Conectar
by Hala M. AlOmari, Hanady Bani Hani, Telda Alkhateeb, Dua’ Qutaishat
Background and objectivesTelehealth is the provision of healthcare services remotely via telecommunications technology. The implementation, clinical applications, and perceived effectiveness of telehealth among audiologists across the Arab region, particularly following its accelerated adoption due to the COVID-19 pandemic was investigated.
Materials and methodsA cross-sectional survey was conducted between April and June 2024 among 194 audiologists from multiple countries. A non-probability purposive sampling approach was implemented. The respondents were grouped into providers and non-providers of telehealth services. The questionnaire collected data on demographics, service delivery models, telehealth applications, training background, and perceived challenges. Descriptive and inferential analyses were performed to identify predictors of teleaudiology adoption.
Results46.9% of the sample reported providing telehealth services. Many of them (69.2%) indicated that they began offering telehealth services following the COVID-19 pandemic. Synchronous delivery was commonly utilised. Younger professionals and those employed in public institutions were more likely to engage in remote service delivery (p Conclusions
The audiologists’ reported perceptions and experiences indicate that teleaudiology remains limited in clinical diagnostic service delivery. Broader integration of teleaudiology practices may benefit from enhanced professional training, the development of standardised guidelines, and investment in technological infrastructure to support access to remote hearing healthcare.
Tuberculosis is the leading cause of death globally from a single infectious agent. Early diagnosis is critical to reducing morbimortality. In cases of negative smear microscopy or limited sputum production, bronchoalveolar lavage (BAL) samples offer an alternative for diagnosis. Culture, the gold standard, requires a high bacterial load, extensive infrastructure and is time-consuming. Xpert MTB/RIF provides faster results with a higher cost. Previous systematic reviews present substantial limitations, including significant heterogeneity. Therefore, the diagnostic utility of Xpert MTB/RIF using BAL samples in adults with negative or scant sputum for pulmonary tuberculosis (PTB) needs to be reassessed.
A systematic search of MEDLINE, Embase, LILACS and Web of Science will be conducted without language or publication date restriction. Cross-sectional diagnostic studies of negative or sputum-scarce adults with presumptive PTB who underwent bronchoscopy to obtain samples for Xpert MTB/RIF and culture will be included. Screening and data extraction will be performed independently. Methodological quality will be assessed using the QUADAS-2 tool. A bivariate hierarchical random-effects model will synthesise sensitivity and specificity. Meta-analysis will be performed using Meta-DiSc 2.0. Heterogeneity will be assessed using I2 and Cochrane thresholds. Subgroup analyses will be performed based on study design, population differences, country, culture method and risk of bias. Publication bias will be investigated using a funnel plot. The certainty of evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. There was no patient or public involvement in the development of the systematic review protocol.
Ethical approval is not required as this study will use publicly available data. Findings will be disseminated through peer-reviewed publication.
CRD42025639440.
Healthcare utilisation (HU) is key to improving the health of residents in urban informal settlements. This study aimed to explore household-level factors influencing HU among informal settlement households in Freetown, Sierra Leone.
Cross-sectional survey.
Three informal settlements (Cockle Bay, Dwarzark and Moyiba) in Freetown, Sierra Leone.
Primary data from 4871 households were collected during the Health and Wellbeing survey conducted between April and May 2023, targeting households with adults aged 18 years and older.
The primary outcomes were households HU both within and outside informal settlements. Household-level predisposing and enabling explanatory variables were derived from Andersen’s Behavioural Model of HU.
Disability in households increases HU within settlements (especially in Dwarzark, 13% and Moyiba, 10%) but is less likely outside. Households engaged in income-generating activities are more likely to seek healthcare within settlements, but 12% less likely outside in Cockle Bay and Dwarzark. Food insecurity decreases HU within Dwarzark (9%) and increases HU outside by 174% in Moyiba. Longer water fetching times and water shortages were associated with higher HU (between 6% and 16%) within settlements, especially in Cockle Bay and Dwarzark. Clean water sources (eg, piped dwelling, bowser, surface, bottled) were consistently associated with higher HU both within and outside settlements. Shared sanitation facilities (such as shared toilets) were positively associated with HU both within and outside settlements, particularly in Dwarzark and Moyiba. Households with income from fishing, informal salaried work and bike riding showed higher HU both within and outside settlements, especially in Dwarzark and Moyiba.
