Conectar
by Pureheart Ogheneogaga Irikefe, Mohammad Falahat, Ahmad Danial Zainudin, Ihtisham Ullah, Nohman Khan, Bernard Ojonugwa Anthony
With progress toward the 2030 Agenda faltering, many see innovation as a key to sustainable development. The Association of Southeast Asian Nations (ASEAN) bloc represents a unique opportunity to examine how innovation capabilities drive sustainability in diverse economic and developmental contexts. Using panel data for ASEAN countries from 2011 to 2022, this study breaks down innovation into the seven pillars of the Global Innovation Index (GII) and investigates their impact on the Sustainable Development Goal (SDG) Index; with the objective of identifying which GII pillars most strongly predict SDG, while examining the moderating role of government effectiveness and controlling the impacts of gross national income per capita and foreign direct investment. Fixed effects models were used to analyse the data and supplemented by Driscoll-Kraay standard errors, addressing unobserved heterogeneity and cross-sectional dependence. Results reveal that only Institutions and Infrastructure pillars exert a consistently positive impact on SDG performance. In contrast, Creative Outputs have a negative impact. Importantly, Government Effectiveness reverses the negative impact of Creative Outputs, so that this pillar becomes positive for SDG achievement, without significant moderation of the other six GII pillars when controlling for year effects. In conclusion, these findings contest the efficacy of universal innovation policies and underscore the imperative for nuanced, context‑specific ones. It is recommended that ASEAN governments prioritize institutional and infrastructural investments and develop tailored regulatory frameworks, such as green intellectual property regimes and digital economy standards, to harness the creative economy for inclusive, sustainable growth by explicitly integrating innovation strategies with governance reforms.by Kexin Wang, Chao Ban, Liming Zhao, Haiyan Ruan, Ziqiong Wang, Yi Zheng, Sen He
BackgroundThe study aimed to investigate the associations between cooking oils and survival outcomes in a nationwide, community-based, prospective cohort study of older adults in China.
MethodsA total of 5372 older participants (median age: 85.0, inter-quartile range [IQR] age: 77.0–93.0; male: 46.1%) from the 2014 wave of the Chinese Longitudinal Healthy Longevity Survey (CLHLS) in 2014 were included, with follow-up until 2018. The exposure was cooking oils, including vegetable oils and lard, and outcomes were overall survival (OS) and disease-specific survival (i.e., cardiovascular disease [CVD]-specific survival and non-CVD-specific survival). Accelerated failure time (AFT) models were used to analyze the associations between cooking oils and study outcomes.
ResultsDuring a median follow-up of 3.5 years (IQR: 2.4–4.2 years), 2064 (38.4%) deaths were recorded, including 433 CVD deaths, 1229 non-CVD deaths, and 402 deaths with unknown causes. Kaplan-Meier analysis revealed cooking with lard was associated a higher CVD-specific survival probability than vegetable oils (93.9% vs. 88.2%, log-rank p Conclusions
Cooking with lard was associated with significantly longer CVD- specific survival compared to vegetable oils among older adults in China.
by Kindu Alem, Mucheye Gizachew, Mulat Dagnew, Worku Ferede, Solomon Belay, Baye Gelaw, Feleke Moges
BackgroundKlebsiella pneumoniae, Acinetobacter species, and Pseudomonas aeruginosa are priority pathogens identified by the World Health Organization that have emerged as major causes of healthcare-associated infections. Their increasing resistance to multiple antimicrobial agents poses significant challenges to clinical management and infection control efforts.
ObjectiveThis study aimed to determine the prevalence, associated risk factors, antimicrobial resistance patterns, and carbapenemase production of K. pneumoniae, Acinetobacter spp., and P. aeruginosa among hospitalized patients with suspected bloodstream, urinary tract, and surgical site healthcare-associated infections at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia.
MethodsA hospital-based cross-sectional study was conducted from August 2024 to June 2025 among 477 patients suspected of bloodstream, urinary tract, or surgical site healthcare-associated infections. Socio-demographic and clinical data were collected using a semi-structured questionnaire. Blood, urine, and wound/pus specimens were aseptically collected and inoculated on MacConkey, blood, and cysteine lactose electrolyte-deficient agar following standard microbiological techniques. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disc diffusion method on Mueller-Hinton agar according to Clinical and Laboratory Standards Institute guidelines. Data were analyzed using SPSS version 27. Bivariate and multivariate logistic regression analyzes were used to identify factors associated with healthcare-associated infections. P value Results
Among the 477 patients, 118 (24.7%) developed healthcare-associated infections caused by K. pneumoniae, Acinetobacter spp., and P. aeruginosa, with culture positivity rates of 14.9%, 4.8%, and 5%, respectively. Significant associated factors included age under five (AOR = 13.260, p K. pneumoniae, 69.6% of Acinetobacter spp., and 58.3% of P. aeruginosa isolates. Carbapenemase production occurred in 92%, 77.8%, and 57.1% of these carbapenem-resistant isolates, respectively. Amikacin, meropenem, and ciprofloxacin were the most effective antimicrobials, whereas chloramphenicol was effective only against K. pneumoniae.
