Rehabilitation has been identified by the World Stroke Organization (WSO) as a key priority to reduce the global burden of stroke. Global access to rehabilitation is inconsistent and is particularly limited in low-and-middle-income countries. Progress in rehabilitation has not been as well evidenced as progress in acute care. The WSO certification program, which commenced in 2021, focuses on acute interventions. A rehabilitation certification program, applicable in both inpatient and outpatient rehabilitation settings, has been developed to complement the acute certification program to address global implementation of evidence-based stroke care. To develop globally applicable, evidence-based, stroke rehabilitation recommendations and performance metrics for use in a stroke rehabilitation certification program. Strong recommendations were extracted from high-quality stroke rehabilitation Clinical Practice Guidelines, systematic reviews and syntheses of clinical practice guidelines, and from the defining criteria of the International Stroke Recovery and Rehabilitation Alliance (ISRRA) Centers of Clinical Excellence. The WSO Rehabilitation Implementation Committee led the development of the recommendations and invited input from three international, multidisciplinary consultation groups. Group 1 compared strong recommendations from the Australia/New Zealand Living Guidelines with other international guidelines to identify consistent, high-quality recommendations. Group 2 mapped recommendations from global guideline syntheses against the Australia/New Zealand Living Guidelines. Group 3 reviewed and adapted the ISRRA Center of Clinical Excellence recommendations. Recommendations were consolidated through consensus meetings involving representatives from each workgroup, including people from high, upper-middle, and lower-middle-income countries. Strong recommendations that were consistent across teams, alongside additional recommendations based on certainty of evidence, anticipated risk versus benefit, and relevance across settings, were included as patient-level recommendations in the implementation certification program. Service-level recommendations were generated through consensus or derived from existing guidelines. An implementation manual, outlining "what," "who," and "how," as well as indicators to demonstrate performance of each recommendation, was developed to support clinical implementation and to facilitate assessment for certification. The criteria were piloted between November 2024 and September 2025 at 15 centers in six upper- and lower-middle-income countries (three continents) and subsequently refined. Expectations (mandatory or recommended) for each level of certification (Minimal, Essential and Advanced) were set post-pilot through rating strength of evidence, a series of group discussions and review of pilot data.ResultsFifty-five recommendations were included. Nine recommendations address service-level indicators, and 46 address patient-level indicators. Service-level indicators address defining features of rehabilitation services that are not apparent in individual patient medical record audits. Patient-level indicators address management of swallowing impairment, nutrition and hydration, information provision and goal setting, amount and timing of rehabilitation, exercise and motor rehabilitation, visual function, communication, mood and cognition, management of complications, and discharge planning and support. An implementation manual complements the recommendations to guide clinical care and consistent assessment.ConclusionsThe WSO rehabilitation recommendations and performance metrics incorporate the most current evidence and have been refined following pilot-testing. The recommendations are globally relevant and support both resource-limited and high-income settings in participating in the rehabilitation certification program to advance international stroke rehabilitation delivery.
Deep brain stimulation (DBS) of the ventral capsule/ventral striatum (VC/VS) can benefit patients with treatment-refractory obsessive-compulsive disorder (OCD). However, time to respond post-operatively ranges from weeks to over a year. We examined neuroanatomical determinants of this variability. We studied 16 treatment-refractory OCD patients who responded to VC/VS DBS, classifying them as rapid (≤3 months) or slow (>3 months) responders. We compared contact locations along anterior-posterior, dorsal-ventral, and medial-lateral axes. In 11 patients with diffusion-weighted magnetic resonance imaging (dMRI), we utilized volumes of tissue activated (VTAs) for both initial and most recent effective DBS settings to filter tractograms of the anterior limb of the internal capsule to 11 predefined prefrontal cortical regions. We analyzed streamline counts as a proxy for connectivity strength with mixed-effects models. Rapid (n=8) and slow (n=8) responders exhibited a clear bimodal distribution of time-to-response, supported by a Bayesian Information Criterion difference (Δ BIC) of 9.14. Rapid responders' right-hemisphere contacts were positioned more superiorly, and there was a trend toward their left-hemisphere contacts being positioned more posteriorly. Connectivity fingerprints and mixed-effects modeling showed greater dorsolateral prefrontal cortex engagement in rapid responders than in slow responders, whereas slow responders showed enhanced central orbitofrontal cortex connectivity over time. Variability in VC/VS contact placement corresponds to distinct prefrontal cortical connectivity patterns and response timelines. Patient-specific targeting and connectivity-informed programming may accelerate response to treatment.
