An initial comparison of 16S rRNA gene sequences between Alkalispirochaeta alkalica Z-7491T and other members of the genus Alkalispirochaeta revealed ≥99.4% sequence similarity, suggesting their close relatedness and the possibility that some members are in fact the same species. The genus Alkalispirochaeta includes five species with validly published names. A. alkalica Z-7491T (=ATCC 700262T=DSM 8900T) and Alkalispirochaeta sphaeroplastigenens JC133T (=KCTC 15220T=NBRC 109056T) were both isolated from alkaline lakes (Lake Magadi in Kenya and Lonar Lake in India), respectively. The present study used whole-genome data to clarify the taxonomic assignment of these two closely related Alkalispirochaeta species. A. alkalica Z-7491T and A. sphaeroplastigenens JC133T share similar phenotypic and chemotaxonomic characteristics. They are Gram-stain-negative, motile, helical-shaped bacteria that require sodium for growth and grow optimally under alkaliphilic and mesophilic conditions, and their main cellular fatty acid is C18 : 1 ω7c. Overall genomic relatedness indices analyses indicated average nucleotide identity and digital DNA-DNA hybridization values >95.0% and >70.0%, respectively. These values exceed thresholds currently accepted for bacterial species delineation. Further, these taxa cluster together within the genus Alkalispirochaeta in both the 16S rRNA gene phylogenetic tree and the core-genome phylogenomic tree. Based on the combined evidence and the earliest validly published names, priority is given to Alkalispirochaeta alkalica (Zhilina et al. 1996) Sravanthi et al. 2016. Alkalispirochaeta sphaeroplastigenens (Vishnuvardhan Reddy et al. 2013) Sravanthi et al. 2016 is proposed to be a later heterotypic synonym of Alkalispirochaeta alkalica (Zhilina et al. 1996) Sravanthi et al. 2016.
Hip fracture and cognitive impairment often coexist in later life, but whether cognitive disadvantage precedes the fracture-report index, worsens afterward, or both remains unclear. We examined pre- and post-index cognitive trajectories among older adults with reported incident hip fracture and matched controls. We used Health and Retirement Study (HRS) data from 1996-2016. From 5,833 eligible US adults aged ≥ 65 years without baseline hip fracture, 543 incident hip fracture cases were matched to 1,538 controls using exact age/sex matching and propensity-score matching on sociodemographic, cognitive, and depressive-symptom measures. Incident hip fracture was reported at biennial interviews; cases were indexed at the age of first reported fracture, and matched controls were assigned the same index age. Global cognition was the primary out- come; mental status and memory were secondary outcomes. Event-centered piecewise linear mixed-effects models estimated pre-index slopes, index differences, and post-index slope differences, with covariate adjustment for residual imbalance. Sensitivity analyses examined raw-score outcomes, event-time assumptions, and post-index follow-up completeness. Of 558 eligible incident hip fracture cases, 543 were matched to 1,538 controls across 543 matched sets; the maximum absolute standardized mean difference was 0.055. For the primary outcome, global cognition was similar eight years before the index, lower by the index interview, and further separated eight years after the index. The post-index slope difference indicated additional worsening for global cognition (-0.022 (95% confidence interval [CI] -0.042 to -0.002)). Among secondary outcomes, mental status showed a similar adverse post-index slope difference (-0.030 (95% CI -0.052 to -0.007)), whereas memory did not (-0.009 (95% CI -0.028 to 0.009)). In this matched longitudinal analysis of US adults aged 65 years or older, reported hip fracture marked a more adverse trajectory of cognitive aging. Cognitive vulnerability was evident before the fracture-report index, cognition was lower by the index interview, and additional post-index divergence was most apparent for global cognition and mental status.
Miniaturization has emerged as a major technological trajectory in robotic surgery, encompassing single-port systems, flexible endoscopic platforms, capsule robotics, and microrobots designed to reduce surgical trauma and improve procedural precision. Despite rapid growth in this area, no previous bibliometric study has comprehensively mapped miniaturization as an integrated technological and clinical evolution across robotic surgery. Therefore, this study aimed to systematically analyze the global research landscape, collaboration patterns, thematic evolution, and emerging technological trends in miniaturized robotic surgery using advanced bibliometric and science-mapping approaches. A bibliometric analysis of 1,775 original articles indexed in the Elsevier Scopus database between 1996 and 2026 was conducted using Bibliometrix, VOSviewer, and CiteSpace to evaluate publication trends, collaboration networks, thematic evolution, citation bursts, and emerging technological trajectories. The literature demonstrated rapid expansion, with an annual growth rate of 17.1%, involving 6,293 authors across 492 sources and an international collaboration rate of 21.93%. The United States dominated scientific productivity and citation impact, followed by China, South Korea, Italy, and Germany. Thematic and cluster analyses identified robotic surgery, single-port systems, minimally invasive surgery, and medical robotics as the principal research domains. Citation-burst and trending-topic analyses revealed a temporal transition from capsule endoscopy, image-guided systems, and flexible robotics toward clinically deployable single-port robotic surgery, da Vinci SP platforms, partial nephrectomy, and postoperative pain. Highly cited studies emphasized continuum robotics, magnetic actuation, microrobotics, and biohybrid robotic systems, highlighting increasing convergence between robotic surgery, biomedical engineering, artificial intelligence, and nanotechnology. Miniaturization has evolved into a mature and rapidly expanding research domain characterized by strong technological convergence and increasing clinical translation. Current trends indicate a shift from feasibility-driven innovation toward intelligent, precision-oriented, and patient-centered robotic interventions.
