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The Chiropractic Educators Research Forum (CERF) convened a conference on December 6, 2025. During the meeting, presenters and panelists took an in-depth look at concepts and research related to educators and chiropractic programs engaging stakeholders.
Despite the exponential growth of artificial intelligence (AI) solutions designed to assist radiologists in clinical practice, their actual impact on radiology departments remains below initial expectations. Daily workflows have not been profoundly transformed. The actual clinical benefit of these tools is often limited to single, modality-specific "narrow AI" tasks, and their return on investment is unclear. The purpose of this article was to analyze: (i), the human and perceptual challenges that shape attitudes toward AI among radiologists, referring clinicians, and patients; (ii), the technical and clinical limitations of current AI models, including the mismatches between target tasks and real-world needs, and between published versus real-life performances; (iii), the lack of objective return on investment quantification and the paucity of medicoeconomic studies in a context of constrained hospital budgets; (iv), the limitations of the current "assistive models" of human-AI interaction in radiology; (v), the technical and organizational difficulties that information and technology departments face in integrating, maintaining, and securing a growing number of AI applications across specialties within complex hospital information systems; (vi), the ethical and patient safety concerns related to bias, transparency, data protection, and regulatory compliance with respect to data protection officers and the European General Data Protection Regulation; and (vii), the underexplored environmental and energy implications of large-scale AI deployment. Finally, potential solutions relating to AI governance, national data infrastructures, user education, and the design of randomized clinical trials and cost-effectiveness studies, are discussed to promote the responsible, evidence-based integration of AI into radiology practice.
The Chiropractic Educators Research Forum (CERF) convened a conference on June 28, 2025. During the meeting, presenters and panelists took an in-depth look at concepts and research related to the continuous quality improvement efforts of educators and chiropractic programs.
The Chiropractic Educators Research Forum (CERF) convened a conference on December 7, 2024. During the meeting, presenters and panelists took an in-depth look at concepts and research related to what educators and chiropractic programs are doing for collaboration.
Pelvic congestion syndrome (PCS) is a major cause of chronic pelvic pain in women of reproductive age. It is often associated with pelvic venous insufficiency and venous dilatation of the ovarian and uterine veins, resulting in a variety of symptoms exacerbated by venous hypertension. Despite its prevalence, PCS lacks standardized diagnostic and management protocols, making effective treatment challenging. The purpose of this expert consensus statement was to summarize the opinions of French radiologists and gynecologists regarding the diagnosis, imaging, treatment, and management of PCS. A working group of 14 expert radiologists and gynecologists from various French medical centers used a Delphi panel approach with several rounds of remote and face-to-face meetings to formulate and refine expert opinions based on the current literature and clinical expertise. These opinions were categorized according to diagnostic criteria, imaging techniques, therapeutic options, and follow-up protocols. The group formulated 72 initial opinions, and 65 were retained after rigorous evaluation for consensus. Key diagnostic tools include Doppler ultrasound for detection of venous reflux and magnetic resonance imaging for detailed assessment of venous anatomy. Endovascular embolization was highlighted as the primary treatment approach and recommended after thorough imaging evaluation. Noninvasive treatments and multidisciplinary care were also emphasized for comprehensive management. The expert opinion also included post-treatment follow-up to assess quality of life and symptom resolution. This structured consensus approach helped develop standardized expert opinions on management of, providing clear guidelines for diagnosis, treatment, and follow-up. These guidelines should improve clinical practice and patient care in the management of PCS.
Unmeasured confounding bias threatens the validity of observational studies. Although sensitivity analyses and study designs have been proposed to address this problem, they often overlook the growing availability of auxiliary data. Using negative controls from these data is a promising new approach to reduce unmeasured confounding bias. In this article, we develop a Bayesian nonparametric method to estimate a causal exposureresponse function (CERF) using information from negative controls to adjust for unmeasured confounding for continuous exposures. We model the CERF as a mixture of linear models. This strategy captures the potential nonlinear shape of CERFs while maintaining computational efficiency, and it leverages closed-form results that hold under the linear model assumption. We assess the performance of our method through simulation studies. We find that the proposed method can recover the true shape of the CERF in the presence of unmeasured confounding under assumptions. To show the practical utility of our approach, we apply it to adjust for a possible unmeasured confounder when evaluating the relationship between long-term exposure to ambient PM2.5 and cardiovascular hospitalization rates among the elderly in the continental US. We implement our estimation procedure in open source software and have made the code publicly available to ensure reproducibility.
