Conectar
by Sean Hartmann, Andrew Sharp, Heather Johnston, Michael S. Gee, Susie Y. Huang, Mukesh G. Harisinghani, Jens Gühring, Wei-Ching Lo, Vibhas Deshpande, Oleg S. Pianykh
PurposeHigh complexity of modern processes renders manual process optimization impossible. The main goal of our work was to formalize and to demonstrate the practical efficiency of explainable rule-learning AI in complex process optimization.
Materials and methodsProcess optimization methodology was based on globally-optimal Boolean rule-learning AI models, capable of identifying multiple inefficiency patterns, and supporting process-oriented optimization metrics. To illustrate this approach in real-word environment, the study used 3994 liver and prostate Magnetic Resonance Imaging (MRI) exams performed on five 3T scanners at three outpatient facilities from January 2019 to January 2024. Imaging exams longer than 25 minutes were labeled as requiring optimization, which applied to 35.4% of liver and 52.6% of prostate cases. Rule-learning AI was applied to the MRI scanner log data to discover short and interpretable process optimization rules. The selected Boolean rules were used to implement improved exam protocols, and a permutation test was used to measure the statistical significance of the resulting change in average exam duration.
ResultsN=1000 top rules, identifying the most significant processing delay patterns, were discovered by rule-learning AI from the scanner log data based on F1 score. A smaller set of 20 top rules was selected using the secondary operational impact metric, an estimate of each rule’s impact on average scan duration. A change in liver MRI protocols based on findings from the top rule resulted in a 10.9% reduction of median scan time. The proportion of long liver exams was reduced from 35.4% to 23.9% (p < 0.001). Similar optimizations in prostate protocols were used to add a new scanning sequence, improving exam quality.
ConclusionsGlobally optimal, multi-model rule-learning AI can transform feature-rich device logs into concise, interpretable, and operationally meaningful rules. When combined with domain expertise, this approach can support measurable and sustainable improvements in complex clinical workflows.
Parkinson’s disease (PD) is the second most common neurodegenerative disorder, its principal symptom being deterioration of motor function. Current treatment options are limited to symptom management but there is evidence that physical activity can provide motor benefits. More recently there is evidence to suggest that rhythmic auditory stimulation may improve gait and balance in PD. Sparky Samba is a community initiative in South Wales, UK, founded by a person living with PD. Sessions incorporate the following samba rhythms from a trained facilitator and are held weekly in a community setting.
The Sparky Samba trial is a multi-site, non-blinded, randomised controlled feasibility trial of Sparky Samba compared with activity as usual. A total of 60 people with PD will be randomised 1:1 to take part in a local Sparky Samba group for 12 weeks or continue their normal activities for the same length of time. The primary outcome is feasibility defined by recruitment, retention, data completeness and intervention adherence. Secondary outcomes relating to motor function, cognition, well-being and self-efficacy will also be assessed at baseline and at 12 weeks. Additionally, we will conduct a process evaluation to understand contextual mechanisms surrounding Sparky Samba. This will be achieved through qualitative interviews and structured participant questionnaires following individual trial completion and through structured questionnaires with intervention delivery staff, supplemented with qualitative interviews.
Feasibility outcomes will be assessed according to pre-defined criteria. For secondary outcomes, means and standard deviations (or medians and IQRs) will be calculated by arm, alongside 95% CIs for change from baseline to 12-week follow-up. Qualitative data will be subject to thematic analysis using NVivo software.
This study received a favourable ethical opinion from the North of Scotland Research Ethics Committee in April 2025 (REC reference 25/NS/0037). Study results will be disseminated through the peer-review literature, the ISRCTN registry and directly to participants, which will be facilitated by the study’s public and patient involvement steering group.