Studies characterising the immunoglobulin (Ig)-bound microbiota apply varying methodologies, making comparisons difficult. This scoping review synthesised evidence on Ig-microbiota binding patterns in maternal and infant contexts, identified recurrent Ig-bound and -unbound bacteria across studies, and highlighted knowledge gaps for further study. Nine articles investigating Ig-microbiota binding patterns in stool or breastmilk samples in mothers or infants were included. Ig-microbiota associations were influenced by sample type, Ig-subclass, genetics, and diet. The most important antibody was IgA, with partial functional redundancy with IgM, while IgG appeared more selective for pathobionts. Ig-bound taxa in early life included important commensals and pathobionts, with high levels of individuality. Ig-microbiota associations shifted with microbiome maturation, environmental and host factors, resembling adults at around 2 years of age. Transfer of Ig-bound Bifidobacterium through breastmilk may contribute to vertical transmission from mother to infant. Ig-microbiota associations also differed between health and disease states, beyond the overall microbiota. Results were limited by study numbers and a lack of methodological consistency. We propose the standardised term "Ig-Seq" in referring to the technique to study Ig-microbiota binding patterns, and suggest standardisation of laboratory protocols, bioinformatic pipelines, and statistical analyses to improve consistency in Ig-Seq.
Soundscapes reflect interacting biological, physical, and sensor-driven processes; thus, passive acoustic monitoring (PAM) can provide a wealth of unique, multifaceted ecological information. Using coral reefs as an example, we outline how mechanistic, integrative interpretation is essential for reliable ecological inference and for realising PAM's growing potential in ecosystem monitoring.
The STRATA randomised-controlled trial (RCT) examined the antidepressant sertraline vs placebo for treating anxiety in autistic adults. Autistic people are often assumed to be reluctant to take part in RCTs due to intolerance of their inherent uncertainty. This study aimed to qualitatively examine autistic people's experiences of RCT participation, specifically regarding their random assignment to an antidepressant (sertraline) or placebo for their mental health, whilst blinded to treatment allocation. Semi-structured interviews were undertaken with a purposive sample of 62 STRATA participants. The interviews examined why they chose to take part, why they continued in the trial and/or discontinued medication, and their overall experience of participation. Interviews took place either during participation, or at participants' final trial appointment at 52-weeks post randomisation ('exit interviews'). Data were analysed thematically through a collaborative process, with multiple researchers independently coding, discussing, and refining themes. Interviewees often discussed improved anxiety, attributing changes to believing they were taking sertraline, experiencing the placebo effect, or external factors. Post-analysis unblinding revealed that improved anxiety was discussed equally by participants in both the sertraline and placebo groups. Some participants, including those taking placebo, experienced side effects, which mirrored the types, frequency, and severity seen in the general population. Many were able to manage these and continue, but some discontinued medication as a result. Aspects of trial design and delivery facilitated continuation with the study medication, including frequent appointments, shared control over medication dose, and meaningfully involving autistic people in trial design. Such non-pharmacological factors may enhance therapeutic benefits, and may improve RCT design and therapeutic alliances with autistic people.
The acute respiratory distress syndrome is a heterogenous syndrome characterized by the rapid development of respiratory failure. Nearly 40% of patients who develop ARDS will die, and there is growing interest in identification of biomarkers to identify patients at risk of death and/or inform treatment decisions. Most prior work on biomarkers in ARDS has focused on the plasma compartment, but there is concern that circulating biomarkers may not reflect alveolar pathobiology. The anti-inflammatory microRNA-146a has been shown to be upregulated in inflammatory cells in human bronchoalveolar lavage fluid, but it is not known if these levels correspond with outcomes. We measured miR-146a expression by digital droplet PCR in human biospecimens from four different cohorts of patients with respiratory failure requiring mechanical ventilation - two plasma cohorts, one bronchoalveolar lavage cohort, and one heat moisture exchange (HME) filter fluid cohort. We found that miR-146a was detectible in plasma, bronchoalveolar lavage fluid, and HME fluid. However, only when measured in the alveolar space, was miR-146a expression significantly lower in older adults and those who died. It did not correlate with outcomes when measured in plasma. To our knowledge, this is the first report that nucleotides can be measured in HME fluid and builds upon expanding literature that circulating biomarkers may not reflect complex biology of the alveolar microenvironment during ARDS.
