity disorder (ADHD) and cardiometabolic risk profile at the time of type 2 diabetes (T2D) diagnosis and examine longitudinal changes in cardiometabolic measures following T2D diagnosis.
A nationwide cohort study using linked Swedish health registers.
Adults aged 18–65 years with a first recorded diagnosis of T2D between 1996 and 2020. ADHD, treated as a lifetime condition, was identified through diagnostic and prescription records.
The cardiometabolic risk profile, comprising nine clinical parameters and two behavioural factors, was assessed at T2D diagnosis and was tracked for up to 5 years post-diagnosis. Linear regression (βADHD) and Poisson regression models with robust variance (risk ratios (RRs)) compared cardiometabolic risk factors at diagnosis between individuals with and without ADHD. Generalised estimating equations (βADHD*t) assessed longitudinal changes in clinical parameters following the diagnosis.
Among 80 607 individuals with T2D, 1204 (1.5%) had an ADHD diagnosis. At T2D diagnosis, individuals with ADHD were younger and had statistically significantly higher body mass index (BMI) (βADHD: 1.93 (95% CI 1.54 to 2.32)), triglycerides (βADHD: 0.31 (95% CI 0.17 to 0.45)) and smoking prevalence (RR: 1.58 (95% CI 1.44 to 1.74)) compared with those without ADHD. Other cardiometabolic risk factors did not differ significantly. Over the subsequent 5 years, trajectories in cardiometabolic risk factors were broadly similar, except for a greater reduction in BMI in individuals with ADHD (βADHD*t: –0.26 (95% CI –0.34 to –0.17)), independent of baseline BMI and glucose-lowering medications. After inverse probability of treatment weighting, the BMI reduction was substantially reduced and not significant (βADHD*t: –0.05 (95% CI –0.17 to 0.07)).
Among adults with newly diagnosed T2D, those with co-occurring ADHD had broadly similar cardiometabolic profiles to those without ADHD but presented at a younger age with a modestly higher BMI, triglycerides and smoking prevalence. Individuals with ADHD also showed a slightly greater reduction in BMI over time following T2D diagnosis. Despite modest overall cardiometabolic differences, incorporating ADHD status into preventive diabetes care may help identify a younger, more vulnerable subgroup who could benefit from targeted risk factor management.
To identify and map evidence on factors that influence nurses' engagement in clinical research.
A scoping review was conducted in accordance with the JBI methodology.
First, titles and abstracts of articles, then full-text articles, were screened by two independent researchers against inclusion and exclusion criteria. Data was extracted into a data extraction table. Findings from articles were synthesized using thematic analysis.
Searches were conducted in Medline All (Ovid), Embase (Ovid), APA PsycInfo (Ovid), CINAHL Plus with Full Text (Ebsco) and Scopus on April 28, 2025.
Seventy-nine articles were included in this review. There were significant barriers that prevented nurses from engaging in research, including: lack of time, inadequate training, negative internal beliefs, insufficient organizational support and an unsupportive research culture. Factors that facilitated nurses' engagement in research included: research infrastructure, training and mentorship, visionary leadership, unit-level support, improved motivational components and enhanced organizational research culture. A multi-level framework and strategic recommendations are provided, along with an overview of the 23 interventions reported in the included articles are provided.
Nurses are constrained from conducting research to generate nursing knowledge due to multiple barriers. Visionary leadership is needed that prioritizes nursing research, establishes infrastructure and creates a culture of research excellence to enhance the quality and safety of nursing care.
Healthcare organizations should support nursing research by providing nurses with paid release time from their clinical duties and building an accessible infrastructure. Infrastructure can include programmes, centres and academic-practice partnerships that provide nurses with access to research training, experienced mentorship, librarian and statistical support, grant and manuscript writing assistance and funding pathways for small and large studies.
This scoping review is reported in accordance with the PRISMA-ScR guidelines.
No patient or public contribution.
Registered with the Open Science Framework: 10.17605/OSF.IO/5VWE9 (12/03/25).
Sub-Saharan Africa (SSA), including Tanzania, is double-burdened with high rates of teenage pregnancy and new HIV infections among adolescent girls and young women (AGYW) aged 15–24 years. Moreover, pregnant AGYW living with HIV in SSA have poorer adherence and retention on HIV treatment and elevated risks of vertical HIV transmission to their infants, as compared with older women. This paper describes the methods for the ENGAGE project, aiming to investigate and optimise healthcare for prevention of vertical HIV transmission (commonly prevention of mother-to-child transmission (PMTCT)) for AGYW living with HIV in Tanzania.
