搜索结果：Help

The emergency medical services in Berlin are facing an increasing number of missions, partly because people with low-priority psychosocial problems are calling the emergency number 112 for help. Although international evidence shows that telephone counseling can resolve some cases, there is currently no alternative to dispatching ambulances for these calls in Germany. The study examines the efficacy of a psychosocial telephone service in the emergency control center (PSAPL) in reducing the number of ambulance dispatches. This is a randomized, controlled study conducted in the emergency dispatch center. Participants were selected according to standardized emergency call query codes. On intervention days, callers with low-priority psychosocial requests for help were advised by the PSAPL and, if necessary, referred to other support structures. On control days, an ambulance was routinely dispatched. Individuals who gave their consent were contacted again after 14 days to collect self-reported outcomes (e.g., satisfaction). There were 72 PSAPL conversations during the 2‑month study period. Callers were mostly the affected persons themselves or people close to them. The median call duration was 14 min. In 48 cases, an ambulance dispatch was avoided and alternative assistance was usually provided. In 24 cases, it was not possible to conclude the case by telephone consultation and an ambulance was dispatched. Those seeking help were predominantly satisfied with the PSAPL intervention. For the first time, case-resolving telephone counselling at the control center actively prevented ambulance missions and transports to emergency rooms in the psychosocial spectrum. The PSAPL, therefore, offers a way to close an existing gap in acute psychosocial care and to refer these requests for help in a targeted manner. This could save direct ambulance costs as well as costs of follow-up care. HINTERGRUND: Der Rettungsdienst in Berlin sieht sich mit steigenden Einsatzzahlen konfrontiert, unter anderem, weil sich Menschen mit niedrigprioritären psychosozialen Hilfeersuchen (NPH) an den Notruf 112 wenden. Obwohl internationale Evidenz zeigt, dass eine telefonische Beratung fallabschließend möglich ist, gibt es aktuell in Deutschland für diese Einsätze keine Alternative zur Entsendung von Rettungswagen (RTW). Die Studie untersucht die Wirksamkeit eines psychosozialen telefonischen Arbeitsplatzes in der Leitstelle der Berliner Feuerwehr (PSAPL) zur Reduktion von RTW-Entsendungen. Es handelt sich um eine randomisierte, kontrollierte Studie in der Leitstelle der Berliner Feuerwehr. Die Teilnehmendenauswahl erfolgte nach standardisierten Notrufabfragecodes. An Interventionstagen wurden Anrufende mit NPH am PSAPL beraten und ggf. an andere Hilfestrukturen weitergeleitet. An Kontrolltagen wurde routinemäßig ein RTW disponiert. Personen mit Einwilligung wurden nach 14 Tagen rekontaktiert und selbstberichtete Endpunkte (u.a. Zufriedenheit) wurden erfasst. Von 129 NPH konnten 72 an den PSAPL weitergeleitet werden. Es konnte in 37,2 % aller NPH-Fälle und in 66,8 % der beratenen Fälle (n = 48) ein RTW-Einsatz vermieden und in der Regel an alternative Hilfsangebote vermittelt werden. In 24 Fällen war eine fallabschließende telefonische Beratung nicht möglich und es wurde ein RTW disponiert. Die Hilfesuchenden waren mit der PSAPL-Intervention überwiegend zufrieden. Es wurden zum ersten Mal durch fallabschließende telefonische Beratung in der Leitstelle RTW-Einsätze und Transporte in Notaufnahmen im psychosozialen Spektrum aktiv vermieden. Der PSAPL bietet somit eine Möglichkeit, eine bestehende Lücke in der psychosozialen Akutversorgung zu schließen bzw. NPH zielgerichtet weiterzuvermitteln.

