Artificial intelligence (AI)-assisted endoscopy represents a promising approach for lesion detection, yet frequent false-positive detections impair clinical utility by disrupting examinations and diminishing physician confidence. Linked-color imaging (LCI), an image-enhanced endoscopy technique that amplifies mucosal and vascular contrast, may address this limitation. This investigation evaluated whether LCI reduces false-positive AI detections compared with white-light imaging (WLI). This retrospective study analyzed consecutive AI-assisted upper endoscopies performed between March 2024 and June 2025. WLI and LCI were performed sequentially within the same endoscopic session in each patient. False-positive AI detections were compared between modalities using two computer-aided detection (CAD) versions. Propensity score adjustment was used as a sensitivity analysis for baseline differences between CAD Versions I and II. Of 66 initially screened cases, 63 remained after excluding patients with prior gastric surgery. LCI reduced false-positive AI detections compared with WLI (median 2 vs. 5; p < 0.001). In CAD version-stratified sensitivity analyses, LCI reduced false-positive AI detections in both Version I (5 to 2; p = 0.01) and Version II (2 to 0; p = 0.03). This reduction remained consistent across atrophic grades. Both imaging modalities identified all gastric lesions, achieving 100% detection sensitivity. LCI assessment performed after WLI observation yielded fewer false-positive CAD-EYE detections while maintaining lesion detection sensitivity. However, because the observation sequence was fixed, these findings should be interpreted cautiously and require confirmation in prospective or counterbalanced studies. Trial Registration: N/A (retrospective study).
Cosmos is a vendor-facilitated platform created in collaboration with healthcare systems using electronic health records (EHRs) from Epic Systems Corporation. Participating organizations can use the platform to advance research and apply insights at the point of care. This manuscript outlines evolutions in the platform's infrastructure, growth of available data, and usage. Data from participating systems is sent via encrypted Health Level Seven Clinical Document Architecture to the Cosmos host at Epic Systems Corporation. Deduplicated data are stored in two relational Structured Query Language (SQL) databases, which can be accessed remotely. Aggregate counts from a limited dataset (LDS) are accessed through a no-code data visualization and analysis tool. Line-level data from an expert-determined de-identified dataset are accessed in a secure virtual computing environment. Data quality and user support frameworks facilitate a feedback loop improving data quality and researcher efficiency. Platform growth was measured as participating organization counts, data elements, and proportion of patient records with data spanning over 5 years. Medical literature was reviewed for peer-reviewed studies using Cosmos data. Over 330 organizations across Canada, Lebanon, Saudi Arabia, and the United States submit data to Cosmos. The platform includes more than 300 million deduplicated patient records, 39% of which have over 5 years of clinical data. Ongoing expansion of data elements within Cosmos has allowed the platform to serve as the data source for over 100 peer-reviewed studies across multiple disciplines. With its expanding size, tooling, and breadth of data elements, Cosmos may enable a wide range of study types. Cosmos remains subject to limitations such as variation in workflows, documentation error, and bias inherent to a population sourced from healthcare organizations using a single EHR vendor. Cosmos demonstrates a use case of vendor-facilitated collaboration to enable a broad spectrum of research.
This study aimed to determine the relationship between the interfacial properties of proximal cavities (microbial leakage and marginal adaptation) and restorative materials (alkasite, resin composite, and glass hybrid). This study involved 66 human third molars that were left intact. Standardized Class II cavities were done on the mesial surface. The samples were then divided into five groups: (i) Cention N (CN, Ivoclar Vivadent), (ii) Filtek Z350XT (FZ, 3M ESPE), (iii) EQUIA Forte (GC Corporation), and (iv) two controls. For 40 days, a dual-chamber model containing Streptococcus mutans was used to study microbial leakage. Qualitative assessments of the sectioned samples were also carried out using a scanning electron microscope (SEM). Moreover, this study employed descriptive and Kaplan-Meier analyses, alongside a one-way analysis of variance for additional descriptive comparisons (p < 0.05). Across different restorative materials, notable variations in microbial leakage were recorded. From the supplementary analysis between CN and FZ, a statistically significant difference was demonstrated (p = 0.037). In comparison to other restorative systems, CN also produced a prolonged mean time before microbial leakage occurred. For the interfacial properties of the restorative systems, illustrative information was offered via the SEM images. Regarding microbial leakage, all restorative systems presented their occurrence (despite the constraints of this study). When assessing CN and FZ restorative systems, a slower rate of microbial leakage was also concluded for CN. For the tooth-restoration interface, qualitative data were verified through SEM observations.
