Patients with a rare genetic disease face unmet needs deepened by the traditional American healthcare system. Social, educational, and financial support resources help address some of these challenges; however, for patients who are Spanish speaking, the language barrier makes it more difficult to attain such resources. This compounds with already existing healthcare disparities faced by the Latino/Hispanic community. This study explores the current state of resources available for patients in Alabama who are Spanish speaking with a rare genetic disease and identify specific areas for improvement. Eleven expert stakeholders who work with either rare genetic disease, patients who speak Spanish, or both, completed 1-hour online audio-only semi-structured interviews. Interviews focused on the current state of resources for this population and ideas for improvement. Transcripts were analyzed using reflexive thematic analysis. A lack of sufficient access to Spanish speaking medical staff and interpreters prevents patients from accessing social support and the healthcare system. Additionally, digital or educational resources in Spanish are rarely accessible to patients. When resources are available they tend to be of high quality, but their implementation is inconsistent. This lack of accessible resources creates an undue burden for both patients and providers.
Hearing loss is a concern globally which can present challenges for those affected and their communication partners. This study explored the experiences of individuals providing support for people with hearing loss, focusing on caregiver burden. Qualitative in-depth interviews were conducted with communication partners and parental caregivers. Template analysis, guided by Burden of Treatment Theory, explored illness burden (the daily impact of a health condition) and treatment burden (the workload involved in managing care). Twenty-seven caregivers of people with hearing loss participated, representing diverse ages and relationship types. Analysis focused on two a priori burden domains: illness burden and treatment burden, while recognising resources that could alleviate burdens. Illness burden included assuming the role of mediator, emotional work, and changes in communication. Treatment burden themes encompassed managing medical and audiological care and maintaining hearing devices and assistive technology. Resources identified included sharing knowledge, empathising with the person with hearing loss, and working as a team. Caregiving in the context of hearing loss is complex and multifaceted. These findings highlight the potential for targeted resources and support for parents and communication partners to improve experiences of individuals with hearing loss and their supporters.
Genomics is increasingly part of routine clinical care. However, hospital leaders face a range of organisational challenges in implementing safe, effective genomic care including: insufficient resources, rapidly evolving practices, gaps in genomic literacy, data infrastructure demands and limited governance frameworks. Good clinical governance can overcome these barriers by aligning leadership, resources, workforce development, monitoring and accountability to enable structured, reliable adoption. To describe our iterative co-design processes and final outputs in developing a resource for hospital executives. This toolkit resource applies clinical governance principles to support organisation-wide implementation and oversight of evidence-based genomic care in hospitals. A co-design implementation science-informed approach was adopted, following the updated Medical Research Council guidance for complex interventions. This involved 85 individuals from 14 healthcare organisations across Victoria (Australia) participating in a concept testing workshop, usability testing and content advisory groups. A maturity self-assessment tool was initially designed. Interested organisations could map their current state of maturity in the identified domains. The tool was assessed for feasibility, usability and potential value to stakeholders and revised through three major co-design steps. The evaluation of feedback and learnings led to the decision to transition the self-assessment prototype to the Genomics and Your Hospital Toolkit (the 'toolkit'). This comprised seven key action domains and a suite of resources designed for any hospital undertaking genomic care, irrespective of their maturity. The key action areas are as follows, with supporting resources developed for each: (1) form a genomics leadership group; (2) define models of care; (3) understand and mitigate risks; (4) check workforce skills and support; (5) support and monitor quality and value; (6) review new genomic practice and (7) involve consumers in genomic medicine services. The toolkit is designed to lower the barriers to hospital executives embedding high-quality genomic care across their organisation. Although developed specifically for genomics, the toolkit addresses common challenges in the implementation and oversight of care that includes large-scale emerging technologies intended to make individual care more precise.