Sungaya inexpectata is a tropical stick insect endemic to the Philippines, providing a useful system for investigating cold responses in tropical ectotherms. In this study, we exposed individuals to low temperature (8 °C) and normal temperature (25 °C) and characterized their transcriptomic responses. A total of 1656 differentially expressed genes were identified, including those involved in energy metabolism, cuticular proteins (CPs), and heat shock proteins. Since CP-related genes were notably enriched, we focused on this family. qPCR assessment provided preliminary expression profiles for selected candidate CP genes. Using comparative transcriptomics with eight New Zealand alpine stick insect species, we reconstructed the phylogeny of major CP families and annotated their conserved domains. Clade analysis revealed significant positive selection in the CPAP3-3 gene. In summary, this study reveals the transcriptional response of cuticular protein genes in S. inexpectata under cold exposure at 8 °C. These findings provide preliminary transcriptional data for understanding how this species responds to low temperature.
Differential synthetic aperture radar interferometry (DInSAR) of COSMO-SkyMed (CSK) SAR 1-day tandem pairs was used to map the 2020-2021 grounding line (GL) of the Cook Ice Shelf, East Antarctica, and to assess the observed retreat relative to the 1996 GL and 2018 grounding zone (GZ). To interpret the dynamics of the retreat, we combined annual ice velocities, ice-thickness change rates, and bed topography. Agreement between tidal predictions and DInSAR-derived vertical displacements within the hydrostatic-equilibrium zone indicates that the GL mapping is robust. The CSK-DInSAR GL shows inland retreat of ~ 5.8 km relative to the 2018 upstream GZ boundary in the western Cook East Ice Shelf and ~ 8.8 km relative to the 1996 GL across Cook West Ice Shelf, while other sectors remain stationary. In the retreating sector of western Cook East Ice Shelf, ice flow slowed in 2017-2018 and then increased by ~ 60 m/yr in 2018-2019, returning to prior speeds with no further acceleration. The retreat occurred where the 2018 upstream GZ already lay on a retrograde bed. The 2020-2021 GL occupies either a local prograde bed or a retrograde segment immediately seaward of a prograde transition, suggesting threshold-like retreat controlled by bed geometry.
Objective: To assess the disease burden of non-alcoholic fatty liver disease (NAFLD)-related cirrhosis in China from 1990 to 2021. Methods: Data were obtained from the Global Burden of Disease (GBD) 2021 study. The age-standardized rate was calculated using the direct standardization method with the GBD world standard population as the reference. The Joinpoint model was used to calculate the change of NAFLD-related cirrhosis in China, and the age-period-cohort analysis was used to estimate the independent effects of age, period, and cohort. Results: In 2021, the age-standardized incidence rate (ASIR) of NAFLD-related cirrhosis in China was 621/100 000, with the age-standardized prevalence rate (ASPR) of 15 606/100 000 and the age-standardized mortality rate (ASMR) of 0.31/100 000. The average annual percentage change (AAPC) of ASIR of the whole population from 1990 to 2021 was 0.74% (95%CI: 0.69%, 0.78%). There was a decreasing trend in the ASMR of the whole population with an AAPC of -1.73% (95%CI:-2.06%, -1.40%). The age effect showed a fluctuating downward trend in the overall incidence rate with age. The overall mortality rate showed an increasing trend. The period effect showed that the period rate ratios (RR) first decreased and then increased, with the highest incidence risk in 2017-2021. The period RR of incidence rate was 1.16 (95%CI: 1.11, 1.21). The trend of RR change in mortality rate showed a decreasing tendency, with the highest mortality risk in 1992-1996. The RR of mortality risk was 1.50 (95%CI: 1.43, 1.58). The cohort effect showed a significant increase in incidence risk and a decreasing trend in mortality risk from 1977 to 2002. Conclusion: The overall disease burden of NAFLD-related cirrhosis in China has shown a continuous upward trend from 1990 to 2021, and there are significant gender and age differences. 目的： 探究1990—2021年中国非酒精性脂肪性肝病（NAFLD）相关肝硬化的疾病负担。 方法： 利用2021年全球疾病负担研究（GBD 2021）中的中国NAFLD相关肝硬化负担数据，年龄标准化率采用直接标准化法并以GBD世界标准人口为参照进行计算，采用连接点模型分析趋势变化，采用年龄-时期-队列模型分析来估计年龄、时期和队列的独立影响。 结果： 2021年，中国NAFLD相关肝硬化的年龄标准化发病率为621/10万，年龄标准化患病率为15 606/10万，年龄标准化死亡率为0.31/10万。1990—2021年全人群年龄标准化发病率（ASIR）平均年度变化百分比（AAPC）为0.74%（95%CI：0.69%，0.78%）。全人群年龄标准化死亡率（ASMR）呈下降趋势，AAPC为-1.73%（95%CI：-2.06%，-1.40%）。年龄效应显示，随年龄增长发病率总体呈波动式下降的趋势。死亡率总体呈升高趋势。时期效应显示时期率比值（RR）呈先减低后升高趋势，2017—2021年发病风险最高，发病率的时期RR为1.16（95%CI：1.11，1.21）；死亡率的时期变化RR值变化趋势呈降低趋势，1992—1996年死亡风险最高，死亡率的风险RR值为1.50（95%CI：1.43，1.58）。队列效应显示，1977—2002年发病风险明显升高，死亡风险呈降低趋势。 结论： 1990—2021年中国NAFLD相关肝硬化的疾病负担总体呈持续上升趋势，且存在性别和年龄差异。.