by Andrew McKenzie, David Yuzva Clement
In today’s hybrid and digitally connected world, hate and violent extremism persist across social and digital environments worldwide, driven by complex radicalization pathways that emerge among individuals and groups often driven by grievance and complex vulnerability. In addition to their most violent expressions, including hate crimes, extremist and terrorist violence, these phenomena wield severe negative, detrimental, traumatic, and intergenerational impacts. As governments increasingly adopt social care and public health approaches to prevent and counter violent extremism and associated harms, a gap has emerged in understanding how social workers describe their roles, theoretical frameworks, and practice experiences in what has become known as the field of preventing and countering violent extremism (P/CVE). Problematically so, social work research and scholarship regarding P/CVE seems to remain limited conceptually and geographically dispersed, leading to uncertainty and practical challenges for professionals in the field. To date, no scoping review has been conducted to systematically assess, synthesize, and discuss social work research related to P/CVE. Against this backdrop, the objective of this scoping review is to identify the current research landscape, gaps, and future directions regarding social work and P/CVE. It aims to provide a comprehensive overview of elements, findings, and practice-relevant limitations and opportunities on social work and P/CVE and contributes to both the development of a nuanced understanding of an emerging social work practice field while also furthering the knowledge base and theory of P/CVE.by Justin Clements, Jenna E. Stanek, Kylie Gallegos, Jessica Celmer, Jesse Berryhill, Andrew Thiros, Mark A. Peyton, Shannon M. Gaukler
Polychlorinated biphenyls (PCBs) are a group of industrial chemicals that were widely used in the United States before being banned by the Toxic Substances Control Act in 1976. Concerns regarding PCBs arose in the 1960s due to their toxicity, classification as a carcinogenic compound, and longevity in the environment. Although the production of PCBs in the United States is currently banned, PCBs can still be found in legacy equipment, and the environment and PCBs are still unintentionally produced in common building materials. To document the concentration of PCBs in biota predominantly found in northern New Mexico, biota (mammalian, avian, and reptilian) were opportunistically collected from 2009 to 2025. We grouped biota species into feeding guilds (carnivore, herbivore, and omnivore) to examine whether different feeding guilds had higher or lower proportions of total PCBs, PCB homologs, dioxin-like PCB congeners, and toxic equivalents. When we examined the concentrations of PCB homologs and total PCBs, we found the highest abundance of PCBs in the carnivore feeding guild compared with both herbivores and omnivores. We also observed differences of dioxin-like PCB congeners among feeding guilds, examined in this study. Toxic equivalents were also observed at higher values in carnivores. Furthermore, we demonstrate the biomagnification of PCBs across trophic levels, with higher concentrations observed in mountain lions relative to their primary ungulate prey (mule deer and elk). A comparison of biota revealed a significant difference in concentrations of PCBs found in samples (mule deer and elk) collected in developed areas when compared with rural locations, with the developed areas having higher concentrations. Our investigation provides significant insight into the distribution, composition, and biomagnification of PCB in terrestrial animals in New Mexico, including the biomagnification of PCBs within the carnivore feeding guild, which could be at a higher risk of adverse effects from PCB exposure.by Yan Nee Gan, Sin How Lim, Frederick L. Altice, Sharifah Khadijah Syed Razif, Mariani Ahmad Nizaruddin, Reena Rajasuriar, Sazali Basri, Joselyn Pang, Andrew Yap, Iskandar Azwa, Rafdzah Zaki
IntroductionIn 2024, only 3,451 individuals accessed free oral HIV pre-exposure prophylaxis (PrEP) at government clinics in Malaysia, despite an estimated 354,000 key population members who could benefit from PrEP. To inform pre-implementation refinement of a pharmacy-led PrEP service delivery model, we explored stakeholder perspectives on implementing the model within private community pharmacies in Malaysia.
Materials and methodsA one-day stakeholder consultation was conducted in April 2023 in Kuala Lumpur with 28 stakeholders representing community pharmacies, professional societies, telemedicine providers, non-governmental organizations (NGOs), and HIV implementation science researchers. The meeting began with a review of preliminary findings from formative qualitative research involving key populations, community pharmacists, and PrEP prescribers. Through facilitated discussions, stakeholders identified short- and long-term solutions to implementation barriers. Stakeholder inputs from discussions and structured worksheets were synthesized descriptively to identify recurring implementation considerations that informed refinement of the pilot model.
ResultsKey implementation considerations included enhancing awareness and demand generation, ensuring privacy, confidentiality, and affordability, integrating HIV self-testing, using digital checklist-based assessments, simplifying laboratory testing requirements, developing practical workflows supported by a reference guide, strengthening pharmacist training, and fostering cross-sector collaboration. Identified training needs included PrEP fundamentals, eligibility assessment for initiation and continuation, referral procedures, and scenario-based learning. Key competencies included knowledge of HIV and sexually transmitted infections, risk assessment, professional conduct, and person-centered communication. Six study sites were selected, with preparation requirements including HIV self-test kits, PrEP medications, informational materials, trained pharmacists, telemedicine subscriptions, and nearby referral clinics. The consultation informed refinements to the implementation plan.