We identified strong settlement-specific patterns of household-level factors that influence HU both within and outside Freetown’s informal settlements. These findings provide a foundation for developing targeted policies such as strengthening local services, addressing affordability and accessibility barriers and supporting vulnerable occupation groups.
Status epilepticus (SE) in adults is a serious neurological emergency that can lead to high morbidity and mortality rates. Although functional outcomes are often assessed using general scoring systems, limited data on health-related quality of life (HRQoL) in patients admitted to intensive care units (ICUs) are still limited. Furthermore, comprehensive evaluations of patient-reported physical, cognitive, mental health and psychological outcomes are lacking in this population. POSEIDON 2 aims to assess HRQoL and cognitive, physical and psychological impairments at 3 and 12 months after ICU discharge following SE and quantify caregiver burden.
POSEIDON 2 is a prospective, multicentre, longitudinal study conducted in 19 French ICUs. The study combines data from the SE ICTAL Registry with data from patients who survived admission to the ICU for SE, who will be recruited for the study. The study also includes patient-reported outcome (PRO) data collected 3 (M3) and 12 (M12) months after discharge from the ICU using validated instruments. The Zarit scale will be used to measure the burden on caregivers at M3 and M12. The primary endpoint is the prevalence of overall HRQOL impairment at M3 and M12, as defined by dichotomous scores on the physical and mental components of the 36-Item Short Form Health Survey compared with those of the general population. Secondary endpoints include domain-specific impairments, such as cognitive function, dependence, mental health and patient experiences. The sample size has been calculated based on an estimated prevalence of 75% for HRQoL impairment, with a planned sample size of 140 patients.
The POSEIDON 2 study protocol received ethical approval from the ethics committee ‘Comité de Protection des Personnes Ouest VI’ on 5 October 2023 (#2023-A01223-42). The study is conducted in accordance with the Declaration of Helsinki, Good Clinical Practice and the regulatory requirements of France. Written informed consent is obtained from participants, who are able to decline participation or withdraw from the study at any time. Findings will be disseminated through publication in peer-reviewed journals and presentations at scientific conferences.
Common mental health outcomes among children in conflict with the law in correctional facilities in Africa are an under-researched area with significant public health implications. This review will synthesise available and accessible evidence on the prevalence and associated factors of common mental health outcomes among children in conflict with the law in Africa.
Comprehensive electronic searches will date from 01 January 2015 to 31 December 2025 and will be conducted in PubMed, Sabinet, Scopus, EBSCOhost, Web of Science and PsycINFO. Articles will be screened using defined inclusion and exclusion criteria and assessed for eligibility by three independent reviewers. Discrepancies will be reviewed by a ninth reviewer. The selection process of included articles will be reported by using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses will be used. The Mixed Methods Appraisal Tool will assess study quality, and data will be synthesised using meta-analysis or a narrative synthesis approach, depending on heterogeneity levels.
This study will not require ethical approval from an institutional review board, as it does not entail the direct collection of data from children in conflict with the law, nor does it pose any risk to their privacy. Once finalised, the full review report will be submitted for publication in a peer-reviewed journal. The key findings will also be shared at both local and international conferences, highlighting common mental health outcomes among children in conflict with the law.
CRD420251011484.
This community-led research study protocol emphasises placing black youth impacted by the legal system, their families and their communities at the forefront of substance use treatment development research and decision-making. The study, the Cultural Adaptation of a Substance Use Treatment (CAST) Project, challenges traditional top-down approaches to treatment creation, advocating for a grassroots model that centres community knowledge, values and active participation.
The CAST project is a US-based mixed-methods study with an exploratory design that examines the impact of racial discrimination on substance use in black youth impacted by the legal system. The study participants are black youth impacted by the legal system (N=15), parents of black youth impacted by the legal system (N=10) and community members who serve black youth (N=10) (total N=35 study participants). Study participants from each group (youth, parents and community members) will participate in three separate focus groups, respectively, to provide feedback on the culturally responsive content needed to best support black youth impacted by the legal system around substance use and mental health. The eight-step Assess, Decision, Adaptation, Production, Topical Expert, Integration, Training, Testing framework will be used as a guide to inform adaptations to the Motivational Enhancement Therapy and Cognitive Behavioural Therapy (MET/CBT12) for black youth impacted by the legal system. Once the cultural adaptation process has been completed, the study will conclude with an open feasibility and accessibility trial of the culturally adapted MET/CBT12 manual. The primary outcomes of this study are the feasibility and acceptability of the culturally adapted manual, measured by treatment attendance and participant feedback. Secondary outcomes include reductions in substance use and discrimination distress, and improvements in mental health symptoms.
