The increasing frequency and severity of wildfires has necessitated assessing fire effects on soil systems. Variation in fuel loads and fire effects create landscape mosaics with distinct abiotic properties, a heterogeneity that has been dubbed pyrodiversity. Expanding on the pyrodiversity framework, the pyrodiversity-biodiversity hypothesis posits that pyrodiversity increases niche diversity, thereby promoting biodiversity. This hypothesis, however, has remained untested for soil microbes and microeukaryotes. We explored this hypothesis for soil fungal communities using pre- and post-fire data from three empirical fuel load manipulations and across a total of five different vegetation contexts. We first compared pre- and post-fire abiotic heterogeneity to test whether fuel load manipulations would lead to greater environmental heterogeneity, particularly in soil properties. We then tested whether such manipulations led to greater fungal biodiversity as measured by fungal richness, β-diversity, and community dispersion. Labile abiotic soil resource (e.g. plant available phosphorus and inorganic nitrogen) heterogeneity increased post-fire, but this effect depended on the experimental context. In contrast, we observed little evidence for pyrodiversity-associated increases in post-fire fungal richness or diversity; community dispersion increased only in the study with the most extreme fuel load manipulations. Although our analyses did not clearly answer whether pyrodiversity begets biodiversity, our results highlight the nuances of soil responses to fire. Pyrodiversity-biodiversity linkages appear to depend on the system and on the diversity metric: the hypothesis had no support based on fungal richness, but community dispersion provided some support, even if only in one experiment. Understanding system-specific responses may be particularly important as fires increase in systems where they have been suppressed or have been historically rare.
This study investigated context-associated variation in vocalizations in Malinois dogs through acoustic parameter analysis. Vocalizations from thirty adult Malinois dogs (15 males, 15 females) aged 2 to 3 years were recorded across 11 behaviourally defined contexts. Using Praat software, key acoustic parameters-fundamental frequency (F0), harmonic-to-noise ratio (HNR), and formant frequencies-were extracted and analyzed. Results indicated that different vocalization types (barking, whimpering, growling, snarling, howling) exhibited distinct acoustic profiles. Whimpering and howling showed significantly higher F0 values than barking (p < 0.05), with whimpering uniquely displaying both low and high F0 components. Dogs in contexts expected to be positively valenced (e.g., food anticipation) showed lower HNR than those in contexts expected to be negatively valenced (e.g., separation) (p < 0.05). However, the actual internal states were not independently verified. Formant analysis revealed that snarling and howling had lower Formant 1 (F1) values (p < 0.05), while formant dispersion varied with emotional state. These findings suggest that acoustic analysis of dog vocalizations can provide objective insights into dogs' motivational and arousal changes, thereby improving our understanding of canine vocal communication, social behavior, and the human-dog bond. This approach has potential applications for working-line Malinois breeding programs and for enhancing human-working dog interactions.
Hazardous acoustic event detection is critically important for intelligent surveillance, emergency response systems, and public safety monitoring applications. Accurate and real-time identification of dangerous sound events such as explosions, alarms, screaming, and weapon-related sounds can significantly improve situational awareness and accelerate emergency response in safety-critical environments. This study proposes a lightweight deep learning architecture for hazardous sound classification based on convolutional feature extraction and channel attention mechanisms. The proposed framework utilizes log-mel spectrogram representations as input and incorporates a TinyCNN backbone enhanced with squeeze-and-excitation channel attention modules to improve discriminative spectral feature learning while preserving computational efficiency. A custom balanced dataset consisting of eight hazardous acoustic classes, including crying, dog barking, emergency alarm, explosion, fire, glass breaking, screaming, and weapon-related sounds, was constructed with one thousand audio samples per class. The model was evaluated using accuracy, precision, recall, and F1-score metrics. Experimental results demonstrate that the proposed architecture achieves strong multi-class classification performance while maintaining real-time inference capability suitable for edge deployment scenarios. Quantitative evaluations confirm the effectiveness of the lightweight framework for hazardous acoustic event detection. Additional ablation studies indicate that the integration of channel attention mechanisms and spectrogram-based augmentation strategies substantially improves model robustness, feature discrimination, and generalization performance. The obtained findings demonstrate that the proposed lightweight channel-attention-enhanced architecture provides an efficient and reliable solution for real-time hazardous sound detection in intelligent monitoring and public safety systems. The combination of computational efficiency and robust classification performance highlights the suitability of the proposed framework for deployment in resource-constrained and edge-based environments.
