Conectar
by Sarah Zuern, Bella Romero, Carlos Spichiger, Leandro Ortiz, Alejandro Jerez, Esteban Basoalto, Max Emil Schön, Sigisfredo Garnica
The microsporidium Vairimorpha (Nosema) ceranae is an emerging threat to honey bees (Apis mellifera), known to disrupt gut microbiota and suppress immune responses, potentially contributing to colony losses. Fungal extracts have recently gained interest as sources of bioactive compounds with antimicrobial and immunomodulatory potential. In this study, we explored the effects of different dietary supplements—sugar syrup, HiveAlive™, and a novel Ganoderma australe extract (GanoBee)—on gut bacterial composition and immune-related gene expression in honey bees subjected to experimental exposure to V. ceranae 1 x 104 spores per bee. The GanoBee diet altered the gut microbiota, notably reducing the relative abundance of Rhizobiaceae (Bartonella apis) and increasing Frischella compared to other treatments. While alpha diversity was not significantly affected by diet or exposure to V. ceranae, beta diversity differed significantly in bees fed with GanoBee. Additionally, the expression of the antimicrobial peptide genes abaecin and hymenoptaecin was elevated in both exposed and unexposed bees fed with GanoBee, depending on the sampling day. However, the establishment of V. ceranae infection appeared limited, likely due to low spore viability, and mortality in control bees was higher than expected. The low Vairimorpha ceranae infection levels observed in this study are likely attributable to reduced spore viability caused by storage conditions and/or suboptimal environmental conditions within the laboratory cages. Post hoc analyses indicated that the high viscosity of GanoBee-supplemented diets likely contributed to the elevated bee mortality observed, underscoring a critical limitation of the experimental design related to diet formulation and delivery method. These physical factors complicate the interpretation of treatment efficacy and highlight the importance of optimizing feeding protocols to avoid confounding effects. Despite these constraints, GanoBee demonstrated promising potential as a modulator of gut microbiota composition and immune-related gene expression, supporting the need for further research under improved and carefully controlled experimental conditions.To explore the qualitative literature regarding the experiences of survivors of critical illness re-engaging in activities of daily living.
Qualitative systematic review.
Databases were searched with three broad categories of search terms: (1) critical illness, (2) activities of daily living, and (3) participant experiences. Articles were included if they reported qualitative data on the experiences of adults who were re-engaging with activities of daily living after admission to an intensive care unit. The findings from these studies were thematically analysed.
A search of Medline, Embase, CINAHL, PsycINFO and AMED was conducted on the 9th September 2024.
After removing duplicates, the literature search identified 6267 articles. The full texts of 120 articles were reviewed, and 44 were included for data extraction. Thematic analysis identified three themes: (1) loss of autonomy, (2) striving to reclaim independence, and (3) shifting familial dynamics and imposing a burden.
Survivors of critical illness face significant challenges when re-engaging with daily activities. The effort to regain autonomy often leads to feelings of helplessness and a reluctance to engage in both daily tasks and social activities. The emotional burden of dependence and the perception of being a burden further complicate their recovery.
Health services should focus on integrating physical rehabilitation, mealtime support, and cognitive and psychological therapy to effectively cater to the diverse needs of critical illness survivors and their families.
This review highlights the complex challenges of re-engaging in activities of daily living after critical illness and emphasises the need for multidisciplinary rehabilitation to improve physical, cognitive, and emotional recovery.
Reporting of this review followed the ENTREQ checklist, in accordance with EQUATOR guidelines.
No Patient or Public Contribution.
Intrahepatic cholangiocarcinoma (ICC) has a high recurrence rate after curative surgery, with no standard neoadjuvant therapy. Hepatic arterial infusion chemotherapy (HAIC) has shown efficacy in locally advanced ICC, while immune checkpoint inhibitors and anti-angiogenic agents have demonstrated promising response rates. The NEO-ERA-01 study evaluates the feasibility of neoadjuvant HAIC-GEMOX plus lenvatinib and Adebrelimab in high-risk resectable ICC.