This study was approved by the Institutional Review Board (IRB) at the University of California, San Francisco (IRB Protocol Number: 23-40126). All study procedures will be conducted in accordance with the ethical standards outlined by the institutional review board. The results from this study will be shared through peer-reviewed publications, academic conferences, community forums and policy briefs to support broader implementation of culturally adapted adolescent substance use interventions that address discrimination-related stress and substance use among black individuals impacted by the legal system.
To identify the factors associated with low psychological resilience among university students in the Grand Est region of France at the end of the first national COVID-19 lockdown.
A cross-sectional online survey was conducted (May 2020) among students at the University of Lorraine using the LimeSurvey platform and institutional mailing lists.
Higher education setting in north-eastern France, involving students from the University of Lorraine (multicampus public university) and Sciences Po Nancy, a political science institute in the same region.
A total of 3708 students fully completed the online questionnaire, including the Brief Resilience Scale (BRS), resulting in an estimated response rate of 7.1%. All students enrolled at the University of Lorraine and Sciences Po Nancy during the 2019–2020 academic year were eligible to participate.
The primary outcome was psychological resilience, measured using the BRS. Secondary measures included perceived social support assessed with the Multidimensional Scale of Perceived Social Support, quality of interpersonal relationships evaluated using the Quality of Interpersonal Relationships Scale (Échelle de la Qualité des Relations Interpersonnelles, EQRI) and frequency of positive and negative thoughts measured with the Thermometer of Thoughts Tool. Factors associated with low resilience were analysed using bivariable and multivariable logistic regression.
Among 3708 students included in the sample, corresponding to a response rate of approximately 7.1%, 50.6% had normal resilience, while 37.3% reported low resilience. Female gender (OR=2.1, 95% CI: 1.8 to 2.6) and low social support (OR=1.7, 95% CI: 1.1 to 2.6) were the factors associated most strongly with low resilience. Negative thoughts (OR=1.4, 95% CI: 1.4 to 1.5), lower quality of relationships with people in general (OR=1.5, 95% CI: 1.3 to 1.8) and studying arts, humanities or languages (OR=1.4, 95% CI: 1.0 to 1.8) were identified as factors associated with low resilience. Increased age (OR=0.9, 95% CI: 0.9 to 1.0) and flat sharing (OR=0.6, 95% CI: 0.4 to 0.9) were inversely associated with low resilience levels.
Resilience seems to be impacted primarily by internal and micro-environmental factors. Consolidating levels of individual resilience of at-risk populations by acting on these factors could be the key to improving their mental health.
Heart failure (HF) is associated with complex symptoms and frequent hospitalisation that reduce patients’ quality of life (QoL). This study aims to assess the association between angiotensin receptor-neprilysin inhibitor (ARNI) use and changes in QoL and disease-related outcomes among patients with HF in Jordan.
Prospective observational cohort study.
The study was conducted among patients with HF attending the outpatient cardiology clinics at Jordan University Hospital, a tertiary care centre in Amman, Jordan. Patients either initiated on ARNI or receiving angiotensin-converting enzyme inhibitor (ACEI)/angiotensin receptor blocker (ARB) were included in the study at a 1:2 ratio. All participants were followed up for up to 1 year after recruitment. The study period was from 4 February 2024 to 29 May 2025.
Data on QoL, New York Heart Association (NYHA) functional class and left ventricular ejection fraction (LVEF) were collected at baseline and after 3 months of treatment. Hospitalisation data were collected for the preceding year and the year following participants’ recruitment. Medication adherence and ARNI side effects were assessed after 3-month of follow-up period.
A total of 227 patients with HF were included; 74 were initiated on ARNI, and 153 were receiving ACEIs/ARBs. At baseline, significantly lower QoL scores and LVEF were observed in the ARNI group compared with the ACEIs/ARBs group. After 3-month, the ARNI group showed improvements in all QoL scores, NYHA functional class and LVEF (p
ARNI use was associated with favourable QoL, NYHA class, and LVEF as well as lower hospitalisation rates among patients with HF in Jordan. The safety profile was consistent with previous studies.