Autonomous robots can streamline repetitive and time-consuming surgical tasks like ultrasound scanning. AI can provide the necessary intelligence, but for clinical acceptance, systems must move predictably, offer intuitive interaction, and maintain low latency on medical-grade hardware. We present an integral robotic platform for autonomous ultrasound scanning. The platform allows to perform scanning on either manual or autonomous mode. The autonomous control combines AI-driven ultrasound target segmentation with geometric motion algorithms designed to focus the probe on the segmented target. We optimized the image processing models for specialized hardware to ensure real-time performance with constrained resources. Users can control the platform via natural language voice commands processed by a Large Language Model (LLM) and visualize the procedure through a synchronized 3D Digital Twin and an augmented reality (AR) environment. We tested the platform in hepatic tumor localization in a synthetic phantom. Autonomous tumor localization showed a success rate of 84% with an average execution time of 5.75 s. Our system successfully automates ultrasound tasks, allowing the user to control the process through an intuitive, multimodal interface. By pairing optimized AI with specialized hardware, we achieved low-latency, real-time adaptability with minimal hardware resources. In the future we plan to adapt this platform for more complex neurosurgical and urological procedures.
Although Brownlowia tersa and Brownlowia argentata are classified as near-threatened and data-deficient mangrove species, respectively, their genomic resources remain limited. Here, we present chromosome-level genome assemblies for both species and a SNP data for B. tersa in Thailand. The assembled genomes of B. tersa and B. argentata are 392.91 Mb and 395.11 Mb in size, with scaffold N50 values of 25.70 Mb and 26.03 Mb, respectively. Both genomes showed approximately 98% complete BUSCOs and LAI scores of 10. Approximately 96% of each assembly was anchored to 14 pseudochromosomes. Repetitive elements comprised approximately 45% of both genomes, including 25% unclassified repeats. A total of 31,864 and 28,920 protein-coding genes were predicted in B. tersa and B. argentata, respectively, of which approximately 88% were functionally annotated and 90% were complete BUSCOs. Additionally, 1,196 and 1,222 ncRNAs were identified in B. tersa and B. argentata, respectively. SNP data from 37 B. tersa accessions were also generated. These genome assemblies and the SNP dataset provide valuable resources for studying mangrove evolution and conservation.
Completing continuous maternity care (COCMC) is crucial for preventing morbidity and mortality, but a low proportion of mothers use it. There is a paucity of evidence about the level of COCMC and the associated factors in agro-pastoralist communities. To identify and compare the level of COCMC and associated factors among pastoralist and agrarian communities in Ari and South Omo zones. A community-based comparative cross-sectional study was conducted from March to May 2024. A comparative study on COCMC was conducted in Ari and South Omo zones of South Ethiopia. A multistage sampling technique was employed to select 632 women who gave birth 6 months before data collection. The outcome variables were the level of COCMC and its associated factors. The results of outcome variables were presented with proportions and adjusted ORs (AORs) with the corresponding 95% CIs. Data were collected with a standard questionnaire via the Kobo toolbox and analysed with the R software. Due to sparse data about the proportion of COCMC, a penalised likelihood (Firth logistic regression) model was employed. A p value <0.05 was considered a cut-off for statistical significance. A total of 632 women participated in this study giving the response rate of 97.4%. The overall level of COCMC was 46 (7.3%; 95% CI 5.3% to 9.3%), 27 (7.5%) among pastoralists and 19 (7.0%) among agrarian districts, the difference was not statistically significant (p value=0.84). The COCMC was associated with living in urban areas (AOR: 2.76, 95% CI 1.17 to 6.34), women's ability to pass a decision on household resources (AOR: 2.57, 95% CI 1.17 to 5.55), being a government employee (AOR: 8.71, 95% CI 1.38 to 50.94), middle level household economy (AOR: 3.81, 95% CI 1.16 to 15.83) and receiving no home-to-home healthcare (AOR: 0.33, 95% CI 0.14 to 0.70). The level of COCMC is low in the study area. Therefore, equitable interventions targeting both communities, enhancing maternal decision-making power to use resources for maternal services, focusing on the housewives and those engaged in daily work and strengthening integrated home-based healthcare are all recommended.
In this qualitative study, we investigate the perceptions and impact of a Bereavement Referral Program (BRP) developed to address the needs of parents impacted by unexpected pediatric death. The BRP starts when a coroner connects parents to a grief navigator (GN) who helps parents find bereavement and social support resources. This work aims to understand the efficacy of the BRP from parents' perspectives using semi-structured qualitative interviews to assess the program's strengths and weaknesses and solicit suggestions for improvement. Results showed that parents valued interactions with the GNs, and felt the program offered an opportunity for support. Areas of improvement relate to when parents are connected to GNs, and additional resources GNs could share with parents. This work contributes to knowledge about how to support parents after unexpected pediatric death by showing the value of the BRP and informing improvements to the intervention that can be applied to other communities.