Cryptosporidium spp. are important zoonotic parasites that can cause moderate to severe diarrhea in humans and animals. However, the epidemiological data of Cryptosporidium in sika deer in China need to be updated. In this study, a total of 466 fecal samples were collected from sika deer in Shandong, Jilin, Liaoning, and Heilongjiang provinces. Nested PCR was used to amplify the SSU rRNA gene to detect Cryptosporidium spp. The results showed that the overall infection rate of Cryptosporidium spp. was 14.81%, with no significant differences among regions (p = 0.05). The highest infection rate was found in Heilongjiang Province (23.60%) and the lowest in Jilin Province (10.71%). The infection rate in summer (23.61%) seemed higher than that in autumn (13.20%), but the difference was not statistically significant (p = 0.30). Notably, young sika deer showed a significantly higher infection rate (28.21%) compared to adults (10.32%) (p < 0.0001). Sequence analysis identified two Cryptosporidium species/genotypes: Cryptosporidium deer genotype (98.55%) and Cryptosporidium ubiquitum (1.45%). Subtyping revealed that the C. ubiquitum isolate belonged to the zoonotic XIIa subtype. These findings provide new insights into the prevalence and genetic diversity of Cryptosporidium in sika deer and suggest that sika deer may act as a potential reservoir for zoonotic Cryptosporidium transmission. Prévalence et caractérisation de Cryptosporidium chez le cerf sika du nord de la Chine. Les Cryptosporidium spp. sont d’importants parasites zoonotiques pouvant provoquer des diarrhées modérées à sévères chez l’homme et l’animal. Cependant, les données épidémiologiques concernant Cryptosporidium chez le cerf sika en Chine doivent être mises à jour. Dans cette étude, 466 échantillons fécaux ont été prélevés sur des cerfs sika dans les provinces du Shandong, du Jilin, du Liaoning et du Heilongjiang. La PCR nichée a été utilisée pour amplifier le gène de l’ARNr SSU afin de détecter les Cryptosporidium spp. Les résultats ont montré que le taux d’infection global par Cryptosporidium spp. était de 14,81 %, sans différence significative entre les régions (p = 0,05). Le taux d’infection le plus élevé a été observé dans la province du Heilongjiang (23,60 %) et le plus faible dans la province du Jilin (10,71 %). Le taux d’infection en été (23,61 %) semblait plus élevé qu’en automne (13,20 %), mais la différence n’était pas statistiquement significative (p = 0,30). De manière notable, les jeunes cerfs sika ont montré un taux d’infection significativement plus élevé (28,21 %) que les adultes (10,32 %) (p < 0,0001). L’analyse de séquence a identifié deux espèces/génotypes de Cryptosporidium : Cryptosporidium génotype « deer » (98,55 %) et Cryptosporidium ubiquitum (1,45 %). Le sous-typage a révélé que l’isolat de C. ubiquitum appartenait au sous-type zoonotique XIIa. Ces résultats apportent de nouvelles perspectives sur la prévalence et la diversité génétique de Cryptosporidium chez le cerf sika et suggèrent que le cerf sika pourrait agir comme un réservoir potentiel pour la transmission zoonotique de Cryptosporidium.
This article presents a simple regression model to inform decisions on the allocation amount from the United Nations' Central Emergency Response Fund (CERF) in response to new or deteriorating humanitarian emergencies. The model offers a quick and user-friendly way to summarise historical (2016-24) CERF allocations and to estimate amounts for new allocations. It includes four elements: type of emergency; total funding required for a short-term humanitarian response; overall humanitarian needs and risks in the country; and the number of people who would receive humanitarian assistance or protection services with a CERF allocation. The model is integrated into CERF's decision-making process, which considers other factors as well. It provides a check by generating an analytical comparison with almost 380 past allocations. In an external review, the model has been found 'fit for purpose'. The article concludes with a discussion of other potential uses of the model and how it could be developed.