The Salmonella inner membrane is not just a selectively permeable barrier. It is also a working platform where transport, energy metabolism, protein export, signal transduction, envelope biogenesis, and host adaptation are brought together. In this review, inner membrane proteins are therefore not discussed only as isolated structural units. We use representative transporters, respiratory enzymes, secretion systems, sensor kinases, envelope assembly factors, and phospholipids to show how these modules can work with one another under infection-related stress. Protein secretion covers Sec/Tat translocation as well as type III secretion systems (T3SSs), because these routes together link protein export with envelope assembly, motility, invasion, and intracellular survival. ATP-binding cassette (ABC) importers and secondary transporters help Salmonella take up nutrients, metals, ions, and osmoprotectants, whereas efflux systems and lipid transporters help Salmonella cope with antibiotics, bile, antimicrobial peptides, and small molecules from the host. Respiratory complexes and F₀F₁-ATPase translate changing oxygen and electron-acceptor conditions into proton motive force and ATP, which then feed back into transport, secretion, and stress tolerance. At the same time, lipid A/lipopolysaccharide (LPS), phospholipids, peptidoglycan, and cell division pathways shape envelope integrity, immune recognition, antimicrobial peptide resistance, and intracellular survival. These effects are often condition-dependent, so drug resistance and virulence phenotypes need to be read in the context of host niche, stress conditions, growth state, strain background, and compensatory regulation. Viewed in this way, the Salmonella inner membrane is a coordinated adaptive network, and this view can help identify antibacterial targets that weaken bacterial adaptation rather than simply blocking one isolated protein.

This review seeks to clarify and enhance our current understanding around miscorrection following osteotomy surgery around the knee. Whilst many of the principles described also extend to surgery performed for axial and sagittal plane deformity they are mainly predicated on the larger scientific and experiential base which exists in osteotomy for varus and valgus deformity. Miscorrection is not, however, simply the failure to achieve an accurate correction target in the coronal plane but also incorporates a large, interrelated matrix of factors some of which have greater effect than others. Scrutiny of the scientific literature and expert consensual information from two recent European projects facilitates a comprehensive overview of multiple factors in planning, surgical technique and rehabilitation with the current methods employed towards the prevention of miscorrection. The relevance of factors in planning including the level(s) of correction, Joint Line Convergences Angle and Joint Line Obliquity are analysed. Techniques which have evolved to reduce miscorrection include comparison between computer assisted navigation (CAS) and patient-specific instrumentation (PSI) technologies. The use of hinge wire protection in tibial and femoral osteotomy and fixation techniques is considered. The article attempts to clarify the various definitions around the subject with specific attention to the concepts of target, surgical accuracy, accuracy range and tolerance. The realisation that no one target for coronal correction befits all disease processes is mirrored by an understanding that individualised planning is relevant for every patient and depends on many parameters of which some await scientific investigation. The article therefore highlights areas where greater research is required and endorses the growth of Artificial Intelligence and its various domains which may help to 're-process' historic research in addition to helping to design and direct future investigation. LEVEL OF EVIDENCE: Level V.

Formalized language sample analysis (LSA), which uses standardized protocols and validated, software-supported transcription and analysis methods, is an evidence-based approach to assessing spoken language disorders. However, most school-based speech-language pathologists (SLPs) have reported that system-level barriers substantially limit their ability to use formalized LSA. This study applied the Active Implementation Frameworks to evaluate how guided implementation supports may promote the uptake of formalized LSA among school-based SLPs and to examine their effects on key implementation outcomes. SLPs were assigned to a guided implementation group (training, services, and expert-facilitated discussion) or a self-directed group (free resources only). Using a convergent mixed-methods design, we assessed fidelity, acceptability, adoption, and appropriateness. SLPs in the guided group demonstrated high fidelity and rated implementation supports as acceptable. Adoption of formalized LSA increased from 0% to 100% in the guided group, compared to a modest increase in the self-directed group. Appropriateness showed mixed patterns across groups: Compatibility differed significantly, whereas self-efficacy did not. Qualitative findings helped explain these distinctions by illustrating how guided supports influenced clinicians' perceptions of LSA's fit and feasibility. Guided support enhances LSA adoption and fidelity. Sustained use requires attention to both competency and organization drivers. Implementation science frameworks help identify barriers and guide strategies for translating evidence-based practices into routine use. https://doi.org/10.23641/asha.32764518.