Home care services are under increasing pressure due to population aging, rising chronic disease prevalence, and workforce shortages. Digital health technologies, particularly home telemonitoring systems, are seen as promising tools to detect early clinical deterioration, reduce hospital use, and support continuity of care. However, real-world evidence on the implementation of such technologies in public home care systems remains limited. In 2023-2024, the Quebec Ministry of Health and Social Services funded a pilot to implement a multidevice telemonitoring intervention for older adults with heart failure across three integrated health and social services centers (CISSS). The initiative aimed to assess feasibility, acceptability, and the organizational conditions shaping implementation. This study documents the real-world implementation of a multidevice telemonitoring program from the perspective of home care nurses, with complementary insights from managers. It identifies perceived barriers, enablers, and contextual strategies for adaptation and sustainability. We conducted a qualitative study guided by the iCHECK-DH framework and principles of implementation science. Data sources included 30 semistructured interviews, 19 with home care nurses, and 11 with clinical and administrative managers. The intervention combined four connected devices (ie, Bluetooth scale, smartwatch, xPill adherence system, and voice-activated tablet), monitored by nurses through the Virtuose dashboard. Data were analyzed thematically, focusing on implementation processes, user experience, and organizational integration. The intervention involved 67 patients initially recruited (34 completed the 6-mo intervention) and was implemented across three home care organizations. Qualitative findings were based on 30 semistructured interviews with home care nurses (n=19) and administrative managers (n=11). About 16/21 (76%) of nurses accessed the dashboard daily or near-daily, but challenges included alert fatigue, workflow disruption, and limited integration with clinical systems. Nurses described mixed initial reactions to telemonitoring, valued hands-on training, and emphasized the need for clearer workflows and technical support. Digital tools were seen as clinically useful but added complexity to care delivery. Sustained use required local adaptation, attention to digital literacy, and greater system integration. Relational care remained central to nursing practice, even in digitally supported contexts. Telemonitoring programs can be successfully implemented in public home care settings when supported by strong leadership, responsive training, and adaptive workflows. This study highlights the relational, technical, and organizational dimensions of implementation and offers lessons to inform future scale-up efforts in similar public health systems.
Background: Culturally and Racially Marginalised (CaRM) communities in Australia encounter subtle and covert forms of prejudice, commonly referred to as "new racism". Within healthcare settings, these experiences can shape trust, engagement, and patterns of help-seeking. Mental health nurses are often the first point of contact in care delivery, and their ability to recognise, respond to, and mitigate the impacts of new racism is critical for fostering therapeutic relationships and supporting equitable access. Understanding how CaRM communities perceive the conditions that influence their mental health service use is fundamental for informing more equitable and culturally responsive care. Objective: This study explored the viewpoints of CaRM community members regarding the factors they consider important for addressing new racism in healthcare systems and supporting engagement with mental health services. Design: Q methodology was used to identify statistically derived viewpoints that reflect shared viewpoints about the conditions perceived as critical for addressing the impacts of new racism on mental health service use. Setting: Participants were recruited from culturally and linguistically diverse communities across Australia through community settings, social media, and professional networks. Participants: Thirty-five individuals from CaRM backgrounds completed the Q-sort. Methods: This Q methodology consisted of five steps: (1) set up of the Q-sorting instrument, (2) selection of participants, (3) data collection, (4) factor analysis, and (5) factor interpretation. Results: Three distinct viewpoints were identified: (1) raising awareness of mental health issues within CaRM communities (community-focused), (2) providing visible anti-racism and culturally safe services (service-focused), and (3) recognising and formally addressing new racism within healthcare systems (policy-focused). Conclusions: This study offers the first empirically derived, community-informed set of viewpoints on addressing new racism in Australian mental healthcare. While exploratory, the findings highlight multi-level considerations that are potentially relevant to mental health nursing practice, and may be useful to inform future research, policy development, and service redesign aimed at strengthening cultural responsiveness and equity in mental health systems.
