To compare the four-week patency and degree of intra-graft stenosis of a percutaneously created extraluminal arterial bypass using a stent graft to a surgically created prosthetic bypass in a porcine carotid artery model. Seven female Yorkshire swine underwent both percutaneous and surgical carotid artery bypass procedures. Percutaneous bypasses were created using subcutaneously tunneled 6-mm GORE VIABAHN stent grafts, while surgical bypasses were performed on the contralateral side. Animals received dual antiplatelet therapy and were monitored weekly with Doppler ultrasound for four weeks. Graft patency and stenosis were assessed with angiography and explant inspection. Percent stenosis at cranial, mid-graft, and caudal segments were calculated and compared. Percutaneous bypass creation was technically successful in 6 of 7 pigs (86%); one failure was due to stent graft maldeployment. All successfully placed percutaneous and surgical grafts remained patent at four weeks. Mean angiographic stenosis for percutaneous grafts was 47% (caudal), 20% (mid), and 43% (cranial); versus 34% (caudal, p=0.26), 12% (mid, p=0.69), and 35% (cranial, p=0.42) for surgical grafts after four weeks. Visual inspection demonstrated comparable degrees of intimal hyperplasia (p=1.0). Four seromas occurred adjacent to surgical bypasses, whereas none occurred with percutaneous bypasses (p=0.06). Percutaneously created extraluminal arterial bypass demonstrated similar short-term patency and intra-graft stenosis compared to surgical bypass, supporting its potential as an alternative revascularization strategy in complex PAD.
Marijuana is a schedule I controlled substance under federal law, but the Drug Enforcement Administration has published a proposed rule to reschedule it to schedule III at the federal level. This may create an even more complex regulatory landscape for the drug, with potentially ongoing conflicts between federal and state law. To evaluate the current scheduling of marijuana in the United States. In January 2026, two researchers independently conducted a 50-state survey to identify the schedule of marijuana in all 50 states and D.C. Westlaw, a legal database, was used to conduct searches in each state using the following search terms: "marijuana, "controlled substance," "schedule," "cannabis," and "marihuana." Most states listed marijuana as a schedule I controlled substance (n=33; 65%), which is the most restrictive schedule and consistent with current federal law. A total of nine (18%) states did not schedule marijuana. A total of nine (18%) states included marijuana in another schedule or classification system, with two (4%) states having already adopted schedule III. This review of state laws highlights implications of potentially rescheduling marijuana to schedule III, including three post-change scenarios: (1) state law is stricter than federal, (2) federal law remains stricter, and (3) automatic change in schedule when state law defers to federal. This will likely create more regulatory complexity immediately post-change, and pharmacists must be mindful of their state's laws in practice to ensure compliance, particularly for states that become the stricter law on the topic.
Each day, over 100 randomized controlled trials (RCTs) are published, making it impossible for clinicians to stay up-to-date with medical literature. Large language models (LLMs) can identify and summarize emerging clinical evidence and support medical education. We created and prospectively evaluated a newsletter, Trial Files, which leverages an LLM to summarize RCT abstracts relevant to general internal medicine. We created a software tool, called PaperScrape, which leverages the Medline application programming interface (API) to identify trials published in five high-impact journals. Information from each RCT's abstract was extracted, and plain-language summaries were generated using OpenAI's LLM API. We analyzed the accuracy of summaries generated by an LLM (compared to manual review), results of a subscriber survey, and effectiveness of marketing strategies on user growth. From June 2023 to March 2025, 50 newsletters with 3 RCTs each were distributed to 648 subscribers. A subset of 96 RCTs was randomly selected to evaluate reporting accuracy with prompt engineering. The accuracy for reporting study information with prompt engineering, compared to manual review, was 97.1% for study phase, 92.2% for blinding, 85.4% for sample size, 97.9% for patient population, 94.7% for comparison groups, and 92.7% for primary outcome. Forty-three subscribers completed a survey about Trial Files. The mean overall rating was 4.7 out of 5 (5 representing "very good"), and all respondents agreed the newsletter made it easier to keep up-to-date with emerging clinical trials in internal medicine. The most effective strategy for user growth was promotion at a meeting, conference, or education session (6.8 subscribers per day, compared to 0.7 subscribers gained per day on days without promotion, p < 0.0001). LLMs can provide concise, accurate summaries of RCTs, which can help general internists stay up-to-date on recently published trials.