Canines exhibit various behavioral abnormalities, such as excessive barking, destructive behaviors, and indoor defecation when left at home alone. Identifying these abnormal behaviors and implementing scientific and reasonable interventions can help improve canine welfare and promote harmonious coexistence between humans and companion animals. However, existing canine behavior recognition methods struggle to adapt to the characteristics of strong temporal continuity and uneven motion amplitude of abnormal behaviors exhibited by lonely dogs, resulting in inadequate temporal feature representation and low recognition accuracy. Therefore, this study developed a TP-CanineNet model based on a Weakly Supervised Video Anomaly Detection (WS-VAD) framework to address this issue. The model integrated a Temporal Context Aggregation (TCA) module to efficiently capture local-global temporal dependencies and suppress temporal noise, and further enhances the representation of temporal features in dog behaviors. Meanwhile, a Pseudo-Instance Discriminative Enhancement (PIDE) module is adopted to strengthen the feature distinction between abnormal and normal behaviors. We constructed an Alone-Dog dataset comprising 430 video samples and 60 ground-truth labeled samples to validate the model's effectiveness. Experimental results showed that the proposed model achieved a frame-level AUC of 85.19% and an AP of 72.55%, representing improvements of 2.20% and 8.33%, respectively, over the baseline model. The method can provide intelligent detection of domestic dog behaviors when left alone at home.
Chronic nonspecific cough in children is a common and challenging clinical problem. Flexible bronchoscopy plays a crucial role in identifying underlying etiologies when non-invasive investigations are inconclusive. This study aimed to assess bronchoscopy and related diagnostic findings in children presenting with chronic cough. This prospective cross-sectional study included 64 children aged 3 months to 18 years who presented with chronic nonspecific cough lasting more than four weeks. All patients underwent a standardized evaluation that included clinical assessment, laboratory tests, chest X-ray, and high-resolution CT. Pulmonary function testing was performed in children older than five years. Flexible bronchoscopy was conducted, and bronchoalveolar lavage samples were examined for cytological and microbiological analysis. This prospective study included 64 children (32 males) with a median age of 8 months (IQR 36-84) with chronic cough, classified as dry (n = 38), wet (n = 21), or barking (n = 5) cough. Bronchoscopy revealed abnormalities in 87.5% of cases, most commonly purulent secretions and congenital airway anomalies. BAL showed neutrophilia in 95.3%, and cultures were positive in 20.3%, mainly for Haemophilus influenzae and Streptococcus pneumoniae. For predicting PBB, the combined multivariable model demonstrated good discriminative ability (AUC = 0.809, P = 0.004). Increasing age (OR = 1.038, P = 0.024) and tobacco smoke exposure (OR = 4.15, P = 0.04) were significant independent predictors. For congenital airway anomalies, the combined model demonstrated excellent predictive performance (AUC = 0.912, P < 0.001), outperforming individual clinical variables. Flexible bronchoscopy demonstrated a high diagnostic yield in children with chronic cough that remained unexplained following comprehensive noninvasive evaluation. However, a definitive assessment of its clinical utility requires direct comparison with other diagnostic modalities, which is addressed in the subsequent analysis.