A substance use disorder (SUD) treatment gap exists globally, with the greatest gaps in settings with the fewest resources. Integrating SUD care into primary care is needed to expand access to SUD care and support adherence to chronic disease services, especially HIV, in high-burden areas. Guided by stakeholder feedback, our team has previously adapted and piloted a peer-delivered behavioral intervention for antiretroviral therapy (ART) adherence for people with HIV and SUD in HIV care ("Khanya")-based on behavioral activation, problem-solving, motivational interviewing, and mindfulness-based relapse prevention skills-which was shown to be feasible, acceptable, and preliminarily effective. This study builds upon prior work to conduct a fully powered, randomized hybrid type 2 effectiveness-implementation trial (n=160) to evaluate the effectiveness of a stepped-care model of Khanya versus enhanced treatment as usual (ETAU) on ART adherence and substance use, implementation outcomes, and cost-effectiveness over 12 months. The trial is being conducted at two public primary care clinics that integrate HIV and other chronic disease services in a high-prevalence HIV setting in South Africa. We are recruiting people with HIV who self-report SUD and demonstrate one or more indicators of ART nonadherence. Eligible participants are randomized 1:1 to Khanya or ETAU. Participants randomized to Khanya first receive "step 1"-a single-session Life-Steps intervention for ART adherence delivered by a peer interventionist, followed by 2 weeks of real-time electronically monitored ART adherence using Wisepill to determine step-up decisions (ie, <80% triggers a step-up to receive the full 6-session Khanya intervention). The RE-AIM (reach, effectiveness, adoption, implementation, and maintenance) framework guided outcome measure selection, including effectiveness (ART adherence: Wisepill; substance use: urinalysis and WHO ASSIST [World Health Organization's Alcohol, Smoking and Substance Involvement Screening Test]); implementation (feasibility, acceptability, fidelity, and uptake assessed using 2 validated quantitative measures and qualitative feedback over 6 months); and cost-effectiveness (microcosting, health care use, and health-related quality of life using the EuroQol-5D). Descriptive analysis will be used to summarize implementation outcomes, and intent-to-treat analysis using a linear mixed model will be conducted for effectiveness outcomes. Funded in August 2022, recruitment for the trial began in June 2023, and primary data collection is projected to be completed in February 2027. Recruitment for the clinical trial (n=162) was completed in March 2026. It is projected that all exit interviews will be completed by March 2027. This trial builds upon formative work to evaluate the effectiveness, implementation, and cost of a peer-delivered, stepped care intervention integrated into primary care. A stepped-care design to maximize optimal use of resources and integration into primary care is a necessary step to increase accessible intervention programs for people with HIV with comorbid SUD globally.
Avian paramyxovirus 4 (APMV4) is detected sporadically in wild birds and poultry, globally. While predominantly detected in waterfowl, the natural reservoir and ecology of APMV4 remains unclear. Herein we report historical and contemporary detections of APMV4 in Australia, and through sequencing demonstrate the likely long-term presence in a diversity of Australian wild bird species. This is evidenced by contemporary Australian genome sequences being more similar to historical Australian genomes rather than contemporary Asian genomes and that these genomes form a single lineage. This suggests that APMV4 has been circulating on the continent for decades. While APMV4 has demonstrable, albeit sporadic, impact on poultry globally, there has never been a report of this virus causing disease in poultry in Australia, suggesting it likely continues to pose a low risk for the poultry industry. As wild birds serve as natural reservoirs for numerous viruses of potential concern to poultry, dedicated surveillance is critical for revealing the risk profile of wild bird viruses, such as APMV4, to poultry.
Drugs are generally classified according to the Biopharmaceutics Classification System (BCS) based on their solubility and intestinal permeability. Group I drugs tend to have higher bioavailability due to their high solubility and permeability. Drugs in group II have low solubility and high permeability, while drugs in group III have high solubility and low permeability. Drugs in group IV have low bioavailability and require various techniques to enhance their delivery due to their low solubility and permeability. Bile acids are commonly known as biological molecules with surfactant capabilities and continue to be underutilized in enhancing the pharmaceutical profile of drugs. Hence, this review will explore some of the common drug delivery methods and will focus on the use of bile acids and various applications of nanotechnology to enhance drug delivery, including lipid nanotechnology, as well as carbon nanotubes and quantum dots. The authors aim to provide more insights into drug delivery research and contribute to the development of novel drug delivery strategies. A literature search was conducted using ProQuest and PubMed, covering publications up to 10 years. Older references were included as appropriate. Bile acids are natural molecules produced in the body that can help dissolve and transport substances that dissolve poorly. Despite their useful characteristics, they remained under-researched and underutilized in systems that deliver drugs to the body. This review discusses common and newer methods of drug delivery and highlights the potential of bile acids to improve drug delivery. The review also explores how nanotechnology applications, such as lipid nanocarriers, carbon nanotubes, and quantum dots, can be used as applications in drug delivery. By bringing together current research on bile acids and nanotechnology, this review aims to provide insights that may support the development of more effective drug delivery systems.