NEO-ERA-01 is a prospective, multicentre, phase II trial using Simon’s two-stage design. Thirty patients with histologically confirmed resectable ICC and high-risk recurrence factors will be enrolled in China. Neoadjuvant therapy consists of HAIC-GEMOX (gemcitabine 800 mg/m², oxaliplatin 85 mg/m² every 3 weeks), lenvatinib (8 mg/day from Day 5) and Adebrelimab (1200 mg on Day 3, every 3 weeks) for 2–4 cycles. Surgery eligibility will be assessed post-treatment. Resected patients will receive adjuvant capecitabine (1250 mg/m² two times per day on Days 1–14, every 3 weeks) and Adebrelimab (1200 mg on Day 1, every 3 weeks) for 6 months.
The primary endpoint is the completion rate of study treatment. Secondary endpoints include safety, R0 resection rate, response rate, event-free survival, disease-free survival and overall survival. Exploratory endpoints include immune microenvironment and biomarker analysis.
The study is approved by the ethics committee of all sites and follows the Declaration of Helsinki and good clinical practice guidelines. Results will be disseminated via peer-reviewed publications and conferences.
To report on the unique perspectives of senior nursing leaders on the value proposition of the Clinical Nurse Specialist (CNS) role, their organisational experience and the barriers and facilitators to optimise and promote the long-term sustainability.
A qualitative sub-study of a larger multi-method study focused on informing policy recommendations to optimise the CNS workforce, informed by integrated knowledge translation.
Chief Nursing Officers (CNOs) and other senior leaders in all health authorities in British Columbia, Canada, were invited to participate in semi-structured interviews via video call between August–December 2023. We recruited 13 participants from diverse health regions, including 5 CNOs.
Leaders collectively conveyed a renewed interest in the CNS role to support nursing and multidisciplinary teams to better meet patient and system needs, and a sense of urgency to optimise the role in diverse settings. The overarching theme of “success by design” was supported by three thematic priorities: (1) understanding the CNS role, (2) a role that needs protection and connections and (3) moving forward together. Views were aligned to co-construct implementation-ready policy recommendations to guide provincial strategies.
Senior leaders reported a common understanding of the value-add of the CNS workforce and had a shared experience of barriers to optimisation. Contemporary policy guidance is needed to equip health systems to address this gap.
Across international regions, the role of CNSs is not fully optimised. This is a wasted opportunity to address the pressing need for nursing practice leaders to transform health systems and improve outcomes. This study provides new knowledge about the perspectives of Chief Nursing Officers and other nursing leaders to shape comprehensive and targeted policy recommendations and address enduring and new challenges to realise the full impact of the CNS workforce.
We have adhered to COREQ reporting guidelines (See supplemental file).
This study did not include patient or public involvement in its design, conduct, or reporting.
by Achilleas Livieratos, Maria Kudela, Yuxi Zhao, All-shine Chen, Xin Luo, Junjing Lin, Di Zhang, Sai Dharmarajan, Sotirios Tsiodras, Vivek Rudrapatna, Margaret Gamalo
BackgroundNetwork meta-analysis (NMA) can compare several interventions at once by combining head-to-head and indirect trial evidence. However, identifying, extracting, and modelling these often takes months, delaying updates in many therapeutic areas.
ObjectiveTo develop and validate MetaMind, an end-to-end, transformer-driven framework that automates NMA processes—including study retrieval, structured data extraction, and meta-analysis execution—while minimizing human input.
MethodsMetaMind integrates Promptriever, a fine-tuned retrieval model, to semantically retrieve high-impact clinical trials from PubMed; a multi-agent LLM architecture--Mixture of Agents (MoA)-- pipeline to extract PICO-structured (Population, Intervention, Comparison, Outcome) endpoints; and GPT-4o–generated Python and R scripts to perform Bayesian random-effects NMA and other NMA designs within a unified workflow. Validation was conducted by comparing MetaMind’s outputs against manually performed NMAs in ulcerative colitis (UC) and Crohn’s disease (CD).