Multimodal perception can often evoke performance that is greater than the sum of its unimodal parts in cognitive tasks. For example, choice reaction time research has found responses to multimodal stimuli that are faster than could be explained by responses to its individual unimodal components. This has led to a growth in multimodal perceptual research to explain behavioural observations, but less is known about multimodal influences on more cognitively demanding tasks such as semantic activation and memory. Across 3 well-powered pre-registered memory experiments (total n = 792), this study tested if multimodal encoding could reduce perceptual demands, evoke semantic processing, and encourage episodic recollection. In Experiment 1 the presence of congruent visual information aided later unimodal auditory retrieval (e.g., a dog picture and a barking sound), but multimodal manipulations had similar effects across young and older adults. Experiment 2 equated auditory only and visual only memory for picture-sound items by utilising blurring of the visual pictures, generating a novel shared stimulus set. Here there was no benefit to multimodal encoding, and identifiability of a given stimulus was more strongly related to memory following multimodal encoding than memory following unimodal encoding. Experiment 3 utilised the remember-know paradigm and found no specific multimodal encoding effects on episodic remembering, but did find that item identifiability was more strongly linked to recollection than to familiarity. Our data highlight how multimodal processing is nuanced and supports a general need for multimodal research to explain wholistic sensory processing.
Cohabiting companion dogs establish hierarchy among themselves. It is hypothesized that the owner represents the main and undividable resource, thus primary access to this is a main organizing factor of rank-related behaviors of dogs. Here we tested high- and low-ranking cohabiting companion dogs' (N = 70) reactions to their owner's absence in a 3 min separation test. Rank scores have been assigned with a validated questionnaire (DRA-Q). We predicted that dominant dogs would show stronger reactions to being separated from their owner. Indeed, we found that higher-ranking dogs showed more intense activity and sooner arising attempts to leave the room (rearing at the wall, scratching the door, moving around, barking) than lower-ranking dogs did. These reactions may show also the intention to reestablish their connection with the absent owner. The associations between dogs' rank and the behavioral responses were modified by the dogs' age (negatively), the number of cohabiting dogs (positively), and we found that subcategories of the dog's dominant status (such as 'agonistic' and 'leadership' subscales) were also associated with finer details of the outcome. These are the first results indicating that presence of the owner may provide more reassurance to higher-ranking dogs against stress than it does to lower-ranking dogs.
Human activities increasingly reshape wildlife diel activity patterns, yet species-specific adjustments across land-use gradients with varying levels of human pressure and protection remain poorly understood. Nepal's 2020 COVID-19 lockdown created a quasi-experimental reduction in human mobility, allowing clearer attribution of temporal responses to human pressure. Using camera trap data from matched 30-day windows (March 24-April 24) in 2019 (pre-lockdown) and 2020 (lockdown) across the Bardia complex, representing a mosaic of human pressure and protection gradients, including Bardia National Park (NP), its buffer zone (BZ), and adjacent human-dominated areas outside of buffer zone (OBZ). NP-2020 treated as the baseline and quantified species-specific activity patterns with kernel densities, coefficients of overlap (Δ, 95% CIs), circular mean peak-time shifts (hours, 95% CIs), and a nocturnality index (% detections between 19:00-05:00 h, 95% bootstrap CIs). We analyzed four contrasts and reported overlap and peak-time shifts within species, contrasting NP-2020 with the same species in BZ and OBZ during survey periods 2019 and 2020. Relative to the NP-2020, herbivores -especially chital, barking deer, hog deer, and wild boar shifted activity peaks by ~ 6-11 h toward night and showed reduced overlap within-species in BZ and OBZ, with several near anti-phase schedules in OBZ. Sambar remained comparatively stable and crepuscular, while tigers exhibited low NP-BZ overlap and near 12 h offsets in their activity peaks. Lockdown conditions increased overlap and attenuated nocturnal displacement for several species (notably chital and sambar), evidencing rapid behavioral relaxation. The dominant pattern is a gradient of increasing nocturnality and declining overlap in activity patterns as human pressure increases from NP to BZ to OBZ, with persistent nocturnality in hog deer and wild boar indicating chronic constraints. We emphasize integrating temporal refugia into management by limiting high-intensity human activities during crepuscular periods and reducing nighttime noise and lighting at forest-agriculture interfaces, so wildlife need not rely on extreme nocturnality to coexist with humans. Long-term monitoring that couples activity metrics (overlap, peak-time shifts) with environmental factors and physiological indicators is needed to evaluate demographic and fitness consequences and to inform temporal ecology in multi-use landscapes.