ConclusionsThis stakeholder consultation informed refinement of a pharmacy-led PrEP service delivery model for pilot implementation in Malaysia and identified practical implementation considerations related to privacy, affordability, HIV self-testing, physician-pharmacist coordination, training, and referral systems. The findings may inform future implementation planning for similar urban, private-sector PrEP delivery models.
by Gerald Mbuthia Mahuro, Murungaru Kimani, Andrew Kyalo Mutuku
Unmet need for contraception is defined as the proportion of exposed fecund reproductive age women desiring to limit fertility but who are contraceptive nonusers, and it has invaluable contributions to population dynamics policies besides engendering fertility discourses. Aligning with the continuous evolution of conceptualization, the fluidity of the robust measurement model was indispensable, stemming from a formula that identified a pool of reproductive age women in irrational situations, discrepant behavior, “KAP-Gap” and unmet need for contraception. Extant fertility literature suggests the possibility of some reproductive age women classified as having unmet need but genuinely have “no unmet” need. This study proffers that exposed women whose husbands have a virility issue attendant to genetic, health, social, and lifestyle factors may obliviously forgo birth control methods on the perception of reduced pregnancy risk. Upon incorporating husbands’ virility loss, this study generated a modified “Revised” algorithm and utilized 2014 Kenya demographic and health survey data to select 8,710 reproductive age women who met fertility criteria. Using Stata ® the modified “Revised” algorithm estimated unmet need for contraception at 16.4 percent, lower than national estimates by 1.1 percentage points, implying 6.6 percent overestimation. The “modified” estimates were highest among adolescents, rural dwellers, and residents of Northeastern region but decreased with increasing education and household wealth. This study has generated a modified “Revised” algorithm, confirmed overestimation of “unmet need” for contraception, incorporated overlooked husband’s virility loss, and proved reclassification of women from “unmet need” to “no unmet need.” These results, therefore, endorse incorporation of virility loss as a reason exuded by exposed reproductive age women for abstaining from birth control methods.To explore bereaved parents' experiences of receiving psychosocial interventions (PSIs) in hospital-based perinatal bereavement care in Ireland.
Descriptive qualitative study.
Fifteen bereaved parents (13 mothers and 2 partners) whose loss occurred within the past three years were recruited via a national parent-led charity. Semi-structured online interviews were conducted between November 2024 and March 2025. Data were analysed using reflexive thematic analysis.
Six themes captured parents' experiences: (1) emotional support as the foundation of feeling cared for; (2) informational support as essential for reassurance and preparedness; (3) practical and inclusive support to ease burdens and extend care; (4) memory-making to reconstruct meaning and connection; (5) sustaining supports beyond hospital; and (6) contextual support for sensitivity, continuity, and consistency. Interpreting these themes through the Socio-Ecological Model reflected multi-level influences shaping parents' experiences of receiving PSIs during hospitalisation.
Key PSIs valued by parents included emotional, informational, practical, inclusive, memory-making, psychological, and peer supports, as well as follow-up and contextual sensitivity. However, variability in how these supports were offered revealed gaps between parents' expectations and practice.
Findings highlight the need for a standardised framework outlining key PSIs, while retaining sufficient flexibility to accommodate individual preferences. Embedding these PSIs within organisational structures, supported by enhanced staff training, improved continuity of care, and minimisation of environmental triggers, has the potential to improve the quality, equity and consistency of perinatal bereavement care.
This study addresses gaps in understanding parents' perspectives on PSIs in perinatal bereavement care and offers practical insights to inform the development of core components of future PSIs for perinatal bereavement.
COREQ.
Bereaved parents and midwives formed a steering group, advising on study design, recruitment materials and interview guides, ensuring sensitivity and grounding in lived experience.
To investigate the impact of a workplace leadership development programme on nurse manager leadership capability, knowledge, skills and confidence.
Quasi-experimental repeated-measures design without a control group.
Associate Nurse Unit Managers at a large tertiary hospital in Melbourne, Australia, were invited to engage in a clinical leadership programme involving education and subsequent peer group reflective practice. A longitudinal survey with multiple pre- and post-programme timepoints was conducted. Measures included the Leader Efficacy Questionnaire, researcher-developed Likert-scale items to evaluate programme learning outcomes and free response items. Quantitative items were analysed using descriptive statistics and repeated measures analyses; free response items were explored using content analysis.
