Risk screening for pre-eclampsia relies on accurate gestational age assessment, but routine access to ultrasound-based gestational dating remains challenging in many low- and middle-income countries. As part of the formative work for the ‘Preventing pre-eclampsia: Evaluating AspiRin Low-dose regimens following risk Screening’ (PEARLS) platform, we aim to validate and implement an artificial intelligence (AI)-based algorithm for estimation of gestational age, using blind sweeps done with a handheld ultrasound device. This study protocol outlines the accuracy cohort for AI-based gestational age estimation in participating facilities in Ghana, Kenya and South Africa.

This multicountry prospective cohort study will recruit 969 pregnant women at 13 health facilities across Kenya, Ghana and South Africa. The eligible population is pregnant women presenting for antenatal visits from 11⁺⁰ to 13⁺⁶ weeks’ gestation. Eligible women will have a gestational age assessment by a trained sonographer using fetal biometry (reference standard), followed by gestational age estimation conducted by a trained midwife using the AI-based Intelligent Ultrasound ScanNav FetalCheck system (experimental). Both conventional and AI-based gestational age scans will be conducted with the General Electric VScan Air platform. Women will return for a second visit between 14⁺⁰ and 27⁺⁶ weeks’ gestation (week of visit is randomly selected) for an assessment with both conventional and AI-based ultrasound. The primary objective is to determine the accuracy and precision of gestational age estimation using an AI ultrasound system in first and second trimesters, as compared with gestational age estimation using crown-rump length measurement by conventional ultrasound in first trimester (11⁺⁰ to 13⁺⁶ weeks’).

This study has received or sought ethics approval from the following entities: Australia: University of Melbourne, Office of Research Ethics and Integrity (Reference Number: 2024–28489-49438-3) and the Alfred Hospital Ethics Committee (Reference: Project 727/23); Ghana: Ghana Health Service Ethics Review Committee (GHS-ERC Number 002/01/24); Kenya: Kenyatta National Hospital, University of Nairobi ERC (Ref: KNH-ERC/01/MISC/20); South Africa: University of Cape Town, Faculty of Health Science, Human Research Ethics Committee (HREC Ref: 138/2024). Key findings will be disseminated to research teams to inform future scale-up of AI-based pregnancy dating and pre-eclampsia risk screening. Findings from this pilot work will be published in peer-reviewed open-access journals, conferences and meetings to maximise reach of our findings.

Diabetes has reached epidemic proportions in Pakistan. This study applied machine learning (ML) techniques to identify comorbidity-based and diabetic complications-based clusters in hospitalised patients with diabetes and examine their association with in-hospital mortality.

Retrospective cross-sectional study.

Aga Khan University Hospital, Pakistan.

Adult patients (≥18 years) with diabetes admitted between 2008 and 2021.

Diagnoses were extracted using International Classification of Diseases (ICD-9 and ICD-10) codes. Data was integrated from the Hospital Information Management Systems (HIMS). The K-Modes clustering algorithm was applied to categorical diagnostic data, with the optimal number of clusters determined using elbow curve and silhouette score analysis. Latent-Dirichlet Allocation and Term Frequency-Inverse Document Frequency were applied to identify frequent terms from each cluster followed by expert validation. Logistic regression was performed to assess the association between cluster membership and in-hospital mortality.

Among 78 271 patients, four clusters were identified with varying mortality risks: (1) cardio, tumour and tobacco (CTT), (2) renal complication cluster (RCC), (3) cardiovascular cluster (CVC) and (4) uncontrolled diabetes mellitus, hypertension, stroke and kidney (HSK). The within cluster mortality was highest in the RCC cluster (682; 18.1%), followed by CVC (543; 4.4%), HSK (1,379; 4%) and CTT (603; 2.2%). Compared with CTT, the unadjusted odds of in-hospital mortality were significantly higher in RCC (OR=9.9, 95% CI 8.9 to 11.2, p

Among hospitalised patients with diabetes, the RCC cluster demonstrated the highest mortality risk, comprising predominantly older patients with severe complications. These findings highlight the utility of unsupervised ML approaches for identifying high-risk clinical phenotypes and informing risk stratification in resource-constrained settings. Longitudinal studies are warranted to evaluate progression and long-term outcomes across clusters.