ConclusionThis study showed high prevalence of multidrug resistance and carbapenemase production among K. pneumoniae, Acinetobacter spp., and P. aeruginosa in the study area, highlighting the urgent need to strengthen infection prevention and control measures and to promote antimicrobial stewardship programs.
by Malik Hamrouni, Ayushman Gupta, Sophie Middleton, Sabrina Prosper, Theresa Harvey-Dunstan, Joanne Porte, Tricia M. McKeever, Ian P. Hall, Charlotte E. Bolton
AimsTo characterise symptoms, function and patient-reported outcome measures (PROMs), and identify associated factors in adults with persisting respiratory symptoms post-COVID.
MethodsCross-sectional analysis of 210 non-hospitalised adults referred to a post-COVID respiratory clinic (December 2020-July 2024) who consented to research. Assessments included demographics, symptoms, lung function, chest CT, and several PROMs: MRC dyspnoea score, Nijmegen Questionnaire score (NQ), Hospital Anxiety and Depression Scale, Chalder Fatigue Scale, Short Physical Performance Battery (SPPB) and Fried Frailty Index. Multivariate logistic regression examined key exposure-outcome associations.
ResultsAmong participants (mean age 49.4 years; 68% female; median 13.3 months since COVID-19 diagnosis), 95% reported shortness of breath, 54% had clinically significant breathlessness (MRC ≥ 3), 68% had an NQ score (>23) consistent with dysregulated breathing, 32% had a low SPPB score ( Conclusion
In non-hospitalised patients with persistent respiratory symptoms post-COVID, dysregulated breathing, deconditioning and psychological distress were key factors linked with symptom burden. These findings suggest a multidisciplinary approach should be considered to optimise recovery.
by Zoya Waqas, Aisha Irum, Muhammad Ibrahim, Maheen Sughra, Sanaa Khan, Ayesha Khan, Adnan Ahmad Khan
IntroductionUnintended pregnancies remain a major public health concern globally and in Pakistan, where family planning (FP) uptake continues to be hindered by entrenched social and behavioral barriers. This study applies the Theory of Planned Behavior (TPB) to examine how attitudes, subjective norms, and perceived behavioral control (PBC) shape women’s contraceptive intentions in Pakistan.
MethodsWe analyzed data from 13,335 non-pregnant women aged 15–49 using the Pakistan Demographic and Health Survey (PDHS) 2017–18. Partial Least Squares Structural Equation Modeling (PLS-SEM) was used to test TPB pathways. Model reliability, validity, and fit were assessed using Composite Reliability, Average Variance Extracted, discriminant validity indices, and bootstrapped estimates to ensure analytical rigor.
ResultsOver half of respondents lacked formal education, and most (84%) were unemployed. Only 23% had FP knowledge, and 96% were unaware of contraceptive side effects. Subjective norms negatively influenced contraceptive intentions (β = −0.056, p Conclusion
The study demonstrates the applicability of TPB for understanding contraceptive intentions in a collectivist, patriarchal context. Subjective norms and PBC emerge as critical determinants, underscoring the need for interventions that engage families, strengthen women’s autonomy, and improve access to FP services. The findings offer a theoretically grounded and policy-relevant framework for designing behaviorally informed family planning programs in Pakistan.
by Forest W. Arnold, Leslie Wolf Parrish, Subathra Marimuthu, Jamie Findlow, Angela Quinn, Vidyulata Salunkhe, Daniya Sheikh, Phillip Bressoud, T’shura Ali, Dawn Balcom, Mohammad Ali, Ryan S. Doster, Deepti Deepti, Mohammad Tahboub, Fama Ndiaye, Jay Lucidarme, Stephen A. Clark, Ray Borrow, Paul Balmer, Steven Gootee, for the CERID study group
BackgroundNeisseria meningitidis is a cause of meningitis and outbreaks of it among young adults, especially college students. Rates of nasopharyngeal colonization and prevalence of specific capsular groups vary with age, geography as well as time, and may be influenced by meningococcal vaccination. The objective of this study was to measure the change in colonization rate, and define which meningococcal genogroups were present, in college students over a 3-month semester.
MethodsThis was a prospective, longitudinal cohort study with sequential oropharyngeal swabbing among college students at the University of Louisville (UofL) in Louisville, Kentucky from August to November 2022. Participants were ≥18 years of age and were enrolled within 48 hours of moving to campus-affiliated housing. Oropharyngeal swabs were collected at enrollment, one month and at three months. Samples were screened for N. meningitidis, and isolates were characterized using phenotypic and genotypic methods. Behavior questionnaires were obtained at each visit to identify risk factors for N. meningitidis colonization.