At baseline (T1), 103 Associate Nurse Unit Managers pooled from three cohorts consented to participate, of whom 98 provided sufficient data for analysis. Data were collected across 5 timepoints (T1–T5); T2 was used primarily to assess baseline comparability with T1; longitudinal analyses focused on T1, T3, T4 and T5. Sixteen participants provided data at all relevant follow-up timepoints and were included in the main longitudinal analyses. Following the leadership programme scores on the Leadership Efficacy Scale increased significantly. There were no significant changes in perceptions of organisational support or confidence in giving and receiving feedback. Participants reported positive experiences of the programme and identified future opportunities to refine topics, teaching and learning approaches and opportunities for peer networking.
A workplace clinical leadership programme for Associate Nurse Unit Managers demonstrated sustained increased leadership efficacy. Embedding coaching, mentoring and peer networks within leadership development may be an effective strategy to translate learning to practice and foster a sustainable healthy work environment. Further evaluation of education translation to practice and long-term organisational outcomes are important next steps.
For Associate Nurse Unit Managers, supporting leadership education by establishing organisation-wide peer groups and structured coaching and mentoring may help consolidate and embed leadership knowledge and skills into practice. Future leadership education programmes should intentionally combine workplace learning with mentoring, organisational supports and peer networks to provide ongoing feedback and protected time, maximising long-term benefits for staff wellbeing, retention and patient outcomes.
Effective clinical leadership is essential to nurse wellbeing and retention; however, the role preparation of these clinical leaders is variable and at times absent. A workplace leadership programme integrating education and peer-group reflective practice for Associate Nurse Unit Managers produced measurable increases in leadership efficacy, strengthening frontline leadership capability. Embedding coaching, mentoring and peer networks into these programmes underpins future translation of learning into practice to build health work environments that promote staff wellbeing and patient safety.
Transparent Reporting of Evaluations with Non-randomised Designs (TREND).
No patients, service users, caregivers or members of the public were involved in this study. Instead, this study was focused on the experiences and perceptions of nurses.
Improved survival from critical illness has led to an increase in patients with long-term physical and psychological morbidity. Postintensive care rehabilitation services are variable and it is recognised that there is a need for inclusive and accessible interventions to support recovery after critical illness. We engaged with people with lived experience of critical care admission to co-produce a virtual reality mediated intervention (ViRtual REality to AiD recoverY post intensive care unit (ICU) (VR READY).
Our primary objective was to determine the feasibility and acceptability of VR READY to improve the patient experience during recovery from critical illness. Secondary objectives included assessment of the feasibility and acceptability of selected outcome measures for use in future efficacy and cost-effectiveness studies for ICU recovery.
The co-developed intervention (VR READY) was evaluated in a single arm, non-randomised feasibility trial with embedded process evaluation in patients leaving critical care.
District General Hospital in Wales.
Adults who had been admitted to an ICU requiring organ support for more than 48 hours during their current hospital admission. Patients were approached at the point of stepping down from the ICU to a general ward (±48 hours). 87 patients were screened for eligibility, 37 were approached and 22 participants were recruited.
Participants were asked to use VR READY for at least 5 min per day for 14 days.
The primary outcome was feasibility defined by prespecified criteria. Secondary outcomes prioritised by patients and pertaining to recovery and well-being were assessed at baseline and 14 days. A qualitative interview was conducted 4–6 weeks later.
22 participants were recruited with 91% completion of baseline measures, 49.5% completion at 14-day follow-up and 27.3% completing the qualitative interview. Intervention adherence was poor (37.9%), however qualitative findings suggested that participants that engaged with the intervention considered VR READY beneficial to their recovery. While feasibility criteria were met for recruitment and data completion, criteria for retention and intervention adherence were not.
Critical illness is a traumatic experience. Our co-developed rehabilitation intervention VR READY was not feasible in its current format, potentially as a result of being offered too early in recovery when patients were struggling with fatigue, motivation and resilience. VR READY may be beneficial to recovery but further research is needed into optimal mode and timing.
Walk-and-talk therapy integrates psychological support and physical activity conducted in outdoor environments, and has potential to better align with men’s preferences and masculine norms around emotional communication. Conventional indoor psychotherapy is effective for treating depression but can be less engaging for men, leading to less satisfaction and high rates of dropout. This trial aims to determine whether walk-and-talk therapy offers men with depressive symptoms clinically meaningful benefits over conventional indoor therapy.