Hyperkalaemia (HK) is common in the emergency department (ED) and can cause life-threatening arrhythmias. Patiromer is a potassium binder whose role in acute HK management is uncertain; therefore, we investigated the efficacy and safety of patiromer as an adjunct to the standard of care treatment of HK in the ED.
A prospective, randomised, double-blind, placebo-controlled study.
16 ED sites across the USA.
Patients aged ≥18 years treated at a participating ED who were found to have serum potassium ≥5.8 mEq/L.
Participants were randomised 1:1 to standard combination therapy (25 g intravenous dextrose, 5 units intravenous insulin and 10 mg albuterol) with either patiromer or placebo. The initial dose was given within 1 hour of the potassium result, and the second dose 24 hours later.
The primary endpoint was net clinical benefit (NCB) at 6 hours, defined as the change in number of potassium-lowering interventions minus change in serum potassium. Adverse events (AEs) were also recorded.
The study was terminated early and did not reach the prespecified sample size. Overall, 111 patients (53 patiromer and 58 placebo) were analysed. Mean (SD) age was 61.34 (15.21) years, 34% were female, 48% white and 22.5% received chronic haemodialysis. Mean baseline potassium was 6.5 mmol/L. NCB at 6 hours was similar between patiromer and placebo (–0.6 vs –0.4; p=0.44). Potassium levels at 2, 4 and 6 hours were similar between the groups (5.50 vs 5.70, 5.45 vs 5.65, 5.50 vs 5.60; patiromer and placebo (all p>0.05)). The number of interventions per patient was similar (p>0.05) between groups at each time point. The proportion of patients experiencing AEs was not significant between the patiromer and placebo groups (16.98% vs 32.76%; p=0.08).
No differences in efficacy were reported in this study, which was underpowered to detect statistical efficacy of patiromer over placebo.
Acute respiratory distress syndrome (ARDS) is a major public health problem, accounting for 23% of intubated patients and associated with high mortality rates. Although lifesaving, invasive mechanical ventilation can worsen lung injury when ventilator settings are poorly adjusted to lung physiology. We hypothesise that individualising ventilator settings via (1) the bedside assessment of lung recruitability using a one-breath derecruitment manoeuvre and measurement of airway opening pressure to set positive end-expiratory pressure (PEEP), (2) controlling the distending pressure and (3) controlling respiratory drive improves ARDS outcomes.
The CAreful Ventilation In ARDS trial is an investigator-led multicentre (33 centres in eight countries), open-label, randomised controlled basket trial comparing two ventilation strategies in two subpopulations of moderate-to-severe ARDS: induced or not by COVID-19. A total of 740 patients will be randomised (370 in each substudy) in a 1:1 ratio to individualised ventilator settings or to using traditional PEEP to inspired fraction of oxygen tables for PEEP setting. Indications for proning and weaning strategies are similar in both arms. The primary outcome is all-cause mortality at day 60. Secondary outcomes include duration of mechanical ventilation, duration of intensive care unit (ICU) and hospital stay, organ dysfunction, barotrauma and mortality in ICU, at day 28 and in hospital.
Ethics approval has been obtained for all participating centres: Unity Health Toronto Research Ethics Board (for three centres: St Michael’s Hospital, Toronto General Hospital and Toronto Western Hospital); Comité de Ética de Investigación con Medicamentos del Hospital Universitari Vall d’Hebron; Comité de protection des personnes Ile de France III; Comité d'Ética de la Investigatción con Medicamentos de la Fundació de Gestió Sanitària del Hospital de la Santa Creu i Sant Pau; Comitato Etico—Fondazione Policlinico Gemelli; Comitato Etico di Area Vasta Emilia Centro; NYU Langone Health Institutional Review Board; Comité Ético Científico de Ciencias de la Salud; Il Comitato Etico Area 1 dell’Azienda Ospedaliero-Universitaria ‘Ospedali Riuniti’ di Foggia; HIGA ‘Eva Perón’ Comité de Bioética; Comité de Revisión Institucional del Hospital Británico Comité de Ética en Investigación; Complejo Médico Churruca-Visca Comité de Ética Biomédica; Comité de Ética SATI Comité de Ética en Investigación; Comité de Ética en Investigación del CEMIC; Comité de Ética SATI Comité de Ética en Investigación; Medical Research Ethics Committees United. Findings will be disseminated in peer review journals and conference presentations.
To identify obstacles faced by nurses when using health technologies in Intensive Care Units (ICUs).