ResultsA total of 1047 participants were seen initially, of whom 821 attended all three visits. The baseline colonization rate was 3.5% followed by 3.9% after one month and 5.7% after three months. The genogroups of recovered isolates were capsule null (48%), B (38%; of which 11% were expressing capsule) and E (12%). No genogroup ACWY isolates were recovered. A total of 36% of participants had a history of receiving at least one MenB vaccine dose and 74% had a history of receiving at least one MenACWY vaccine. Risk factors for N. meningitidis nasopharyngeal carriage included being a second-year student, living on campus for the second year, smoking/vaping, kissing and sexual contact.
ConclusionsAn increase in N. meningitidis colonization over the 3-month semester was observed from 3.5% to 5.7%. The overall proportion of student carriers was significantly lower, and there were no genogroup A, C, W or Y strains isolated compared to studies conducted prior to the availability of meningococcal vaccines and the COVID-19 pandemic. However, genogroup B carriage, transmission and acquisition were almost identical to pre-COVID pandemic studies. This study reinforces the importance of periodic epidemiological monitoring of carriage as well as disease.
by Xuying Zhang, Johanna Mainzer, Isabella Giambra, Tong Yin, Petra Engel, Hannah Hümmelchen, Henrik Wagner, Axel Wehrend, Christiane Egerer, Katharina Gerhards, Gerald Reiner, Sven König
Long tails trigger tail biting in pigs and increase the risk of flystrike infections in sheep. Tail docking has been a common management practice in both species for decades, but increasingly conflicts with legal animal welfare guidelines. Sustainable solutions require breeding strategies targeting shorter tails. In consequence, the aims were to conduct whole-genome sequencing (WGS)-based genome-wide association studies (GWAS) and comparative genomic analyses (CGA) to explore functional elements influencing tail traits. Phenotypically divergent experimental populations of pigs and sheep were established through unified selection and mating experiments. Tail traits included tail length (TL) measured at birth, and tail abnormalities (TA) assessed radiographically at 14 weeks of age. WGS-based GWAS identified a significant locus on SSC18 in pigs and suggestive loci for TL in both species, which, together with previously reported loci for TA, were further analyzed by CGA. The genomic windows of the significant locus on SSC18 in pigs and the TL GWAS locus on OAR4 in sheep were found to be conserved, harboring six common genes with predicted functional variants. These variants were jointly associated with TL (Plm ) in both species in linear regression models adjusted for sex, age of the dam, body length, and body weight. In other GWAS locus windows (±1 Mb), species-specific TL candidate genes were identified in sheep (HOXB13, MUC5B, EPB41L3, MTCL1, PIEZO2, MPPE1, and LOXHD1) and in pigs (KNL1, DISP2, SPRED1, TGFB2, and HAND1), each harboring associated putative functional variants. For TA, sheep-specific candidates (PGM2, LRRC66, CRACD, LOC105601916, and SH2D4B) and pig-specific candidates (MYOT, TMCO6, and PCDHAC2) were revealed using logistic regression models (Pglm ). GO analyses of candidate genes predicted shared biological processes between sheep and pigs, whereas pathway analyses indicated that common carbohydrate metabolism pathways, along with species-specific immune and inflammatory signaling, and pig-specific TGF-β signaling and endochondral ossification, may contribute to tail length variation and abnormalities. These findings provided deeper insights into the genetic basis of differential embryonic tail morphogenesis and perinatal tail development across species.by Job Kasule, Julius L. Tonzel, Natalie Burns, Tyler Hamby, Roger Ying, Grace Mirembe, Immaculate Nakabuye, Hannah Kibuuka, Margaret Yacovone, Betty Mwesigwa, Trevor A. Crowell, for the Multinational Observational Cohort of HIV and other Infections (MOCHI) Study Group
BackgroundPeople with behavioral vulnerability to HIV face barriers to healthcare engagement that may impede uptake of non-pharmaceutical and other interventions to prevent COVID-19. Understanding COVID-19 knowledge, attitudes, and practices in this population can inform disease prevention efforts during future pandemics.
Materials and methodsFrom October 2022 to September 2024, we enrolled participants aged 14–55 years without HIV who endorsed recent sexually transmitted infection, injection drug use, transactional sex, condomless sex, and/or anal sex with male partners. At enrollment, we collected socio-behavioral data, including assessments of COVID-19 knowledge, attitudes, and practices. Robust Poisson regression with purposeful variable selection was used to estimate prevalence ratios with 95% confidence intervals for factors associated with COVID-19 preventive practices.