Immediate dental implant placement has been proposed as a strategy to reduce treatment time and improve patient satisfaction. However, systematic reviews addressing immediate versus delayed implant placement have reported inconsistent findings, limiting clinical interpretability. An umbrella review is warranted to synthesise, appraise and contextualise the existing evidence.

This umbrella review will include systematic reviews with or without meta-analysis comparing immediate implant placement after tooth extraction with delayed placement in healed sites. Comprehensive searches will be conducted in September 2026, in PubMed/Medical Literature Analysis and Retrieval System Online (MEDLINE), Embase, Scopus, Web of Science, LILACS, the Cochrane Database of Systematic Reviews. Methodological quality will be assessed using A Measurement Tool to Assess Systematic Reviews (AMSTAR 2). Overlap of primary studies will be quantified using the corrected covered area. Outcomes of interest include implant survival, success and failure rates, biological and technical complications, patient-reported outcomes and surgical time. A structured narrative synthesis will be performed.

This overview does not require ethics approval, as it uses secondary data from previously published studies. The results will be disseminated through the publication in a high-impact journal.

https://doi.org/10.17605/OSF.IO/GZ3DR

The Entebbe Mother and Baby Study (EMaBS) was established in 2001 to test the hypothesis that treating helminth infections during pregnancy and early childhood could improve children’s responses to Bacillus Calmette-Guérin (BCG) and other vaccines given in infancy and influence immune responses to other infectious pathogens. Follow-up was subsequently extended to address further research questions and continue to the present day.

Two thousand five hundred and seven pregnant women were recruited when attending antenatal services at Entebbe General Hospital, Uganda; 2345 resulting live-born children were enrolled into the EMaBS birth cohort.

Initial results from EMaBS showed that treating helminths in pregnancy and early childhood was safe and that treatment with albendazole reduced anaemia in mothers with heavy hookworm infections. Maternal anthelminthic treatment had small effects on infant response to tetanus immunisation, but no effect, either beneficial or detrimental on the occurrence of infectious diseases in childhood. However, treatment of helminths during pregnancy resulted in increased rates of eczema in early childhood, although this was not sustained to nine years. Subsequent work in early adolescence found that postnatal weight gain was important in the developmental programming of blood pressure in this population and current and early-life malaria modified blood pressure and lipid levels. We also showed that variation in host genes significantly shapes antibody responses to multiple childhood vaccines, highlighting genetics as a key determinant of vaccine performance.

Cohort ‘children’ are currently aged 19–22 years, and future plans focus on investigating longer term effects of early-life and childhood exposures. A new round of data collection is ongoing with the aim of determining the impact of early-life exposures on adult non-communicable disease risk. Work determining whether frequent childhood infections lead to specific epigenetic changes implicated in later disease development is also underway.

The EMaBS began as a randomised controlled trial (ISRCTN32849447). Two further randomised controlled trials have been nested within the cohort: TB042 (NCT03681860) and POPVAC C (ISRCTN10482904).

Parenting interventions have shown promise in improving mental well-being for parents and children and strengthening family relationships. Parenting for lifelong health (PLH) is an open-access, evidence-informed programme that aims to improve positive parenting practices, reduce family violence and promote mental health, particularly in low-resource settings. This study will evaluate the implementation and (cost-)effectiveness of an adapted version of the PLH for Parents and Teens programme. It will focus on supporting positive parenting, communication, mental health and well-being of adolescents and their caregivers in North Macedonia and Moldova.