Pulmonary arterial hypertension (PAH) is a rare, progressive disease characterised by elevated pulmonary vascular resistance that can lead to right ventricular failure and premature death. Ralinepag is an oral, once-daily, selective prostacyclin IP receptor agonist developed to treat PAH. We aimed to evaluate the efficacy and safety of ralinepag in patients with PAH. ADVANCE OUTCOMES was a randomised, double-blind, placebo-controlled, event-driven, phase 3 trial of ralinepag in patients with PAH. Eligible patients were aged 18 years or older and PAH was diagnosed on the basis of the 2022 European Society of Cardiology and European Respiratory Society guidelines (mean pulmonary artery pressure >20 mm Hg, pulmonary artery wedge pressure ≤15 mm Hg, and pulmonary vascular resistance of >2 Wood units). Patients were randomly assigned (1:1) to ralinepag or placebo, initiated at a dose of 50 μg once daily and titrated weekly until the highest tolerated individualised dose was reached. Randomisation was stratified by baseline 6-minute walk distance (6MWD), PAH aetiology, and oral background therapy. A block size of four was used within each combination of stratification factors. The sponsor, patients, and all personnel directly involved with the conduct of the study were masked to study drug identity and randomisation assignments. The primary outcome was time to first clinical worsening event, a composite of death from any cause, admission to hospital due to worsening PAH or right heart failure, initiation of parenteral or inhaled prostacyclin-pathway therapy, disease progression, or unsatisfactory long-term clinical response. Efficacy analyses were done in the full analysis set and safety analyses in the safety set; both sets comprised 687 patients after exclusion of 41 randomly assigned and treated patients from sites in China (exclusions due to regulatory challenges and data integrity concerns). This study is registered with ClinicalTrials.gov (NCT03626688) and euclinicaltrials.eu (2023-509304-16-00) and is complete. Patients were enrolled between Jan 24, 2019, and June 20, 2025. Of 1037 patients screened for eligibility, 728 were randomly assigned and received at least one dose of ralinepag or placebo; 687 were included in the full analysis and safety sets, of whom 350 received ralinepag and 337 received placebo. Median follow-up from randomisation to clinical worsening event, censoring, or study closure was 85·0 weeks (IQR 27·6-160·9) in the ralinepag group and 78·4 weeks (34·6-137) in the placebo group. At baseline, patients had a mean 6MWD of 438·9 m (SD 104·8) and 548 (80%) of 687 patients were receiving dual background PAH therapy. Overall, 64 (18%) of 350 patients in the ralinepag group and 121 (36%) of 337 patients in the placebo group had a first clinical worsening event (hazard ratio 0·45 [95% CI 0·33-0·62]; p<0·0001). The largest numerical between-group differences in components of the composite outcome were observed for disease progression, initiation of parenteral or inhaled prostacyclin-pathway therapy, and unsatisfactory long-term clinical response. Adverse event was the primary reason for treatment discontinuation in 65 (19%) of 350 patients in the ralinepag group and ten (3%) of 337 patients in the placebo group. Serious adverse events occurred in 98 (28%) patients in the ralinepag group and 104 (31%) patients in the placebo group. Adverse events leading to death occurred in 15 (4%) and 14 (4%) patients, respectively. In patients with PAH receiving contemporary background therapy, ralinepag significantly reduced the risk of first clinical worsening compared with placebo, but was associated with more adverse-event-related treatment discontinuations. These results support the use of ralinepag as an oral, once-daily prostacyclin-pathway treatment option for PAH. United Therapeutics Corporation.