ResultsAmong 418 participants, 228 (56.9%) were female, the median age was 21 years (interquartile range 19−24), and 362 (84.9%) reported sex work. Knowledge about SARS-CoV-2 transmission routes was high (95.4%) but lower for the consequences of genetic variants (48.5%−69.7%) and possibility for asymptomatic infection or transmission (66.7%−80.8%). Handwashing was practiced by 90.8% of participants in the preceding month, whereas mask-wearing (76.5%), avoiding symptomatic people (73.7%), and any history of COVID-19 vaccination (46.9%) were less prevalent. Males were more likely to report avoiding symptomatic people (adjusted prevalence ratio 1.16 [95% confidence interval 1.03–1.31]) and COVID-19 vaccination (1.30 [1.05–1.60]). Enrollment during the BQ.1/BQ.1.1 Omicron wave was associated with less mask-wearing (0.81 [0.67–0.99]) but more vaccination (1.59 [1.29–1.95]).
DiscussionWe observed variable COVID-19 knowledge and attitudes among Ugandan adolescents and adults with little impact on COVID-19 preventive practices. Efforts to address suboptimal uptake of disease preventive practices during this and future disease outbreaks will require more than just improving knowledge.
by Pieter L. van den Berg, Shane G. Henderson, Hemeng Li, Bridget Dicker, Caroline J. Jagtenberg
BackgroundCommunity First Responders (CFRs) are commonly used for out-of-hospital cardiac arrests, and advanced systems send so-called phased alerts: notifications with built-in time delays. The policy that defines these delays affects both response times and volunteer fatigue.
MethodsWe compare alert policies by Monte Carlo Simulation, estimating patient survival, coverage, number of alerts and redundant CFR arrivals. In the simulation, acceptance probabilities and response delays are bootstrapped from 29,307 rows of historical data covering all GoodSAM alerts in New Zealand between 1-12-2017 and 30-11-2020. We simulate distances between the patient and CFRs by assuming that CFRs are located uniformly at random in a 1-km circle around the patient, for different CFR densities. Our simulated CFRs travel with a distance-dependent speed that was estimated by linear regression on observed speeds among those responders in the above-mentioned data set that eventually reached the patient.
ResultsThe alerting policy has a large impact on the four metrics above, and the best choice depends on volunteer density. For each volunteer density, we are able to identify a policy that improves GoodSAM New Zealand’s current policy on all four metrics. For example, when there are 30 volunteers within 1 km from the patient, sending out alerts to 7 volunteers and replacing each volunteer that rejects by a new one, is expected to save 10 additional lives per year compared to the current policy, without increasing volunteer fatigue. Our results also shed light on polices that would improve one metric while worsening another, for example, when there are 10 volunteers within 1 km from the patient, dispatching them all immediately increases our survival estimate by 11% compared to the current policy, with the downside of also increasing the redundant arrivals by 137%.
ConclusionsMonte Carlo simulation can help CFR system managers identify a good policy before implementing it in practice. We recommend balancing survival and volunteer fatigue, aiming to ultimately further improve a CFR system’s effectiveness.
by Chi Peng Chan, Babaniji Omosule, Courtney Lightfoot, Ellesha A. Smith, Ffion Curtis, James O. Burton, Paul Gardner, Sarah Jasat, Sherna F. Adenwalla, Jyoti Baharani, Daniel S. March
BackgroundChronic pain affects up to 60% of people with chronic kidney disease (CKD), yet remains under-recognised and under-treated. Pain management in this population is complicated by altered drug pharmacokinetics, polypharmacy, and the potential nephrotoxicity of conventional analgesics. Despite the high prevalence and significant impact on quality of life, evidence-based guidance specific to pain management in CKD remains limited.
ObjectivesThis systematic review aims to evaluate the effectiveness and safety of both pharmacological and non-pharmacological interventions in reducing chronic pain intensity among people with CKD on dialysis, not on dialysis, and kidney transplant recipients, across all stages of CKD.
MethodsThe primary outcome is the effectiveness of interventions in reducing chronic pain intensity as assessed by pain assessment tools. We will conduct a comprehensive search of MEDLINE, Embase, CINAHL, Web of Science, and ClinicalTrials.gov from their inception to the present date to identify studies for chronic pain management in people living with CKD. Study screening will be conducted independently by two reviewers. One reviewer will extract data from each study, with a second reviewer cross-checking for accuracy and completeness. Data will be extracted on study characteristics, participant demographics, intervention components, pain outcomes, and adverse events. The certainty of evidence will be evaluated independently by two reviewers using the GRADE approach. Where applicable, data will be combined in meta-analyses using random-effects models. Additionally, a network meta-analysis will be performed if enough studies are available.