Habitat selection governs subterranean organism distributions, where environmental gradients and restricted resources impose strong constraints, suggesting many cave-dwelling species respond primarily to fine-scale microhabitat variation rather than broad spatial patterns. To evaluate this hypothesis, we examined environmental drivers of invertebrate richness and community composition across 24 limestone caves in a tropical semi-arid region. Adopting a multi-scale framework, we quantified landscape attributes, cave-level habitat features, and local microhabitat conditions, recording 336 invertebrate species representing 40 orders and 106 families, including 38 obligate subterranean taxa. Our findings demonstrate that these communities are governed by a hierarchy of localized environmental filters, while regional spatial processes exert a negligible footprint. At the mesoscale, cave identity and internal sectors heavily determine community composition, overriding geographic distance and maintaining high species turnover. Across internal gradients, non-troglobitic and troglobitic fauna display an inverse spatial sorting between scales. For non-troglobitic communities, species richness declines sharply toward deeper zones, a negative effect intensified at the microscale where these organisms respond positively to trophic resource availability. Conversely, obligate troglobitic richness is constrained by moisture availability at the mesoscale but becomes solely and positively driven by distance from the entrance at the microscale, as specialized species track deep, buffered microhabitats to avoid competitive interactions in high-energy zones. Together, our results confirm that niche-based environmental filtering structures these assemblages, positioning each cave as an ecologically singular unit. Consequently, Brazilian environmental licensing cannot rely on regional offsetting, since individual caves are not ecological substitutes, and fine-scale inventories are critical to prevent biodiversity loss.
To systematically review educational interventions for staff working on acute paediatric wards aimed at improving the care of children and young people (CYP) admitted for mental health support. We conducted a systematic search of PubMed, The Education Resources Information Centre, PsychInfo and Web of Science from 2000 to March 2026 using terms related to healthcare professionals, training/education, mental health and children/young people. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. Interventions were classified using the Kirkpatrick model and the Behavioural Change Technique Taxonomy (BCT V.1) to identify mechanisms underpinning effective change. We found nine studies meeting inclusion criteria, across a range of teaching methodologies and settings. Most interventions were designed and applied for nurses. Overall quality of evidence was poor. Although no single intervention could be recommended, analysis identified potentially useful components tailored to different learner needs, mapped through the Kirkpatrick and BCT frameworks. A notable gap was a lack of codesign with CYP and carers with lived experience and the absence of strategies to engage ambivalent or reluctant learners who might not attend educational interventions voluntarily. Existing educational interventions contain elements that may support behavioural and practice change among staff caring for CYP with mental health needs. However, future research should prioritise high-quality, framework-based evaluations developed through codesign with CYP and carers. Interventions should also address how to engage learners who may be reluctant to participate in training for this area of clinical practice.
Healthcare workers are exposed to many stressors including long hours, intense physical and emotional labor, and consistent exposure to suffering and death. Together these stressors can culminate into more chronic and severe stress responses when not appropriately addressed. To help mitigate the impact of these stressors, peer-administered post-event psychosocial support programs have been developed, such as Psychological First Aid and Stress First Aid. Unfortunately, few resources exist to help those interested in designing, implementing, and evaluating such a program within their organization. This manuscript provides an in-depth review of the development and implementation of an adapted peer-administered post-event psychosocial support training program created in a Mid-Atlantic Level 1 Trauma Hospital to meet the organization's specific needs. The adapted program blends elements of Psychological First Aid and Stress First Aid and was found to be an effective means to improve healthcare workers' ability to recognize and respond to stress injuries among colleagues. Findings indicate that support programs, such as Psychological First Aid and Stress First Aid, can be adapted to meet specific needs of the institution while still being highly effective in training healthcare workers.