Immune checkpoint inhibitors (ICI) have transformed oncology treatment. This study presents a case series of adults diagnosed with ICI-induced diabetes mellitus (ICI-DM) and evaluates the challenges involved in the diagnosis and management of this rare immunotherapy side-effect. A single-centre case series from the UK involved individuals who developed new onset insulin dependent diabetes after ICI treatment between 2017 and 2026. Data were extracted from the electronic medical records (EPIC® Systems Corporation). Thirteen individuals (61.5% male, median age: 61 years [IQR 45-71]) diagnosed with ICI-DM were included. The majority were from a White ethnic background (84.6%). Time from ICI start to ICI-DM presentation had a median of 4 months (IQR 2-18). Most (n = 9, 69.2%) presented with diabetic ketoacidosis (DKA), with two requiring intensive care. Importantly three cases of DKA were potentially avoidable with earlier insulin initiation. Diabetes autoantibodies were positive in 54.5% (5 with GAD65 and 1 with IA-2 antibodies) with median C-peptide levels at diagnosis 161 pmol/L (IQR 10-232). The mean HbA1c before ICI start was 40 ± 7 mmol/mol (5.8 ± 2.8%) climbing to 80 ± 15 mmol/mol (9.5 ± 3.5%) at diagnosis, within a median interval of 3 months (IQR 2-4). It is essential to increase healthcare professional awareness of immunotherapy side-effects to achieve early recognition and prompt management. Increased use of capillary glucose testing and immunotherapy alert card can improve outcomes. Future studies can investigate the relationship between potential risk factors and predisposition to ICI-DM development.
Electronic portal imaging devices (EPID) are well suited to radiotherapy in-vivo dosimetry (IVD), but limited guidance remains a barrier to routine clinical use. This SunCHECK (Sun Nuclear Corporation) user survey captured real-world configurations and tolerances for EPID-based patient-specific verification, as well as other aspects of patient-related QA, to establish consensus benchmark data and inform guidance for new and existing users. A structured survey was distributed to SunCHECK Patient users across the UK and Europe. Respondents reported current clinical practice for treatment plan verification, patient-specific quality assurance (PSQA), and IVD, including calibration methods, analysis modes, and investigation tolerances. Sixty-four responses were received from 18 countries. Linear accelerator manufacturer, treatment planning algorithm, and level of SunCHECK experience had minimal influence on applied tolerances. Point dose difference is no longer widely used as a pass-fail metric. Most centres use gamma analysis for calibration with global normalisation, a 10% threshold, and a 95% pass rate. Plan verification and PSQA are almost universally assessed using gamma criteria of 3%/3 mm with a 95% passing tolerance. IVD tolerances fall into two main approaches: gamma criteria of 10%/5 mm for detecting gross errors, and tighter criteria of either 3%/3 mm or 5%/5 mm for identifying smaller, clinically relevant discrepancies. Despite extensive configurability within SunCHECK, there is strong consistency across centres in selected settings and investigation tolerances. These benchmark data provide practical guidance for reviewing and optimising local configurations. This work provides consensus-based guidance for configuring EPID IVD systems to reliably identify treatment delivery inconsistencies in clinical practice.