Material-intensive infrastructure systems, such as flexible pavements, offer significant opportunities for reducing resource consumption and associated life-cycle environmental impacts through design-level interventions. This study integrates structural performance metrics, specifically modulus improvement factor (MIF), into life cycle assessment (LCA) decision-making for pavements. The life cycle carbon emissions of conventional and sustainably reinforced pavements were evaluated. Besides, the inclusion of acidification potential and abiotic fossil resource depletion was evaluated for pavement at the material stage. Further, sensitivity analysis and field verification were performed. Results reveal that material production and manufacturing contribute more than half of total emissions, while transportation contributes to one-third, with the least at the construction stage. A carbon emission reduction factor (CERF) was formulated to compare reinforced and unreinforced materials, demonstrating that geogrid inclusion reduces embodied carbon across all subgrade conditions. The proposed LCA framework demonstrates a practical pathway for structural benefits along with sustainability evaluation into pavement design.
Dried chilies, although widely used as food ingredients such as paprika, present food safety risks across the production chain due to bacterial contamination, including Salmonella. This study assesses the fate of Salmonella Montevideo on red peppers during microwave drying and compares predictive models incorporating the effects of dynamic temperature and water activity (aw). Fresh red chilies (aw = 0.98) were sliced lengthwise, inoculated with Salmonella Montevideo, then dried at two power levels in a microwave oven for 45 min (120W) and 18 min (240W) to achieve aw<0.60. Temperature dynamics (24.5-87.6°C) were captured using an infrared camera, then the aw and Salmonella counts were measured at each sampling point. Salmonella survival parameters were estimated with four primary models (Weibull, log-linear, Geeraerd, and Cerf models), and then the Bigelow-type model was incorporated into the selected primary model to characterize the effects of temperature and aw on Salmonella inactivation. All models were assessed using the corrected Akaike information criterion (AICc). Higher microwave power resulted in lower Salmonella survival over time (p < 0.05) with a reduction range of 2.3-3.2 log. The log-linear/Bigelow (zT) yielded the lowest AICc value (11.94), which was the best-fitted model with D77°C-value of 4.24 min and a zT-value of 9.15°C. Temperature changes are determinant to describe Salmonella survival during chili drying, as the log-linear/Bigelow (zT) model better described the nonlinear reduction of Salmonella during the process. These findings serve as a basis to develop and refine spice drying conditions to improve Salmonella control while maintaining quality.
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Submucosal injection is essential during endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD) to create a protective cushion and enable safe lesion removal. However, commonly used solutions such as normal saline diffuse rapidly and provide only transient mucosal elevation. This study aimed to develop and characterize a thermosensitive hydrogel based on poloxamer 407 (P407) to achieve a more sustained submucosal lift. A design of experiments approach identified an optimized formulation containing 20% (w/v) P407 in water for injection, exhibiting suitable gelation temperature, gelation time, osmolality, and pH. Rheological analyses demonstrated low viscosity at room temperature, rapid sol-gel transition near 30°C, and the formation of a stable elastic network at 37°C. In vitro degradation showed progressive erosion, with complete dissolution within 24 h. Sterile filtration and needle passage produced only minor changes in viscoelastic moduli and did not alter gelation kinetics. Ex vivo studies using porcine gastrointestinal tissues confirmed that the hydrogel generated an initial mucosal lift comparable to 0.9% NaCl but maintained the elevation significantly longer. These findings demonstrate that P407-based thermosensitive hydrogel displayed favorable physicochemical, rheological, and functional properties for submucosal injection, supporting its potential as a next-generation lifting agent for EMR and ESD. Further in vivo studies are warranted to assess performance, safety, and clinical applicability.