ENGAGE uses a mixed-methods design to co-create and prototype an intervention package for pregnant/postpartum AGYW living with HIV through three phases in three Tanzanian regions. Phase 1 characterises the problem by investigating care engagement and outcomes in a cohort of N=10 147 AGYW receiving PMTCT services in routine healthcare. Phase 2 uses qualitative interviews to understand the social-structural drivers of care engagement from the perspective of AGYW, healthcare providers and community stakeholders and an evidence review of potential solutions. In phase 3, we will use findings from phase 1 and 2 to co-create (together with AGYW and healthcare providers) an intervention package to optimise PMTCT care for most at-risk AGYW. The co-creation will be done through an intervention development action cycle, where ideas are presented, feedback sought and refinements made iteratively via several workshops over about 6 months. The resulting co-created intervention package will be prototyped at selected facilities/communities and refined into a final version, ready for piloting for feasibility, acceptability and preliminary effect in a later phase. This protocol focuses on the co-creation phase 3 and its preceding phases 1 and 2.
ENGAGE has received ethical approval from the Tanzania National Health Research Ethics Committee (NIMR/HQ/R.8a/Vol.IX/4637), and the Swedish Ethical Review Authority (2024-05745-01) for analysis of data in Sweden. Findings will be disseminated to AGYW, healthcare providers, community stakeholders, health officials, researchers, policy makers and the wider local and global scientific community.
To evaluate the effectiveness of multidisciplinary offloading versus standard care on one-year diabetic foot ulcer recurrence, amputation, mortality, and functional recovery. In this prospective cohort study, 232 patients with healed diabetic foot ulcers were stratified into a control group (76 patients) or an intervention group (156 patients) receiving offloading modalities ranging from felt padding to custom-made therapeutic footwear. Assignment was based on shared decision-making considering biomechanical needs and economic feasibility. Primary outcomes included recurrence, amputation, and mortality. Secondary outcomes assessed quality of life, working ability, and ankle function. The intervention group demonstrated significantly lower recurrence (10.9% vs. 25.0%; p = 0.007) and mortality (3.2% vs. 14.5%; p = 0.004). Multivariable analysis identified offloading as independently protective against recurrence (odds ratio 0.35) and mortality (odds ratio 0.24). Amputation rates did not differ significantly after adjustment. Functionally, the intervention group achieved superior recovery in quality of life, working ability, and ankle scores (p < 0.001). Subgroup analysis indicated that customized therapeutic footwear yielded the lowest complication rates and highest patient satisfaction. Multidisciplinary offloading significantly reduces recurrence and mortality while restoring physical function. Although financial barriers influence device selection, customized therapeutic footwear offers the optimal balance of biomechanical protection and functional outcomes.
by Jie Yao, Changshuai Zhou, Liren Ding
BackgroundLung adenocarcinoma (LUAD) is a predominant subtype of lung cancer associated with an unfavorable prognosis. However, the roles of the tumor microenvironment (TME) and Kynureninase (KYNU) in LUAD remain largely unclear. This study aimed to investigate the potential role of KYNU in macrophages and LUAD.
MethodsAll LUAD related data were downloaded from The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) databases. The expression of KYNU was analyzed across different cell types following dimensionality reduction analysis. Immune cell infiltration and immunotherapy response prediction were performed using CIBERSORT and TIMER, respectively. Gene set variation analysis (GSVA) was employed for functional enrichment.
ResultsAmong all immune cells in LUAD, KYNU was primarily expressed in monocytes and macrophages. The upregulated genes in KYNU+macrophages group were significantly enriched in in gene ontology (GO) terms related to antigen processing and presentation. There were increased MHC-I/ MHC-II signal interactions between KYNU+macrophages and B cells as well as T cells. In LUAD patients with higher proportions of KYNU+macrophages, a significantly greater number of patients benefited from immunotherapy (p = 0.033). GSVA results indicated that the MHC pathway was significantly activated in high KYNU+macrophage group.
ConclusionsKYNU is primarily in LUAD macrophages, contributing to the distinct immune features and correlating with the enhanced antigen presentation in LUAD. This study preliminarily confirms that KYNU may serve as a potential biomarker for immunotherapy.