Evidence for inclusion strategies in the workplace is limited. In our previous research we identified challenges for newly qualified racially minoritized physiotherapy staff within a large UK urban NHS Trust. In this study we evaluated the impact of strategies co-created to facilitate their inclusion. A process and outcomes evaluation approach was used with our previous work to co-create and implement inclusion strategies. Mixed methods of data collection included a staff survey, workplace guidelines, proforma usage, and interviews with key protagonists which were informed by a theory of change. Six months after the project was implemented, we found that newly qualified staff responded more positively to statements about feeling included. There was little improvement in socializing or connecting on a personal level with colleagues, despite a greater variety and frequency of social events. Even though participants were unchanged in their perception of space for inclusive conversations, more agreed they were able to converse about race albeit with ambivalence about whether action would be taken. We noted a small increase in proportions of newly qualified staff feeling vulnerable and unable to bring their authentic self to work. This study implemented a proactive co-design approach for inclusion in physiotherapy with partial success. The findings at 6-months show some change in raising awareness, fostering dialogue and improving perceptions. However, a limitation of the process employed is that it may have surfaced deeper racial and intersectional tensions that require sustained and complex local and organizational action, which is an ongoing and iterative endeavor.
During the commissioning and qualification (C&Q) of a new large-scale freeze-thaw unit in a GMP manufacturing environment, a significant cleaning concern was identified involving the bottom shelf assembly. A non-fixed Teflon plate, intended as an insulation layer between the lower shelf and the pressure table, creates a narrow gap prone to fluid accumulation. This area is inaccessible for standard manual cleaning, posing a microbial and cross-contamination risk.The Teflon plate provides an insulation layer between the lower shelf and the pressure table. The current removal process is labor-intensive, requiring a two-person lift to clear internal pins, which introduces ergonomic risks and potential mechanical strain on critical hose connections. To resolve this, we collaborated with the vendor on a design evolution. This presentation details the investigative approach used to identify this "hidden" risk and the subsequent collaboration with the equipment vendor to re-engineer the pin design. Reducing pin length enables horizontal plate removal without lifting the shelf assembly, which successfully bridges the gap between mechanical requirements and GMP cleanability.
Schistosomiasis (SCH) and Soil-transmitted helminthiasis (STH) remain major neglected tropical diseases across sub-Saharan Africa. In Akwa Ibom State, preventive chemotherapy (PC) has been implemented in endemic Local Government Areas (LGAs). This study assessed the impact of five effective rounds of PC on the prevalence and intensity of SCH and STH in 26 endemic LGAs. This study was carried out in 26 LGAs of Akwa Ibom State between September and October 2025. A school-based cross-sectional survey was employed. Schools were purposefully selected from endemic wards, and a total of 200-300 samples were collected per LGA from school children of both sexes aged 8-14 years. Samples were collected using a systematic random sampling method. Questionnaires were administered using electronic data forms. Stool samples collected were analyzed using the Kato-Katz technique, while urine samples were analyzed using the urine filtration method. Conventional microscopy alongside a novel AiDx digital microscope was used to examine prepared specimen. Data obtained were analyzed using descriptive statistics, chi-square test, bivariate and multivariate logistic regression on SPSS, and maps were generated using ArcMap. No cases of Schistosoma mansoni or Schistosoma haematobium were detected across the 26 LGAs (0.0% prevalence). The overall prevalence of STH was 27.62% (95% CI: 26.54-28.72), ranging from 4.92% to 71.65% across LGAs. Species-specific prevalence was 15.38% (95% CI: 14.52-16.28, range: 3.3% to 38.3%) for hookworm, 15.10% (95% CI: 14.24-15.99, range: 1.6% to 67.0%) for Ascaris lumbricoides, and 1.52% (95% CI: 1.25-1.85, range: 0.4% to 9.3%) for Trichuris trichiura. Mbo (71.65%) and Udong Uko (62.04%) recorded the highest prevalences, whereas Ika (4.92%) had the lowest. Prevalence was significantly higher among children aged 11-14 years (31.77%; 95% CI: 29.95-33.64) compared with those aged 8-10 years (95% CI: 23.77-26.46), and among males (29.30%; 95% CI: 27.80-30.86) compared with females (25.73%; 95% CI: 24.24-27.35) (p < 0.05). 