Treatment goal limitations, such as "do not resuscitate", "do not escalate" and "comfort terminal care" are frequent in acute hospital care for patients with advanced illness, multimorbidity or impending death. Their ethical defensibility depends on transparent documentation of medical indications, proportionality and, where relevant, patient will. To examine whether documentation made medical rationale, patient will, advance directives, relatives' involvement or ethics consultation visible. We retrospectively analyzed documentation in an Austrian internal medicine department with intensive care over 12 months. Documents were identified in the hospital information system and descriptively analyzed. Deceased patients with documented limitations underwent manual review. Data were anonymized and analyzed using Microsoft Excel for Microsoft 365 (Microsoft Corporation, Redmond, WA, USA) and IBM SPSS Statistics, version 29 (IBM Corp., Armonk, NY, USA). Across 3998 inpatient stays involving 1829 patients, 277 patients had a documented treatment goal limitation (15.1%). Among 174 deceased patients, 111 had a documented limitation at death (63.8%). The most frequent order was combined do not resuscitate/do not escalate (75/111; 67.6%), followed by isolated do not resuscitate (23/111; 20.7%). Complete records were available for 101 cases; in 10 the rationale was not clearly traceable. Among the 101 manually reviewed cases, an explicit or presumed patient will was documented in 7 cases (6.9%), involvement of relatives in 13 cases (12.9%) and ethics consultation in 1 case (1.0%); medical rationale or physician decision was documented in 90 of 91 cases with traceable rationale (98.9%). Treatment goal limitations were common and usually medically justified in the records. The findings do not imply inappropriate decisions or lack of communication but show limited reconstruction of patient-centered reasoning. Documentation should make clearer how benefit, care, respect for autonomy and justice informed treatment limitation.
GLP-1 receptor agonists (GLP-1RAs) have shown preclinical effects on reward-seeking behavior across several substance classes, but human randomized controlled trial (RCT) evidence remains limited. This systematic review and meta-analysis evaluated the effects of GLP-1RAs on substance-use outcomes in adults with substance use disorders. Electronic databases and trial registries were searched from inception to April 30, 2026, for parallel-group or crossover RCTs comparing any GLP-1RA with placebo or control. Outcomes included days without alcohol consumption, cigarettes smoked per day (CPD), and Fagerström Test for Nicotine Dependence (FTND) scores. Five RCTs met the inclusion criteria, including 764 participants with follow-up ranging from six to 52 weeks. Three RCTs contributed alcohol-related outcomes, and four contributed tobacco-related outcomes. Random-effects meta-analysis showed no statistically significant effect on days without alcohol consumption (MD -1.96 days, 95% CI -17.97 to 14.05; I² = 74%), CPD (MD -0.55 cigarettes/day, 95% CI -1.76 to 0.65; I² = 45%), or FTND score (MD 0.02, 95% CI -0.32 to 0.36; I² = 0%). Risk-of-bias assessment using the Cochrane Risk-of-Bias (RoB) 2 tool rated three trials as low risk overall and two as having some concerns. Certainty of evidence assessed using GRADE (Grading of Recommendations, Assessment, Development and Evaluations) ranged from low to moderate. Current pooled RCT evidence does not demonstrate a statistically significant benefit of GLP-1RAs for alcohol or tobacco use outcomes. A possible signal of benefit in patients with comorbid alcohol use disorder and obesity should be interpreted as hypothesis-generating because of the small number of trials, clinical heterogeneity, and imprecision. Adequately powered, long-duration, agent-specific RCTs using standardized substance-use outcomes are required before clinical translation can be recommended.
Fine-grained load profiling is important for demand response and energy management in smart grids, yet supervised approaches remain constrained by the scarcity of high-quality labeled datasets. To address this limitation, we propose GridCL, a self-supervised contrastive learning framework for low-label load profiling in smart grids. GridCL forms paired daily-load views using conservative input perturbations-small temporal rolling, multiplicative perturbation, and energy renormalization-and combines them with a temporal convolutional encoder to learn discriminative representations from unlabeled data. Experiments on three anonymized city datasets and one pooled benchmark show that GridCL achieves strong clustering quality on the pooled AllCities benchmark, reaching 0.648±0.115 ARI, 0.719±0.064 NMI, and 0.620±0.046 silhouette, while also attaining a best city-level ARI of 0.804±0.084. Under sparse-label evaluation, GridCL reaches 0.845±0.042 accuracy on the pooled benchmark with only 10% labeled users, and remains stable at 20% and 30% labeled users with accuracies of 0.851±0.033 and 0.849±0.034, respectively. These results indicate that GridCL provides an effective low-label solution for fine-grained load profiling in practical smart-grid settings.