Creutzfeldt-Jakob disease (CJD) is a rapidly progressive neurodegenerative disease characterized by significant changes in EEG and structural alterations on MRI. Both are integrated in the current World Health Organization (WHO) surveillance criteria of CJD. We aimed to re-evaluate the EEG recordings, along with clinical and MRI data, in patients with different subtypes of definite CJD by applying the adapted American Clinical Neurophysiology Society (ACNS) criteria, 2021. Fifty-one routine EEG recordings in 16 patients with sporadic CJD were reanalyzed. Generalized slowing, according to standard terminology, was present in 94% of patients. Generalized periodic discharges (GPDs) and generalized rhythmic delta activity (GRDA), as defined by the 2021 ACNS criteria, occurred frequently (31% and 38%, respectively). The differentiation from ictal activity may be challenging because 25% (4/16) of the patients fulfilled the criteria of the recently proposed ictal-interictal continuum (IIC) in at least 1 EEG. By contrast, no status epilepticus (SE) was observed. The EEG alterations varied among the different CJD molecular subgroups: more cortical involvement in MM/MV1 and mixed MM/MV1 + 2C histotypes was associated with periodic discharges (PDs) (57% and 80%) and also IIC (43% and 20%). We could not detect any PD or IIC in patients with the VV1 or MV2K (predominant subcortical pathology) histotype. Assessing the EEGs according to the 2021 ACNS criteria may help prevent misdiagnosis of nonconvulsive status epilepticus, and repetitive recordings may help in earlier diagnosis of CJD.

Plants release volatile organic compounds (VOCs) as part of their defense mechanisms when attacked by phytopathogens and herbivores. These specific volatile emissions can help plants avoid damage. In this study, we investigated the effects of the brown marmorated stink bug (BMSB), Halyomorpha halys, and the phytopathogens "Candidatus phytoplasma mali", causing apple proliferation (AP) or "Ca. P. pyri", causing pear decline (PD) on the volatile emissions from apple (Malus domestica) or pear (Pyrus communis) trees. We analyzed VOCs emitted by uninfected and infected trees exposed to male and female BMSB. Using random forest analysis, the profiles of uninfected trees and those singly infected with PD- or AP-phytoplasma were clearly distinguishable from those infested with BMSB and double-infections with both phytoplasma and BMSB. BMSB-infested apple and pear trees emitted higher levels of linalool and 4,8-dimethyl-1(E)-3,7-nonatriene (DMNT) compared to uninfested trees. In addition, dual infections with phytoplasma and BMSB showed an induction in the content of these VOCs. Phytoplasma-infected apple trees significantly increased emissions of methyl salicylate (MeSA), whereas MeSA content was significantly increased in pear trees exposed to BMSB and also dual infections with phytoplasma and BMSB. In apple trees, α-farnesene was emitted at a higher amount only from phytoplasma-infected trees exposed to BMSB males, whereas in pear trees this VOC was significantly induced in response to female BMSB and dual infections with phytoplasma and female BMSB. Furthermore, we found three acids in healthy pear trees, n-hexadecanoic acid, octadecanoic acid, and oleic acid, which were not detected in phytoplasma-infected or BMSB-infested trees. It was demonstrated that this information can help to identify specific chemical signatures and specific VOCs, which may be used as biomarkers for detecting and monitoring these pests.

Sleep disturbances and low physical activity are common among breast cancer (BC) survivors and are associated with increased morbidity and mortality. Given the increased access to technological devices and the growing popularity of SMS text messaging-based mobile health interventions, these tools have the potential to both address sleep disturbances and promote physical activity in a scalable and cost-effective way. To understand and make effective use of these tools, it is important to consider the preferences of BC survivors with sleep disturbances, including how SMS text messaging-based mobile health interventions could deliver interventions involving physical activity and sleep hygiene. The objective of this study was to explore the perspectives and preferences of BC survivors regarding text messaging-based mobile interventions targeting sleep and physical activity. Three focus groups (n=13 participants) and 3 individual interviews (n=3) were conducted from May 2020 to March 2021 with 16 BC survivors (mean age=59.3, SD 8.9 y) currently experiencing sleep disturbances. The interview questions focused on their experiences with poor sleep and preferences for text messaging-based mobile health interventions. Thematic analysis was applied to the deidentified transcriptions of audio recordings. Three themes were identified: (1) attitudes toward health interventions delivered through text messaging, (2) specific user needs, and (3) technology usage habits and preferences. Most participants reported a positive attitude toward the possibility of using technology to help improve their sleep and increase their physical activity. Most expressed a high level of acceptance toward some technologies, such as text messaging and mobile apps, but not others, such as voice interactions. In terms of desired features, reminders and accountability features, such as meeting physical activity goals, were mentioned most frequently. In addition, incorporating bedtime and relaxation exercise reminders was thought to be helpful. Regarding time and frequency, a daily reminder scheduled for 1 hour before bedtime was found to be acceptable. The insights have been used to guide the development of a messaging-based mobile health intervention for improving sleep and physical activity in BC survivors. Future research will focus on delivering an intervention addressing these health behaviors and assessing its acceptability and effectiveness.