Allergen immunotherapy (AIT) is the only disease-modifying treatment for grass pollen-induced allergic rhinoconjunctivitis (ARC). Three delivery routes-subcutaneous (SCIT), sublingual drops (SLIT-D), and sublingual tablets (SLIT-T)-lack head-to-head comparative evidence. To compare three ALK-Abelló grass pollen AIT modalities using pairwise meta-analyses and adjusted indirect treatment comparisons restricted to a single manufacturer. We searched PubMed, Embase, and CENTRAL for double-blind, placebo-controlled RCTs evaluating ALK grass pollen AIT. Primary outcomes were symptom scores (SS) and medication scores (MS), analyzed as standardized mean differences (SMD, Hedges' g). Indirect comparisons used the Bucher method. A prespecified sensitivity analysis excluded two biased studies (Dolz 1996, Feliziani 1995). GRADE assessed certainty of evidence. Studies span three eras: SCIT (1991-2006), SLIT-D (1995-2009), SLIT-T (2006-2017). Fifteen RCTs (5 SCIT, 3 SLIT-D, 7 SLIT-T; 3,546 patients) were included. SCIT and SLIT-T showed significant efficacy versus placebo; SLIT-D showed a non-significant trend. SCIT had the largest effects (SS: SMD = -1.07; MS: SMD = -1.35) but substantial heterogeneity (I2 = 89-91%), driven by the outlier Dolz 1996 (g = -6.59). SLIT-T showed consistent effects (SS/MS: SMD = -0.24; p < 0.001). In the sensitivity analysis, SCIT heterogeneity disappeared (I2 = 0%), effect sizes converged, and SCIT-vs-SLIT-T comparisons became non-significant. GRADE certainty: moderate for SLIT-T; low-to-very-low for others. Excluding high-risk-of-bias studies, SCIT and SLIT-T show broadly similar efficacy. SLIT-T provides the most robust evidence base. SLIT-D did not reach statistical significance in either analysis. Treatment selection should integrate efficacy, patient preferences, and practical considerations via shared decision-making.
Outdoor air pollutants have been inconsistently associated with pancreatic cancer incidence and mortality. We investigated associations between outdoor fine particulate matter (PM2.5) and nitrogen dioxide (NO2) and pancreatic cancer risk. We estimated historical pollutant concentrations at enrollment (1995-1996) residences in the NIH-AARP Diet and Health Study (N = 486,431). We estimated hazard ratios and 95% confidence intervals (HR [CI]) for associations (continuous and categorical) with incident pancreatic cancer overall (N = 4999) and pancreatic ductal adenocarcinomas (PDAC; N = 4708) in models adjusted for lifestyle and sociodemographic factors. We observed small, non-significant associations with pancreatic cancer overall (PM2.5 HR per 5 μ g / m 3  = 1.03[0.99-1.08]; NO2 HRper 10 ppb = 1.02[0.99-1.06]) and with PDAC (1.03[0.98-1.08]; 1.02[0.98-1.06], respectively). We found no exposure-response across categories (p-trend > 0.05). The PM2.5 association was apparent only among participants aged 55-64 years at enrollment (p-interaction = 0.04). Marginal associations between PM2.5 and NO2 and pancreatic cancer risk are consistent with a small number of prior studies. This study builds on a small prior literature of associations between air pollution and pancreatic cancer risk. Our analyses in a large U.S.-based cohort revealed small, positive, but non-statistically significant associations between PM2.5 and NO2 and incident pancreatic cancer, and some heterogeneity was suggested by age. Future research incorporating enhanced exposure assessment across more demographically and geographically diverse populations may help to further elucidate these associations.