Electron delivery within and between bacterial cells is a central bottleneck in anaerobic biotransformation of electron acceptor-type substrates (EATS). Using hexabromocyclododecane (HBCD) as a model organohalogen, we developed a cysteine desulfhydrase (CSD)-associated periplasmic FeS biomineralization strategy in a defined synthetic consortium. CSD-associated FeS formation enabled rapid installation of FeS conduits in non-sulfate-reducing bacteria within ∼3 h, forming predominantly periplasmic conductive interfaces that lowered interfacial charge-transfer resistance and increased capacitive electron storage. Electrochemical analyses revealed coculture-specific electron-transfer behavior, increased electron-accepting capacity, and enhanced transport activity; cocultures outperformed monocultures, consistent with strengthened interspecies electron transfer. Detection of lower-brominated intermediates and bromide release supported dihaloelimination-dominated debromination, with Fe-matched cell-free FeS accounting for only 2.8% of the live-cell Br- signal. Inhibitor profiling further suggested that FeS alters electron-transfer behavior from NADH/menaquinone-linked steps toward terminal reductive processes, consistent with relief of respiratory bottlenecks. Structure prediction and docking support a working model in which a QueG-like, cobalamin-dependent candidate terminal reductase may participate in HBCD reduction, while FeS conduits enhance local electron delivery, charge-transfer behavior, and whole-cell debromination. Overall, periplasmic FeS conduits provide a CSD-associated interfacial strategy to modulate electron flux in this defined coculture, highlighting a potentially transferable route for transforming emerging organohalogens and other EATS.
How physicians deliver care is shaped by who owns their practice, yet no study comprehensively maps the ownership landscape within a specialty. Using Medicare claims and hand-collected transaction data from 2012 to 2022, we classified dermatologists and gastroenterologists into 5 mutually exclusive ownership categories-independent, corporate chain, hospital or health system, insurer, and supergroup-and distinguished 2 pathways out of independent practice: acquisition and organic physician entry. Independent practice declined from 62% to 44% of dermatologists and from 52% to 31% of gastroenterologists. By 2022, corporate chains, nearly all private-equity backed, accounted for 16% of dermatologists and 11% of gastroenterologists, while hospital ownership reached 26% and 47%. Hospitals were the largest nonindependent owners in both specialties; corporate chains grew fastest in dermatology. Corporate chains pursued different growth strategies by specialty: Acquisitions of established physician-owned supergroups dominated gastroenterology, while growth in dermatology also came from building new chains from small practices. Increasingly, corporate growth was driven by organic entry of both experienced physicians and recent graduates, overtaking acquisitions by 2021 in dermatology. Who owns a doctor's practice, and how that ownership grows, varies widely-heterogeneity that has implications for patient care and policy addressing provider consolidation.
Merrigan, JJ, Ray, N, Barrett, K, O'Connor, M, Smith, R, Walters, JR, Hagen, J, Eckerle, J, and Briggs, R. Jump assessments on force plates do not determine musculoskeletal injury risk in active-duty air force personnel. J Strength Cond Res XX(X): 000-000, 2026-This study evaluated jump performances and lower extremity musculoskeletal injury (MSKI) risk in active-duty Air Force (N = 963). During the 6-month surveillance period, 88 subjects sustained MSKI, while 875 subjects reported no lower extremity injuries (No-MSKI). Previous injuries were documented within 6 months before testing. Jump assessments consisted of maximal effort arm-swing countermovement jumps (ASCMJ), no arm-swing countermovement jumps (CMJ), bilateral repeated hop test (BRHT), CMJs with a weighted vest loaded countermovement jump (LCMJ), and drop jumps (DJ), in that order. Drop jumps were not different between MSKI and No-MSKI groups. On the remaining assessments, MSKI had lower jump heights, less reactive strength indexes, and greater peak landing force relative to body mass. According to logistic regressions, previous injury was associated with odds of sustaining MSKI (no-MSKI = 6.06%; MSKI = 30.68%). Higher jump heights were associated with lower odds of MSKI for ASCMJ (odds ratio, OR = 0.49), CMJ (OR = 0.52), LCMJ (OR = 0.51), and BRHT (OR = 0.60), but no model accurately classified MSKI occurrences. Chi-square results demonstrated greater risk ratios for those below the 25th percentile (ASCMJ = 3.53; CMJ = 3.26; BRHT = 2.38; LCMJ = 2.41; p < 0.05) and between 25 and 50th percentiles (ASCMJ = 2.64; LCMJ = 2.33; p < 0.05) compared with those above the 75th percentile. These findings suggest that while force-plate jumps demonstrate associations with MSKI risk, they were not effective as standalone tools for accurately classifying MSKI risk in active-duty military personnel. Nonetheless, performance below the 25th percentile may help identify individuals who could benefit from additional preparatory training aimed at reducing injury risk.