This multicountry hybrid type 1 effectiveness-implementation randomised waitlist-controlled trial will recruit 660 adolescents aged 10–14 years and their caregivers through schools, Youth Clinics and community partner organisations, including vulnerable and linguistically diverse families. The intervention group will receive the adapted PLH programme with assessments conducted postintervention and at 6-month follow-up. The waitlist control group will receive the adapted PLH programme after completion of the intervention group’s 6-month post-baseline assessment. Primary outcomes include adolescent emotional problems, family functioning, parenting practices, adolescent and caregiver quality of life. Secondary outcomes assess a range of mental well-being, family and other psychosocial outcomes. Other prespecified outcomes include implementation and cost outcomes. Primary analyses will compare intervention and waitlist control groups at postintervention and 6-month follow-up using intention-to-treat, baseline-adjusted linear mixed models. A within-trial economic evaluation will include cost–utility analysis and cost-effectiveness analysis. A macroeconomic analysis will assess broader economic impacts using public financing and budget impact analysis. The study uses a mixed-methods process evaluation, and integrates qualitative data, budget impact analysis and simulation modelling to inform scale-up considerations.

The study has received ethical approval from all relevant sites. Results will be disseminated through peer-reviewed publications, scientific conferences and webinars, newsletters, social media and open-access platforms, alongside engagement with researchers, clinicians, policymakers and the public. The Family-Focused Adolescent & Lifelong Health Promotion project uses a targeted communication and dissemination strategy for families, implementers and policy stakeholders to promote the adoption and scale-up of evidence-informed, open-access parenting interventions for adolescents and caregivers in low-resource settings. Dissemination focuses primarily on North Macedonia and Moldova while also engaging actors across the wider Eastern European region.

NCT07240571.

To evaluate the availability of mental health services and resources across a stratified multistage sample of care and treatment clinics (CTCs) delivering HIV care from eight geographical zones of Tanzania.

Cross-sectional facility-based baseline survey.

81 CTCs representing national geographical zones and service delivery tiers.

Health facility in-charges or service providers with knowledge of HIV/non-communicable disease (NCD) services (Tier 1: n=11; Tier 2: n=13; Tier 3: n=9; Tier 4: n=48).

Availability of (1) trained mental health professionals, (2) screening/assessment tools for mental health and (3) educational materials.

Mental health services were unevenly distributed across facility tiers. Over half of Tier 1 facilities reported having trained mental health professionals (6/11; 54.5%) and screening tools (6/11; 54.5%), compared with only 35.4% (17/48) and 2.1% (1/48), respectively, in Tier 4 facilities. No Tier 2 or Tier 3 facilities reported availability of trained staff or screening tools. Educational materials were present in only 18.2% (2/11) of Tier 1 facilities and 8.3% (4/48) of Tier 4 facilities. Overall, more than two-thirds of facilities lacked any mental health resource assessed.

Mental health services remain limited across all facility levels, with nearly complete absence at lower-tier facilities. Urgent investment is required to integrate mental health into HIV and NCD care, especially at primary care settings.

Dissemination of study results to research participants is an ethical imperative, yet it is rarely implemented in resource-limited settings partly due to a lack of clear guidance. The purpose of this study was to evaluate and explore dissemination activities that were conducted as part of a multi-site clinical trial of Plasmodium vivax treatment options, informing future dissemination strategies in similar resource-limited settings.

Qualitative study using focus group discussions (FGDs) and an inductive–deductive thematic analysis approach.

Clinical trial study site catchment areas in Cambodia, Ethiopia and Pakistan.

Dissemination attendees were invited to participate in FGDs, a subset agreeing and able to participate. There were 25 participants in Cambodia, 34 in Ethiopia and 23 in Pakistan.

The dissemination activities were well accepted by participants despite some expectations in receiving individual results rather than only aggregated trial results and suggestions for broader community dissemination. Dissemination participants perceived having learnt from the dissemination, demonstrating their knowledge of the trial and its results and attributing it to the dissemination. Dissemination activities may have failed to correct certain misconceptions, including the blurred distinction between clinical care and trial-related care; however, the dissemination had positive impacts, including making participants feel part of a larger endeavour.