Expected resultsThis review will synthesise the current evidence for pain management strategies in CKD, by evaluating effectiveness of interventions among people receiving different renal replacement therapy modalities with varying pain and disease phenotypes. Findings will highlight the comparative effectiveness of various interventions while considering their safety profiles specific to the CKD context. The review will identify gaps in the literature and provide recommendations for clinical practice and future research.
SignificanceThis review seeks to deliver a thorough evaluation of pain management strategies for people living with CKD. This systematic review is supported by the UK Kidney Association (UKKA), and findings will inform the upcoming UKKA guideline on symptoms management in people with CKD, alongside the other symptoms including itch, fatigue, and gastrointestinal symptoms. This review will aid clinicians in making well-informed decisions regarding pain management strategies, ensuring a balance between effectiveness and the specific risks associated with CKD.
by Elham Ahmadi, Sophia Baierl, Stephan Voss, Ida Asenkerschbaumer, Ursula Berndt, Leonie Bernhard, Anita Hennig, Anna-Lena Würfele, Michaela Coenen
Urban soundscapes, particularly those experienced in green spaces, have been increasingly recognized as factors that influence human mental health. This scoping review explores the existing literature on soundscapes within urban green spaces and their associated mental health outcomes. It aims to classify the methodologies used in this domain, identify mental health outcomes related to urban green space soundscapes, and examine specific soundscape elements and their correlations with mental health. A systematic search of peer-reviewed studies was conducted. After screening titles, abstracts, and full texts, 22 studies met the inclusion criteria. Diverse methodological approaches were identified, with an emphasis on quantitative multi-method designs. Commonly studied mental health outcomes include stress reduction, mood enhancement, perceived restorativeness, and cognitive restoration. Standardized psychometric tools, such as the Perceived Stress Scale (PSS-14), Positive and Negative Affect Schedule (PANAS) and Perceived Restorativeness Soundscape Scale (PRSS) are frequently used as outcome measures. Natural soundscape elements such as birdsong, water sounds, and rustling leaves had a positive association with relaxation and perceived mental restoration throughout all studies, while mechanical sounds, such as traffic noise were linked to adverse mental health outcomes. These findings highlight that natural soundscapes in urban green spaces have a potential positive relationship with mental health by reducing stress and enhancing mood. However, the cross-sectional design and methodological heterogeneity of the included studies limit causal interpretation. Future research should explore multi-sensory experiences and examine soundscapes in diverse urban contexts to provide more robust insights into their relationship with mental health. The practical implications suggest that urban planners should prioritize integrating natural sound elements into urban areas to improve mental health. The study protocol of this scoping review had been registered at OSF (osf.io/4r7gd).by Xiangxiang Kong, Lujie Karen Chen, Sancharee Hom Chowdhurry, Ryan B. Felix, Shiming Yang, Peter Hu, Neeraj Badjatia, Jamie Erin Podell
Paroxysmal sympathetic hyperactivity (PSH) is a syndrome that occurs in a large subset of critically ill traumatic brain injury (TBI) patients and is associated with complications and poor recovery. PSH is defined by recurrent episodic vital sign elevations in the appropriate clinical context. However, standard diagnostic criteria rely heavily on subjective judgment, leading to challenges and delays in recognition, monitoring, and management. The objective of this study was to develop automated PSH detection and quantification tools that exclusively utilize objective bedside continuous vital sign data. Using a cohort of 221 critically ill acute TBI patients with at least 14 days of continuous physiologic data (of which 107 were clinically diagnosed with PSH) we developed a high-resolution clinical feature scale based on established PSH-Assessment Measure criteria and two artificial intelligence-based episode detection models including an expert system approach and a machine learning model approach, using a clinician-annotated case example as ground truth. For the episode detection methods, PSH was quantified as the number, duration, and overall temporal burden of detected episodes. To evaluate performance, we compared quantifications across PSH cases and controls and explored precision and recall. All three methods demonstrated initial face validity to delineate PSH cases from non-PSH TBI controls. Future optimization and implementation of the described computational frameworks with real-time patient data could improve the standard monitoring and management of this challenging clinical syndrome.by Claire L. Chan, Saskia Eddy, Jennie Hejdenberg, Ben Morgan, Heather M. Morgan, Gillian Lancaster, Clare Robinson, Sandra M. Eldridge
BackgroundThe National Institute for Health and Care Research accepts applications for pilot and feasibility studies to their Research for Patient Benefit (RfPB) programme. There has been limited work describing the design practices of these applications and funding status. Knowing some of the qualities which may contribute towards a pilot or feasibility study application successfully gaining funding could help researchers improve the quality of their applications. Therefore, this study describes the protocol for a review looking at the characteristics of funded and non-funded external pilot trial applications. In particular, the primary objective is to describe the planned sample size and sample size justifications.