Calcification of the lateral collateral ligament (LCL) of the knee is a rare cause of lateral knee pain related to hydroxyapatite crystal deposition. We report a case series of four patients presenting with lateral knee pain. Diagnosis was established using imaging. In one case, calcification was first detected on ultrasound and subsequently confirmed on radiography and MRI. In two other cases, calcification was identified on radiography and MRI, with spontaneous radiographic resolution on follow-up in one patient. In the fourth patient, dual-energy CT was additionally performed to exclude gout. All patients were treated conservatively with nonsteroidal anti-inflammatory drugs and physiotherapy, with symptomatic improvement. Our findings suggest that plain radiography is usually sufficient to identify LCL calcification, while advanced imaging aids in excluding other diagnoses and in assessing associated soft-tissue changes. Most patients can be managed conservatively, and spontaneous resolution of calcification may be observed in some cases.
Compressor stations are significant sources of methane (CH4) emissions in the transmission and storage operations of the natural gas system. However, these emissions in China have not been quantitatively assessed using top-down measurement approaches. The present study determined CH4 emissions from two natural gas compressor stations in China using a methodology of UAV-based measurements combined with a mass balance computation algorithm. Four controlled-release experiments were conducted to validate the methodology, yielding individual deviations ranging from -10% to +4% between the estimated and actual release rates. For the compressor stations, CH4 emissions showed substantial variabilities both across different days and within individual days. The geometric mean CH4 emission rates were 6.47 kg/h (95% CI: 5.25-7.82 kg/h) and 8.61 kg/h (95% CI: 7.52-9.86 kg/h) for the two stations, respectively. Emission rates were positively correlated with natural gas throughput and compressor rotational speed, indicating that these parameters could be effective indicators of CH4 emission levels at compressor stations. Measurements over more compressor stations will be necessary to increase the representativeness of CH4 emissions from compressor stations in China. Overall, this study offers valuable empirical data and derived emission factors for electrically-driven centrifugal compressor stations in China.
This procedure guideline for SPECT examinations of striatal dopamine transporter availability is intended to support the planning, execution, quality control, interpretation and reporting of cerebral SPECT scans with [123I]ioflupane. It is an update and expansion built on the 2019 version of the procedure guideline. It was developed through an informal process as a consensus of the Neuroimaging Working Group of the German Society of Nuclear Medicine and in consultation with the German Neurological Society. It is intended for use by physicians and technical staff working in the field of nuclear medicine. Die vorliegende S1-Handlungsempfehlung zur Durchführung von SPECT-Untersuchungen der striatalen Dopamintransporter-Verfügbarkeit soll bei der Planung, Durchführung, Qualitätskontrolle, Beurteilung und Erstellung des Befundbriefs der SPECT des Gehirns mit [123I]Ioflupan unterstützen. Sie stellt eine Aktualisierung und Erweiterung der Fassung aus dem Jahr 2019 dar und wurde in einem informellen Verfahren als Konsens der Arbeitsgemeinschaft Neuronuklearmedizin der Deutschen Gesellschaft für Nuklearmedizin und in Abstimmung mit der Deutschen Gesellschaft für Neurologie erarbeitet. Sie richtet sich an ärztliches sowie an medizinisch-technisches Personal in der Nuklearmedizin.