The role of periacetabular osteotomy (PAO) in symptomatic borderline hip dysplasia (borderline HD) remains controversial because the lateral centre-edge angle may not reflect global dysplastic morphology. We examined whether selected borderline dysplastic hips showed additional dysplastic features and compared mid- to long-term outcomes with frank hip dysplasia (frank HD). This retrospective comparative cohort study included 33 patients (35 hips) with borderline HD (18° ≤ lateral centre-edge angle < 25°) and 319 patients (357 hips) with frank HD (lateral centre-edge angle < 18°) treated with PAO from 1996 to 2009. Radiographic morphology, Kaplan-Meier total hip arthroplasty-free survival, and patient-reported outcome measures (PROMs) after 1:3 propensity score matching were analysed. In the borderline HD cohort, 33 hips (94.3%) met at least one frank HD criterion other than lateral centre-edge angle and 12 hips (34.3%) met three or more. Mean follow-up was 14.0 years in the borderline HD cohort and 13.9 years in the frank HD cohort. One borderline dysplastic hip and 50 frank dysplastic hips underwent total hip arthroplasty. The 20-year survival rate was 90.0% in borderline HD and 78.8% in frank HD (log-rank p = 0.101). Matched PROMs did not differ significantly between groups. Borderline dysplastic hips selected for PAO usually showed multidirectional dysplastic morphology resembling frank HD. In carefully selected symptomatic borderline HD, PAO was associated with favourable long-term survival and PROMs comparable with frank HD.
Background/Objectives: Long-term clinical data on direct posterior composite restorations are scarce, particularly beyond simple survival outcomes. This study aimed to characterize the long-term functional, esthetic, and biological behavior of posterior composite restorations after nearly three decades of service using selected FDI criteria and to assess changes across available follow-up examinations, including within a predefined sub-cohort. Methods: This observational follow-up involved 21 patients with 57 posterior composite restorations placed in 1995-1996 at the Department of Operative Dentistry, Goethe University Frankfurt, by undergraduate dental students under supervision. The 2025 follow-up used FDI criteria to assess functional, aesthetic, and biological properties, classifying outcomes as clinically acceptable, intervention needed, or failure. Descriptive analyses were applied to the entire cohort. Longitudinal analyses were conducted on a sub-cohort of 14 patients with 27 restorations at three time points. Exploratory analyses assessed associations with restoration factors, caries experience, and gingival health. Results: In 2025, 54.4% of restorations were clinically acceptable, 28.1% required intervention, and 17.5% were failures. Functional criteria remained mostly acceptable, though form and contour showed the highest mean values. In the longitudinal sub-cohort, significant changes over time were observed in anatomical form and occlusal wear. Retention, marginal adaptation, proximal contact, and surface luster did not change significantly. Biologically, restorations available for direct assessment had low incidences of secondary caries, hard-tissue defects, and postoperative sensitivity or pulpal issues. Conclusions: Posterior composite restorations can function for nearly three decades but gradually deteriorate in certain aspects. Long-term changes mainly involve cumulative functional aging of the anatomical form and occlusal wear, rather than widespread biological failure. These findings underline the importance of differentiated long-term assessment and support conservative management approaches where clinically feasible before replacement is undertaken.
African swine fever (ASF) poses a persistent and escalating threat to global swine production. To comprehensively characterize its global spatiotemporal dynamics from 1996 to 2025, we developed an integrated framework combining multi-distance spatial analysis and advanced time series forecasting, utilizing a dataset of 57,253 outbreak records. Our findings reveal a clear divergence in transmission patterns: wild boar accounted for approximately 70% of outbreaks and predominantly sustained transmission in Eastern Europe, whereas domestic pig outbreaks were largely concentrated in Southeast Asia. A pronounced epidemiological shift occurred between 2017 and 2020, during which ASF spread transitioned from a predominantly north-south axis linking Africa and the Caucasus to a broad east-west expansion across Eurasia, coinciding with rapid dissemination throughout Asia. In the Northern Hemisphere, ASF outbreaks exhibited a bimodal seasonal pattern, with peaks observed in January-March and July-August. Comparative forecasting analyses demonstrated that machine learning approaches consistently outperformed both traditional statistical and deep learning models. Among these, the random forest algorithm achieved the highest predictive accuracy, surpassing SARIMA, Prophet, XGBoost, and GRU. Collectively, these findings underscore the pivotal role of wild boar in maintaining global ASF transmission and highlight the necessity of integrated surveillance at wildlife-livestock interfaces. Furthermore, they support the application of machine learning-based approaches for improving early warning systems and enhancing the effectiveness of global ASF control strategies.
This study explored the global scientific landscape of early mobilization after surgery and Enhanced Recovery After Surgery protocols. It aimed to identify research trends, key themes, and knowledge gaps to guide future evidence-based nursing practices. A bibliometric research design was employed to quantitatively map the scientific output and intellectual structure of this field. Data from 645 articles (1996-2025) were retrieved from the Web of Science database. Analysis was performed using the Bibliometrix R package. The metrics included keyword frequency, author productivity (Lotka's Law), and journal distribution (Bradford's Law). Publication volume has increased significantly since 2010, peaking in 2024. While the USA, China, and Germany are the most prolific, the UK and Denmark lead in terms of citation impact. Research is highly collaborative, with 90.4% of the authors contributing to a single study. The dominant themes included "enhanced recovery" and "outcomes," whereas "complications" and "operating room efficiency" remained underrepresented. International collaboration accounts for 13.33% of the literature. Although the field is expanding, it remains unevenly distributed across topics. This review provides a roadmap for nursing research by highlighting the need for more focused studies on under-represented clinical complications. This emphasizes that standardized reporting and interdisciplinary collaboration are essential for refining postoperative mobilization protocols.