Global surgery has emerged as a critical domain within global health, but despite growing academic interest, the structure, scope, and organization of global surgery initiatives within Canadian academic institutions remain incompletely characterized. We sought to conduct a national environmental scan of academic global surgery initiatives in Canada, examining participant characteristics, the structure and focus of initiatives, community motivations, and future priorities. We conducted a cross-sectional, survey-based study between July 2024 and April 2025, targeting Canadian physicians, trainees, researchers, and health professionals involved in global surgery. We invited participants via professional networks, academic institutions, and the trainee network of the Canadian Global Surgery Trainees' Alliance. The survey included both quantitative and qualitative items across 4 domains. We used descriptive statistics and thematic analysis to analyze responses. Forty respondents from 10 Canadian medical schools completed the survey, representing diverse surgical specialties and career stages. Most were affiliated with university-based global surgery offices (62%). Engagement was highest in research (65%), teaching (55%), and capacity building (55%), with trainees playing a central role. Key barriers included limited funding (95%), infrastructure gaps (70%), and lack of training opportunities (54%). Motivations for involvement included commitment to health equity, education, and sustainable partnerships. Respondents also identified future priorities, including training and education, improving access to surgical resources, and enhancing mentorship and evaluation frameworks. This study offers an overview of Canadian global surgery efforts, revealing enthusiastic but fragmented engagement. Findings highlight opportunities to strengthen coordination, formalize training structures, and improve sustainability within global surgery programs in Canada.
Patients living with dementia (PLWD) require attention to social determinants of health (SDoH), but social information is often unavailable or incomplete during care encounters, and clinicians report uncertainty about how to act on this information. This study aimed to co-design the Intelligent Social Risk Management in Alzheimer's Disease and Alzheimer's Disease-Related Dementias Patients (iSMART) clinical decision support (CDS) prototype, which integrates an AI-driven individualized polysocial risk score (iPsRS) to identify PLWD at high social risk for hospitalization. We conducted a qualitative user-centered design study with nine outpatient providers and clinical staff who care for PLWD at a large academic health system. Participants completed semi-structured interviews to explore perceived social risks in dementia care, gather feedback on the iSMART prototype and its features, and identify implementation considerations. Interview transcripts were coded and analyzed via rapid qualitative and thematic analysis. Nine participants (six providers, two nurses, and one social worker) were interviewed. Lack of caregiver or family support was identified as the most important social factor to consider for PLWD, followed by financial strain and transportation issues. Participants described the iSMART prototype as helpful for identifying social risks among PLWD, summarizing and prioritizing factors contributing to hospitalization risk, and connecting patients to relevant social resources. Participants suggested primary care providers and social workers should be the primary users. Recommended improvements included auto-populated (as opposed to manual entry) but editable SDoH fields for model input, incorporating caregiver presence as a model input, and providing clearer visual representations of risk. Outpatient providers and staff viewed the iSMART prototype as a promising approach to support social risk screening, resource connection, and referral support in dementia care. These findings inform practical strategies for integrating iPsRS-informed CDS tools into routine workflows in dementia clinics.
Trajectories of age-related neurocognitive decline are nonuniform, and are impacted by numerous environmental and physiological factors. Earlier life phases set the stage for later life neurocognitive function, with midlife marking a critical transition characterized by increasing variability in cognitive, affective, and physiological functioning. Despite its importance, this turbulent period remains underrepresented in open neuroimaging data resources. To address this gap, the Nathan Kline Institute - Rockland Sample (NKI-RS) created 'Mapping Interindividual Variation in the Aging Connectome' (MIVAC), an openly shared, multimodal dataset designed to map brain aging trajectories beginning in midlife and assess the influence of key modifiable factors linked to dementia prevention such as cardiorespiratory fitness, sleep, and mood. This longitudinal investigation includes 348 community-ascertained participants aged 38 to 71 years at baseline, with 219 participants completing 3 annual timepoints. Data collection incorporated deep phenotyping, including detailed assessment of cognitive, behavioral, medical, and cardiorespiratory fitness domains, to compliment multimodal neuroimaging (resting-state fMRI, diffusion MRI, morphometric MRI, and arterial spin labeling) and biospecimen collection. The protocol harmonizes with prior NKI-RS sub studies, enabling lifespan cross-sectional or longitudinal questions, while incorporating age-specific considerations for cognitive and neural aging. The full dataset is openly available.