This assessor-blinded, parallel group randomised controlled trial is comparing the efficacy of walk-and-talk therapy to conventional indoor therapy for men with depressive symptoms. After randomisation, all participants receive 10 fortnightly 1-hour individual psychotherapy sessions over 20 weeks as either: (1) conventional indoor therapy (sitting down indoors) or (2) walk-and-talk therapy (walking outdoors). Participants are assessed at ‘pre-intervention’ (baseline), ‘post-intervention’ (5 months post baseline) and ‘follow-up’ (12 months post baseline) time points. The primary outcome is change in overall psychological distress (21-item version of the Depression, Anxiety and Stress Scale (DASS-21)) at post-intervention. Secondary outcomes include male-type depression symptoms, mental well-being, suicidal ideation and quality of life. Costing data is being collected for cost-effectiveness analysis. Linear mixed models will be used to examine the impact of group (conventional indoor vs walk-and-talk), time (baseline, 5-month and 12-month) and the group-by-time interaction for primary and secondary outcomes.
This study is approved by the University of Newcastle Human Research Ethics Committee (H-2024-0090). Results will be published in an open access peer-reviewed journal and disseminated through conference presentations.
ACTRN12624000794505.
To explore stakeholder perspectives on care coordination barriers and facilitators in regionalised neuro-oncology delivery, using brain tumours as a model for examining complex care pathways serving mixed rural-urban populations.
Reflexive thematic analysis of semistructured interviews from stakeholders across the neuro-oncology care pathway was used to identify themes of care system strengths, barriers to effective service delivery and priorities for system improvement.
Regionalised Canadian health system serving one of Ontario’s largest catchment areas, characterised by predominantly rural populations and substantial geographic distances to tertiary care.
36 stakeholders purposively sampled to represent diverse roles across the care pathway, including family caregivers (n=6), healthcare providers from multiple specialties and care settings (n=28) and Indigenous community advisors (n=2).
Thematic analysis identified seven themes organised within two broad domains: care system strengths and barriers to care continuity. Care system strengths included three themes: responsive palliative care integration, provider dedication and compassionate commitment, and intra-institutional coordination infrastructure. Barriers to care continuity included four themes: insufficient pathway standardisation across settings; inadequate educational infrastructure for patients, families and providers; absent cross-institutional coordination infrastructure and limited regional clinical trial access. Participants described relatively coordinated processes within the tertiary centre, while communication and follow-up were more fragmented at interfaces with referring hospitals and community services, with participants describing patients becoming ‘lost in transitions’.
Findings reveal how regionalised cancer systems can achieve localised coordination while experiencing fragmentation at interfaces between organisations. Participants described relatively coordinated processes within the tertiary centre, alongside more fragmented communication and follow-up across interfaces with referring hospitals and community services. These stakeholder perspectives highlight potential directions for service redesign, including standardised pathways, shared information systems and clearer cross-site accountability structures, which warrant future evaluation alongside consideration of resource allocation and local feasibility. Brain tumours, requiring rapid multidisciplinary coordination, expose these interface failures with clarity, offering transferable insights for improving integrated cancer care in regionalised health systems serving geographically dispersed populations.
by Sinan Ersan, Charles Zhang, Yousef Yousef, Nicholas Kemmis, Brendan Perreault, Ismet F. Vardar, Karen M. Allison, Andrew L. Reynolds, Margaret M. DeAngelis
ImportanceStrict adherence to follow-up ophthalmic care after emergency department visits is critical not only for monitoring disease progression, assessing therapeutic response, and preventing avoidable complications, but also because ophthalmic examinations may provide one of the few opportunities to identify otherwise unrecognized systemic disease.
ObjectiveTo identify variables associated with loss to follow-up (LTFU) care after emergency department ophthalmology consultations, and to characterize similarities and differences between self-reported race.
DesignRetrospective cohort study examining emergency department ophthalmology consultations between January 1st, 2019, and December 31st, 2021, at a level 1 trauma center serving Western New York, Northern Pennsylvania and Southern Ontario.
SettingSingle center study at Erie County Medical Center in Buffalo, New York, USA.
ParticipantsA total of 2323 ophthalmology consultations were analyzed.