Interpreting the histopathology report after stillbirth and applying it to care in a subsequent pregnancy can be challenging. A retrospective cohort study of singleton stillbirths in Iceland 1996-2021 (n = 338). Clinical information and description of placenta and umbilical cord were reviewed, and microscopic slides re-evaluated according to the Amsterdam Consensus. Clinical and histopathological findings, including major patterns of placental injury and umbilical cord at risk, were correlated and compared between gestational age groups: <28 weeks (n = 102), ≥28 but <37 weeks (n = 114), and ≥37 weeks (n = 122). Placental slides were reviewed for 96.4% (326/338) of singleton stillbirths and classified into major patterns of placental injury. Maternal vascular malperfusion (MVM) was diagnosed in 19.0% of placentas (62/326), fetal vascular malperfusion (FVM) in 31.6% (103/326), acute chorioamnionitis (ACA) in 32.2% (105/326), chronic villitis of unknown etiology (VUE) in 15.9% (52/326), and none of the major patterns in 27.9% (91/326). More than one pattern of placental injury was found in 7.7% of placentas (25/326), most often at term. A similar proportion of MVM was found irrespective of gestational age; FVM was more common after 28 weeks, ACA before 28 weeks, but VUE most frequent at term. A higher proportion of MVM was found in stillbirths with small for gestational age (SGA) infants than non-SGA (23.0 vs. 6.1%), as well as in stillbirths with maternal hypertensive disorder of pregnancy than in stillbirths with a normotensive mother (23.9 vs. 11.8%). The latter association was not seen with high-grade FVM nor VUE. The umbilical cord was at risk in 53.8% (175/326) of singleton stillbirths, increasing with gestational age to 71.7% (86/120) at term. Hypercoiled, excessive long, and wrapped cords were most common. Term stillbirths with cord at risk often also had placental MVM or VUE. Understanding major patterns of placental injury and their correlation with clinical phenotypes can help counseling after stillbirth. Stillbirths with placental MVM often had clinical signs suggesting a high-risk pregnancy. However, term stillbirths with placental VUE or FVM and umbilical cord at risk were commonly without recognized risk factors.
Extreme precipitation in the Eastern Himalaya is increasingly associated with coupled hillslope-floodplain hazards. This study examines the 17th-18th September 2020 rainfall event in Arunachal Pradesh initiating landslides and its downstream impacts in Assam, India, using multi-sensor satellite data and long-term rainfall records. Sentinel-2 imagery was used to map landslides and debris flows, Sentinel-1 SAR data to delineate flood extent, and IMD gridded rainfall (1996-2020) to analyse rainfall spell characteristics. The event triggered widespread slope failures, localized landslide damming, and a subsequent breach, generating sediment-laden flows that inundated ~ 100 km2 of the Dhemaji floodplain. A backscatter-derived Relative Flood Volume Index (RFVI) indicates spatial variability in inundation intensity, although it does not represent absolute flood volume. Rainfall analysis suggests that antecedent wetness from preceding spells preconditioned slopes, while peak daily rainfall (> 170 mm day-1) initiated landsliding. Power-law scaling shows negligible dependence of intensity on duration (R2 ≈ 0.0004), whereas cumulative rainfall exhibits a stronger relationship with duration (R2 ≈ 0.54). These results indicate distinct roles of rainfall intensity and accumulation in controlling landslide initiation and downstream flooding, respectively, highlighting the importance of compound rainfall forcing in rapid hydrogeomorphic cascades.
Type 2 Diabetes prevalence is rapidly increasing in low- and middle-income countries (LMICs), where constrained health budgets and inequitable resource distribution limit access to quality care. Primary healthcare is central to addressing these challenges; however, the implementation of evidence-based diabetes care remains inconsistent. This scoping review mapped implementation strategies for integrating diabetes care into primary healthcare settings in LMICs and identified associated barriers and facilitators influencing implementation. This review focuses on type 2 diabetes, given its predominance and relevance to primary healthcare delivery in LMICs, and followed the Joanna Briggs Institute methodology for scoping reviews and was reported in accordance with PRISMA-ScR guidelines. The search strategy was peer-reviewed using the PRESS checklist. Eight electronic databases were searched for studies published between January 1996 and November 2024. Eligible studies were conducted in LMICs, as defined by the World Bank, and described the implementation, adaptation, or evaluation of evidence-based Type 2 diabetes care in primary healthcare settings. Two reviewers independently screened titles, abstracts, and full texts. Implementation strategies were mapped to the Expert Recommendations for Implementing Change (ERIC) taxonomy, while reported barriers and facilitators were coded using the Consolidated Framework for Implementation Research (CFIR). Ninety-two articles describing 85 studies across 27 LMICs were included. Implementation strategies most frequently clustered within Engage Consumers, Change Infrastructure, and Use Evaluative and Iterative Strategies, whereas Adapt and Tailor to Context and Utilise Financial Strategies were less often explicitly reported. Forty-three studies reported clinical outcomes only, 11 reported implementation outcomes only, and 31 reported both. Studies more frequently reported improvements in clinical and/or implementation outcomes that combined multiple strategies, particularly provider training and decision support alongside patient or family engagement and pragmatic system redesign. Co-occurrence analyses indicated that Train and Educate Stakeholders was frequently paired with Engage Consumers, supported by supervision, feedback mechanisms, and infrastructure strengthening. CFIR mapping suggested that workflow integration, leadership engagement, regular supervision, and reliable medicine and diagnostic supplies were commonly associated with improved adoption and fidelity, while connectivity challenges, stock-outs, and high workload disrupted implementation and limited scale-up. Reporting of adoption, fidelity, and acceptability remained uneven, and financial strategies were poorly described despite their relevance to sustainability. In LMIC primary healthcare settings, diabetes care implementation most commonly emphasises provider training, infrastructure strengthening, and interactive support strategies, while explicit attention to contextual adaptation and financial mechanisms is less frequently reported. Implementation outcomes were reported to be influenced by leadership engagement, digital tools, and community involvement, alongside persistent constraints related to workforce capacity, supply chains, and feedback systems. Future implementation efforts should more explicitly address contextual fit, system integration, and sustainability when designing and scaling diabetes care interventions in primary healthcare.