Brain death after hanging-induced cardiac arrest is a fatal complication about which few data are available. We aimed at identifying the early predictors of progression to brain death in patients with hanging-induced cardiac arrest. Retrospective study including adults with return of spontaneous circulation from hanging-induced cardiac arrest admitted to 34 ICUs in France and Belgium between 2000 and 2024. Logistic multivariate regression was performed to identify factors associated with progression to brain death. Of the 554 patients with hanging-induced cardiac arrest, brain imaging was performed on admission in 443 (80.0%) patients. Overall, 169/554 (30.5%) and 142/443 (32.1%) patients progressed to brain death within a median time of 3 days, and up to 12 days, after the hanging-induced cardiac arrest. In 443 patients with brain imaging, five factors were independently associated with a higher risk of progression to brain death: female (OR, 1.76; 95% CI, 1.06-2.90; p = 0.03), asystole as first recorded rhythm (OR, 2.03; 95% CI, 1.27-3.29; p = 0.004), low-flow time > 30 min (OR, 1.84; 95% CI, 1.07-3.17; p = 0.03), total Logistic Organ Dysfunction System Score at day 1 (OR, 1.93/per point; 95% CI, 1.14-3.29; p = 0.02), and cerebral oedema and/or ischemic complication on brain CT scan at ICU admission (OR, 1.62; 95% CI, 1.01-2.61, p = 0.04). Conversely, age > 50 years (OR, 0.59; 95%CI, 0.35-0.98, p = 0.04) and status myoclonus ≤ day 2 (OR, 0.24; 95%CI, 0.09-0.54, p = 0.001) were associated with a lower risk of progression to brain death after hanging-induced cardiac arrest. Our findings emphasise the very high rate of brain death after hanging-induced cardiac arrest. In our population, factors associated with brain death after hanging induced cardiac arrest predominantly reflect initial injury severity.
The benefits of non-invasive respiratory support strategies (NIRS), such as high-flow nasal oxygen therapy, in delaying intubation remain uncertain. We used an emulated target trial approach to evaluate outcomes associated with late intubation in patients with severe acute respiratory failure due to COVID-19. We conducted a retrospective multicentre cohort study using the French prospective OUTCOMEREA database. Adult patients admitted to intensive care units (ICUs) for severe SARS-CoV-2 pneumonia with an ICU length of stay of at least seven days were included in the study. Descriptive analyses were used to compare patients who were intubated after day 6 with those who remained under NIRS. In the emulated target trial, patients who were eligible between ICU days 7 and 12 were assigned to undergo late intubation or to remain under NIRS. Weighted Cox proportional hazards models were used. The primary outcome was 60-day mortality. Of the 1206 ICU patients with SARS-CoV-2 pneumonia, 288 were still in the ICU on day 7. Of these, 65 (22.6%) subsequently underwent late intubation and had a 60-day mortality rate of 78.5%. In the emulated target trial, which included 234 patients at risk of intubation, 57 underwent late intubation. Late intubation was associated with a higher risk of death (adjusted hazard ratio: 2.89; 95% confidence interval: 1.50-3.92). The estimated absolute difference in 60-day survival was - 0.34 (95% CI - 0.62 to 0.30). The restricted mean survival time was 17.8 days shorter in the late intubation group (95% CI - 30.6 to 10.8). In this multicentre cohort, patients requiring late intubation had a very high mortality rate. In the emulated target trial analysis, late intubation was associated with poorer survival compared to continued NIRS, suggesting a subgroup of patients with progressive respiratory failure rather than a direct effect of intubation timing.