Chronic obstructive pulmonary disease (COPD) is a major public health burden in China, but remains underdiagnosed, with most cases identified only after significant lung function decline. Effective, low-cost tools are therefore needed to identify high-risk individuals for targeted spirometry. This study developed risk prediction models and nomograms to guide personalized COPD prevention. A community-based cohort of 32,327 adults aged 40-74 years without COPD was enrolled in 2016 and followed until March 2024. COPD diagnosis was obtained from Shanghai Songjiang District Healthcare Information Platform. Stepwise Cox regression analyses were conducted to select predictors, including demographics, lifestyle, disease history, and medical resources use, for overall and sex-specific prediction models. Discrimination and calibration were assessed by C-index, AUC, and Brier score, with 10-fold cross-validation and sensitivity analysis for validation. Over 7.0 years of follow-up, COPD incidence was 7.98 (95%CI: 7.61∼8.23) per 1,000 person-years, higher in men (10.60) than women (6.23). Sex, age, BMI, cooking habits, physical activity, smoking, occupational exposure, family history of respiratory diseases, other respiratory diseases, outpatient visits/year, and antibiotic prescriptions/year were significant predictors in the overall model. Male predictors additionally included central obesity, while female predictors additionally included fruit intake, history of tuberculosis and menopause. C-index was 0.780/0.770/0.781 (overall/male/female); Brier score was 0.035/0.044/0.028; Time-dependent AUCs at 1, 3, and 5 years ranged from 0.783 to 0.813, indicating good predictive performance over short, medium, and long term follow-up periods. Nomograms were created for overall, male and female populations. The study developed overall and sex-specific COPD risk prediction models with C-indices exceeding 70%. Corresponding nomograms provide practical tools for supporting routine COPD risk prediction to facilitate individualized preventive care.
Tuberculosis (TB) remains underdiagnosed in many high-burden countries due to high costs and limited availability of rapid molecular tests. Globally, only half of people with TB receive a molecular test as their initial diagnostic test. Pooled testing combines sputum samples from multiple individuals into a single molecular assay, offering cost savings by optimising existing resources, particularly in resource-constrained health systems. Although pooled sputum testing has now been recommended by the World Health Organization in 2026, evidence on real-world feasibility and acceptability for people with TB and healthcare providers remains limited. This study explored multisectoral stakeholder perspectives on the feasibility and acceptability of pooled sputum testing for TB. Multicountry qualitative study using key informant interviews and focus group discussions. Data were analysed using a framework approach guided by established feasibility and acceptability models. Facility and community settings across seven high-TB-burden countries: Bangladesh, Brazil, Cameroon, Kenya, Malawi, Nigeria, and Viet Nam. Thirty-eight key informant interviews and 18 focus group discussions were conducted with National TB Programme (NTP) representatives, laboratory technicians, people with TB and international experts. Pooled testing was considered feasible and acceptable in facility and community settings with greater confidence in countries with prior implementation experience. Feasibility depended on alignment with diagnostic algorithms and laboratory workflows, biosafety, training and clear standard operating procedures.Acceptability operated at two levels: early NTP engagement with healthcare providers to secure professional buy-in and clear communication between healthcare providers and people undergoing testing to support understanding. Pooled testing was considered feasible and acceptable in settings with robust laboratory systems and routine practices. Readiness varied across countries, with some suitable for rapid implementation and scale-up while others required system strengthening. In settings perceived as having suitable infrastructure and readiness, pooled testing was viewed as a pragmatic strategy to optimise molecular TB testing.