98.66%, 99.09% and 100.0% of schoolchildren had light infections of A. lumbricoides, hookworms and T. trichiura respectively. Compared with baseline data, STH prevalence declined by 30.15%. Significant risk factors associated with STH include; males (aOR = 1.196, 95% CI: 1.072 - 1.335), age group of 11-14 years (aOR = 1.391, 95% C.I.: 1.244 - 1.554), dry pit latrine (aOR = 1.464, 95% C.I. = 1.239 - 1.731), schools where children urinate (aOR = 2.620, 95% C.I.: 2.362 - 2.929) and defecate (aOR = 1.238, 95% C.I. = 1.097 - 1.396) around school or wait to defecate after school (aOR = 1.830, 95% C.I. = 1.365 - 2.454), schoolchildren that drinks from surface water (aOR = 1.731, 95% C.I. = 1.486 - 2.017) or boreholes that uses hand pump (aOR = 1.666, 95% C.I. = 1.412 - 1.965). Schistosomiasis was not reported in 26 LGAs of Akwa Ibom. Soil-transmitted helminths had a significant reduction in prevalence, but with varying prevalence across the states. There is a need for sustained preventive chemotherapy against STH in the State. Improvement in water, sanitation, and hygiene (WASH) infrastructures to create behavioural change, and strengthen the control efforts.
Sulfidation modification creates a redox-noninnocent sulfur interface on cobalt ferrite/red mud (CoFe2O4/RM, and its sulfidated form is denoted as S-CoFe2O4/RM), enabling both fast and selective peracetic acid (PAA) activation for sulfamethazine (SMT) degradation. The S-CoFe2O4/RM/PAA system removes 95.1 % of SMT within 5 min, with a rate constant 12.77 times that of unmodified CoFe2O4/RM. Using X‑ray absorption near-edge structure (XANES), time-resolved X‑ray photoelectron spectroscopy (XPS), operando attenuated total reflectance Fourier‑transform infrared spectroscopy (ATR-FTIR), and density functional theory (DFT) calculations, we reveal that surface sulfur acts as a dynamic interfacial cofactor. First, low-valence sulfur species (S2-, SO32-) can serve as electron donors that continuously regenerate Co2+/Fe2+, sustaining rapid metal redox cycling. Second, sulfur alters the adsorption configuration of PAA and steers asymmetric O-O bond cleavage, switching the dominant reactive oxygen species from non-selective •OH to highly selective R-O• and 1O2. Nine degradation intermediates are identified, with pathways including hydroxylation, S-N bond cleavage, and N-centered radical coupling. Most intermediates are predicted to exhibit lower toxicity than SMT. The system shows strong resistance to anions and humic substances, excellent recyclability, and stable performance in real water matrices. This work establishes sulfur as a redox-noninnocent interfacial cofactor that decouples activation rate from indiscriminate radical chemistry, offering a new design principle for selective PAA activation in antibiotic wastewater treatment.
Alterations in serum calcium (Ca2+) and phosphate (Pi) balance have been associated with poor outcomes in heart failure (HF). However, these data are mostly derived from small observational studies. Moreover, the impact of SGLT2 inhibitors on Ca2+and Pi levels have not been explored in large, randomized HF trials. Using EMPEROR-Pooled data we aim to study the prognostic associations of serum Ca2+ and Pi in patients with HF and study the impact of empagliflozin on Ca2+ and Pi levels. EMPEROR-Pooled (N=9718) was used to create serum Ca2+ and Pi categories (quintiles, Q). Cox and mixed-effects models were used. Mean Ca2+ levels were 2.35±0.12 mmol/L and Pi 1.14±0.18 mmol/L. Compared to patients with higher Ca2+ levels (Q5, mean 2.5±0.1 mmol/L), those with lower Ca2+ (Q1, mean 2.2±0.1 mmol/L) presented more peripheral edema and higher NT-proBNP levels (P<0.05). Low Ca2+ was modestly associated with a higher risk of cardiovascular death or HF hospitalization. The effect of empagliflozin (vs placebo) on cardiovascular death or HF hospitalization was not influenced by serum Ca2+ levels (interaction-P>0.1), while the mortality reduction appeared more marked among patients with higher serum Ca2+ (interaction-P=0.08). Serum phosphate levels were not associated with outcomes and did not influence the effect of empagliflozin (interaction-P>0.1). Empagliflozin induced a minor increase in serum Ca2+ and Pi levels over time: +0.004 (0.001-0.006) mmol/L (P=0.002), and +0.030 (0.026-0.034) mmol/L (P<0.001), respectively. Low serum Ca2+ may be associated with poor outcomes but did not influence the effect of empagliflozin in a statistically significant manner.