ResultsPromptriever outperformed baseline SentenceTransformer with higher similarity scores (0.7403 vs. 0.7049 for UC; 0.7142 vs. 0.7049 for CD) and narrower relevance ranges. Promptriever performance achieved 82.1% recall, 91.1% precision and an F1 score of 86.4% when compared to a previously published NMA. MetaMind achieved 100% accuracy on a limited set of remission endpoints regarding PICO (Population, Intervention, Comparator, Outcome) element extraction and produced comparative effect estimates and credible intervals closely matching manual analyses.
ConclusionsIn our validation studies, MetaMind reduced the end-to-end NMA process to less than a week, compared with the several months typically needed for manual workflows, while preserving statistical rigor. This suggests its potential for future scaling of evidence synthesis to additional therapeutic areas.
Surgical site infections (SSI) in vascular surgery have a huge impact on patients’ morbidity and mortality and healthcare systems worldwide. Dialkylcarbamoylchoride (DACC) is a synthetically produced material that can irreversibly bind and inactivate bacteria that exhibit cell-surface hydrophobicity (CSH). The DACC in the Reduction of Surgical Site Infection (DRESSINg) trial is a multicentre randomised controlled trial which aims to assess the effectiveness of DACC-coated post-operative dressings in the prevention of SSI in vascular surgery. Seven hundred and eighteen participants undergoing clean or clean-contaminated lower limb vascular surgery will be randomised in a 1:1 ratio to either DACC-coated dressings or standard dressings for their postoperative wounds. The primary outcome is the incidence of SSI defined by the Centers for Disease Control and Prevention (CDC) criteria or total ASEPSIS score of 21 or more within 30 days of surgery. The secondary outcomes include satisfactory wound healing with a total ASEPSIS score of 10 or less, quality of life pre and post surgery, Bluebelle wound healing scores, resource use and financial (£), and environmental (KgCO2e) cost analyses. This multicentre randomised controlled trial will provide level 1 evidence on the effectiveness of preventing SSI in lower limb vascular surgery.
Pressure injuries present significant challenges in clinical care, leading to severe complications such as infection, pain and delayed wound healing. They are a common chronic wound that contribute to increased morbidity, prolonged hospital stays and substantial healthcare costs. Despite national efforts to enhance chronic wound management, development of optimal treatment strategies remains a priority. The Pressure Injury Treatment Advisory (PITA) Quick Guide was developed to provide an evidence-based guide to support clinicians in pressure injury management. A survey was conducted to evaluate clinician perspectives on the usability and practicality of the Guide in acute care, residential aged care and community settings. A post-test survey was conducted on a convenience sample of healthcare professionals from three healthcare settings across metropolitan, regional and rural Australia. The survey included 5-point Likert-scale items assessing ease of use, effectiveness and integration with workflows. Three hundred and two responses were received (66.7% response rate). Clinicians expressed overwhelmingly positive perceptions, with over 95% agreeing or strongly agreeing on the guide's utility and effectiveness. No respondents strongly disagreed with any item. Residential aged care and rural clinicians rated the tool slightly higher than acute care and medical clinicians. The PITA Quick Guide was well-received across all settings, demonstrating strong potential to enhance evidence-based pressure injury management.
To develop and psychometrically test a comprehensive Cancer Nurse Self-Assessment Tool (CaN-SAT).
Modified Delphi to assess content validity and cross-sectional survey to assess reliability and validity.
Phase 1: An expert group developed the tool structure and item content. Phase 2: Through a modified Delphi, cancer nursing experts rated the importance of each element of practice and assessed the relevance and clarity of each item. Content Validation Indexes (CVI) were calculated, and a CVI of ≥ 0.78 was required for items to be included. Phase 3: Cancer nurses participated in a survey to test internal consistency (using Cronbach's alpha coefficients) and known-group validity (through Mann–Whitney U tests). This study was reported using the Guidelines for Reporting Reliability and Agreement Studies (GRRAS) checklist.