Anti-MDA5 dermatomyositis (anti-MDA5 DM) is the most severe subtype of dermatomyositis, due to its pulmonary involvement. Current treatment involves corticosteroids and immunosuppressants, but variability in responses exists. This study aims to evaluate the efficacy and safety of Janus kinase (JAK)- and calcineurin-inhibitor combination (JAK-CNI) in anti-MDA5 DM patients. A nested case-control study was conducted within a retrospective cohort of 234 anti-MDA5 DM patients. Patients receiving JAK-CNI were matched 1:2 with comparators. All-cause mortality or transplant within a year was compared using Cox proportional hazards models. Infectious and noninfectious side effects were also assessed. Twenty-seven patients receiving JAK-CNI were compared to 52 matched controls. Almost all these patients had pulmonary involvement. Thirty-nine (49%) died or were transplanted during follow-up. No significant improvement in survival or transplant-free survival was observed with JAK-CNI compared with comparators (hazard ratios 1.02, 95% confidence intervals [0.48-2.16]). Results were consistent regardless of intensive care unit (ICU) admission status and when analyses were restricted to patients with rapidly progressive interstitial lung disease. A trend toward a beneficial effect of the JAK-CNI combination was observed in non-ICU patients. Infectious complications were frequent (n = 49, 62%), with no excess risk in patients receiving JAK-CNI. JAK-CNI showed a similar outcome to other immunosuppressive combinations. However, as the study included the most severe cases, the potential benefit of early JAK-CNI introduction in less severe forms cannot be dismissed, as suggested by the nonsignificant trend in non-ICU patients. Future studies are needed to clarify the optimal timing and patient selection for JAK-CNI therapy in anti-MDA5 DM.
Percutaneous ablation is a treatment modality used in the management of primary and metastatic lung malignancies. Factors affecting local control rate (LCR) following microwave ablation (MWA) are poorly understood due to inconsistent and limited reporting of histology and procedure-related outcomes. Single-center retrospective study of patients with primary and metastatic lung malignancies who underwent MWA between January 2010 and July 2021. Patient, tumor and ablation characteristics were recorded. Outcomes evaluated included technical success, local tumor control and adverse events (AEs). A total of 669 nodules were identified from 383 patients (197 male/186 female with a median age of 59 years (IQR = 21 years)) across 459 ablation sessions. This comprised 83 primary and 586 metastatic lung tumors. One-year and two-year local LCRs (±SD) across the cohort were 90.3% (±1.1%) and 84.7% (±1.4%), respectively. Multivariable analysis identified ablation power settings, age, concomitant chemotherapy and histology as significant covariates associated with time to local recurrence (TTLR). Standard power was associated with longer TTLR, compared to low power, with no significant difference in AE rates. A significant difference in TTLR was noted between different histological groups. MWA of primary and metastatic lung tumors is safe and effective. LCRs differ across different histologies. Standard power MWA is associated with longer TTLR without increased AEs rates. Question Reported local control rates for microwave ablation (MWA) vary widely, with limited and heterogeneous data on histology-specific and parameter-related outcomes, leaving a gap in understanding. Findings MWA achieved 90.3% and 84.7% one- and two-year local control rates, with longer time to recurrence for standard power MWA. Histology-specific differences noted in time to recurrence. Clinical relevance MWA is a safe and effective treatment for primary and secondary lung cancers, offering comparable local control rates to radiotherapy and surgical resection. Further refinement of treatment parameters may enhance outcomes and address histology-specific challenges.
Stereotactic radiotherapy (SRT) is a standard approach for treating multiple brain metastases. However, variation in planning practices may impact treatment quality. This study assessed planning consistency and dose-volume-based outcomes across radiation oncology centers. A Computed Tomography (CT) scan of an anthropomorphic phantom with structure set was distributed to participating centers. Each center created SRT plans as for a clinical case. Dose distributions were evaluated based on Planning Target Volume (PTV) coverage (V100% (PTV)), dose to 95% of Gross Target Volume (GTV) volume (D95% (GTV)), maximal PTV dose (Dmax), conformity index (CI), gradient index (GI), brain volume receiving different percentages of the prescribed dose, and doses delivered to 0.035 cm3 and 0.5 cm3 of the brainstem. Twenty-four centers, using 30 treatment units, submitted plans. The V100% (PTV) ranged from 95% to 100%, with Dmax between 110% and 150% of the prescribed dose. Mean GTV dose ranged from 110% to 135%, and 81% of GTVs had D95% between 110% and 120%. High conformity was achieved in 74% of plans (CI < 1.1), while 67% had a GI between 3.4 and 5. All plans met clinical dose constraints for the brainstem and uninvolved brain. This interinstitutional comparison demonstrated high plan quality and adherence to critical organ constraints, despite variability in planning strategies. These findings support nationwide planning and quality assurance standards to ensure consistently high-quality SRT.