MethodsThe study will be conducted on 100 applications from Competition 31–37 with a randomised feasibility design, identified and given access to us by RfPB where the lead applicant has consented. We will screen these applications to identify the external pilot trials, first looking through the titles and then the full text. Following this, we will extract data on information such as medical area, study design, objective(s), sample size, sample size justification, and funding outcome stage one and two. Validation will be performed on 20% of the data extracted; discrepancies will be resolved by discussion or a third reviewer will decide if there is no consensus. We will use descriptive statistics to summarise quantitative data, and will analyse qualitative data using thematic analysis. Findings will be summarised through discussion with the project contributors to produce a reader-friendly guidance document.
DiscussionThis work will provide a more complete picture of RfPB external randomised pilot and feasibility trials. The findings will assist researchers when planning their pilot trials, and could help improve the quality of submitted applications.
Protocol RegistrationOpen Science Framework protocol registration DOI: https://doi.org/10.17605/OSF.IO/PYKVG.
Chronic obstructive pulmonary disease (COPD) affects approximately 480 million individuals globally and is projected to reach 600 million by 2050, representing a substantial burden on healthcare systems and patient quality of life. Pulmonary rehabilitation is a cornerstone intervention for COPD management, delivering clinically meaningful improvements in exercise capacity, health-related quality of life and dyspnoea. Despite strong guideline recommendations and established efficacy, only 2%–4% of eligible patients with COPD access traditional centre-based pulmonary rehabilitation due to geographical barriers, transportation difficulties, scheduling conflicts and limited healthcare resources. Digital health technologies offer promising alternatives to overcome these access barriers while potentially maintaining therapeutic benefits. Various digital delivery models have emerged, including video-based telerehabilitation, virtual reality platforms, mobile health applications and web-based programmes. However, their comparative effectiveness remains unclear, limiting evidence-based clinical decision making. This systematic review and network meta-analysis will aim to compare and rank the effectiveness and safety of different digital health delivery models for pulmonary rehabilitation in patients with COPD, providing evidence to inform optimal intervention selection in clinical practice.
We will conduct a systematic review and Bayesian network meta-analysis following Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Network Meta-Analyses guidelines. Comprehensive searches will be performed across five electronic databases (PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL) from inception to January 2026, without language restrictions. Eligible studies will include randomised controlled trials comparing digital health delivery models for pulmonary rehabilitation in adults with COPD. Digital health interventions will be categorised into four distinct delivery models: video-based telerehabilitation, virtual reality rehabilitation, mobile health rehabilitation and web-based platform rehabilitation. Interventions combining multiple modalities will be categorised according to the predominant component based on intervention frequency, duration and primary therapeutic mechanism. Two independent reviewers will perform study selection, data extraction and risk of bias assessment using the Cochrane Risk of Bias 2 tool. The primary outcome will be change in 6 min walk distance. Key secondary outcomes will include disease-specific quality of life measures, dyspnoea severity, hospitalisation rates, exacerbation frequency, intervention adherence and adverse events. A Bayesian random-effects network meta-analysis will be conducted, calculating mean differences or ORs with 95% credible intervals. Treatment rankings will be estimated using surface under the cumulative ranking curve probabilities. Evidence certainty will be assessed using the Confidence in Network Meta-Analysis framework. Planned subgroup analyses will explore potential effect modifiers including disease severity, intervention duration, supervision mode and technological features.
As this systematic review will use data from previously published studies, formal ethical approval is not required. Findings will be disseminated through peer-reviewed publication, presentations at relevant scientific conferences and communication to healthcare providers, policymakers and patient advocacy organisations.
CRD420251268701.
Immune checkpoint inhibitors (ICIs) have revolutionised cancer treatment through targeted disruption of the physiological pathways that maintain tissue tolerance, but which are co-opted by cancers to evade immunosurveillance. Thus, the resultant T-cell activity often causes immune-related adverse events including immune checkpoint inhibitor-induced inflammatory arthritis (ICI-IA). ICI-IA results in functional impairment that frequently persists, even after ICI discontinuation, with substantial quality-of-life impacts for cancer survivors.
A high-quality body of evidence to guide ICI-IA management remains an unmet need. Pharmacological treatment may be prolonged, typically begins with non-specific immunosuppression, including systemic steroids, and is usually only rationalised to more targeted therapy in resistant cases. Moreover, retrospective data suggest the high dose glucocorticoids sometimes used in new-onset ICI-IA may be associated with worse cancer outcomes.
Tumour necrosis factor (TNF) inhibition strategies are well established with excellent efficacy and safety profiles in ‘spontaneous’ inflammatory arthritides including rheumatoid and psoriatic arthritis. Mechanistic evidence from ex vivo and murine studies also supports the utility of anti-TNF therapy for steroid-refractory cases of ICI-IA. Although good clinical responses have been reported in this setting, the REACT trial (REmission induction of Arthritis caused by Cancer ImmunoTherapy) aims to provide randomised and robust clinical evidence for deploying targeted therapy earlier in ICI-IA management. It will test whether up-front anti-TNF therapy can more effectively and quickly control symptoms, reduce glucocorticoid exposure, prevent early ICI discontinuation and increase the frequency of drug-free ICI-IA remission.