The CaN-SAT underwent two rounds of Delphi with 24 then 15 cancer nursing experts. All elements of practice were rated as important. Only three items achieved a CVI < 0.78 after round one; however, based on open-ended comments, 26 items were revised and one new item added. After round two, all items received a CVI above 0.78. The final tool consisted of 93 items across 15 elements of practice. Cronbach's alpha coefficients were between 0.92 and 0.98 indicating good reliability. Mann–Whitney U tests demonstrated significant differences between clinical nurses and advanced practice nurses across 13 out of 15 elements of practice.
The CaN-SAT is a comprehensive, valid and reliable tool that can be used for cancer nurses to self-assess current skill levels, identify their learning needs and inform decisions about educational opportunities to optimise cancer care provision.
The research team included three patient advocates from Cancer Voices NSW, who were actively involved in all aspects of the study and are listed as authors.
To examine published studies on nursing academics' experience with student incivility, explore their management strategies, and identify existing knowledge gaps.
This scoping review was guided by Arksey and O'Malley's five-stage framework.
Studies published between 2009 and June 2024 in English were retrieved from PubMed, CINAHL Complete, ProQuest, and Scopus.
The review included qualitative, quantitative, and mixed-methods studies on nursing academics' experiences or perceptions of student incivility and/or interventions to manage it in higher education. Data were analysed using descriptive methods.
Thirty-five studies met the inclusion criteria. The studies mostly explored nursing academics' experiences (n = 18) or perceptions (n = 15) of student incivility. Of the eleven studies that investigated how academic staff address student incivility, nine were interventional studies and two qualitative studies explored academics' experiences.
The prevalence of reported nursing student incivility is substantial in the literature, yet there is limited evidence on sustainable, targeted management strategies to address the issue and support nursing academics.
Further research is needed to evaluate the feasibility and long-term effectiveness of strategies and interventions aimed at reducing student incivility and to explore effective management strategies adopted by nursing academics across diverse cultural and online learning settings. It is critical to develop interventions that address the root causes of student nurse incivility and strengthen institutional support systems.
This scoping review addresses gaps in the literature on managing nursing student incivility across diverse learning environments, providing evidence to inform the development of contextually appropriate strategies that support nursing academics in managing incivility effectively within evolving educational settings.
This review followed the PRISMA Extension for Scoping Review (PRISMA-ScR) Checklist.
No patient or public involvement.
Statins are a cornerstone of cardiovascular disease prevention yet remain underused among eligible patients. Clinical decision support systems embedded in electronic health records (EHRs) are commonly used to encourage guideline-concordant prescribing. Interruptive reminders (eg, pop-ups) may be effective but interfere with clinical workflows and contribute to alert fatigue. Non-interruptive alerts are less intrusive, but their effectiveness remains unclear. The Interruptive versus Non-Interruptive Reminders for Statin tHerApy in Primary Care (INIRSHA-PC) trial is designed to evaluate the comparative effectiveness of interruptive and non-interruptive reminders on statin-prescribing rates.
INIRSHA-PC is a single-centre, pragmatic, three-arm, parallel-group randomised controlled trial embedded in the EHR at Vanderbilt University Medical Center. The trial will enrol adults aged 18–74 seen in primary care who are eligible for, but not currently prescribed, statin therapy. The planned sample size is 3000 patients (1000 per arm). Enrolled patients will be randomised 1:1:1 to (1) interruptive reminder, (2) non-interruptive reminder or (3) no reminder (usual care). The primary outcome is statin prescription within 24 hours of enrolment. Secondary outcomes are statin prescribing within 12 months and low-density lipoprotein cholesterol levels measured between 30 days and 12 months after enrolment. Enrolment began on 14 August 2024. The study is expected to be completed on 19 November 2025.