This study examined whether social robots influence 4-5-year-olds' persistence. Almost all participants (97%) were Japanese. Most participants lived in urban or suburban areas in Osaka and came from middle socioeconomic backgrounds. The data were collected in 2023-2025. In Experiment 1 (N = 108, 45 girls), a robot's verbal time updates enhanced persistence, but robot interactions did not. In Experiment 2 (N = 27, 12 girls), providing time updates from a personal computer (PC) did not increase persistence. In Experiment 3 (N = 54, 24 girls), children worked with a robot (from Experiment 1), a human, or alone. Verbal time updates from both agents increased persistence compared to working alone although children behaved differently, for example, making qualitatively different comments to each agent. Findings indicate that robots and humans can foster children's persistence, though their roles may differ, reflecting robots' growing presence in children's lives. Young children often give up when tasks become difficult. This study explored whether robots could help children keep trying. We worked with 189 Japanese children aged 4–5 years and asked them to work on a challenging task. When a robot told the children how long they had been working, the children persisted longer, whereas time updates from a computer did not have this effect. When a human provided the same time information, the children persisted longer. The children interacted differently with robots and humans, suggesting that robots and humans may support persistence in different ways. These findings suggest that reminding children of their ongoing effort can help them keep trying. Robots could play a supportive role in children’s persistence.

Assisted peritoneal dialysis (PD) is an important option for frail patients with advanced age, comorbidities, and reduced autonomy who face barriers to self-managed home dialysis. This study evaluates the current use of assisted PD in Italy using data from the 2024 Italian Peritoneal Dialysis Census and compares findings with previous surveys conducted since 2008. Data were collected from 228 dialysis centers, with 221 centers providing information on assisted PD, covering 4,229 prevalent PD patients. Assisted PD was reported in 904 patients (21.4%). Family members were the main caregivers (86.2%), followed by paid caregivers (8.1%), institutional staff (2.9%), and nursing home personnel (2.8%). Over time, the proportion of assisted PD remained stable between 21% and 25%, with no significant change in caregiver distribution. Centers applying assisted PD were larger, had higher PD prevalence, and managed more PD patients compared with centers not using assisted PD. Geographic variability was observed, with the highest prevalence in island regions. Only a small proportion of patients in nursing homes were treated with PD compared to hemodialysis, highlighting organizational and staffing barriers. These findings show that assisted PD in Italy has remained stable over the past two decades and is predominantly based on family caregiving, unlike Northern European countries where professional home care predominates. The limited use of institutional and nursing home support suggests unmet needs and potential areas for improvement. Economic incentives, regional support programs, and telemedicine may help expand assisted PD access and promote home-based dialysis in frail populations.

Linezolid exhibits significant pharmacokinetic variability in hospitalized patients, which may lead to suboptimal exposure or toxicity. Therapeutic drug monitoring (TDM) has been proposed to optimize treatment, although real-world data under standardized dosing conditions remain limited. Objective was to evaluate linezolid exposure in routine clinical practice under standardized dosing conditions and to identify factors associated with overexposure, dose optimization and hematological toxicity. A retrospective observational study was conducted using a hospital-based TDM database. Only patients receiving linezolid 600 mg every 12 hours were included. A single trough concentration (Cmin) per patient was analyzed, defined as the first determination obtained at &#x2265;48 hours after treatment initiation. Exposure was categorized as subtherapeutic (<2 &#xb5;g/mL), therapeutic (2-10 &#xb5;g/mL), or supratherapeutic (>10 &#xb5;g/mL). Logistic regression analyses were performed to identify factors associated with overexposure and thrombocytopenia. A total of 76 patients were included. The mean Cmin was 4.75 &#xb1; 4.45 &#xb5;g/mL (median 3.07; range 0.67-23.6). Subtherapeutic, therapeutic and supratherapeutic exposure occurred in 26.3%, 60.5% and 13.2% of patients, respectively, with 39.5% of patients outside the therapeutic range. Age was associated with higher exposure (OR 1.03 per year; p=0.025), while renal function showed a non-significant trend. Thrombocytopenia occurred in approximately 5-6% of patients and showed a non-significant association with higher trough concentrations. TDM led to dose modification in a relevant proportion of patients. Linezolid exposure shows substantial interindividual variability in hospitalized patients despite standardized dosing. A considerable proportion of patients present subtherapeutic or supratherapeutic concentrations. TDM may help identify patients at risk of underexposure or toxicity and support individualized dosing strategies, particularly in elderly patients and those with renal impairment.