This paper examines forms of racialized stress experienced by Black mothers throughout the life course. The literature suggests that racialized pre- and post-natal stress experienced within health care settings tend to create pathways for negative physical and mental health outcomes. These outcomes highlight the need for critical resources to improve the quality of maternal mental health among Black birthing populations. We incorporate perspectives from social work - Grand Challenge to Eliminate Racism and sociology to re-envision the exhaustive efforts made by Black mothers to protect their children in the face of racism. Our analysis suggests that Black mothers often exercise agency to resist mental health effects that may impair their ability to parent in a healthy manner. Resilience may emerge in the form of cognitive flexibility and the healing power of spirituality. Strategies to eliminate racism include adoption of an anti-racist perspective inclusive of an intersectionality paradigm as well as qualitative methodologies to address interlocking systems of sexism and racism experienced by Black mothers throughout their parenting journey.
To address the ecological implications of spatiotemporal heterogeneity on microbial assembly and flavor formation in Chinese aromatic vinegar, this study systematically revealed these dynamics during the solid-state acetic acid fermentation (AAF). Temporally, Lactobacillus, Acetobacter, and Komagataeibacter synergistically drove acid and aroma formation. In the early stage (day 1), Lactobacillus dominated, creating an acidic niche for Acetobacter. During the main fermentation stage (days 7 to 13), Acetobacter oxidized ethanol to acetic acid, while Lactobacillus accumulated lactic acid, facilitating ester production. In the late stage (day 21), increased Komagataeibacter abundance further enhanced the accumulation of acetic acid and ketones. Spatially, oxygen availability created distinct metabolic zones: the aerobic upper layer favored rapid acetic acid accumulation by the proliferation of Acetobacter and Komagataeibacter. The middle layer served as a metabolic transition zone. The anaerobic lower layer dominated by Lactobacillus accumulated lactic acid, alcohols, and esters. Bacterial community assembly shifted from stochastic to deterministic processes, with high-abundance Acetobacter and Lactobacillus (over 90%) reinforcing metabolic synergy through environmental filtering. The layer-by-layer turning process gradually reduced spatial heterogeneity, converting compartmentalized metabolism into integrated synergy, thereby ensuring balanced accumulation of aromatic compounds and maintaining acid production efficiency.
Against the backdrop of the shortages of nursing managers, this paper examines predictors of career aspirations among nurses in Ireland. Rather than viewing career aspirations as being determined solely by personal, job related or organizational factors we consider the individual nurse, within the context of their job, interacting with the overall organization and seek to ascertain how these factors are related to nurse's career aspirations. The objective of this study is to explore how personal, job-related, and organizational factors shape nurses' career aspirations. The research question guiding this study is: "What variables relating to the individual, job or organization predict career aspirations among nurses?". This cross-sectional study gathered questionnaire data from 263 nurses. A large public hospital group in Ireland comprising 5 hospitals. Pearson correlations provided an initial understanding of the bivariate relationships between scales measuring career aspirations and scales measuring resilience, job satisfaction, employee engagement, psychological safety, organizational citizenship behavior, and organizational commitment. Multivariate Linear Regression models examined factors independently associated with career aspirations. Correlational analysis identified statistically significant relationships between career aspirations and the individual, job and organizational scales, with resilience showing the strongest positive correlation (r = 0.418, p < 0.01). The Multivariate Linear Regression analysis identified having a postgraduate qualification (β = 2.92, 95% CI [1.38, 4.45], p < 0.001) and higher levels of resilience (β = 2.22, 95% CI [1.26, 3.19], p < 0.001) as statistically significant independent predictors of career aspirations. The findings provide insights into developing strategies to create a pipeline of qualified nurses to optimize recruitment and succession planning for nurse managers, thereby building a sustainable workforce. Hospital managers should develop policies and programs that promote organizational support for further education and resilience-building workshops. These initiatives could encourage more nurses to pursue nursing management roles.