Lassa virus is endemic in many West African countries and has significant epidemic/pandemic potential. The Coalition for Epidemic Preparedness Innovations (CEPI) Centralized Laboratory Network (CLN) is developing validated, harmonized methods to support and accelerate vaccine development in the event of an outbreak. We present here the development and validation of an assay to quantify anti-Lassa virus neutralizing antibodies. As the method uses a pseudotyped virus (PV) instead of authentic Lassa virus-a pathogen listed as hazard group 4-it can be performed at a lower containment level, making it widely accessible especially in those regions where Lassa fever is circulating. A recombinant vesicular stomatitis virus (rVSV)-based pseudotyped virus neutralization assay (PVNA) was developed. A working standard was prepared and calibrated against the International Standard (IS) for Lassa virus neutralizing antibodies, enabling results to be expressed in International Units. The method was validated according to the International Council for Harmonisation (ICH) Q2(R2) guidelines. The rVSV-based PVNA was successfully developed and validated. The analytical range of the assay was established as 10-100 IU/mL, and seropositive samples from a Lassa vaccine clinical trial fell within this range. Results from the PVNA showed direct correlation with results obtained from authentic virus neutralization methods. The method was, therefore, concluded to be fit-for-purpose. We have successfully developed and validated a PVNA for the quantification of neutralizing antibodies against Lassa virus. We have also provided a practical example of how to calibrate a serological method to the WHO International Standard to achieve greater harmonization and comparability between studies. The method is now being transferred to partner laboratories within the CLN to enable harmonized testing of clinical trial samples and support the development and evaluation of Lassa vaccine candidates.
Nonpharmacological lifestyle interventions can prevent age-related cognitive decline, but people find adhering to healthy habits challenging. The Aging Well through Interaction and Scientific Education - Action Plan (AgeWISE-AP) program provides brain health and lifestyle group education followed by individualized goal setting sessions modeled on the VA Whole Health model. To use examples of the individualized healthy aging goals and strategies created in the AgeWISE-AP program action-plan sessions to demonstrate the importance of considering what matters most when working toward lifestyle change. Veterans (cognitively intact, age ≥60) in the action-plan component of AgeWISE-AP participated in eight one-on-one sessions to create and implement individualized lifestyle goals to support positive brain health outcomes. Participants (n = 36) developed up to four unique SMART (Specific, Measurable, Achievable, Relevant, Time-bound) brain health goals, generating 120 goals across brain health domains. Case examples demonstrate the process of engagement, goal setting, and implementation. Participation in a nonpharmacological intervention focused on individualized selection of lifestyle changing goals can support healthy brain aging. Understanding what matters most to older adults (their "why"), together with personal interests and activities that motivate them to consistently participate in behavior goals (their "what"), may aid in the success of such interventions.
Informed consent is a cornerstone of ethical practice. Eliciting patient questions during informed consent increases patient engagement and understanding, thus enhancing integrity of the consent process. However, a patient in visible pain can add an additional challenge to the informed consent process. The purpose of this research was to examine if and how anesthesiology residents ask for questions from a patient displaying severe pain during an informed consent simulation. Anesthesiology residents recruited from three anesthesia residency programs were video recorded performing an informed consent with a 52-year-old White male simulated patient awaiting urgent repair of a perforated gastric ulcer who was displaying verbal and nonverbal signs of pain. Two independent coders evaluated whether, when and how residents elicited patient questions during the informed consent process. Among a sample of 65 first- and third-year anesthesiology residents, more than 20% of residents did not elicit questions during the informed consent encounter. Those who elicited questions typically did so late in the process, with approximately 10% inviting questions only after the consent form had been signed. Most questions were closed-ended (yes/no questions). Although residents did not typically incorporate the patient's name when eliciting questions, most residents demonstrated eye contact. There were no differences in the number or characteristics of questions elicited based on resident gender or level of training. Our findings suggest there is a need for increased education regarding the purpose and approach to eliciting patient questions during the informed consent process, especially for patients who are experiencing pain. When a patient is about to have surgery, they talk with their doctor about what to expect. Then they must agree to have the surgery and agree to the anesthesia needed for the surgery. This is known as the informed consent process. Patients who are about to have surgery may have a lot of questions for their doctor. It is important for the doctor to ask the patient if they have any questions. This study looked at videos of a training session for anesthesiology residents, who are doctors in advanced training to give anesthesia. In this training session, the anesthesiology residents were asked to get informed consent from a patient. The patient was an actor pretending to be in a lot of pain. This study looked at whether the anesthesiology resident ever asked the patient if he had any questions. Our results show that sometimes the doctors did not ask if the patient had questions. Sometimes the doctors ask after the consent form has been signed. We need to train anesthesiology residents to always ask if the patient has questions before the patient agrees to the surgery and the anesthesia.