Social factors play a pivotal role in both the development of and recovery from alcohol use disorder (AUD), and social network analysis provides a rigorous framework to understand these influences. The current study applied social network analysis to understand recovery from AUD, with a secondary aim of examining sex differences in social network influences. A cohort of adults with AUD making a significant recovery attempt (N = 501) were followed over six waves during a 1-year period (83% retention) and completed assessments of egocentric networks (up to 20 closest alters) and drinking behaviors. Hierarchical models run within a Bayesian imputation framework examined social network characteristics in relation to three recovery outcomes: abstinence, reduction in World Health Organization (WHO) drinking levels, and reductions in drinks/week. Follow-up analyses were stratified by sex. Three social network characteristics predicted abstinence: number of family member alters, number of alters in mutual help organizations (MHOs), and interaction frequency with alters; the latter two factors were also predictive of WHO drinking level and drinks/week. Network heavy drinking days was specifically negatively associated with reductions in WHO drinking level. Sex differences revealed greater network heavy drinking selectively impeded WHO level reductions for female participants, whereas having more MHO program members in one's network selectively facilitated recovery for male participants. These findings reveal the importance of social networks, particularly involvement in MHOs and the family, in AUD recovery. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Health practitioners often work in high-pressure environments with time constraints, organizational demands, and emotional stressors, leading to burnout, psychological distress, and non-recovery-oriented practices. Recovery Colleges (RCs) are learning centers that promote recovery-oriented practices and wellbeing among diverse learners, including health practitioners. However, little quantitative research has examined outcomes for health practitioners in RCs. This study compares outcomes of health practitioner learners with other learner types in an RC course. A preexperimental, one-group pretest-posttest design with repeated measures was used. A total of 434 learners completed questionnaires assessing wellbeing, anxiety, resilience, and stigma at three time points. Sociodemographic data were also collected. Health practitioners are more likely to hold a master's degree, work full-time, and possess a higher proportion of clinical and theoretical knowledge. Linear mixed models revealed significant effects of time on wellbeing (P < 0.001), anxiety (P < 0.001), resilience (P = 0.011), and stigma (Disclosure/Help-seeking: P < 0.001). Differences were found by learner type for wellbeing (P = 0.004), anxiety (P < 0.001), resilience (P = 0.015), and stigma (Attitudes: P < 0.001; Social Distance: P = 0.032). Health practitioner reported higher wellbeing and resilience, and lower anxiety and stigma scores (Attitudes and Social Distance) than other learners. No significant interaction was found between time and learner types. Despite baseline differences and varying sociodemographic profiles, health practitioner learner outcomes are comparable with those of other learners. RC courses support mental health and recovery-oriented practices that address stigma and complement other continuing professional development activities.

Accurate diagnostic tests are essential for effective screening and treatment. However, individual biomarkers often fail to provide sufficient diagnostic accuracy, as they typically capture only one aspect of the complex disease process. Combining multiple biomarkers, each capturing a distinct mechanism, can help construct more informative diagnostic tests. In practice, logistic regression is used as the default to combine biomarkers, but it can perform poorly when biomarker distributions exhibit skewness or differ across disease groups. Nonparametric methods provide more flexibility but generally require large sample sizes that are infrequently available in biomedical research. We propose a novel framework called transformation discriminant analysis which combines biomarkers through the likelihood ratio function to construct theoretically optimal diagnostic scores. Transformation discriminant analysis (TDA)&#xa0;balances between flexibility and efficiency. It can accommodate a wide range of distributional shapes and disease-specific dependence structures while remaining fully parametric. This allows for likelihood inference and strong performance even in small-sample settings. We evaluate TDA through simulations and benchmark its performance against commonly used methods. Finally, we illustrate its utility in constructing an optimal diagnostic test for hepatocellular carcinoma, a disease with no single ideal biomarker. An open-source R implementation is provided for reproducibility and broader application.