Post-stroke dysphagia, which affects 40% to 70% of stroke survivors, frequently leads to aspiration pneumonia and diminished quality of life. Despite achieving a 98.8% initial swallowing screening rate, the nasogastric tube removal rate in our unit of 52.7% was below the national benchmark of 57.4%. A quality control circle root cause analysis was conducted, with five critical issues identified. These included a lack of routine in-service education, insufficient interdisciplinary collaboration, inconsistent screening tool versions being used, a deficit in integrated educational resources, and ambiguous re-screening protocols during patient transfers that resulted in a low re-screening rate (60.3%). This project was implemented to increase the nasogastric tube removal rate in stroke patients from the baseline of 52.7% to a minimum target of 67.8%. Four key interventions were implemented using quality control circle methodologies. These included: (1) Organizing interdisciplinary workshops to clarify intervention timing and professional roles across disciplines; (2) Integrating a "Three-Stage Swallowing Screening Tool" incorporating pre-procedural oral hygiene protocols and clinical decision-making algorithms; (3) Developing interdisciplinary patient education materials encompassing nursing, traditional Chinese medicine, and speech-language pathology; and (4) Revising standard operating procedures to mandate re-screening during all inter-unit transfers. Post-intervention, the nasogastric tube removal rate increased from 52.7% to 69.9%, which exceeded the targeted goal. Notably, no re-intubations occurred within the six-month post-discharge follow-up period. In addition, the re-screening rate during inter-unit transfers improved markedly from 60.3% to 97.4%. Ancillary benefits included redirecting approximately 15 minutes of tube maintenance time per nurse daily into high-value individualized patient care,and an estimated savings in annual healthcare costs of NT$24,708 per family. The process standardization and enhanced interdisciplinary synergy achieved under this project effectively eliminated gaps in care, resulting in substantially improved patient safety and care quality. 運用品管圈手法提升腦中風病人鼻胃管移除率. 腦中風後吞嚥障礙發生率約40%至70%，常導致吸入性肺炎與生活品質下降。本單位雖初次吞嚥篩檢率達98.8%，然腦中風病人鼻胃管移除率僅52.7%，低於國內標竿值57.4%。經品管圈真因分析確立五大問題：缺乏常規在職教育、跨領域團隊協作認知不足、篩檢表版本不一致、缺乏多職類衛教工具，以及病人轉換單位時篩檢時機不明確且再次執行吞嚥篩檢率僅60.3%。. 提升腦中風病人鼻胃管移除率，根據現況值52.7%，將目標值設定為67.8%。. 運用品管圈手法實施改善措施：(1)舉辦跨領域協作與篩檢在職課程，並明確定義各職類的介入時機與定位；(2)整合「三階段吞嚥篩檢表」，加入口腔清潔前置步驟與臨床決策指引；(3)建立護理、中醫、語言治療之多職類衛教單張；(4)修訂作業指導書，明確規範「單位轉換時」需再次執行篩檢。. 專案介入後，腦中風病人鼻胃管移除率由52.7%提升至69.9%，達成預期目標，且自出院日起後續追蹤六個月內無重新置管案例。再次執行吞嚥篩檢率由60.3%大幅提升至97.4%。附加效益方面，移除管路節省之技術時數轉化為高價值個別化照護（每日約15分鐘），並預估為每個家庭每年節省24,708元之醫療成本。. 本專案透過流程標準化與強化跨領域團隊合作，有效消弭照護空窗期，實質提升病人安全與照護品質。.
Acoramidis, an oral transthyretin stabilizer that achieves near-complete stabilization, is approved for the treatment of transthyretin amyloid cardiomyopathy (ATTR-CM) based on the phase 3 study, ATTRibute-CM (NCT03860935). To complement trial data, ACO-REAL (NCT07235462) was designed to generate real-world evidence on acoramidis use in ATTR-CM. This article describes the rationale and design of ACO-REAL. ACO-REAL is an ongoing, prospective, non-interventional, multicenter study planned in approximately 2000 adults with ATTR-CM (wild-type or variant) initiating treatment with acoramidis in real-world settings across 21 European countries. The primary objective of ACO-REAL is to assess the characteristics and treatment patterns of participants with ATTR-CM receiving acoramidis during an observational period of around 12 months. The primary objective is to assess demographics (including age and sex), disease characteristics, and treatment patterns of participants treated with acoramidis. Disease characteristics include type, diagnosis, and manifestations of ATTR-CM, and ATTR-CM-relevant comorbidities. Treatment patterns include adherence, persistence, and reasons for treatment modifications, including switching from a different ATTR-CM medication to acoramidis. The secondary objective is to describe the safety profile of acoramidis. The clinical course of ATTR-CM in participants initiating acoramidis is also being evaluated through measuring cardiac function, functional capacity and health status (New York Heart Association classification and 6-min walk distance), and health-related quality of life (Kansas City Cardiomyopathy Questionnaire and EuroQol 5-Dimension 5-Level questionnaire). Healthcare resource utilization is also being evaluated. Statistical analyses will be exploratory and descriptive. Categorical variables will be presented as frequencies and continuous variables as sample statistics. ACO-REAL is the first multinational observational study to collect regular, prospective, real-world data in participants with ATTR-CM treated with acoramidis. This study aims to provide insights into ATTR-CM treatment using real-world evidence from European healthcare systems and may help to guide decision-making in clinical practice. Graphical abstract available for this article. ClinicalTrials.gov identifier, NCT07235462. Acoramidis is an oral drug that was approved for the treatment of transthyretin amyloid cardiomyopathy (ATTR-CM), a type of heart disease, based on positive results from the ATTRibute-CM study (NCT03860935). This manuscript describes a new study, ACO-REAL (NCT07235462), that aims to provide information about acoramidis in patients in the real world. ACO-REAL is an ongoing study that is collecting data from participants over the course of 12 months who are receiving acoramidis to treat ATTR-CM. The study will include around 2000 participants from 21 European countries, and will focus on participant characteristics, treatments, reasons for any changes in treatment, and side effects. The study will assess participants’ heart function, how the ATTR-CM disease changes over time, as well as participants’ overall health and ability to function normally. The study will also assess quality of life and use of healthcare resources (such as hospital and emergency room visits). By analyzing data in a broad European population, this study should improve understanding of acoramidis use in patients with ATTR-CM in the real world, adding to data obtained from controlled clinical trials.