Systematic review following PRISMA and registered in PROSPERO.
Six databases were searched. Two reviewers independently screened studies and appraised methodological quality using the Joanna Briggs Institute tool. Data were synthesized narratively.
Eight studies met eligibility criteria. Barriers clustered around limited training and technical competence, shorter professional experience, increased workload with multiple devices, organizational culture, and reduced direct patient contact, which may undermine patient-centered care. Heterogeneity of study designs precluded meta-analysis.
Obstacles to technology use in ICUs arise from individual and organizational factors. Addressing these barriers requires structured education, mentoring for novice nurses, workload management, and supportive policies that integrate technology without displacing bedside care.
Nursing leaders and educators should implement ongoing, ICU-specific technology training and mentoring. Managers and policymakers must ensure adequate staffing and promote Health Technology Assessment to align device implementation with clinical needs, safeguarding patient safety and the human dimensions of care.
This study investigated perinatal depressive symptoms among pregnant and postpartum Filipino women.
Cross-sectional survey.
The Philippines.
Participants were recruited online and face-to-face from maternal care facilities.
Perinatal depressive symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS) score, with prevalence calculated based on ≥13 cut-off, indicating clinically significant symptoms of depression. Patterns of depressive symptoms were examined by demographics, perinatal time period and other obstetric information using adjusted regression coefficients (ab) and risk ratios (aRR).
A total of 856 women participated in the study, comprising 356 pregnant and 500 postpartum women. EPDS scores were, on average, similar between pregnant (14.4) and postpartum women (14.1). Using the locally validated cut-off of ≥13 revealed that 69.1% of pregnant and 62.0% of postpartum women reported clinically significant depressive symptoms. Consistent EPDS scores and prevalence were observed across pregnancy trimesters and within 12 months postpartum and beyond. Women who received adequate prenatal care were less likely to experience antenatal (ab=–1.59, 95% CI –3.13 to –0.05) and postpartum (ab=–1.30, 95% CI –2.48 to –0.12) depressive symptoms. Postpartum EPDS scores and depressive symptom prevalence (EPDS score ≥13) were higher among 18–24-year olds (ab=1.96, 95% CI 0.30 to 3.61; aRR=1.23, 95% CI 1.03 to 1.47) and single mothers (ab=3.46, 95% CI 0.22 to 6.71; aRR=1.42, 95% CI 1.07 to 1.90), compared with older and married mothers, respectively.
At least 60% Filipino mothers experienced clinically significant perinatal depressive symptoms, which exceeds the established global average of 25%. Younger and single postpartum women were at greater risk, while pregnant and postpartum women who attended adequate prenatal visits were less likely to report depressive symptoms. Our study underscores the need for further research to uncover the true burden of poor perinatal mental health and calls for targeted early interventions and integrative public health strategies to support at-risk mothers, particularly those from socially disadvantaged backgrounds.
To examine outcomes from respiratory pathogens containment strategies focused on international travellers.
We developed a compartmental model generalisable to respiratory infectious diseases, in which international travellers interact with each other and airline/airport workers during transit. We used SARS-CoV-2 Omicron surge data (basic reproduction number (R0): 9.5) as a case example and performed sensitivity and scenario analyses, including varying the R0 for different respiratory pathogens.
A US high-volume airport.
Simulated international travellers and airline/airport workers.
Projection of new and imported SARS-CoV-2 infections without intervention (No Intervention); pre-travel screening for travellers who intend to travel (intended travellers) with PCR (Pre-travel PCR); or antigen testing (Pre-travel Ag); mask-wearing guidance for travellers and workers (Mask-wearing); and a Combined strategy (Pre-travel PCR & Mask-wearing).
The number of new and imported respiratory disease infections over the 90-day simulation period.
Over the 90-day simulation, the number of infected travellers entering the USA would be: 1 155 580 (27.2% of 4.2 million (M) intended travellers) with No Intervention; 709 560/4.2M (16.7%) with Pre-travel PCR; 862 330/4.2M (20.3%) with Pre-travel Ag; 1033 820/4.2M (24.4%) with Mask-wearing; and 650 480/4.2M (15.3%) with Combined. The number of new infections among airline/airport workers would be: 25 670 (73.3% of 35 000 workers) with No Intervention; 25 260 (72.2%) in Pre-travel PCR; 25 590 (73.1%) in Pre-travel Ag; 24 630 (70.4%) in Mask-wearing; and 18 770 (53.6%) in Combined. In scenario analyses, the most impactful parameters were R0 of the respiratory pathogen and population immunity level.