Transverse testicular ectopia (TTE) with fused vas deferens is an extremely rare anomaly, often diagnosed intraoperatively. Current TTE classifications do not address internal ductal variations, limiting surgical guidance. To systematically review cases of TTE with fused vas deferens, summarize presentation, operative strategies, outcomes and identify patterns that highlight the need for classification refinement. A PRISMA 2020-compliant systematic review (PROSPERO; CRD420251247785) was performed across PubMed, ScienceDirect and citation of included articles through December 2025. Case reports and series confirming fused vas deferens were included. Data extracted comprised demographics, presentation, imaging, surgical approach, and outcomes. Quality assessment used JBI checklists. 12 studies (16 patients) were included. Most presented with unilateral inguinal hernia (62%) and contralateral undescended testis (68%); 81% were diagnosed intraoperatively. Anatomical patterns included common/proximal fused vas (87%), Y-shaped fusion (6%), and long-loop vas (6%). Trans-septal orchidopexy was the preferred approach, with preservation of vas integrity. Postoperative outcomes were favorable; long-term follow-up was limited. TTE with fused vas deferens represents a distinct variant requiring careful intraoperative recognition. We propose a Type IV TTE category for internal ductal fusion to guide surgical planning and classification refinement. Further accumulation of case-based evidence may help clarify its anatomical patterns and operative implications.

Machine-learning approaches are now widely used to predict the 3D structures of proteins and RNA molecules. However, prediction accuracy for RNAs is much lower than for proteins due to the scarcity of experimental structural data and homologous sequences. This situation is even worse for single-stranded DNA (ssDNA) molecules, such as DNA aptamers, which have diverse clinical and biotechnological applications. To address this problem, we integrated our physics-based method 3dDNA with an RNA language model and a deep-learning RNA structure prediction model to build 3D structures of DNA aptamers. This integrated approach largely overcomes the data scarcity problem for ssDNA molecules. The resulting method, 3dDNAi, improves global and backbone-level structural agreement for ssDNAs in the evaluated benchmarks, while the comparison with AlphaFold3 is metric-dependent. The framework established by 3dDNAi may also help address structure prediction challenges in other biomolecular systems where experimental data is limited.

This study incorporates text mining into critical discourse analysis to examine how government science agencies in China and the United States position themselves in space science communication on social media. Two specialized corpora have been built by collecting posts from government science agencies on Weibo from China and X (formerly Twitter) from the U.S. With the help of the text mining tool KH Coder, this study gives a corpus-assisted discourse analysis of the particular ways of positioning at different levels of discourse: (1) topics/themes, (2) addressing terms, and (3) those words that co-occur with self-addressing terms in a sentence. The findings reveal significant differences in their preferential ways of positioning. Chinese government science agencies present themselves as state-affiliated yet approachable institutions, blending achievements and operational efficiency with patriotism and collective pride. Their use of diverse addressing terms and co-occurrence patterns portrays them as experienced, supportive guides, balancing national identity with interpersonal closeness. In contrast, U.S. government science agencies emphasize professionalism, focusing on research, space exploration, mission execution, and audience engagement, with minimal reference to state affiliation. Their addressing terms are formal and standardized, with pride centred on mission success and discovery, highlighting expertise and scientific leadership. Their preferential ways of positioning are further explained in their respective contexts in order to present a proper understanding of these differences.