To demonstrate the effectiveness of surgical treatment for complicated expiratory tracheal stenosis. The authors present anamnestic data, symptoms, diagnostic approaches, surgical features and outcomes in a patient with expiratory tracheal stenosis and syncopal episodes. Expiratory tracheal stenosis remains an underdiagnosed and underestimated condition. Primary etiopathogenetic factor is excessive intrathoracic pressure during exhalation. The gold standard for diagnosis is tracheobronchoscopy. Imaging techniques are useful only in dynamic formats. Conservative therapy (anti-inflammatory, mucolytic and bronchodilators), including positive end-expiratory pressure (PEEP) ventilation, is effective for most patients, but should be considered as a palliative measure. Surgical treatment aimed at posterior tracheal wall reinforcement is indicated for complications such as syncopal episodes, severe barking cough, and impaired social functioning. Minimally invasive techniques are available and appropriate for expiratory tracheal stenosis. Long-term outcomes depend on consistent lifelong pulmonological care. Иллюстрация эффективности хирургического лечения при осложненном экспираторном стенозе трахеи (ЭСТ). Представлены описание анамнеза, клинических проявлений и методов диагностики, а также особенности хирургического лечения и его результаты у пациента с ЭСТ, приводящим к синкопальным состояниям. ЭСТ остается недооцененным заболеванием. Основным патофизиологическим механизмом ЭСТ является чрезмерное давление в грудной клетке на выдохе. Основным вариантом диагностики остается фибротрахеобронхоскопия. Лучевые способы визуализации имеют смысл только при их динамических вариантах. Консервативная терапия (противовоспалительная, муколитическая, бронходилататационная), включая дыхание с положительным давлением в конце выдоха, у большинства пациентов с ЭСТ эффективна, но ее следует относить к паллиативному варианту. Хирургическое лечение, направленное на укрепление задней стенки трахеи, показано в тяжелых случаях, при развитии таких осложнений, как синкопальные состояния, сильный лающий кашель, ограничивающий социальную адаптацию. При лечении больных с ЭСТ доступны и приемлемы миниинвазивные технологии. Отдаленный результат лечения зависит от адекватной пожизненной терапии под наблюдением пульмонолога.
Minimally invasive repair of inguinal hernias offers several advantages over the conventional open approach in the context of reduced postoperative pain and faster return to daily activities with a non-inferior recurrence rate. With the increasing adoption of robotic platforms in surgical units worldwide, robotic transabdominal pre-peritoneal (rTAPP) repair has become an increasingly popular option offered to the patients. Successful surgical outcomes for any minimally invasive inguinal hernia depend on thorough understanding of the internal landmarks of myopectineal orifice (MPO). A conceptual framework such as inverted Y or 5 triangles described by Furtado et al. is essential to be understood prior to embarking on any minimally invasive inguinal hernia repair. While complex inguinal hernia repairs have traditionally been relative contraindication for laparoscopic repair due to technical difficulties, the robotic approach may help overcome these challenges. What sets this technique apart is the integration of a structured teaching framework designed to standardise the dissection process. We present the case of an 82-year-old female who underwent rTAPP for bilateral inguinal hernias, classified per the European Hernia Society (EHS) as right (P L2M0F1) and left (P L1M0F1). Following Veress needle insufflation, a 12-mm visiport was inserted in the right pararectal space, with two 8-mm robotic ports placed in linear alignment. Instrumentation included a bipolar grasper, camera, and monopolar scissors. A self-adhesive mesh and barbed sutures were introduced intra-abdominally at the outset. Total operative time was 80 minutes. The urinary catheter was removed post-procedure, and the patient was discharged the same day following an uneventful recovery. In this surgical technique we visually overlay Furtado's concept onto the robotic intraoperative view to create a reproducible anatomical roadmap. By mapping these defined safety and danger zones during the robotic dissection, we translate theoretical anatomy into a practical, stepwise intraoperative guide. This educational overlay aims to enhance reproducibility, anatomical orientation during the surgical learning curve, and potentially reduce complications or recurrence by promoting consistent identification of key landmarks. Whilst further randomised studies comparing robotic and laparoscopic approaches are needed to fully assess the role of robotic approach in surgical treatment of inguinal hernias, this visual framework serves as a training tool for surgeons adapting rTAPP.