A Combined strategy of pre-travel PCR testing and mask-wearing would most effectively reduce respiratory infection among international travellers and airline/airport workers, but would still allow a substantial number of infections to enter the USA, especially when the pathogen is highly transmissible.
Integrated digital diagnostics can support complex surgeries in many anatomic sites, and brain tumour surgery represents one of the most complex cases. Neurosurgeons face several challenges during brain tumour surgeries, such as differentiating critical tissue from brain tumour margins. To overcome these challenges, the STRATUM project will develop a 3D decision support tool for brain surgery guidance and diagnostics based on multimodal data processing, including hyperspectral imaging, integrated as a point-of-care computing tool in neurosurgical workflows. This paper reports the protocol for the development and technical validation of the STRATUM tool.
This international multicentre, prospective, open, observational cohort study, STRATUM-OS (study: 28 months, pre-recruitment: 2 months, recruitment: 20 months, follow-up: 6 months), with no control group, will collect data from 320 patients undergoing standard neurosurgical procedures to: (1) develop and technically validate the STRATUM tool and (2) collect the outcome measures for comparing the standard procedure versus the standard procedure plus the use of the STRATUM tool during surgery in a subsequent historically controlled non-randomised clinical trial.
The protocol was approved by the participant ethics committees. Results will be disseminated in scientific conferences and peer-reviewed journals.
To translate, culturally adapt and validate the first Spanish version of the Person-centred Practice Inventory-Care (PCPI-C) instrument.
Cross-cultural adaptation and psychometric validation.
Two-phase research design: (1) the PCPI-C's translation and cultural adaptation from English to Spanish following the ‘Translation and Cultural Adaptation of Patient-Reported Outcomes Measures-Principles Guide of Good Practice’ tool; and (2) a cross-sectional quantitative survey to assess the Spanish version's psychometric properties.
A sample of 200 patients participated to obtain the PCPI-C's Spanish version. No significant issues arose during the translation process or the consulting sessions. No item exhibited an inadequate value following adjustment via the weighted kappa index (−scale-level content validity average of 0.95 for clarity and 0.97 for relevance). Psychometric evaluation revealed acceptable internal consistency (Cronbach's alpha from 0.67 to 0.84) and strong construct validity. Exploratory and confirmatory factor analyses supported a five-dimensional structure consistent with the domain Person-Centred Processes. Fit indices improved after model refinements, achieving CFI = 0.92, SRMR = 0.05 and RMSEA = 0.07. This study's observed psychometric properties confirm that the PCPI-C's Spanish version retains the original instrument's theoretical integrity, while showing strong reliability and validity in the new context.
The PCPI-C's Spanish translation was psychometrically valid when tested with Spanish patients, thus providing a culturally appropriate, psychometrically sound tool to evaluate Spanish-speaking patients' perception of person-centred care.
This study provides a validated instrument that allows for the assessment of person-centred practice in Spanish-speaking clinical environments. It enables healthcare professionals to measure patients' perceptions, track the implementation of person-centred principles and supports international comparative studies, contributing to the development of more ethical and responsive models of care.
Patients participated in cognitive consultations and completed the survey for psychometric testing, ensuring that the translated items were understandable, culturally appropriate and reflective of their experiences of person-centred care.
by Peiling Zuo, Huanhuan Zhu, Chunying Sun, Xiaohan Ma, Sheng Chen, Rong Tang, Tong Wu, Ding Zhang, Xiao Tang, Wenquan Lv, Wenzhong Chen, Xiawei Wei, Encun Hou, Minsheng Wu, Minghe Jiang
BackgroundEvidence indicates that the Endothelial Activation and Stress Index (EASIX) is a predictor of mortality in endothelium-related conditions; however, its association with mortality risk in atrial fibrillation (AF) remains uncertain. Accordingly, this study examines the relationship between EASIX and mortality risk among patients with AF.
MethodsThis retrospective analysis utilized data from the Medical Information Marketplace in Intensive Care IV (MIMIC-IV) database, which includes critically ill patients diagnosed with AF. To examine the association between EASIX scores and mortality, Kaplan–Meier survival analysis, Cox proportional hazards models, and restricted cubic spline regression were applied to evaluate the relationship between EASIX and all-cause mortality. Subgroup analyses were conducted to explore potential interactions with key patient characteristics, and sensitivity analyses were performed to further confirm the robustness of the results.