The trial has been approved by the Vanderbilt University Medical Center Institutional Review Board with waiver of patient informed consent (IRB number: 240419). Results will be disseminated through peer-reviewed publication and presentation at scientific conferences.
by Natalia Mach, Julien Polleux, Lea Heinrich, Lukas Lechner, Iryna Levytska, Cornelia Lass-Flörl, Susanne Perkhofer
Aspergillus terreus is an opportunistic fungal pathogen associated with high mortality rates and intrinsic resistance to amphotericin B. Its ability to persist within host tissues without inducing strong immune responses was suggested to contribute to poor clinical outcomes. The cellular mechanisms underlying A. terreus interactions with host cells remain largely unexplored. In this study, we have used a micropattern-based infection model to investigate the early interactions between A. terreus conidia and alveolar epithelial cells, focusing on the role of Arp2/3-dependent actin remodeling. This system allows quantitative analysis of conidia-cell interactions under defined spatial conditions. We show that A. terreus conidia rapidly bind to micropatterned A549 cell islands, with conidial numbers increasing over time. Conidia were found in actin- and Lamp1-positive vesicles already after one hour of infection. Inhibition of the Arp2/3 complex significantly impaired conidial binding and disrupted the formation of actin-positive vesicles, confirming the essential role of Arp2/3-mediated actin remodeling in early stages of conidial uptake. A subset of conidia was localized to Lamp1-positive phagolysosomes and accumulated over time. Interestingly, we have identified a small but consistent population of Lamp1-positive vesicles decorated with actin structures, potentially resembling actin flashes. These structures were entirely abolished upon Arp2/3 inhibition, indicating active cytoskeletal remodeling at the phagolysosomal interface. Our findings provide the first mechanistic insights into A. terreus internalization by alveolar epithelial cells and establish Arp2/3-mediated actin dynamics as a key process in early host-pathogen interactions. This cellular pathway may further contribute to intracellular trafficking and help understand the delayed onset of A. terreus infections.Qualitative evidence in ovarian cancer (OC) doctor-patient-caregiver communication is scarce. This study explored the information needs of patients and caregivers, comparing these to healthcare professionals’ (HCPs) perspectives, to uncover why gaps exist.
Qualitative, observational, multicentre and cross-sectional study with OC patients, their caregivers and HCPs. Qualitative data were collected through remote semistructured interviews. Themes were identified using thematic analysis. The EORTC QLQ-C30 and the disease-specific EORTC QLQ-OV28 were collected as quality of life measures and analysed descriptively.
Patients were recruited during their routine visits in five university hospitals in Spain.
Patients were ≥18 years of age in stages III or IV according to FIGO classification, were on first line treatment or recurrent and platinum sensitive with the most complex molecular profiles. 19 patients, 7 caregivers and 10 HCPs participated in the study.
Three main themes emerged: (a) patient information needs about the disease and pharmacological treatments, (b) patient information needs about non-pharmacological support and (c) caregiver information needs. The first theme was viewed through three differing attitudes (the Involved, Trusting and Indecisive), with HCPs’ agreeing with the attitudes but without adjusting transmitted information accordingly. For the second theme, patients expressly desired more information on psychosexual issues, psychological support and patient associations (PAs), and HCPs concurred with a need for more non-pharmacological support. Regarding the third theme, caregivers expressed not being engaged by HCPs, despite HCPs recognising their importance, with nurses being more empathetic than oncologists on this matter.
These results highlight the importance of understanding the information needs of OC patients and their caregivers. This understanding enables HCPs to provide better support, helping patients and caregivers make more informed health decisions.
To explore community nurses' experiences of changes to their roles in palliative and end-of-life care.
An e-survey was followed by focus groups.
Fifty-one community nurses with recent experience of delivering end-of-life care in the United Kingdom completed a survey about changes to their roles. A purposive sample of 35 respondents participated in focus groups exploring these changes in more depth; thematic analysis was used with constant comparison.
As well as two new roles—prescribing and verifying death—many participants talked about a broader expansion of their role, increasing their leadership in making complex end-of-life care decisions with patients and families. Most nurses expressed pride in their new knowledge and skills, and satisfaction with the care they were providing. Yet many also expressed distress that heavy workloads impaired their capacity both to provide good clinical care and to train junior colleagues. The importance of General Practitioner support with complex cases was often highlighted, but accessing such support was sometimes difficult.
While welcoming the opportunity to extend their palliative care roles, many participants indicated experiencing moral distress.
Excessive workloads and patchy medical support threaten the retention of the experienced nurses upon whom community palliative care depends.