5-Aminolevulinic acid (5-ALA) guidance helps to maximize surgical resection in Glioblastoma (GBM). It is unclear if the residual 5-ALA pattern can predict the outcome of GBM patients. Patients with GBM treated at our center between January 2018 - Jun 2022 were included. The pattern of 5-ALA residual was classified as no residue; focal residue (5-ALA in 1-2 walls); or diffuse residue (all walls involved). Pattern of recurrence - focal, diffuse or distal - was classified upon central radiology review. Total of 120 patients were screened and 46 were included. The majority of patients presented with temporal lesion (50%) and gross total resection was achieved in 56.52%. No 5-ALA residual was seen in 50% of patients; 39% had focal and 11% had diffuse residual. The pattern of 5-ALA residual - none or focal versus diffuse - was predictive of OS 16.4 versus 9.3 months (p = 0.018) and PFS 10.9 versus 4.5 months (p = 0.007). The univariate analysis showed that extent of resection (HR 0.59, 95% CI 0.39-0.88, p = 0.010), adjuvant chemotherapy (HR 0.39, 95% CI 0.18-0.84, p = 0.016), and higher number of cycles (HR 0.85, 95% CI 0.75-0.97, p = 0.012) were also significantly associated with longer survival. Diffuse 5-ALA residual is a poor prognostic factor for OS and PFS. The absence of a survival benefit of none over focal 5-ALA residual at the end of resection is important for intraoperative decision making.
Middle meningeal artery embolization (MMAE) has emerged as a treatment for chronic subdural hematoma (cSDH), but comprehensive real-world safety data remain limited. We performed a multicenter retrospective analysis of 1781 consecutive patients undergoing MMAE for cSDH (2019-2025). The primary outcome was any procedure-related complication within 30 days. Inverse probability of treatment weighting (IPTW) assessed the association between technical success and complications, adjusting for demographic, clinical, and procedural confounders. Mean age was 72.8 ± 12.4 years; 68.1% were male. The 30-day complication rate was 5.1% (91/1781; 95% CI, 4.1-6.2). In-hospital mortality was 2.9% (47/1625). Technical success was achieved in 97.5% (1505/1543). Among documented complications, thromboembolic events were most common (37.2%; 32/86), followed by hemorrhagic complications (23.8%; 20/84) and access-site hematoma (10.4%; 8/77). Among patients with classifiable symptom status, 80.6% of complications were symptomatic, yielding an overall symptomatic complication rate of 3.0%. Neurological deterioration occurred in 27.1% (248/915). Among 1552 patients with documented surgical approach, complication rates were similar between surgery plus embolization (4.9%; 34/690) and embolization alone (5.2%; 45/860; OR, 0.94; 95% CI, 0.59-1.48; p = 0.79). After IPTW adjustment, technical success was associated with an 86% reduction in complication odds (OR, 0.14; 95% CI, 0.05-0.40; p < 0.001). In this large multicenter cohort, MMAE was associated with a 5.1% complication rate. Technical success was the strongest protective factor. Embolization with or without surgery showed equivalent safety profiles.