ResultsA total of 3,193 patients were included in the analysis. KM survival analysis showed that elevated EASIX levels were associated with a higher risk of both in-hospital and ICU mortality. After adjusting for potential confounders, increased EASIX levels remained significantly associated with in-hospital mortality [HR, 1.09 (95% CI 1.03, 1.15), P = 0.0002] and ICU mortality [HR, 1.10 (95% CI 1.04, 1.17), P = 0.0002]. Stratified analyses revealed a significant interaction between sepsis, respiratory failure, and EASIX in relation to both in-hospital and ICU mortality. To evaluate the robustness of the findings, a sensitivity analysis was performed. After additionally adjusting for metoprolol and heparin as covariates, patients in the highest EASIX group continued to demonstrate the greatest mortality risk: the HR for in-hospital death was 2.08 (95% CI: 1.51–2.85), and the HR for ICU death was 1.83 (95% CI: 1.21–2.65).
ConclusionElevated EASIX levels correlate with higher mortality rates, underscoring its potential as an accessible tool for identifying high-risk patients and informing clinical decisions. However, further studies are needed to explore the underlying mechanisms and validate its applicability across diverse patient populations.
by Renata dos Santos Guarnieri, Guilherme Sá de Oliveira, Kaylaine Marques Ferreira, Aline Penna-de-Carvalho, Vanessa Souza-Mello, Sandra Barbosa-da-Silva
High-intensity interval training (HIIT) is an effective intervention for improving metabolic health and mitigating metabolic dysfunction-associated steatotic liver disease (MASLD). Nonetheless, the stability of these benefits throughout detraining periods and upon weight regain remains inadequately characterized. This study aimed to evaluate whether hepatic improvements induced by HIIT are sustained during detraining, even after body weight regain. Eighty male C57BL/6 mice were fed either a control (10% fat) or a high-fat (HF) diet (50% fat) for 12 weeks. Following this period, the animals were allocated to groups subjected to continuous HIIT or intermittent training cycles (each lasting 3 weeks). The outcomes assessed included body mass (BM), glucose tolerance, lipid profiles, liver enzyme levels (aspartate aminotransferase and alanine aminotransferase), hepatic steatosis, and the expression profiles of genes associated with lipogenesis (Srebf1, Mlxpl, and Fas), β-oxidation (Ppara and Cpt1a), and endoplasmic reticulum (ER) stress (Atf4, Ddit3, and Gadd45). Compared with the sedentary HF-NT condition, continuous HIIT reduced BM and improved glucose tolerance. Intermittent training (HF-TNT, HF-NTN) preserved metabolic benefits and reduced triglyceride and cholesterol levels. Notably, hepatic steatosis was significantly alleviated in all training groups but persisted even after detraining. Additionally, HIIT downregulated the expression of lipogenic genes and upregulated the expression of genes involved in β-oxidation. The levels of markers indicating ER stress were attenuated by HIIT, with a sustained reduction during periods of detraining. HIIT-induced metabolic and hepatic improvements persist partially during detraining, despite weight regain. These findings underscore the therapeutic value of continued or periodically repeated physical training in mitigating the adverse effects of an HF diet and preventing the progression of metabolic disorders such as MASLD.by Verónica Martínez-Borba, Andrés E. Rodríguez-Márquez, Sara Garcés-Arilla, Óscar Peris-Baquero, María Vicenta Navarro-Haro, Esther del Corral-Beamonte, Jorge Osma
BackgroundLong COVID-19 is a medical condition associated with persistent physical, cognitive, and emotional symptoms. Despite its significant impact, there are still few psychological interventions—especially with transdiagnostic approaches— that have been rigorously tested in this population. The aim of the present protocol is to describe a randomized controlled trial to examine the effectiveness and acceptability of the online, group-delivered Unified Protocol (UP) for improving emotional, and cognitive outcomes in adults with long COVID-19. We expect greater improvements in emotional and cognitive outcomes for the UP group compared to controls. Additionally, exploratory analyses will assess changes in neurocognitive performance and hair cortisol/cortisone levels as potential correlates of treatment response.