This study evaluated how integrating intraoral scanners (IOS) into Digital Dentistry and Operative II courses at Tufts University School of Dental Medicine (TUSDM) influenced second-year dental students' perceived understanding of ceramic inlay preparations and examined differences by learning preferences. IOS was incorporated alongside pre-class readings, lectures, and typodont exercises. Students scanned their preparations using IOS to create rotatable 3D models for visualisation and feedback. A Tufts Health Sciences Institutional Review Board-approved Qualtrics survey, validated for face and content, assessed students' perceptions of IOS's educational value and impact on understanding and differences based on individual learning preferences (visual, auditory, reading/writing, and tactile). Nearly all respondents, 96.6% (n = 140), agreed that IOS improved their ability to visualise the design of ceramic inlay preparations and served as a valuable adjunct to the didactic lecture on inlays. Students who self-identified as visual learners reported significantly higher satisfaction with IOS integration compared to nonvisual learners (p = 0.001). In addition, students identified multiple courses where IOS would be a valuable visual aid. Integrating IOS into preclinical instruction improved students' perceived understanding and visualisation of ceramic inlay preparations, with the strongest impact among visual learners. IOS represents an effective complementary tool for enhancing spatial reasoning and bridging theoretical and practical learning in dental education. Future research should incorporate objective learning outcomes and cognitive load measures to validate these findings.
Artificial intelligence (AI) is increasingly promoted as a transformative innovation in in vitro fertilization (IVF), particularly for embryo selection. This article examines how discourses surrounding AI in IVF reflect broader shifts in medical paradigms and market logics. Drawing on a comparative critical discourse analysis of clinic websites, media texts and professional publications in the Netherlands and the United Kingdom, we explore how stakeholders frame the promise and potential of AI-enabled embryo selection. Our findings reveal three interconnected dynamics. First, UK discourses predominantly construct a paradigm shift from evidence-based medicine (EBM) toward data-driven care, positioning AI as a solution to the perceived limitations of randomised controlled trials. Dutch sources, by contrast, largely sustain EBM principles, framing caution as a safeguard against false hype and escalating costs. Second, UK clinics and technology developers predominantly employ promissory narratives that create self-fulfilling prophecies about an AI-driven future, while Dutch actors largely resist the inevitability of technological fixes. Third, the meaning of patient choice diverges: in the UK, choice is increasingly conflated with consumerism, enabling clinics to market unproven add-ons at additional cost; in the Netherlands, patient choice remains more insulated from market forces, though globalised imaginaries exert growing pressure. These findings illuminate how commercial interests and sociotechnical imaginaries shape reproductive care beyond clinical evidence, raising ethical concerns about equity, regulation and the commodification of hope. The IVF sector offers a critical lens on the wider implications of AI-driven medicine for healthcare governance in an era of marketisation.
Developing a skilled workforce pipeline is crucial to scaling operations and ensuring the highest standards of quality and safety. To address this challenge, we propose a dual framework that incorporates both internal employee training to maximize personnel resources, as well as external outreach and workforce development programs.Our Spokane manufacturing site undertook a major workforce transformation by adopting a shared resource model and cross-training existing team members to perform multiple roles. This initiative enabled continuous 24-hour operations, improved flexibility, and allowed for more efficient deployment of technicians across production lines in preparation to scale operations.In addition to internal development, we collaborate with local academic institutions and economic development organizations to drive interest in biomanufacturing careers. Most notability, our investment in future talent through a partnership with the local community college to create a biotech manufacturing certification course prepares potential workforce members with the foundational skills needed to succeed in the growing pharma manufacturing industry.