Resting hemodynamic assessment of suspected pulmonary hypertension (PH) in older adults with cardiovascular risk factors may not effectively discriminate pre-capillary from post-capillary disease. Exercise right-heart catheterization (RHC) can improve the ability to make this distinction, yet its clinical value remains unclear. We aimed to describe the challenges encountered in hemodynamic exercise phenotyping in this population and evaluate the relationships of exercise classifications to worsening clinical events, including mortality. We prospectively recruited patients aged > 50 years with ≥ 1 cardiovascular risk factor referred for hemodynamic assessment of suspected PH, to undergo cycle-ergometry during initial RHC. Resting hemodynamics were classified per the 2022 European Society of Cardiology/European Respiratory Society guidelines, and exercise pressure-flow relationships were analyzed but not disclosed to treating physicians. Win-ratio and Kaplan-Meier analyses evaluated associations between exercise hemodynamic phenotypes and worsening clinical events. Among 43 patients (aged 72 ± 9 years, 47% female), 37 completed exercise. Resting classifications included the following: No-PH (19%), pulmonary arterial hypertension (PAH) (53%), and PH associated with left-heart disease (PH-LHD; 28%). Exercise hemodynamics revealed predominantly PH-LHD (62%), and 22% of patients demonstrated limited increases in cardiac output. The win-ratio was unfavourable for resting PH-LHD vs PAH (0.59; P = 0.035), but no differences in mortality incidence were present (P = 0.858). Conversely, the win-ratio was unfavourable for exercise PAH vs PH-LHD (0.59; P = 0.037), and exercise PAH demonstrated a higher mortality incidence (P = 0.031). In older patients with cardiovascular risk factors undergoing RHC to diagnose suspected incident PH, the upfront addition of exercise was challenging, yielding inconclusive results in approximately one-third of patients. Results also showed that time to death was more unfavourable for those with exercise PAH. L’évaluation hémodynamique au repos de l’hypertension pulmonaire (HTP) suspectée chez les personnes âgées présentant des facteurs de risque cardiovasculaire peut ne pas permettre de faire efficacement la distinction entre les formes pré- et post-capillaires. Le cathétérisme cardiaque droit d’effort permet de mieux faire cette distinction, mais sa valeur clinique demeure incertaine. Nous avons cherché à décrire les difficultés rencontrées lors du phénotypage hémodynamique à l’effort dans cette population et à évaluer les relations entre la classification selon l’effort et l’aggravation clinique, y compris la mortalité. Nous avons recruté de manière prospective des patients âgés de plus de 50 ans présentant au moins un facteur de risque cardiovasculaire, adressés pour une évaluation hémodynamique visant à confirmer une HTP suspectée et pour un test d’ergométrie cyclique pendant un cathétérisme cardiaque droit initial. Les paramètres hémodynamiques au repos ont été classés conformément aux lignes directrices de 2022 de la European Society of Cardiology/European Respiratory Society. Les relations pression-débit à l’effort ont été évaluées, mais n’ont pas été divulguées aux médecins traitants. Les analyses du win-ratio et de Kaplan-Meier ont permis d’évaluer les liens entre les phénotypes hémodynamiques à l’effort et l’aggravation clinique. Sur 43 patients (72 ± 9 ans, 47 % de femmes), 37 ont réalisé l’exercice. La classification au repos était la suivante : absence d’HTP (19 %), hypertension artérielle pulmonaire (HTAP) (53 %) et HTP associée à une maladie cardiaque gauche (HTP-MCG) (28 %). L’évaluation hémodynamique à l’effort a mis en évidence une prédominance des cas d’HTP-MCG (62 %); 22 % de patients présentaient une élévation limitée du débit cardiaque. Le win-ratio a été défavorable pour l’HTP-MCG au repos comparativement à l’HTAP (0,59; p = 0,035), mais aucune différence n’a été observée au niveau de la mortalité (p = 0,858). À l’inverse, le win-ratio a été défavorable pour l’HTAP à l’effort comparativement à l’HTP-MCG (0,59; p = 0,037), tandis que l’HTAP à l’effort a été associée à une mortalité plus élevée (p = 0,031). Chez les patients âgés présentant des facteurs de risque cardiovasculaire qui se prêtent à un cathétérisme cardiaque droit pour diagnostiquer une HTP suspectée, l’exécution initiale d’un test d’effort s’est avérée difficile, et les résultats non concluants dans environ le tiers des cas. Le délai avant le décès a été plus défavorable en cas d’HTAP à l’effort.