Main outcomes and measuresThe primary outcome was the rate of LTFU, defined as failure to attend a scheduled outpatient appointment. Demographic, diagnostic, and socioeconomic variables were analyzed across all patients and stratified by self-reported racial group (White, African American/Black, and Other). Logistic regression analysis was performed.
ResultsOf the 1697/2323 (73.1%) patients that required an outpatient follow-up at The Ira G. Ross Eye Institute, 1003 (59.1%) identified as White, 489 (28.8%) identified as African American/Black and 205 (12.1%) identified as Other. The overall rate of LTFU was 41.8%, with no significant difference in follow-up rates by racial group on multivariable analysis. In the overall patient cohort, LTFU was significantly more common among patients residing in ZIP codes with lower rates of high school completion, those with a longer interval between the emergency department visit and the scheduled follow-up appointment, and those who presented with near-normal visual acuity (close to 20/20). Among White patients, glaucomatous and retinal diagnoses were associated with lower rates of LTFU. Older age, corneal diagnoses and orbital diagnoses were associated with lower rates of LTFU among African American/Black patients.
Conclusions and RelevanceThis study identified both shared and distinct factors associated with LTFU across racial groups. These findings provide a foundation for future studies investigating the mechanisms underlying follow-up adherence and may help inform efforts to improve outpatient follow-up.
by Kittipan Tharakhet, Eakachai Prompetchara, Chirayus Khawsang, Supichcha Saithong, Papatsara Kaewpang, Nongnaphat Yostrerat, Pachara Wangsoontorn, Jenjira Sontikun, Sawaros Tantratorn, Thidarat Khotprathum, Kieu Lam, James Heyes, Drew Weissman, Kiat Ruxrungtham, Chutitorn Ketloy
Dengue virus (DENV) remains a major global health burden, with four antigenically distinct serotypes (DENV-1–4) posing a significant challenge for vaccine development. Dengue non-structural protein 1 (NS1) has been associated with additional protection and reduced disease severity, supporting its inclusion in vaccine design. In this study, we designed a consensus NS1 (cNS1) antigen by integrating sequence elements from all four DENV serotypes (78–89% amino acid identity) to enhance cross-serotype antigenic coverage. The cNS1 sequence was encoded as a nucleoside-modified mRNA and formulated in lipid nanoparticles (mRNA–LNPs). Immunization of BALB/c mice with a low dose (0.2 µg) of cNS1 mRNA–LNP induced broadly reactive NS1-specific IgG responses that recognized NS1 proteins from all four serotypes. In addition, the vaccine elicited interferon-γ (IFN-γ)–producing T cell responses against peptide pools derived from multiple DENV serotypes, indicating the activation of cross-reactive cellular immunity. While broad immune recognition was achieved, this was accompanied by lower serotype-specific response magnitudes as a trade-off. In conclusion, the cNS1 mRNA vaccine induces cross-serotype humoral and cellular immune responses in mice, highlighting the potential of consensus antigen design to broaden immune recognition of DENV NS1. These findings support the further development of NS1-based immunogens as complementary components of next-generation dengue vaccines aimed at achieving broad and effective protection.by Ivaan Pitua, Kim Andrew Otto, Kiragga Denis Lwembawo, Kaweesi Calvin Nantalaga, Maria Gabriella Nampiinga, Michael Ndyomugabe, James Nelson Okema
IntroductionApproximately 39.9 million people are living with HIV worldwide, most in sub-Saharan Africa. Effective antiretroviral therapy has shifted attention to metabolic comorbidities, and emerging evidence links integrase inhibitors such as dolutegravir to elevated serum uric acid, yet the global burden of hyperuricemia and gout in this population is unquantified.
Methods and analysisThis protocol describes a systematic review and meta-analysis of observational studies (cross-sectional, cohort, and case-control) published from inception to May 2026. We will search PubMed/MEDLINE, EMBASE, Web of Science, and CINAHL. Studies involving adults (≥18 years) living with HIV that report the prevalence or incidence of hyperuricemia or gout will be included. Two independent reviewers will screen studies, extract data, and assess risk of bias using the Joanna Briggs Institute Prevalence Critical Appraisal Checklist and the Newcastle-Ottawa Scale (NOS). Primary outcomes are the pooled prevalence of hyperuricemia and gout in PLHIV. Secondary outcomes include risk factors associated with urate dysregulation (ART regimen, Cluster of Differentiation 4 [CD4] count, viral load, metabolic comorbidities, and HIV duration), and gout as an immune reconstitution inflammatory syndrome (IRIS) manifestation. A random-effects meta-analysis using the DerSimonian-Laird method with Freeman-Tukey double-arcsine transformation for prevalence data will be performed in R software. Heterogeneity will be assessed using the I2 statistic and Cochran’s Q test. Subgroup analyses will explore variation by ART class (pre-ART, PI, NNRTI, INSTI/dolutegravir era), geographic region, CD4 category, and study quality.