Generative AI holds ample potential to make agri-food systems more productive, resilient, and nature-friendly, but also poses risks. Here, following a methodical assessment of AI-generated advice on crop protection provided by ChatGPT-5, DeepSeek 3.1 up to 3.2-Exp, NormAI, KissanAI and VirtualAgronomist, we reveal systematic biases, faulty recommendations, and unethical machine behavior. As proprietary AI-powered advisories tend to favor commodified inputs and restrict the plurality of non-chemical alternatives, they may create informational biases that could, in turn, influence farmers' uptake of agroecological and biodiversity-driven solutions. For instance, whereas biological control, soil health and diversification tactics carry notable social-environmental benefits, they are systematically downgraded or even excluded by certain AI systems. Over time, such input-oriented foci can reinforce farmers' dependencies on purchased products - thereby eventually and inadvertently fueling pest proliferation, inflicting environmental harm, and eroding ecosystem services. Greater scrutiny, robust governance, and tailored regulations are urgently needed to safeguard environmental integrity and farmer livelihoods.
Conventional coated stationary phases often suffer from surface area loss due to dense coatings, limiting separation efficiency and interaction site availability. A hierarchical porous structure may overcome this drawback while enabling efficient mass transport for polar compound analysis. In this work, we address this challenge by fabricating a hydrophilic interaction chromatography (HILIC) stationary phase (Sil@CMC-Na/β-CD) via a "rigid-flexible synergistic" coating strategy, using carboxymethylcellulose sodium (CMC-Na, flexible) and β-cyclodextrin (β-CD, rigid) as hydrogel monomers. The CMC-Na/β-CD hydrogel formed abundant self-generated micropores (0.6-1.8 nm) during film formation, which interconnected with the silica's native mesopores to create a continuous hierarchical porous structure. This unique structure unexpectedly increased the specific surface area from 372.88 m2 g-1 (bare silica) to 411.66 m2 g-1 (Sil@CMC-Na/β-CD). Consequently, the stationary phase achieved efficient and symmetric baseline separation of three categories of polar compounds (acidic, basic, and zwitterionic/neutral) with markedly improved resolution and peak symmetry compared to commercial NH2 and Diol columns. The performance stems from the "rigid-flexible synergistic" coating strategy: the flexible CMC-Na network provides hydrophilicity and weak anion-exchange ability, while the rigid β-CD cavities contribute hydrophobic inclusion sites and help maintain the hierarchical porous structure, enabling enhanced mass transport. This work presents a versatile HILIC stationary phase that overcomes the typical surface-area loss of coated materials. The hierarchical porous structure establishes a new paradigm for integrated "structure-performance" platforms, enabling effective discrimination of polar compounds with widely differing acid-base properties. This approach offers a rational route for broad-spectrum analysis of complex polar samples and advances the development of functional separation materials with customized porosity.
The study examines the socio-economic, ideological and religious factors influencing how likely Americans perceive the consequences of environmental regulation to be. Three perception-based items from the Pew Research Center's American Trends Panel Wave 106 (n = 10,156) are examined: higher fuel and electricity prices, gradual loss of individual freedoms, and fewer jobs or declining pay in fossil-fuel-dependent industries. These items are interpreted as subjective expectations rather than observed or causal effects of regulation. We use fuzzy hybrid TOPSIS to create a synthetic index of the perceived effects of environmental regulation on Americans (AP-ERE), and fuzzy clustering to classify respondents as extremely convinced, extremely unconvinced or intermediate. The results reveal significant disparities among ideological, socioeconomic, and religious groups. The convinced cluster is more prevalent among religious, conservative, older and male respondents, suggesting that they perceive a greater likelihood of economic and social costs. Overall, the results suggest that perceptions of environmental regulation are shaped not only by ideology and socio-economic characteristics, but also by religious identity and religiosity.