Elevated low-density lipoprotein cholesterol (LDL-C) is a modifiable risk factor for cardiovascular disease, the leading cause of premature death worldwide. Assessing the LDL-C-related burden is critical for guiding prevention and treatment strategies. To estimate the global, regional, and national burden of ischemic heart disease and ischemic stroke attributable to elevated LDL-C (relative to 35-54 mg/dL) from 1990 to 2023 and to quantify the contributions of population growth, aging, risk-deleted burden, and exposure changes to burden trends. This comparative risk assessment, part of the Global Burden of Disease Study 2023, estimated population-level LDL-C exposure and associated health loss in 204 countries and territories. Mean LDL-C levels were estimated using spatiotemporal gaussian process regression based on 806 studies across 161 countries. Relative risks were derived from meta-analyses of 38 randomized clinical trials. Population-attributable fractions for deaths and disability-adjusted life-years (DALYs) were estimated by age and sex for adults aged 25 years or older from 1990 to 2023, with 95% uncertainty intervals. Population-level LDL-C concentrations. Population-attributable fractions, counts, and rates (all ages and age standardized per 100 000) of LDL-C-attributable deaths and DALYs from ischemic heart disease and ischemic stroke, with uncertainty intervals. In 2023, elevated LDL-C accounted for 3.6 million deaths (95% uncertainty interval, 2.2-5.4 million; 6.0% of global mortality) and 90.7 million DALYs (95% uncertainty interval, 58.9-123.3 million; 3.2% of DALYs). Although global all-ages rates remained stable, age-standardized death and DALY rates decreased by 45.6% and 39.5%, respectively, since 1990. In 2023, age-standardized LDL-C-attributable DALY rates were highest in Eastern Europe and lowest in high-income Asia-Pacific. One-third of the global LDL-C burden occurred in India and China. Population growth and aging drove the increasing burden, with notable regional disparities in LDL-C exposure and risk-deleted DALY rates shifting toward middle-sociodemographic settings. Despite declining age-standardized rates, the absolute LDL-C burden has increased since 1990 due to demographic changes and has shifted toward middle-sociodemographic countries. Measurement and surveillance gaps persist. Strengthened prevention, diagnosis, and treatment access strategies are essential to mitigate the health burden of LDL-C.
To compare short-term visual functions changes in myopic children who had worn the defocus incorporated multiple segment (DIMS), DIMS with triple enhanced design (DIMS TED), and single-vision (SV) spectacle lenses. Thirty-eight Chinese children (six to 13 years) with spherical equivalent refractive error -1.00 D to -5.00 D were recruited. Participants wore DIMS, DIMS TED and SV spectacle lenses in random order. High- and low-contrast distance and near visual acuity (VA), mid-peripheral near VA, binocular functions, accommodation and visual symptoms were assessed before and after 1-week of lens wear, while mid-peripheral distance VA was assessed with and without glare in a second visit. Most visual functions showed no differences before and after lens wear. Central high- and low-contrast distance VA and central high-contrast near VA under room and dim lighting were unaffected by DIMS and DIMS TED spectacle lenses compared to SV lenses (all P > 0.05). Central low-contrast near VA was reduced by 0.06 ± 0.10 logMAR in DIMS TED lenses compared to DIMS lenses under room lighting (P < 0.01), and by 0.06 ± 0.11 logMAR compared with SV spectacle lenses under dim lighting (P < 0.01). Mid-peripheral distance VA and near VA were reduced by approximately 0.10 logMAR in DIMS TED and DIMS compared to SV lenses (P < 0.01), respectively. However, these reductions are unlikely to represent a clinically meaningful impairment in visual function. Most children adapted and accepted the DIMS TED spectacle lenses well. DIMS TED spectacle lenses demonstrated visual performance comparable to DIMS and SV spectacle lenses. The enhanced design of the DIMS TED spectacle lenses maintains visual performance comparable to DIMS and single vision spectacle lenses, and may potentially increase myopia control efficacy.