Methods90 individuals diagnosed with long COVID-19 will be randomized to an experimental group or a waiting-list control group (1:1 ratio). Participants in the experimental group will receive the UP across 12 online group sessions. Longitudinal assessments (pre-treatment, post-treatment and 3, 6 and 12 months follow-ups) will include psychological (e.g., anxiety and depressive symptoms) and cognitive outcomes (e.g., memory failures). Participants in the experimental group will also complete neuropsychological tests and will provide hair samples for the assessment of cortisol/cortisone levels.
Data analysesBaseline characteristics will be described using descriptive statistics, and linear mixed-effects models will evaluate the effects of time, group, and their interaction on psychological and cognitive outcomes. Neuropsychological performance and hair cortisol levels will be analyzed over time in the experimental group. Associations between cortisol and psychological or cognitive measures will be explored through correlational analyses.
ConclusionsWe expect positive outcomes after the intervention in acceptability and in emotional symptoms and cognitive complaints in individuals living with long COVID-19, the maintenance of the benefits in all follow-ups, and statistically significant changes in favor of the UP condition in comparison with the waiting-list control group. If effective, the UP could provide an accessible and evidence-based psychological treatment for this population, improving the quality of healthcare to individuals with long COVID-19.
Trial registrationclinicatrials.gov (registration identifier: NCT06928480; May 22, 2025).
by Dandan Feng, Yakun Song, Zuqi Wu, Wuruo Liu, Yuting Pu, Yangcan Gao, Yuying Sun, Jiquan Zhang
Trypsin, a canonical serine protease in crustaceans, plays a crucial role in ontogeny and antibacterial defense. Whether these biological functions correlate with its catalytic characteristics remains unresolved in the freshwater shrimp Neocaridina denticulata sinensis. To address this gap, we characterized a trypsin gene from N. denticulata sinensis (NdTryp) and assessed both its biological roles and its prospective utility. NdTryp was predominantly expressed in the hepatopancreas, where it localized to storage cells (R-cells) and tubule-lining epithelial cells (ECTs). Across development, NdTryp transcripts were essentially absent during early embryogenesis but rose sharply at late stages, temporally coincident with hatching and the onset of feeding. After a challenge with Vibrio parahaemolyticus, the expression of NdTryp was induced, with the expression level significantly increased relative to the baseline expression level. RNA interference-mediated knockdown rendered shrimp more susceptible to infection and was accompanied by extensive hepatopancreatic injury, including epithelial detachment and disruption of the basement membrane. Biochemically, recombinant NdTryp (rNdTryp) displayed proteolytic activity over a broad temperature and pH span. Activity was differentially tuned by metal ions, with several divalent cations producing marked enhancement, whereas ferric iron exerted strong inhibition. Overall, our results showed that NdTryp functions as a multifunctional protease involved in both late embryonic development and innate antimicrobial defense. Furthermore, the robust stability of rNdTryp underscores its potential as an aquafeed additive and candidate for enzymatic biotransformation.To explore the key knowledge, skills, attributes and organisational support that nurses require to optimise their scope of practice when providing care to people experiencing homelessness.
A qualitative descriptive study exploring nurses' scope of practice for addressing health needs of people experiencing homelessness.
Interviews and focus groups were conducted from 2022 to 2024 with 42 people with lived experience of homelessness across two Australian cities. Thematic analysis identified essential skills, attributes and approaches to improve access to care and eliminate stigma. Findings were then presented in focus groups with 11 registered nurses in specialist homeless health services to elicit views on optimising scope of practice. The study follows COREQ reporting guidelines for qualitative research.
Lived-experience participants—ranging from 18 to 84 years, a third living in cars or tents—identified key nursing attributes and practices, including approachability, compassion, non-judgement, flexibility, community embeddedness, trauma-informed and culturally safe practice, plus skills in physical and mental health assessment, medication management and service navigation. Nurse participants agreed with lived-experience participants, and highlighted organisational support needs, including information sharing, clinical supervision, assertive outreach, nurse prescribing and long-term funding for nurse-led programs.
With rising housing instability, preparing nurses to optimise access to care for people experiencing homelessness is critical. Optimal scope of practice includes personal attributes to build rapport and reduce stigma alongside clinical skills. Co-developing educational programs in partnership with people with lived experience of homelessness and homeless health nurses offers a promising approach.
This research informs the scope of practice definitions and the future development of a co-developed nursing education pathway and organisational framework to improve access to care for people experiencing homelessness in Australia.
Limited patient and public involvement was incorporated and focused on providing feedback on interview guides.
FreshRSS 