This article discusses the approach to triage, obtaining a thorough patient and toxicologic history, and an update to decontamination techniques for common zoologic pet species. Special attention is given to considerations and resources that facilitate rapid assessment of the patient's exposure history to allow for prompt decontamination and treatment. Decontamination principles can be broadly applied across many species, and a comprehensive overview is provided of decontamination techniques in exotic species based on the exposure route.
Visual impairment is a global public health priority because of its high prevalence and impact on quality of life. In Latin America, access to ophthalmologic care is limited by multiple barriers that especially affect vulnerable populations and hinder the timely detection and management of preventable visual diseases. This scoping review aimed to describe the available evidence on the barriers affecting access to ophthalmology services in Latin America. In accordance with the Joanna Briggs Institute (JBI) and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses-Scoping Review (PRISMA-ScR) guidelines, a search was conducted in four scientific databases (PubMed, SciELO, Scopus, and Web of Science), including studies published between January 2010 and June 2025 that addressed barriers to accessing ophthalmology services in Latin America and excluding those focused on other regions of the world. Sixty-eight studies were included, with the main barriers identified being structural, geographic, economic, sociocultural, technological, and health system barriers. Among the strategies implemented to improve access, teleophthalmology, mobile brigades, educational campaigns, and the strengthening of primary care stand out, although significant inequalities persist between regions and population groups. Access to ophthalmologic care in Latin America continues to be affected by multiple barriers that especially affect the most vulnerable populations. Although progress has been made through various strategies, it is necessary to strengthen the integration of services, invest in human and technological resources, and prioritise equity to advance toward universal and effective eye care coverage in the region.
Itaconic acid (IA), an important unsaturated dicarboxylic acid, finds wide applications in industry, medicine, food, and energy. Biotechnological production of IA offers advantages in sustainability, process controllability, and the potential for high titers in selected hosts, although cost competitiveness remains a major barrier to industrial deployment. However, several challenges still hinder its large-scale industrial production, including: low substrate utilization efficiency, difficulty in pathway regulation, downstream separation bottlenecks, and environmental concerns. To address these challenges and further improve IA production through metabolic engineering, this review summarizes recent advances and key technologies in IA biosynthesis. Engineering strategies for de novo IA production were analyzed, the application of whole-cell catalysis and fermentation process optimization to enhance IA yield was discussed, and the use of renewable resources as substrates for IA production was reviewed. In addition, the prospects of AI-assisted strain engineering and green, low-carbon process technologies for IA biosynthesis were examined. These insights provide valuable guidance for understanding metabolic engineering strategies and bioprocess innovations aimed at improving IA production in alignment with sustainable and low-carbon objectives. Industrial demand for bio-based itaconic acid is rising, yet scale-up remains constrained by suboptimal pathway control, transport bottlenecks, and energy-intensive downstream steps. This review integrates advances across strain and process engineering into a coherent playbook: mitochondrial/cytosolic rerouting and transporter tuning, phase-specific dynamic regulation (biosensors, CRISPRi), and low-pH, closed-loop separations. We benchmark renewable feedstocks (methanol, acetate, agricultural and industrial wastes) and align data driven/AI tools with TEA/LCA targets. The result is a practical roadmap to higher titers, lower costs, and greener IA biomanufacturing from lab to pilot.