REACT is a prospective, multicentre, open-label, superiority, two-arm, randomised controlled clinical trial to guide initial therapy for patients with ICI-IA. The trial will compare the current standard of care (initial prednisolone; Arm A) with the anti-TNF drug, adalimumab without glucocorticoids (Arm B).
The primary outcome is glucocorticoid-free arthritis remission rate at 24 weeks where remission is defined as: (i) No use of systemic or intra-articular glucocorticoids (except when used for adrenal insufficiency) within 4 weeks prior to assessment at 24 weeks; and (ii) absence of synovitis on clinical examination.
The protocol was approved by East Midlands—Leicester South Research Ethics Committee on 31-Oct-2024 (Ref: 24/EM/0202). Participants are required to provide written informed consent. The results of this trial will be disseminated through national and international presentations and peer-reviewed publications.
Among the five hepatitis viruses, the hepatitis B virus (HBV) is a major cause of serious acute and chronic liver infections worldwide. The major public health impact of HBV infection arises from chronic liver disease, including cirrhosis and hepatocellular carcinoma, which predominantly affects young and middle-aged adults of both sexes. Therefore, preventive interventions focusing on mothers and infants are critical due to vertical and early childhood transmission dynamics.
HBV prevalence largely varies among pregnant women in Ethiopia because of multiple interrelated factors. This umbrella review will consolidate all existing systematic reviews and create a more reliable picture of HBV infection and its determinants among pregnant women in Ethiopia.
This umbrella review will be conducted according to Preferred Reporting Items for Systematic reviews and Meta-Analyses reporting standards. The review will focus on identifying and integrating evidence from eligible systematic reviews and meta-analyses, with methodological quality appraised using the MeaSurement Tool to Assess systematic Reviews instrument. A comprehensive literature search strategy will be developed using relevant Medical Subject Headings alongside free-text keywords. Electronic searches will be conducted in PubMed/MEDLINE, African Journals Online, Web of Science, Scopus and Google Scholar. Statistical heterogeneity among the included reviews will be quantified using the I² statistic. Data management and meta-analytic procedures will be performed using STATA version 17, and effect estimates will be presented with corresponding 95% CIs to determine statistical precision.
This review uses only published or publicly available data, so ethics approval is not required. Findings will be disseminated via peer-reviewed publications, conference presentations and shared with policymakers, healthcare partners, clinicians and patients to inform policy, enhance education and guide future research.
PROSPERO (CRD420251118982).
Parental psychological challenges and poor well-being are key factors in shaping both the quality of parent-child interactions and child development. Specifically, maternal psychological distress is a central determinant of child development. Elevated levels of distress in mothers are associated with poorer child cognitive, behavioural and social-emotional outcomes, with effects persisting into adolescence and adulthood. While this highlights the critical importance of early prevention and intervention efforts to support parents, postpartum mental healthcare remains limited, despite ongoing and evident needs.
This protocol outlines a 2-year longitudinal follow-up study investigating the impact of a secondary perinatal programme (ie, Toi, Moi, Bébé), completed by mothers during pregnancy, and its impact on children’s cognitive and social-emotional functioning at 24 and 48 months. Further, the study aims to explore whether maternal self-efficacy and emotion regulation may serve as potential mediators or moderators of the relationship between programme participation and child development outcomes. The research aims to leverage the Toi, Moi, Bébé programme, by recruiting mother-child dyads (n=250) in which the mothers participated in the programme during pregnancy. Mothers were randomly assigned to complete the parenting well-being intervention either independently or with added telephone support. Participants who consent will be invited to take part in a two-wave follow-up at 24 months (T1) and 48 months postpartum (T2). At both time points, mothers will complete demographic questionnaires and standardised measures assessing maternal well-being (Generalised Anxiety Disorder-7, Edinburgh Postnatal Depression Scale and Perceived Stress Scale), child cognitive functioning (Ages and Stages Questionnaire-3 and MacArthur-Bates Communicative Development Inventory), child social-emotional functioning (Ages and Stages Questionnaire, Social Emotional—second Edition-2 and Child Behaviour Checklist for Ages 1.5–5), maternal emotion regulation (Cognitive Emotion Regulation Questionnaire) and maternal self-efficacy (Parental Cognitions and Conduct Towards the Infant Scale & Me as a Parent Scale). Parents’ perceptions of their parenting experience will be measured using the Parental Reflective Functioning Questionnaire. Mother-child interaction, parenting quality and cognitive stimulation in the home environment will be measured using a brief virtual interview (StimQ2-Toddler) and a naturalistic observation assessment (Parenting Interactions with Children: Checklist of Observations Linked to Outcomes). Using RStudio, linear mixed models will be used to assess the impact of the intervention (online intervention only vs only with telephone support) on child cognitive and social-emotional development at T1 and T2. In parallel, separate models will be conducted to examine associations between maternal emotion regulation and self-efficacy on the child development outcomes at the same timepoints. Exploratory analyses will be conducted to examine potential moderating effects of child sex and group assignment on the associations between maternal emotion regulation and self-efficacy and child developmental (cognitive and socioemotional) outcomes, using causal inference models.