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Achieving high yield and grain quality in wheat typically requires substantial nitrogen (N) fertiliser application. However, given economic and environmental constraints, it is critical to understand whether growers can reduce N inputs without compromising performance, and whether existing varieties differ in their ability to cope with lower N availability. Using a novel field-based experimental platform, we assessed the performance of fifteen registered wheat varieties under six N regimes and over two seasons with contrasting weather patterns. As expected, yields and grain protein contents both increased with N application, although protein content plateaued at a higher N threshold than yield. We noted higher genotypic differences in N use efficiency (NUE; defined as yield per unit of available N) under zero- N fertiliser applications, revealing intrinsic variation in low-N resilience. N-driven yield increase was more strongly associated with spike number rather than spike weight. Two varieties selected in Denmark where tight fertiliser regulations are in place were included for comparison and could achieve high yield with contrasting strategies; one with low and the other with high spike weight. In addition, using a novel stable isotope field-based method, we could show that under higher N levels, the post-anthesis N uptake was decreased and this trait is critical to achieving positive grain protein deviation (higher increase in grain protein content than expected given its yield). Our findings highlight the necessity of evaluating commercial and pre-breeding wheat germplasm under reduced N conditions to identify genotypes suited to sustainable, lower-input agricultural systems in a changing climate.
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A recent study by Gong et al. maps peripheral immune aging using multi-omic profiling and longitudinal influenza vaccination across adults aged 25-90+, revealing midlife (55-65) immune remodeling. Analyses of PBMCs, proteomics, and cell function show early dysregulation before aging, highlighting links to later disease susceptibility before inflammaging.
Collaborative care between optometry and ophthalmology has demonstrated the potential to improve timely access to care. This study examines three settings where real-time optometry-facilitated telehealth was used to expedite specialist eye care in rural and remote Western Australia. Referrals to ophthalmology were triaged to telehealth or face-to-face services. For telehealth, optometrists performed a comprehensive in-person assessment, then facilitated video-consultation with an ophthalmologist during the same attendance for collaborative decision making. In 2023, retrospective chart review was undertaken for ophthalmology services in towns more than 1500 km from the capital city. Optometrists performed comprehensive in-person assessments and facilitated telehealth in three settings: hospital, community clinic and visiting outreach. Attendance rates were compared between collaborative telehealth and face-to-face ophthalmology. Follow up outcomes and diagnoses for telehealth consultations were reported. A total of 1876 non-surgical ophthalmology episodes of care were delivered in the 12-month period, of which 1044 (55.7%) were delivered by optometry using telehealth. Of those managed by telehealth, only 83 episodes of care required a subsequent face-to-face ophthalmology consultation. The hospital setting provided the greatest proportion (76.4%) of telehealth. Adjusted logistic regression showed the odds of attendance were 3.6 (95% CI: 2.6-5.0) times higher for telehealth appointments than face-to-face (p < 0.001). Surgical rates of outreach ophthalmology were high (30.0 to 74.1% of activity). Common diagnoses in telehealth included cataract, pterygium for direct surgical booking and chronic conditions (glaucoma, diabetic retinopathy) for instituting appropriate management. Collaborative telehealth with optometry improves access to ophthalmology services in rural Australia and should be considered in metropolitan settings and other countries.