Contributing to the limited data on dissemination in resource-limited settings, our findings provide context-informed recommendations that can be applied to similar settings. Our recommendations underscore the importance of tailoring activities according to participant preferences, such as potentially providing individual results and implementing broader community dissemination.

NCT04411836.

Healthcare systems increasingly screen for social needs, yet referrals often fail to connect patients with services—particularly in emergency department (ED) settings where unmet social needs are common. Our research highlights critical barriers to service connection, including unstable access to cellphones, limited internet and low digital literacy. These challenges disproportionately affect socio-economically disadvantaged groups and are associated with poorer health outcomes and more frequent ED visits. With the recognition of information and communication technology (ICT) access as a ‘super social determinant of health’, we have a timely opportunity to test solutions that address these disparities.

We will conduct a three-arm randomised controlled trial enrolling 600 ED patients across three ED sites. Participants are eligible if they self-report at least one unmet social need using the validated Screener for Intensifying Community Referrals for Health (SINCERE) screening instrument, identify barriers to ICT access and want to be referred to community services. Arm 1 will receive community service referrals using email or alternate phone numbers (211 service navigator outreach, usual care). Arm 2 will receive stable cellphone access and community service referrals (cellphone with data+211 service navigator outreach). Arm 3 will receive cellphone access, community service referrals and tailored digital navigation support (Cellphone with data+211 service navigator outreach+digital navigation). Primary outcomes will include community service use and health-related outcomes such as depression, anxiety, social support, loneliness, self-reported global health and healthcare utilisation over 6 months. Using a mixed methods design, we will explore contextual and individual factors influencing engagement and outcomes.

This study has been approved by the University of Utah Institutional Review Board (IRB). Findings will be shared with clinical and policy stakeholders, community organisations and published in open-access journals.

ClinicalTrials.gov NCT07174466, start of enrolment 3 November 2025.*

*The start date for this trial is listed as 8 August 2025 on ClinicalTrials.gov. This date marks the pilot procedures conducted with five patients under IRB approval. These patients were consented and the procedures were trialled to finalise the study protocol. These patients were not randomised and their data are not included in the trial. The trial was registered on ClinicalTrials.gov on 16 September 2025 and the first patient was enrolled and randomised on 3 November 2025.

Ventilator-induced diaphragmatic dysfunction is increasingly recognised as an important complication of prolonged mechanical ventilation (MV) and a major contributor to difficult weaning and extubation failure. Although bedside diaphragmatic ultrasound has emerged as a useful tool for assessing diaphragm function, conventional indices such as diaphragm excursion and thickening fraction may be influenced by ventilatory mechanics and patient effort. Speckle-tracking ultrasound (STU), a deformation-based technique adapted from echocardiography, allows assessment of diaphragmatic strain and strain rate and may provide a more accurate evaluation of diaphragmatic contractility. However, the predictive utility of diaphragmatic STU for successful liberation from MV remains uncertain. This study aims to systematically review the available evidence on the predictive performance of diaphragmatic speckle-tracking ultrasound for successful weaning from MV in adult patients.

This protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and is registered in the PROSPERO database. A comprehensive search will be conducted in MEDLINE (via PubMed), Embase, Scopus, Web of Science, LILACS/BVS and CENTRAL without restrictions on language or publication date. Observational studies and clinical trials evaluating diaphragmatic speckle-tracking ultrasound during the weaning process in adults receiving invasive MV for more than 24 hours will be eligible. Two reviewers will independently select studies, extract data and assess the risk of bias using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool for diagnostic and predictive accuracy studies and the Cochrane Risk of Bias 2 tool for randomised trials. When feasible, meta-analysis will be conducted using Review Manager software. The certainty of the evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE)approach.

Ethics approval is not applicable for this study since no original data will be collected. The results will be disseminated through peer-reviewed publication and conference presentations.

CRD420261338352.