To assess current perceptions of training in adolescent and young adult healthcare among UK resident doctors and educational supervisors (ES), and to identify barriers and opportunities for improvement. Cross-sectional national survey of resident doctors and ES, followed by qualitative focus group discussions. UK-wide, involving medical specialties participating in internal medicine training (IMT) and higher specialty training programmes. 670 resident doctors and 64 ES across 29 specialties. A subset of nine participants (four ES, five resident doctors) took part in focus groups. Exposure to training, confidence in managing adolescent medicine, awareness of transition care tools and policies, perceived barriers and suggestions for improvement. 18% of resident doctors had attended transition clinics and 38% reported no formal training in adolescent medicine. 5% of respondents were aware of national training guidance. Confidence and preparedness were low, with significant variation across specialties. ES confirmed the importance of adolescent medicine training but noted systemic limitations. Key barriers included limited clinical opportunities, lack of curricular emphasis and poor interdepartmental coordination. Training in adolescent medicine remains inconsistent across UK specialties. System-wide reforms are needed to improve preparedness and care quality. This may include mandating adolescent care competencies, structured clinic access and integration into curricula.
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Cerebral arteriovenous malformations (cAVMs) are congenital cerebrovascular anomalies that are associated with a high risk of intracerebral bleeding, which may be exacerbated by cerebral vasospasm (CVS). Despite advances in treatment modalities such as microsurgical resection, stereotactic radiosurgery, and endovascular embolization, CVS remains a significant concern, often precipitating significant neurological morbidity and mortality. Nimodipine, a calcium channel blocker, is widely used in aneurysmal subarachnoid haemorrhage (aSAH) to reduce neurological deficits. However, its role in cAVM-related CVS remains unclear. We performed a comprehensive review, collecting all cases reporting nimodipine use in adult cAVM patients in the literature. We aimed to identify the role of nimodipine in preventing cerebral ischaemia and deterioration in these patients. We executed a qualitative synthesis and calculated risk ratios for aneurysmal presence and odds ratios between the use and absence of nimodipine. Fisher's exact test was also used to calculate p-values when n < 5. A total of 12 articles were included, reporting 27 patients with a mean age of 41.3 years and equal gender distribution. Postoperative neurological deficits were reported in 40.7% of patients receiving nimodipine. Patients who received nimodipine had lower mortality (10.7%) compared with those who did not (33.3%). Current evidence is confined to small, heterogeneous case series; prospective, controlled studies with standardised nimodipine regimens are required to define its role in cAVM-related vasospasm and neurological outcome.
People with severe mental illness have higher rates of cardiometabolic morbidity and premature mortality than the general population. Altered brain energy metabolism can contribute to psychiatric symptoms, suggesting metabolic interventions could improve mental and physical health outcomes. We aimed to identify and prioritise unanswered research questions on metabolic interventions in people with severe mental illness, co-designed with people with lived experience. We conducted a James Lind Alliance (JLA) Priority Setting Partnership involving people with lived experience of severe mental illness, carers, and health and social care professionals, following JLA methodology. Research uncertainties were gathered through an international online survey. Submissions were refined through inductive thematic synthesis; out-of-scope questions were removed and the remainder checked against an umbrella review of evidence to confirm they were unanswered. Verified questions were ranked in an interim prioritisation survey. Final consensus on the top ten priorities was reached through a structured stakeholder workshop. In the initial survey, 456 participants contributed 1439 questions reflecting stakeholder perspectives. After synthesis, 51 summary questions across 13 domains were generated; two were considered answered, leaving 49 uncertainties. An interim prioritisation survey completed by 317 participants produced a shortlist of 19 questions; these were discussed in a final workshop with 31 participants (16 lived experience or carers and 15 professionals). The top ten priorities emphasised mental health effects of dietary and lifestyle interventions, roles of weight-loss medications, mechanisms linking metabolic change to brain outcomes, and metabolic effects of psychiatric medications beyond weight gain. Eight priorities focused on mental health outcomes. Stakeholders prioritised mental health outcomes and mechanistic understanding of metabolic interventions over traditional metabolic endpoints, highlighting a disconnect between current research agendas and stakeholder priorities. These priorities provide a stakeholder-driven research agenda to inform funding, policy, and future studies aimed at improving mental and physical health in severe mental illness.