The current study has been registered, reviewed and approved (MP-37-2025-10894) by the Research Institute of the McGill University Health Centre Research Ethics Board. Findings from this research will be disseminated through peer-reviewed open access publications, and presentations at national and international conferences.
To assess the impact of a National Enhanced Service (NES) incentive for weight management that financially rewarded practices for each eligible patient referred to a weight management programme.
Interrupted time-series analysis to examine the rate of weight management referral and weight management advice.
Primary healthcare records from January 2018 to December 2024 in the Oxford Clinical Informatics Digital Hub, covering 8.3 million patients in 1198 primary care clinics around England.
NES payments to practices for weight management were introduced in April 2021.
The rate of referral increased from 1 referral per 1000 patients per month before the incentive to around 4 referrals per 1000 patients per month afterwards. There was no evidence that the increase differed by age, gender, ethnic group or socioeconomic status. The occurrence of weight management advice was unchanged by the introduction of the NES and was at least three times more common than referral to weight management services.
The NES was associated with a fourfold increase in referrals to weight management services. However, clinicians are much more likely to offer advice rather than a referral to a weight management programme. There is a clear opportunity to improve outcomes for patients by encouraging greater use of referrals to effective weight management services in place of advice.
Some people with HIV (PWH) experience brain changes that affect neurocognition, but little is known about how HIV impacts social cognition or related brain regions. Social cognition, the ability to perceive, understand and respond to social information, is important for maintaining relationships and quality of life. This article provides the protocol for the first comprehensive study examining social brain function in PWH and people without HIV (PWoH). With three aims, this study will: (1) examine neural circuits related to social cognition; (2) examine social cognitive performance across two social cognitive domains and (3) examine the role of social cognition in everyday social functioning.
Referred to as Social Brain Health Study in HIV Study, this cross-sectional study will enrol 105 PWH and 105 demographically matched PWoH aged 18–65 years. The study administers a comprehensive assessment battery across two visits within a 2-week period. Visit 1 includes behavioural measures of social cognition (Perceiving Social Cues and Understanding Others), neurocognition and social functioning (social network size and loneliness). Visit 2 involves functional MRI procedures with three social cognitive tasks designed to activate key brain regions (ie, fusiform face area, superior temporal gyrus, temporo-parietal junction, dorsal medial prefrontal cortex).
This study was funded by the National Institute of Mental Health (MH139613) and approved by the Institutional Review Board of the University of Alabama at Birmingham (IRB-300013394). Data collection is ongoing. The first results are expected to be submitted for publication in 2030. Findings of this study will be published in peer-reviewed journals and presented at local, national and international conferences as well as patient organisations such as AIDS service organisations and community talks.
Postoperative pain is common after surgery, with a high incidence and risk of becoming chronic. Current multimodal analgesia has drawbacks, including limited efficacy from single agents and opioid side effects and addiction risk. These issues have led to opioid-sparing multimodal analgesia. Transcutaneous auricular vagus nerve stimulation (taVNS) is non-invasive and convenient. Studies have shown it can reduce postoperative pain, improve mood and lower adverse events. However, taVNS lacks a comprehensive evaluation and standardised protocols, so further research is needed to provide reliable evidence.
This study strictly adheres to the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols. To identify suitable randomised controlled trials (RCTs), eight credible databases will be searched, including four English databases (Web of Science, PubMed, Cochrane Central Register of Controlled Trials, EMBASE) and four Chinese databases (China National Knowledge Infrastructure, VIP Database for Chinese Technical Periodicals, Wanfang Database, Chinese Biomedical Literature Database). RevMan V.5.3 will be employed to integrate the retrieved data and conduct meta-analyses. The methodological quality of included RCTs will be evaluated using the Cochrane Risk of Bias Assessment 2.0 tool. Additionally, the Grading of Recommendations, Assessment, Development and Evaluation system will be applied to assess the strength and certainty of the evidence. We will also conduct publication bias analyses, sensitivity analyses and subgroup analyses.
No ethical review is required as no private or confidential patient data will be included. Results of this study will be disseminated through a peer-reviewed journal.
CRD420251207651.
FreshRSS 