Physical inactivity among older adults remains a significant public health issue. Age-friendly active spaces with the Seniors Exercise Park equipment in local parks offer an accessible, low-cost opportunity to promote health through physical activity. The ENJOY IMP-ACT project was a multi-site implementation initiative aimed at scaling up the use of the Seniors Exercise Park across six sites in Victoria, Australia. This paper examines factors influencing implementation and uptake. A descriptive practice-based implementation insights approach was used to evaluate the ENJOY IMP-ACT project. Data sources included staff field notes, meeting minutes and park-based activity tracking. Insights were categorized using the TERM framework: training, engagement, resource development, and marketing. Additional analysis considered environmental and organizational factors affecting delivery and uptake. Coordinated planning with local government staff, flexible timelines, and tailored training delivery supported effective program implementation. Local governments with dedicated project officers, clear internal processes, and targeted community engagement strategies demonstrated higher levels of participation. Site visibility, access to amenities, and proactive promotion influenced park usage. Organizational factors, such as changes in staff or limited resources, created barriers to continuity. Efforts to adapt to local contexts, such as modifying training models or leveraging community events, were also important for success. The ENJOY IMP-ACT project highlights the value of a flexible, multi-components implementation framework supported by local partnerships. Consideration of both environmental and organizational factors is essential for sustained delivery of age-friendly health promotion initiatives. These findings offer actionable insights to guide future scale-up efforts in community settings. Trial registration This trial is prospectively registered with the Australian New Zealand Clinical Trials Registry. Trial registration number ACTRN12622001256763. Date registered 20/09/2022. https://www.anzctr.org.au/ACTRN12622001256763.aspx.
The aim of this study was to establish an optimal treatment strategy for functional liver-sparing radiotherapy by incorporating technetium-99 m galactosyl human serum albumin (99mTc-GSA) single-photon emission computed tomography (SPECT) into radiotherapy planning for recurrent hepatocellular carcinoma (rHCC). Three irradiation techniques-volumetric-modulated arc therapy (VMAT), intensity-modulated radiotherapy (IMRT), and three-dimensional conformal radiotherapy (3D-CRT)-were systematically compared. Six patients with rHCC who underwent stereotactic body radiotherapy (SBRT) were included. Eligible patients had previously received SBRT to a different hepatic segment and had undergone 99mTc-GSA SPECT before the current course of radiotherapy. For treatment planning, planning computed tomography (CT) images were rigidly registered with 99mTc-GSA SPECT images, and functional liver regions were manually contoured by radiation oncologists. Using identical functional liver contours, three treatment plans-VMAT, IMRT, and 3D-CRT-were independently generated by medical physicists. The prescribed dose was 40 Gy, delivered in four fractions. These treatment plans were retrospectively created for research purposes and were separate from actual clinical treatments. Under identical planning target volume dose-coverage conditions, the dose-volume histogram indices (V2-V40) of the functional liver were compared among the three techniques. VMAT consistently demonstrated the best preservation of functional liver regions, particularly in the low-dose range, followed by IMRT and 3D-CRT. These findings demonstrate the feasibility of 99mTc-GSA SPECT-guided function-avoidance radiotherapy planning for the re-irradiation of rHCC and suggest that VMAT provides an optimal balance between target coverage and functional liver preservation.
To evaluate the initial safety and feasibility of the Luca™ System, a telemanipulated robotic system with bimanual capabilities, used to perform a Core vitrectomy during surgical treatment of epiretinal membrane (ERM) or macular hole (MH). This was a prospective, single-arm, first-in-human study conducted at Ghent University Hospital in Belgium. Seven patients (mean age 71.0 ± 11.5 years) scheduled for vitreoretinal surgery for ERM (n=6) or MH (n=1) were enrolled between February and June 2024. The Luca™ system was used to create a posterior vitreous detachment and to perform a core vitrectomy, after which the remainder of the surgery (e.g., membrane peeling) was completed manually. The primary safety endpoint was the incidence and severity of device-related Adverse Event (AEs). Secondary endpoints included the proportion of subjects with iatrogenic retinal tears and changes in BCDVA and BCNVA. All surgeries were completed without serious safety incidents, and no device-related AEs or serious AEs were reported. No accidental retinal touches, hemorrhages, or iatrogenic retinal tears related to the robotic system occurred. In 6 out of 7 patients (85.7%), the robotic-assisted part of the procedure was successfully completed according to pre-operative planning. At 3 months, 5 out of 7 patients (71.4%) had a BCDVA gain. The initial clinical experience with the Luca™ robotic system demonstrates a favorable safety, feasibility, and performance profile for vitreoretinal surgery in patients with acquired maculopathies. The safety profile appears comparable to that of manual surgery.