Thyroid eye disease (TED) is a serious medical condition observed in patients with thyroid disorders, and patients often present in emergencies, threatening their vision. This retrospective audit was conducted at Queens Hospital, Romford, and included patients with TED who attended a dedicated ophthalmology-led TED clinic between January 2018 and June 2024. A total of 221 patients were included in this study, and their data were extracted from electronic and paper medical records, including clinic letters. Baseline and post-treatment glycemic monitoring was incompletely documented among steroid-treated patients (n=29). Baseline fasting glucose levels prior to steroid initiation were documented in 12 of 29 (41.4%) patients, and follow-up fasting glucose levels after steroid completion were documented in five of 29 (17.2%) patients. This study included 221 patients who visited the ophthalmology-led TED clinic between January 2018 and June 2024. The study cohort comprised 69% female and 31% male patients, with a mean age of 56.52 years (range, 22-92 years). Of the overall cohort, 29 patients (13.1%), aged 29-85 years, who received oral or intravenous systemic glucocorticoids for TED, were included in the main analysis group. Within this subgroup, four of 29 patients (13.8%) had pre-existing diabetes. Glucose and HbA1c monitoring during systemic glucocorticoid therapy in patients with TED at this center was incomplete and fell below evidence-based recommendations, despite the recognised risk of steroid-induced hyperglycemia and new-onset diabetes with high-dose steroid exposure. There is a need for more standardised and improved care for patients with TED presenting to outpatient clinics. We recommend setting up a "one-stop" TED clinic to provide standardised care.
Enhanced recovery after surgery (ERAS) pathways are defined as evidence-based multimodal perioperative processes designed to minimize stress from surgery and optimize recovery after surgery. The purpose of this research was to evaluate the outcomes of ERAS compared to traditional perioperative processes among patients who had elective surgery. This was a prospective observational comparative study of 40 patients receiving elective surgery at a tertiary care hospital. Participants were divided into ERAS (n = 18) and traditional care (n = 22) groups. Outcome measures included time to oral intake, time to mobilization, average length of hospital stay, complications, readmission rates, and mortality rates. Statistical comparisons utilized the independent samples t-test and the Chi-square/Fisher's exact test, with significance defined as P < 0.05. Participants in the ERAS group had significantly earlier postoperative recovery than the traditional care group relative to oral intake (6.2 ± 2.1 vs. 16.9 ± 5.4 h; P < 0.001) and mobilization (6.8 ± 2.5 vs. 24.3 ± 6.2 h; P < 0.001). The average length of stay was also significantly less among participants in the ERAS group as compared to traditional care participants (8.67 ± 2.57 vs. 12.64 ± 5.23 days; P = 0.002). Postoperative complications were slightly smaller in the ERAS group (5.6% vs. 9.1%), and readmission rates were also lower (5.6% vs. 13.6%); however, these were not statistically significant. No participants died during the period covered by this study. The implementation of ERAS pathways results in improved postoperative recovery and reduced length of stay, with safe, effective care among elective surgery patients. ERAS pathways should be adopted into the practice of elective surgery among sufficient resources available to provide effective, safe surgical care. Résumé Contexte:Les protocoles de récupération améliorée après chirurgie (Enhanced Recovery After Surgery, ERAS) regroupent des stratégies périopératoires multimodales fondées sur des données probantes visant à réduire le stress chirurgical et à accélérer le rétablissement postopératoire. Cette étude avait pour objectif de comparer les résultats des protocoles ERAS à ceux des soins périopératoires conventionnels chez des patients opérés de manière programmée.Méthodologie:Cette étude observationnelle prospective a inclus 40 patients pris en charge dans un hôpital de soins tertiaires. Les participants ont été répartis en un groupe ERAS (n = 18) et un groupe recevant des soins conventionnels (n = 22). Les critères d’évaluation comprenaient le délai avant la reprise de l’alimentation orale, la mobilisation précoce, la durée moyenne d’hospitalisation, les complications postopératoires, les réadmissions et la mortalité.Résultats:Les patients du groupe ERAS ont présenté une reprise significativement plus rapide de l’alimentation orale (6,2 ± 2,1 contre 16,9 ± 5,4 heures ; P < 0,001) ainsi qu’une mobilisation plus précoce (6,8 ± 2,5 contre 24,3 ± 6,2 heures ; P < 0,001). La durée moyenne de séjour hospitalier était également plus courte dans le groupe ERAS (8,67 ± 2,57 contre 12,64 ± 5,23 jours ; P = 0,002). Les complications postopératoires et les taux de réadmission étaient numériquement plus faibles dans le groupe ERAS, sans différence statistiquement significative. Aucun décès n’a été observé.Conclusion:Les protocoles ERAS améliorent la récupération postopératoire, réduisent la durée d’hospitalisation et constituent une approche sûre et efficace pour les patients bénéficiant d’une chirurgie programmée.