Laser-driven light sources are critically important for lighting, display, and communication systems. However, the traditional phosphor ceramics used in these light sources suffer from low light conversion efficiency, low color rendering index and narrowly tunable color temperature. Here we present a approach of rapid pulsed high-temperature sintering technology to fabricate phosphor ceramics with both dense and grain refined microstructure simultaneously. It results in a 31% improvement in light conversion efficiency, markedly better color mixing uniformity, and 1.5-fold increased fracture toughness for Lu3Al5O12:Ce ceramics. Moreover, this method enables the Lu3Al5O12:Ce-CaAlSiN3:Eu composite ceramics with a 95-fold enhancement in quantum efficiency, showing white light under blue laser excitation with a color rendering index of 93 and good reliability. An accurate emission wavelength prediction model was also established with an interval below 5 nm from 495 to 605 nm, and achieved a broad color temperature range (1996-9803 K). This research enhances the development of high-performance light sources toward lighting and indoor/underwater visible light communication.
Refined risk stratification before randomization is clinically important for reducing prognostic imbalance across study arms when evaluating novel therapies for glioblastoma. However, current artificial intelligence-assisted prognostic models are often limited by complex computational pipelines, limited bedside applicability, and insufficient biological interpretability. This study aimed to develop a prognostic model, supported by an online-accessible platform, for individualized risk stratification of glioblastoma using MRI-based intratumoral heterogeneity and routinely available clinical features, and to investigate the biological meaning of model-driven risk stratification. This retrospective multicenter study included 836 patients with isocitrate dehydrogenase-wildtype glioblastoma from six centers between October 1996 and May 2025. The habitat risk score (HRS) for each patient was derived from a proposed intratumoral heterogeneity index and quantitative metrics extracted from three-dimensional preoperative MRI-based vascular habitat mappings. Independent predictors of overall survival (OS) were identified using Cox proportional hazards regression analysis, and three prognostic models (HRS model, clinical model, and radio-clinical model) were developed and validated in spatial and temporal external sets. Model interpretability was assessed using time-stratified Shapley additive explanations (SHAP) analysis. A web-based interactive platform was implemented for rapid individualized risk assessment. The biological meaning of model-driven risk stratification was explored using transcriptomic and histologic profiling. HRS, Karnofsky performance status (KPS), O6-methylguanine-DNA methyltransferase promoter methylation status, and extent of resection were identified as independent predictors of OS, with KPS and HRS contributing most strongly to survival prediction in SHAP analysis. The radio-clinical model demonstrated good predictive performance and outperformed the clinical model and the HRS model, with C-indexes of 0.74 and 0.77 in the spatial and temporal validation sets, respectively. It also effectively stratified patients into low- and high-risk groups regardless of first-line therapeutic regimen (log-rank, P < 0.05). Mechanistically, high-risk tumors showed increased tumor stemness and expanded HIF1α-positive regions, whereas low-risk tumors exhibited an immune-stimulatory phenotype. The deployed web-based platform enabled rapid patient-specific risk estimation to support bedside application. This study establishes an interpretable and clinically deployable framework for glioblastoma risk stratification by integrating imaging-derived intratumoral heterogeneity with routine clinical features, without requiring complex computational infrastructure. The model also provides biologically grounded insights into model-driven risk stratification.