PROSPERO Registration NumberCRD420261360734.
To describe the processes, consensus-building activities, learning and challenges of prioritizing initial programme theories on appropriate nurse staffing models across a multinational research team of academics, trainees and knowledge users from four countries.
Realist review involving literature review, multinational stakeholder engagement and prioritization of programme theories. Realist reviews explore what works, for whom and in what contexts, enabling the development and testing of initial programme theories.
Data sources included (1) a literature review to identify existing theories on optimal nurse staffing models, (2) input from methodological and health system decision makers experts to identify context-mechanism-outcome configurations and prioritize initial programme theories and (3) feedback from health decision-makers and nursing staff through focus groups to augment and prioritize a final set of initial programme theories for subsequent testing.
We summarize the key learnings we gained regarding: (1) effectively communicating the value and unique aspects of realist methodology to team members with varying levels of expertise; (2) achieving a compromise between rigour and relevance in the design of the review itself in working within ‘social laboratories’ and (3) the logistics of conducting a multinational realist investigation: navigating working remotely, differences in time zones and differences in context and language.
Prioritizing initial programme theories on nurse staffing through a multinational realist review is both feasible and valuable. Clear communication, balancing rigour with relevance and managing logistical challenges are essential to producing context-sensitive and evidence-informed staffing models.
Developing evidence-informed staffing models requires local context consideration and stakeholder collaboration. This study offers (a) practical insights for nurse leaders and managers on balancing rigour and relevance, (b) effective team communication and (c) navigating logistical challenges in multinational teams to prioritize programme theories for clinical translation to improve patient care and staff wellbeing.
Consolidated criteria for reporting qualitative research (COREQ).
Health care decision makers, care managers, researchers and academicians were involved.
To explore healthcare practitioner perspectives and experiences of using strength assessment and strength training within pulmonary rehabilitation, focusing on perceived utility, barriers and impact on service delivery and patient care.
Qualitative study using semi-structured one-to-one interviews analysed through reflexive thematic analysis.
A pulmonary rehabilitation service in the South East of England, operating across three community sites.
11 female healthcare practitioners (including physiotherapists, nurses, and associate practitioners) involved in managing, delivering, or assisting in pulmonary rehabilitation programmes.
Four themes were constructed: (1) beyond lung fit: valuing strength training for functional independence; (2) mixed attitudes towards strength assessment utility in practice; (3) navigating the implementation gap: perceived challenges for pulmonary rehabilitation and strength assessment; and (4) the professional training divide: a call for further training. These findings show practitioners have positive views of strength assessment and strength training in pulmonary rehabilitation and recognise the benefits they offer services and patients. However, a number of barriers were identified, including uncertainty of strength assessment practicality in current practices, the need for staff training and education, and service-related challenges (time constraints, limited equipment and high workloads).
Healthcare practitioners perceive strength training as essential to pulmonary rehabilitation and recognise the potential benefits of assessing patient strength. However, organisational constraints, limited equipment, and insufficient staff training limit its routine implementation. Addressing these barriers through resource investment, clearer guidance, and structured training could bridge the implementation gap between evidence and everyday clinical practice, enhancing patient outcomes and the quality and consistency of pulmonary rehabilitation services across the UK.
Autistic children can experience elevated levels of emotional and behavioural problems, which adversely impact their psychosocial functioning. Positive parenting behaviours can significantly shape children’s emotional and behavioural developmental trajectories. However, for autistic children, these parenting behaviours may vary depending on their social, sensory and intellectual profiles. Literature on the association between parenting behaviours and autistic children’s internalising and externalising symptoms has been mixed. Thus, the main objective of this study will be to conduct a systematic review and meta-analysis of studies evaluating the effect of parenting behaviours on autistic children’s internalising and externalising symptoms.