by Hongzhen Yin, Tong Wang, Changshun Zhong, Yingya Cao, Xiaogan Jiang, Qiancheng Xu, Weihua Lu
Airway foreign-body aspiration in adults is uncommon but can be life-threatening.Flexible bronchoscopy is the standard first-line therapy,but critically ill patients may need extracorporeal life support.This study aims to characterize the diagnosis,management,and outcomes of adult airway foreign-body cases treated at a single center over nearly 12 years to inform a standardized clinical pathway.A single-center retrospective observational study of consecutive patients aged ≥14 years with confirmed airway foreign body who were treated at a tertiary hospital in China were conducted.Medical records of consecutive adolescent and adult patients diagnosed with airway foreign-body aspiration and admitted to the hospital from 01/01/ 2014–30/11/2025 were reviewed.Data included demographics,imaging,extraction method, respiratory support and so on.Descriptive statistics were reported as medians with interquartile ranges or counts and percentages.A total of 41 patients were included,with a median age of 59.5 years(interquartile ranges 51–72) and 65.85% male.Flexible bronchoscopy was attempted as the primary intervention in 38 patients(92.68%) and succeeded in 81.58%(31/38) to remove airway foreign body.Most patients(78.05%) required only nasal cannula oxygen,while nine patients(21.95%) needed advanced support including mechanical ventilation (14.63%),high-flow oxygen(4.88%),and extracorporeal life support (2.44%).At discharge,most survivors had a good neurological outcome,with 36 patients(87.80%) having a Cerebral Performance Categories score of 1.The 28-day survival rate was 92.68%.These findings show that flexible bronchoscopy is an effective first-line therapy,and rigid bronchoscopy or surgery is useful when flexible bronchoscopy fails.In unstable cases,timely extracorporeal life support can bridge to definitive removal.These results support a tiered,multidisciplinary approach incorporating early chest computed tomography,flexible bronchoscopy,and escalation to advanced airway or extracorporeal support.by Xiaodong Zhang, Lan Zou, Dunfu Zhang, Bangtao Yao, Junge Chen, Tianfeng Wei, Zhouping Fu, Xin Chang, Lijuan Chen, Yan Geng
BackgroundForearm radial artery occlusion (RAO) is a common complication after transradial coronary procedures. Traditional patent hemostasis, relying on operator-dependent assessment, results in labor-intensive processes and inconsistent RAO rates.
MethodsThis is a single-center, prospective, randomized, open-label, parallel-group superiority trial. We plan to enroll 818 patients scheduled for transradial coronary angiography. Participants will be randomly assigned (1:1) to either a novel balloon pressure monitoring system (integrating high-precision digital manometry with physiologically-phased decompression) or traditional patent hemostasis. The primary outcome is the incidence of ultrasound-confirmed forearm RAO at 24 hours post-procedure. Key secondary outcomes include rates of access-site vascular complications and bleeding events, as well as objective metrics of hemostasis efficiency. Recruitment Status: Recruitment commenced in September 2024 and is ongoing; the target sample size is anticipated to be reached by May 2026. Analysis will follow the intention-to-treat principle.
Results/ Trial StatusAs a protocol paper, no results are reported. The trial is currently in the recruitment phase.
ConclusionsThis trial will provide the first large-scale randomized evidence on whether digital manometry-guided compression reduces RAO, potentially bridging the efficacy-effectiveness gap between optimized research protocols and routine practice.
Trial registrationThe trial was registered with the Chinese Clinical Trial Registry (ChiCTR) in August 2024, under the registration number ChiCTR2400088258.
This study aimed to (1) implement a Safety Protocol of Thirst Management (SPTM) as an evidence-based practice for quenching postoperative thirst and (2) evaluate its effectiveness using a comparative pre-and-post induction design.
A quasi-experimental study using propensity scored matching.
Guided by the Iowa Model, the SPTM was implemented at a tertiary medical centre in Taiwan in 2023. Outcomes were compared between adult surgical patients admitted in 2023 (post-induction) and those admitted prior (pre-induction). Data on thirst and pain intensity, body temperature, and PACU length of stay (LOS) were analyzed for 15,168 patients.
A standardized SPTM flow diagram was established. Following SPTM induction, mean thirst scores significantly decreased from 5.76 to 1.30 (p < 0.001). Although pain intensity and PACU LOS (63.63 vs. 62.23 min) showed statistically significant increases, these changes were clinically marginal. Body temperature remained stable with no incidence of perioperative hypothermia.
The Iowa Model effectively guides nursing organizations in translating evidence into practice. The SPTM provides a safe, consistent framework for nurses to alleviate postoperative thirst, significantly enhancing the quality of surgical care.
This study addresses the lack of standardized thirst management. Results demonstrate that an evidence-based SPTM protocol effectively quenches thirst without increasing adverse clinical risks.
The SPTM was triggered by patient reports of thirst-related distress. During the design phase, patient feedback on the acceptability of cold oral stimuli was used to refine the protocol. While patients did not participate in the data analysis, the primary outcome (thirst intensity) was selected based on its significance to patient-cantered care.
This study was reported according to TIDieR guideline.
FreshRSS 