Enhanced Recovery After Surgery (ERAS) pathways in thoracic oncology emphasize early mobilization and objective discharge readiness, but perioperative functional recovery is often assessed intermittently. Wearable devices may provide continuous, objective recovery metrics. We conducted a PRISMA 2020-based systematic review registered in PROSPERO (CRD420261325339). PubMed, Scopus, and Web of Science Core Collection were searched for English-language studies published between February 2, 1996 and February 2, 2026. Eligible reports included adults undergoing lung cancer surgery or clinically relevant pulmonary resection and evaluated wearable-based activity, physiologic monitoring, or rehabilitation support across the preoperative, in-hospital, or post-discharge phases. Risk of bias was assessed using RoB 2, ROBINS-I, or design-appropriate feasibility and measurement appraisal. Certainty of evidence was qualitatively informed by GRADE principles, and findings were synthesized narratively because of clinical and methodological heterogeneity. Eight reports representing seven independent cohorts were included: two randomized trials, one nonrandomized trial with historical controls, two prospective observational studies, two companion single-arm preoperative feasibility/effectiveness reports, and one development/usability agreement study. In the Move For Surgery RCT, wearable-enhanced preconditioning reduced prolonged hospital stay >5 days from 24% to 7% (12/50 vs 3/45; p=0.021). A digital chest drainage RCT reported shorter postoperative length of stay and chest tube duration in the intervention group, although the cohort was not restricted to lung cancer. Observational studies showed weak but significant associations between perioperative step counts and recovery outcomes. Feasibility studies supported device use and data transmission, while a smartwatch-ePRO study showed close agreement with electronic health record measurements. Wearable-based perioperative monitoring appears feasible and may provide objective recovery signals in lung cancer surgery. However, current evidence remains sparse, heterogeneous, and often indirect. Findings should be interpreted as hypothesis-generating rather than sufficient to support routine clinical implementation. https://www.crd.york.ac.uk/PROSPERO/view/CRD420261325339, identifier CRD420261325339.
The opioid overdose crisis constituted one of the greatest public emergencies in US history. The overpromotion and overprescription of oxycodone and Purdue Pharma's branded formulation, OxyContin, have been implicated as key drivers of the opioid overdose crisis. This study sought to understand Purdue's motivations in developing opioid abuse-deterrent formulations, drugs designed to reduce misuse, abuse, and diversion of prescription opioids. We conducted a qualitative archival analysis of internal corporate documents archived at the UCSF-JHU Opioid Industry Documents Archive (OIDA). We gathered, coded, and analyzed over 80 internal documents spanning from 1996 to 2010 to reconstruct the timeline of events and motivations that drove Purdue's development and eventual release of an abuse deterrent formulation OxyContin in the US. These primary data included emails, slideshows, and other textual and visual documents. We used regulatory documents and court records as a supplementary data source to triangulate and validate our OIDA-based findings. Purdue initially proposed the development of an abuse-deterrent formulation of OxyContin as a strategy to protect its patents and prevent the introduction of a competing generic formulation of oxycodone. When the company successfully litigated against the introduction of a generic medication, it stopped attempting to develop a reformulation until the regulatory environment changed in a way that would prevent competition if Purdue released the reformulated OxyContin. Pharmaceutical companies may focus on strategies such as abuse-deterrent formulations to protect market share rather than to protect public health. Regulators should be aware of the potential risks of encouraging this approach.
Musculoskeletal and back health of school aged children is a global health problem, with evidence that the prevalence of these problems is increasing. Many modern school systems require children to assume sedentary positions for extended periods of time, and the increasing use of classroom-based technology adds to the number of hours seated. With the incidence of musculoskeletal pain reported not only in adult populations but increasingly in young people, an understanding of spinal health and posture may be essential for students. The main objective for conducting this review was to conduct a best evidence systematic review. This means we only included the highest quality papers on the effectiveness of school-based education programs on back health for improving knowledge of back health, ergonomics and postural behaviour in school children aged 4-18 years. We searched the following 21 electronic databases from inception till the 20th January 2023: AMED (EBSCOhost), APA PsycINFO (EBSCOhost), Best Evidence Medical Education (BEME) (EBSCOhost), British Education Index (EBSCOhost), CINAHL (EBSCOhost), Cochrane Central Register of Controlled Trials (Wiley), EMBASE (Ovid), ERIC (EBSCOhost), EThOS (British Library), Europe PMC (Europepmc.org), GoogleScholar. Health Technology Assessment (HTA) (INAHTA), Health Management Information Consortium (HMIC) (Ovid), MEDLINE (EBSCOhost), PEDro (pedro.org.au), ProQuest Dissertations & Theses (Proquest), ProQuest Nursing and Allied Health Database (ProQuest), SCOPUS (Elsevier), SportDISCUS (EBSCOhost), Web of Science (Arts and Humanities Citation Index, Science Citation Index Expanded, Social Sciences Citation Index, Emerging Sources Citation Index, Conference Proceedings Citation Index - Science, Conference Proceedings Citation Index - Social Sciences and Humanities; Clarivate), ZEToC (British Library). Selection Criteria. The population eligible for the review included all children and young people between 4 and 18 years of age, attending school. Exclusion criteria: Children under 4 years of age and adults over 18 years of age; chronic disease or conditions or co-morbidities. Studies needed to meet the following criteria to be included: any formal educational school-based programme that included back health, ergonomics and postural behaviour that was designed to support the educational performance of students' knowledge of posture and ergonomics within an educational establishment. We excluded physical activity or exercise only interventions. Included studies were required to have a control group that represented either business-as-usual (no intervention), or a wait-list design. We included studies that