Our findings suggest that new and extended palliative care roles are viewed positively by nurses. To be sustainable, these changes require better workload management and consistent medical back-up.
We adhered to relevant EQUATOR guidelines, using the SRQR checklist.
Our Public and Clinician Advisory Group helped shape questions and commented on findings.
(1) To analyse individual and institutional-level factors associated with urinary incontinence in older adults living in nursing homes; (2) to estimate the prevalence of urinary, faecal and double incontinence in nursing home residents.
Cross-sectional study.
Residents aged 65+ living in 22 nursing homes in Catalonia (Spain) were included. Descriptive, bivariate, and multilevel analyses were performed.
The final sample comprised 452 residents (75.9% female, mean age of 87.0 years). The prevalence of urinary, faecal and double incontinence was 77.5%, 46.1% and 45.7%, respectively. Urinary incontinence was statistically significantly associated with neurological conditions, moderate cognitive impairment, moderate dementia, severe cognitive impairment, very severe cognitive impairment and age.
Approximately three out of four nursing home residents suffered from urinary incontinence and almost half of the sample from faecal or double incontinence. Individual-level factors (cognition, neurological conditions and age) played a more important role than institutional-level factors for urinary incontinence.
The findings of this study highlight the importance of individual-level interventions to prevent and manage urinary incontinence in nursing homes.
In Catalonian nursing homes, individual factors such as cognitive impairment and neurological conditions were more strongly associated with urinary incontinence than institutional factors. This has implications for improving care provided to older adults, particularly those with dementia and neurological conditions.
STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines.
Nursing home residents were not involved in this study.
Treatment failure remains a major challenge in tuberculosis (TB) management. Rapid and objective assessment of treatment response is essential, as existing tools have limited accuracy and slow turnaround times. The PATHFAST TB LAM Ag assay (PATHFAST-LAM), an automated chemiluminescent enzyme immunoassay, was developed to quantify lipoarabinomannan (LAM) in sputum within 1 hour. Previous studies have shown a strong correlation between sputum LAM concentration and culture-based bacterial load. However, its clinical utility for predicting poor outcomes during treatment has not been prospectively evaluated.
We will conduct a prospective longitudinal study enrolling newly diagnosed, bacteriologically confirmed patients with pulmonary TB at Rhodes Chest Clinic and Mbagathi County Referral Hospital in Nairobi, Kenya. We will follow participants throughout the 6-month treatment course, attempting to collect sputum weekly during weeks 1–4, biweekly during weeks 5–12 and monthly during months 3–6. We will measure LAM concentrations at these time points using the PATHFAST-LAM assay. The primary outcome is to assess whether changes in sputum LAM concentration during the intensive phase (baseline to week 4 and/or week 8) predict a composite poor outcome, defined as positive sputum culture at month 6, treatment failure, death during treatment or relapse within 3 months after treatment completion. The primary endpoint is the area under the curve from the receiver operating characteristic analysis, representing the predictive performance of changes in sputum LAM concentration for the composite poor outcome. We will identify the optimal cut-off value for LAM change and estimate sensitivity and specificity with 95% CIs using 2x2 tables. We will apply an adaptive design that allows sample-size re-estimation after interim analysis.
The study was approved by the Kenya Medical Research Institute (KEMRI/SERU/CRDR/124/5241) and Nagasaki University (250619327). Findings will be disseminated through peer-reviewed publications and scientific meetings.
Understanding the epidemiological shifts of respiratory syncytial virus (RSV) is essential to inform public health interventions, particularly given its increased burden on healthcare systems post-COVID-19 pandemic. This study aimed to examine age-specific trends and seasonal variations in RSV incidence, considering the recent introduction of a newborn RSV immunisation programme in Ireland.
A surveillance time series study analysing routinely collected RSV notification data.
National-level weekly RSV notifications collected by the Health Service Executive-Health Protection Surveillance Centre in Ireland from 2012 to 2024.