Despite a robust literature on the topic, a consistent definition of medical professionalism remains elusive. A single, generalizable definition is ineffective and tends to emphasize prohibited behaviors rather than aspirational concepts. As physicians are increasingly employed by corporate entities, the nature of healthcare work has changed, as well as professional expectations. This study explores how patients and family physicians understand medical professionalism and its drivers.We recruited family physicians who completed the ABFM Continuing Certification Questionnaire in 2024 to participate in in-depth, semi-structured interviews. A trained qualitative researcher used Zoom to interview 27 demographically diverse physicians. We utilized modified snowball sampling to recruit patients through a key informant. All interviews were transcribed verbatim and analyzed utilizing NVivo software following an inductive content analysis approach.Interview results coalesced into a model of professionalism that represents the clinic visit, the practice site, and the overarching system. Three main components of individual physician professionalism emerged, including foundational duties, relationship-based care, and communication. Patient trust in the overarching healthcare system and individual physicians was deeply influenced by the interconnected system.This study presents key elements of physician professionalism while highlighting how deeply physicians are entangled within the larger practice and healthcare systems. Professionalism extends beyond-and is impacted by-more than individual attitudes and behaviors. Institutions must interrogate their own policies to support physicians in developing their skills in relationship-based care and communication.
To evaluate the incidence, causality and risk factors associated with colistin-induced acute kidney injury (AKI) using the Risk Injury Failure, Loss and End-stage renal disease (RIFLE) criteria. This is a retrospective cohort study that involved patients treated with intravenous colistin from 2016 to 2023 in the State of Qatar. The Naranjo Scale was used for causality assessment. A total of 186 cases were included in this analysis. The incidence of colistin-induced AKI at day 14 was 23.7%. The median (interquartile range) time to AKI onset was 5.0 (7.0) days. Of the patients with AKI, 6 (12.8%) patients received renal replacement therapy within 30 days. Naranjo causality assessment showed that the majority of the cases (80.9%) had "possible" colistin-induced AKI (score 1 - 4). Colistin dose per administration (adjusted odds ratio [AOR]: 2.286, 95% CI: 1.246 - 4.194, p = 0.008), and sepsis/septic shock (AOR: 2.380, 95% CI: 1.005 - 5.635, p = 0.049) were independent risk factors for colistin-induced AKI. One in four patients receiving colistin develops AKI, and a subset required a renal replacement therapy within 30 days. Close monitoring of patients, and the application of precision medicine are recommended to minimize the risk of AKI.
Objective: Compare sarcopenia, nutritional status, and health-related quality of life (HRQoL) between urban and rural community-dwelling older adults with dementia in Taiwan. Methods: Cross-sectional analysis of pooled data from two cohorts (N = 240; ≥ 65 years) from a neurology clinic in northern Taiwan (August 2022-September 2023) and a dementia care center in central Taiwan (September 2024-July 2025). Sarcopenia was defined using 2025 Asian Working Group criteria. Nutritional status and HRQoL were assessed. Logistic regression estimated associations with urban residence, adjusting for demographic and clinical covariates. Results: Urban participants had more prevalent sarcopenia (36.3% vs. 23.8%, p = 0.01) and low muscle mass (34.8% vs. 18.1%, p = 0.01) but less prevalent malnutrition or risk (2.2% vs. 30.5%, p < 0.01). After adjustment, urban residence was associated with higher odds of sarcopenia (OR 2.41, 95% CI 1.25, 4.62) and low muscle mass (OR 2.74, 95% CI 1.35, 5.57), and lower odds of malnutrition or risk (OR 0.33, 95% CI 0.18, 0.61). Associations with physical and mental HRQoL were not significant. Conclusions: Urban-rural differences in sarcopenia and nutritional status were observed; HRQoL was not independently associated with residence. Interpretation is limited by cross-sectional design, non-random sampling, and residual confounding.