The classification of harmful radiation-induced effects into 'stochastic' and 'deterministic' or 'cancer/heritable effects' and 'tissue reactions' has played a significant role in the recommendations of the International Commission on Radiological Protection (ICRP) over a number of decades. More recently, however, there has been a debate regarding the adequacy of the current scheme for classification of health effects with current scientific evidence. While these scientific aspects are discussed in greater detail in a parallel article, we will emphasise the practical importance of the classification itself here. The setting of dose limits is quite different for 'deterministic' and 'stochastic' effects. In the first case, provided reliable data regarding the threshold doses for radiation effects on a particular tissue are available, the dose limit is supposed to avoid harm altogether. With 'stochastic effects', the expected risks at the dose limit are supposed to be 'tolerable'. Below the dose limit, optimisation must be aimed for based on the 'prudent' assumption that the stochastic risks linearly depend on the dose and that there is no threshold. If the distinction between the two kinds of harmful effects is drawn into question, possible consequences for the system of radiological protection need to be considered, especially in the context of its aims as they currently apply, namely, 'to manage and control exposures to ionising radiation so that deterministic effects are prevented, and the risks of stochastic effects are reduced to the extent reasonably achievable'. It may be necessary, moreover, to discuss if and how the terminology used by ICRP (and others), in particular the terms 'deterministic effects' and 'tissue reactions', should continue to be used for the classification of radiation effects.
Atraumatic shoulder instability (ASI) poses a significant challenge in orthopedic practice, characterized by functional and anatomical deficits in the glenohumeral joint (GHJ) resulting from chronic overuse rather than acute trauma. This review aims to provide a comprehensive summary of the current understanding of ASI, covering its anatomy, etiology, the influence of psychosocial factors and primarily focusing on management strategies. The management of ASI is a central focus for restoring normal biomechanical and anatomical function of the injured upper extremity. A literature review was conducted, seeking to further understand the current treatment approaches of this condition. The management of ASI employs differing combinations of physiotherapy, rehabilitation and surgery, with treatment dictated by patient stratification models and patient reported outcome measures (PROMs). Clinical stratification of patients along a diagnostic continuum aid devising appropriate patient-centered treatment and is based on the extent of anatomical disruption. Exercise-focused therapy, particularly the Watson Instability Program, is highlighted as a promising approach, emphasizing scapular and rotator cuff muscle strengthening to restore active shoulder control. Surgical interventions, such as open inferior capsular shift, arthroscopic capsular plication, and electrothermal arthroscopic capsulorrhaphy, are discussed in detail, with emphasis on their indications, outcomes, and comparative effectiveness. We also shed a light on the psychosocial factors role in ASI management outcomes, underscoring the importance of a multidisciplinary approach in patient care. In summary, ASI management necessitates a holistic approach that integrates anatomical understanding, tailored treatment protocols, and consideration of psychosocial factors. Further research is warranted to refine treatment strategies, validate rehabilitation programs, and explore the interplay between psychological factors and physical outcomes in ASI patients.