Infants (
Annual trends in RSV epidemiology with special reference to the pre- and post-COVID-19 winter surges, and the time lag in age-related transmission to peak incidence among the various age groups. Data were analysed to evaluate incidence rates, peak timing, age-related transmission trends and lag times before and after the COVID-19 pandemic.
The study examined the increasing incidence of RSV post-COVID-19 and a significant shift toward earlier RSV peaks in recent years (2021/2022, 2022/2023 and 2023/2024 seasons) in Ireland, with the onset and peak of the season nearly 2 months earlier than in pre-COVID-19 pandemic seasons (p
This analysis highlights an early seasonal onset and intensified RSV burden among infants in recent winters (2021/2022, 2022/2023 and 2023/2024 seasons). Quantifying the time lag for the community-level RSV transmission from infants and young children to older adults will offer insights to optimise RSV intervention strategies as a ‘life-course approach’ to alleviate healthcare system pressures during peak seasons.
by Plotine Jardat, Alexandra Destrez, Fabrice Damon, Noa Tanguy-Guillo, Anne-Lyse Lainé, Céline Parias, Fabrice Reigner, Vitor H. B. Ferreira, Ludovic Calandreau, Léa Lansade
Olfaction is the most widespread sensory modality animals use to communicate, yet much remains to be discovered about its role. While most studies focused on intraspecific interactions and reproduction, new evidence suggests chemosignals may influence interspecific interactions and emotional communication. This study explores this possibility, investigating the potential role of olfactory signals in human-horse interactions. Cotton pads carrying human odours from fear and joy contexts, or unused pads (control odour) were applied to 43 horses’ nostrils during fear tests (suddenness and novelty tests) and human interaction tests (grooming and approach tests). Principal component analysis showed that overall, when exposed to fear-related human odours, horses exhibited significantly heightened fear responses and reduced interaction with humans compared to joy-related and control odours. More precisely, when exposed to fear-related odours, horses touched the human less in the human approach test (effect size: Rate Ratio(RR)=0.60 ± 0.24), gazed more at the novel object (RR = 1.32 ± 0.14), and were more startled (startle intensity – Cohen’s d = −0.88 ± 0.39; and maximum heart rate – Cohen’s d = 1.16 ± 0.47) by a sudden event. These results highlight the significance of chemosignals in interspecific interactions and provide insights into questions about the impact of domestication on emotional communication. Moreover, these findings have practical implications regarding the significance of handlers’ emotional states and its transmission through odours during human-horse interactions.by Patricia Quintero-Rincón, Karina Caballero-Gallardo, Elkin Galeano, Oscar Flórez-Acosta
This study investigated the chemical and biological potential of Bidens pilosa and Croton sp., plants from megadiverse ecosystems in Colombia, collected in Santander de Quilichao (Cauca) and San Basilio de Palenque (Bolivar). The chemical profile was analyzed by UHPLC-ESI-Orbitrap-HRMS, and the total phenolic and flavonoid content was quantified using colorimetric methods. Antioxidant capacity was assessed using methods that evaluate reducing power and electron transfer mechanisms. The inhibition of key enzymes in skin aging, such as tyrosinase, hyaluronidase, and collagenase, was evaluated, as well as cytotoxicity in keratinocytes and human melanoma cells. Chemical characterization revealed distinctive phytochemical profiles: B. pilosa contained 21.1 mg GAE/g DT of phenolics and 64.6 mg RE/g DT of flavonoids, dominated by p-coumaric acid and rosmarinic acid, while Croton sp. exhibited higher levels of phenolics (169.4 mg GAE/g DT) and 54.1 mg RE/g DT of flavonoids, highlighting rosmarinic acid, p-coumaric acid and quercetin. Both extracts showed significant antioxidant capacity and enzyme modulation, including moderate collagenase inhibition (53.9–55.0%), high hyaluronidase inhibition (64.5–76.5%), and low tyrosinase inhibition (11.1–12.7%), suggesting protection of extracellular matrix and hyaluronic acid during skin aging. Sun protection factor was limited (SPF: 14.5 for B. pilosa and 11.6 for Croton sp.), with low ultraviolet absorption, consistent with low antityrosinase activity. Cytotoxicity assays demonstrated that B. pilosa was not toxic to HaCaT keratinocytes (IC₅₀ > 500 µg/mL) and displayed antimelanoma activity on A375 cells (IC₅₀ = 398.6 µg/mL), whereas Croton sp. showed moderate selectivity towards melanoma cells (IC₅₀ HaCaT = 329.5 µg/mL; IC₅₀ A375 = 189.0 µg/mL). The results suggest that both plants have potential in dermatological applications such as anti-melanoma agents, antioxidants, and modulators of skin aging enzymes, although highlight the importance of improving strategies to maximize their efficacy and safety.This study assessed whether a previously developed Monte Carlo simulation model can be reused for evaluating various strategies to minimise time-to-treatment in southwest Netherlands for endovascular thrombectomy (EVT) in patients who had an ischaemic stroke.