Included studies have child samples between ages 6 and 17 years and a primary diagnosis of autism/Autism Spectrum Disorder (ASD), pervasive developmental disorder and/or Asperger’s syndrome as well as a measure of parenting behaviour. Primary outcomes are internalising and externalising symptoms. Substantive and methodological moderators will be examined. Searches will be conducted in MEDLINE, PsycINFO, Embase, Education Resources Information Center (ERIC) and ProQuest Dissertations and Theses Global from their inception onwards, and we will also conduct backward/forward searching of eligible studies. Published and unpublished studies will be examined. Two independent reviewers will conduct title/abstract and full-text screening as well as data extraction. Risk of bias will be assessed using the Newcastle-Ottawa Quality Assessment Scale and JBI Critical Appraisal tools. A random-effects meta-analysis model will be used, and summary effect sizes will be calculated. Moderation will be examined via Q-statistics and meta-regression to determine factors contributing to between-study variation in effect sizes.
Ethics approval is not required, as this review will use secondary data from published studies. Results will be disseminated through a peer-reviewed publication and conference presentations. The protocol is registered with the International Prospective Register of Systematic Reviews (PROSPERO; CRD42024528043).
PROSPERO CRD42024528043.
by Yufeng Li, Athia Haron, Chaofan Lin, Yuan Tang, Andrew Weightman, Glen Cooper
The prevalence of diabetes is expected to be 650 million people by 2030, and diabetic foot ulceration (DFU) is one of its most severe complications. It poses a significant challenge to global health and brings substantial social and economic burdens. Although many studies have explored the mechanisms of DFU development, they are still not fully understood. Due to the high cost of the experimental research, many recent studies have employed the computational modelling approaches to simulate the effects of diabetes on foot tissues from mechanical, thermal, fluid, and cellular perspectives. This study aims to provide a comprehensive review of computational modelling approaches used to investigate various factors influencing DFU, discuss current knowledge gaps and limitations, and outline future research directions. A systematic search was conducted in Web of Science, Scopus, and PubMed databases, identifying a total of N = 1631 records up to March 2025, 31 of which studies met the inclusion criteria and were analysed in this study. Results showed that DFU-related computational models can be categorized into five types: mechanical stress models, thermal models, vascular and nerve system models, multiphysics models, and cellular-based models. These models explore the formation mechanisms of DFU from different perspectives, including biomechanics, temperature, fluid dynamics, HHμm neural signalling, and cellular responses. However, except for mechanical stress models, the other approaches remain in the early stages of development, and the single physics modelling strategies are unable to provide understanding on the coupled processes with the foot and their effect on DFU. Future research should further develop modelling approaches and couple these together to develop comprehensive understanding of DFU pathogenesis.Pregnancy in women with pre-existing type 1 or type 2 diabetes (T1D, T2D) is associated with increased risk of complications, largely driven by maternal glucose control. Hormonal changes during pregnancy make glucose management more challenging. Physical activity (PA) may improve glucose control and reduce complications; however, little is known about PA patterns in this population and no pregnancy-specific PA guidance exists for women with pre-existing diabetes. Understanding the behaviours and experiences of both pregnant women and the healthcare professionals (HCPs) who support them is needed to inform evidence-based guidance.
This mixed-methods study comprises three sub-studies. The first will recruit 175 pregnant women (75 with T1D and 100 with T2D) who will complete three 7-day monitoring periods, one per trimester. PA will be assessed using wrist-worn accelerometers and exercise diaries, dietary intake via remote food photography, and corresponding continuous glucose monitor and diabetes-related well-being data will be collected.
The second involves a subsample of ~16 women participating in focus groups to explore experiences of being physically active during pregnancy.
The third invites ~100 HCPs involved in diabetes in pregnancy care to complete an online survey, ~10 HCPS will take part in an optional interview about their experiences of providing PA guidance.
The primary outcome is the change in PA across pregnancy. Secondary outcomes include associations between PA, glucose metrics, diet and diabetes-related well-being, and qualitative themes relating to experiences of women and HCP. Quantitative data will be analysed using multilevel modelling and regression analysis, and qualitative data using reflexive thematic analysis.
Ethical approval was granted by the East Midlands Nottingham 1 Research Ethics Committee (25/EM/0190) and University of Exeter Public Health and Sport Sciences ethics committee. Findings will be disseminated through peer-reviewed publications and conference presentations.
FreshRSS 