The optimal intake of artificial nutrition in critically ill patients remains unclear. While calorie and protein intakes affect glomerular function in patients with chronic kidney disease, their relation to renal function at the acute phase of intensive care is insufficiently documented. We aimed to study associations of a low-calorie and low-protein diet with renal outcomes in critically ill patients. This post hoc analysis of the NUTRIREA-3 randomized-controlled trial included 3036 mechanically ventilated patients with shock. Calorie and protein intakes during the first 7 days were either low (6 kcal/kg and 0.2-0.4 g protein/kg/d) or standard (25 kcal/kg and 1.0-1.3 g protein/kg/d). The primary outcome was the incidence of acute kidney disease (AKD) during the ICU stay (up to ICU discharge or day 90 after inclusion, whichever occurred first). AKD during the ICU stay occurred in 669 (44.6%) low-group patients and 691 (46.1%) standard-group patients (hazard ratio, 0.97; 95% CI 0.88-1.07; P = 0.53). The highest urea level and the urea level at ICU discharge were significantly lower in the low group (P = 0.002). No differences were found for renal replacement therapy requirements or other renal outcomes. The results were similar in patients with early kidney dysfunction, severe organ failures, or end-stage chronic kidney disease. In critically ill patients with shock, early low-calorie and low-protein nutrition for 7 days was not associated with worse renal outcomes or mortality compared to standard feeding, even in patients with preexisting renal dysfunction.
Despite recent advances, refractory celiac disease (RCD) poses challenging questions. In type 2 RCD (RCD2), the lack of response to the gluten-free diet is attributed to an intestinal intraepithelial lymphoma-carrying driver JAK1 or STAT3 mutations. However, it remains unclear whether these can be safely targeted for therapy. In RCD1, pathogenic insights are still lacking. Duodenal biopsy specimens and peripheral blood mononuclear cells from patients with RCD1, RCD2, active celiac disease (CeD), CeD in remission, and controls were analyzed. Lymphocyte populations were characterized using single-cell transcriptomic, genomic, and TCR repertoire profiling. Functional and exome sequencing analyses were performed on patient-derived RCD2 cell lines exposed to JAK inhibitors. We show that clonal malignant RCD2 lymphocytes exhibit interpatient similarities but substantial intratumoral heterogeneity, and provide in vitro evidence that JAK inhibitors can select drug-resistant tumor cells, arguing against their use as monotherapy. In RCD1, we identified clonal T-cell expansions harboring mutations that enhance the JAK-STAT pathway. The detection of both RCD2 and a CD4+ lymphoproliferation in a patient initially diagnosed with RCD1 further illustrates the diversity of lymphoproliferative outcomes in CeD. These findings suggest that RCD subtypes may share underlying mechanisms driven by clonal evolution and JAK-STAT dysregulation. They also highlight the potential limitations of JAK inhibitor monotherapy and the importance of molecularly informed therapeutic strategies.
Antioxidant polysaccharides were synthesized using an innovative, green, enzymatic reaction to catalyze the grafting of ferulic acid (FA) onto pullulan (Pull). Several grades of Pull-FA with verified purity were successfully synthesized, with maximum experimental grafting rates (GR) up to 8.8%, as determined by the Folin Ciocalteu method. For the first time, the chemical structure of the grafts was proposed using 13C solid-state NMR and MALDI-TOF MS analyses, which proposed the putative grafting of a negatively charged, monodecarboxylated FA dimer (β-5). SEC/MALS/DRI/UV/visco analyses confirmed the grafting with a tendency towards intra- and intermolecular hydrophobic self-association, which depends on the grafting rate. The aggregative power of Pull-FAs in dilute medium as a function of the grafting rate and the pH of the medium was highlighted using the Nile red fluorescent probe and light scattering. In semi-dilute/concentrated media, intermolecular self-association was revealed by an increase in texture and a reversible physical gel behavior under favorable pH conditions. DPPH• analyses showed the antioxidant activity of Pull-FAs and confirmed the linear decrease in EC50 as a function of grafting rate.