Heart transplant (HT) rejection surveillance is rapidly evolving with evidence supporting use of donor-derived cellfree DNA (ddcfDNA) with its high negative predictive value and use of cardiac magnetic resonance (CMR). Both modalities are imperfect in diagnosing biopsy proven rejection, however, combining them may improve diagnostic power. Our study goal is to characterize multiparametric CMR trends between pediatric HT patients (PHT) with high versus low ddcfDNA. Single center retrospective study of PHT who had clinically indicated multiparametric CMR (biventricular volumes and ejection fraction (EF), T2 mapping, T1 mapping with extracellular volume fraction (ECV) and ddcfDNA within 30 days; corresponding EMB was not always performed as per institutional clinical protocol. Demographics and CMR variables were compared between ddcfDNA of &#x2265;&#x2009;0.16% (high group) and <&#x2009;0.16% (low group). 68 PHT (14 high group, 54 low group) were included. The high group was significantly older, with longer time between CMR and HT, had longer time between CMR and ddcfDNA, had more frequent CMR indication of clinical concern and had history of CAV or moderate severe rejection. No statistical difference in CMR derived ventricular volumes or function was noted between groups. There were significant differences in multiparametric mapping with high ddcfDNA group showing higher global T1 (1086 [1050, 1118] vs. 1029 [1002, 1075] ms; p&#x2009;=&#x2009;0.01), peak segmental T1 (1163 [1140, 1220] vs. 1121 [1056, 1175] ms; p&#x2009;=&#x2009;0.04), global T2 (52 [50, 55] vs. 48 [46, 51] ms; p&#x2009;=&#x2009;0.008), and peak segmental T2 (58 [54, 60] vs. 53 [51, 59] ms; p&#x2009;=&#x2009;0.04) compared to the low ddcfDNA group respectively. Multiparametric CMR suggests graft structure differences between high and low ddcfDNA PHT. Studies on larger cohorts with wider ddcfDNA ranges can help understand the combined role of CMR and ddcfDNA in improving surveillance.

Late right heart failure (LRHF) following left ventricular assist device (LVAD) implantation remains an under-recognized complication with significant impact on patient outcomes. We conducted a retrospective cohort study of 183 consecutive LVAD patients at our institution between 2010 and 2024. LRHF was defined according to the 2020 Mechanical Circulatory Support Academic Research Consortium criteria. Clinical, echocardiographic, and perioperative parameters were analyzed with group comparisons and logistic regression, whereas outcomes were evaluated using Kaplan-Meier and competing-risk analyses. LRHF occurred in 17% of patients at a median of 8.8 months following LVAD implantation. Patients with LRHF had larger preoperative right ventricular (RV) basal diameters. Early right heart failure (ERHF) and RV basal diameter were independently associated with LRHF development. LRHF patients had significantly longer intensive care unit and hospital stays, higher rates of chest re-exploration, acute kidney injury, ventricular arrhythmias, and significantly more heart failure-related readmissions. Although overall survival was lower among LRHF patients, it did not reach statistical significance (p = 0.06). In conclusion, LRHF remains a frequent and morbid complication after LVAD implantation. Early recognition of RV dysfunction may help identify patients at risk of developing LRHF.

For people with a high risk of social withdrawal, such as Japanese "hikikomori" or NEET, socialising with others can be demanding. For some, however, an alternative to direct real-world socialisation comes in the form of videogames. Past research suggests that videogames could help by providing opportunities for virtual social interaction and relational wellbeing management. But would those with a high risk of social marginalization also withdraw from social interaction in games? Past research entertains both possibilities: individuals may avoid socialising in-game as they do offline, but the anonymity of online gaming could afford safer opportunities for social interaction. To better understand the potential of game-based interventions for audiences at high risk of social withdrawal, we investigated gaming preferences of Japanese players (N&#x2009;=&#x2009;587) with varying levels of NEET-Hikikomori risk. We hypothesized that higher withdrawal risk, measured by the NHR Scale, could either positively or negatively relate to player socialisation and cooperation, as measured by the HEXAD and Game Traits scales. After accounting for age, gender and extraversion, results showed that higher NHR score was associated with lower HEXAD Socialiser, lower HEXAD Philanthropist and lower Game Traits Social orientation scores, suggesting a negative association between NEET-Hikikomori risk and player traits related to socialisation. Furthermore, exploratory analysis showed that a higher NHR score was associated with lower scores in HEXAD Achiever and Game Traits Challenges orientation, suggesting NEET-Hikikomori risk has a negative correlation with challenges and achievement-related gameplay. These findings demonstrate how understanding specific gamer personality types is essential for designing experiences that can act as bridges towards more socialisation, while avoiding the risk of worsening players' conditions through misaligned design.