examined back care knowledge, knowledge of back care ergonomics, back care behaviours and knowledge of back posture. This was a Best Evidence Systematic Review and only research papers scoring a "good" or "excellent "on the Downs and Black (1998) risk-of-bias form were included. The following research designs were included: randomised controlled trials (RCTs), cluster randomised controlled trials (CRCT) and quasi-randomised controlled trials (QRCTs). We included prospective non-randomised studies (NRSs) with a control group because it was anticipated that very few RCTs would be found. Controlled before-after studies (CBAs), interrupted time series (ITS) studies as well as controlled studies that were non-randomised and included a pre- and post-test were also eligible for inclusion. Titles and abstracts were screened in duplicate. Full texts of studies with seemingly relevant abstracts were retrieved and assessed for eligibility using the pre-specified inclusion criteria. Full texts were also screened in duplicate. Studies were classified as either included or excluded. Two authors independently extracted data from relevant studies. 1,327 potentially relevant papers were found through the searches of the academic databases, while no studies were identified through searches of grey literature and reference lists. After removing 1,256 articles which did not meet the inclusion criteria, 71 studies remained for screening. 37 articles were excluded based on screening the titles and abstracts. This left 34 articles for further examination of full texts. After the full texts had been read, these 34 studies continued to the quality assessment/risk of bias stage using the Downs and Black ROB form. Only two papers scored 20 or over (i.e. good or excellent) and were included in this systematic review. As the outcomes of the two studies differed, it was not possible to conduct a meta-analysis. Therefore, a narrative synthesis was conducted. Each of these studies showed statistically significant improvements on knowledge and behaviour, in the short term (3-8 months) though these need to be interpreted in light of concerns regarding risk of bias. Despite the comprehensive search of electronic databases, grey literature, hand searching, journals and reference lists of included studies, we only found two 'good' quality studies (scoring 20-25). No studies achieved an "excellent" score, that provided "excellent" evidence, on the effectiveness of school-based education programs on back health for improving knowledge of back health, ergonomics and postural behaviour in school children aged 4-18 years. This highlights the urgent need for high-quality studies to be conducted to assess the effects of these programmes due to the importance of ergonomics and posture in the activities of daily living of school children. Declarative title Educating School children on their Back Health can improve their Knowledge of Back Health, Posture and Ergonomics (functional design) The review in brief: A review of 1,327 studies identified only two robust enough for analysis. While these studies reported improvements in students’ knowledge and behaviour, potential selection and confounding biases limit the findings. Consequently, there is insufficient high-quality evidence to confirm the efficacy of school-based back health programs for children aged 4–18. Further rigorous research is essential to determine if these interventions effectively improve long-term ergonomics and postural habits. What is this review about? Proper posture training helps the body move efficiently, reducing strain on bones, joints, and soft tissues. Poor posture can cause muscle soreness, headaches, poor circulation, stress, and sleep disturbances. To avoid these issues, the work or school environment should be adapted to the user’s needs, a principle known as ergonomics. Ergonomics boosts productivity and comfort by reducing discomfort. Understanding ergonomics helps students prevent injuries in schools by adjusting tools like desks, chairs, and computer screens, emphasising correct posture to reduce repetitive strain and musculoskeletal issues. Poor ergonomic practices and resulting postures are recognised causes of musculoskeletal aches and pains (Sellschop et al., 2018). Ergonomic assessment in schoolchildren is important, as their activities and postures may contribute to the high prevalence of pain among young people, potentially leading to chronic issues later in life (Pavithra & Anand, 2013; Weiguang et al., 2011). The high rates of back pain in children and adolescents, as well as its predictive value for adult spinal pain, have prompted calls for spinal health interventions in schools . Habits formed during school years can influence the likelihood of developing back problems in adulthood. Back pain in adolescence is a risk factor for pain in later years (Harreby et al., 1996), with risk increasing alongside the frequency of adolescent pain (Lise, Charlotte, & Kyvik Kirsten, 2006; Lise, Charlotte, Ohm, et al., 2006). A systematic review and meta-analysis by Salsali et al. (2023) found a weak correlation between physical activity and posture, suggesting multiple factors influence posture. The study emphasises the need for caution when interpreting meta-analyses due to heterogeneity and publication bias. This Campbell best evidence systematic review assesses the effectiveness of school-based education programmes on back health for improving knowledge, ergonomics, and postural behaviour in school children aged 4–18 years. Despite extensive searching, only two methodologically robust studies met the criteria for inclusion. What are the main findings of this review? Out of 34 studies reviewed (1961–2013), only two were robust enough for inclusion. Due to outcome variations, a narrative synthesis replaced a meta-analysis. Although both studies reported significant gains in knowledge and behaviour, a high risk of bias requires cautious interpretation. Ultimately, the scarcity of high-quality research means there is no strong evidence that school-based programs effectively improve ergonomics or postural behaviour in children aged 4–18. The current evidence base remains insufficient to support broad implementation. What do the findings of this review mean? Despite extensive searches across academic databases, grey literature, and reference lists, only two studies scored ‘good’ (20+ on the Downs and Black scale), and none reached ‘excellent’ (25-28). This highlights the urgent need for high-quality research on school-based back health programmes, as ergonomics and posture are crucial for school children’s well-being and preventing back pain in adulthood. How up to date is this review? The review authors searched for studies published up to 20th January 2023.