Reuse of a previously developed simulation model to simulate various strategies in another region, using prospectively collected data from stroke centres and retrospective data from emergency medical services.
Data from 509 patients who had an ischaemic stroke (≥18 years) treated with EVT (2014–2018) were used.
Input for the simulation model reuse included distributions of observed time delays along the acute stroke pathway. Validation of the baseline models was based on face validity and statistical measures (patient data vs model output) using the Assessment of the Validation Status of Health Economic decision models tool. We simulated strategies for a subregion: interhospital patient transfer by helicopter, transport of the neurointerventionalist to the primary stroke centre (‘drive-the-doctor’), interhospital patient transfer to a thrombectomy-capable stroke centre (TSC) outside the region and prehospital triage using the Rapid Arterial Occlusion Evaluation (RACE) scale.
Onset-to-groin time was the outcome.
Reuse of the original simulation model was obtained by minimal effort, implying limited adaptation. Compared with the baseline model, interhospital patient transfer by helicopter or to a TSC outside the region and prehospital routing using the RACE scale reduced mean onset-to-groin time by 16, 13 and 39 min, respectively (95% CrI for all: equal to the point estimate). ‘Drive the doctor’ reduced mean onset-to-groin time by 27 (car), 49 (ambulance) or 58 min (helicopter), each with a 95% CrI equal to the point estimate.
The original simulation model can be applied to different regions in the Netherlands. Strategies tested within the subregion resulted in promising results of ‘drive the doctor’ and prehospital patient routing using the RACE scale.
To elicit the benefits of shared decision-making to doctors who are champions of this approach.
A qualitative interview study that used practical thematic analysis.
We identified a purposive international sample of doctors in active clinical practice who were recognised champions of shared decision-making, working in various clinical disciplines.
24 doctors in active clinical practice were interviewed; 14 were male and 10 were female; 20 had been in clinical practice for over 10 years (range 1–30). 12 practised in North America, 10 in Europe, 1 in South America and 1 in Asia; 4 doctors worked in internal medicine, 4 in primary care, 5 in surgery, 3 in paediatrics, 3 in oncology and 1 in each of the following disciplines: emergency medicine, palliative care, geriatrics, physical medicine and rehabilitation, anaesthesiology, and cardiology.
This selected sample of doctors consistently reported that shared decision-making provided benefits to themselves, their patients and their teams. Shared decision-making reinforced and enhanced their self-identity as ethical professionals, supporting patient autonomy, increasing their professional fulfilment and reducing their risk of burnout. These intrinsic benefits accompanied reports of other consequential benefits, namely, patients’ achieving better-informed, preference-sensitive decisions, a higher likelihood of improved patient outcomes, improved efficiency and team function. The doctors viewed the approach as providing connectedness, shared responsibility resulting in a lighter burden, acting as a buttress against moral injury and the emotional strain of clinical work and, where relevant, mitigation against becoming the second victim of a bad or unexpected outcome.
Doctors who champion shared decision-making report significant benefits to themselves and their patients. These benefits have not been widely reported, which has implications for motivating doctors to adopt shared decision-making. Instead of addressing presumed gaps in communication skills, it might be better to highlight the positive impact on professional fulfilment and the protective effect of shared decision-making.
FreshRSS 