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Pediatric nurses carry heavy emotional and clinical demands that leave them vulnerable to burnout. Trauma-Informed Care (TIC) has helped ease burnout in the workplace, but psychological factors like Impostor Syndrome (IS) may weaken these benefits. Whether IS mediates the TIC-burnout link has not been well studied. To examine the mediating effect of impostor syndrome on the association of trauma-informed care with burnout in pediatric nurses. A descriptive cross-sectional study was conducted in six hospitals of Mansoura City, Egypt, between October 2024 and January 2025, with a sample size of 251 pediatric critical care nurses (96.5% response rate). Instruments included Trauma-Informed Care Scale, Maslach Burnout Inventory, and Clance Impostor Syndrome Scale. Data were analyzed by means of Pearson correlation, multiple linear regression, and mediation analysis through PROCESS macro with 5000 bootstrap samples. Impostor syndrome was the strongest predictor of burnout (β = 0.383, p < .001), followed by attitude toward TIC (β = 0.234, p = .047). Female nurses reported lower burnout, though only IS acted as a mediator. IS partially mediated the association of TIC with burnout (indirect effect = 0.15, 95% CI (0.06, 0.24)), with the model explaining 50.3% of burnout variance. Impostor syndrome has the potential to alter the work requirements of TIC into further vulnerability to burnout. Comprehensive support for pediatric nurses should incorporate trauma-informed practices alongside programs and strategies to ameliorate the experience of self-doubt, thus improving well-being and care quality.
This article aims to describe several "ups and downs" in the tumultuous life of Charles-Édouard Brown-Séquard (1817-1894). The posthumous son of an American father and a French mother-whose surnames he combined-he was born and spent his youth on the island of Mauritius, then a British possession but largely French-speaking, before leaving for Paris, where he was advised to devote himself to medicine rather than literature, his first ambition. His medical studies were interrupted by the sudden death of his mother and a first, temporary return to Mauritius. When resumed in Paris, they culminated in a doctoral thesis on the physiology of the spinal cord. Despite precarious financial circumstances and a cholera epidemic (1848), Brown-Séquard continued his research on a wide range of subjects, including some rather unusual interspecific organ grafts. At the same time, he refined the description of the symptoms of the spinal cord lesion syndrome that still bears his name, demonstrated the crossing of sensory pathways within the spinal cord, and, through experiments on the rabbit's ear, showed the role of vasomotor innervation. Unable, because of his status as a British subject, to obtain a permanent position in France, he spent thirty years traveling and working abroad, particularly in the United States (with 60 transatlantic crossings), in Philadelphia, New York, and Richmond, and later in London or Dublin and Boston at Harvard. After the death of Claude Bernard, he obtained French naturalization, which allowed him to stand for the Chair of Medicine at the Collège de France, to which he was elected in 1878, as well as to the Académie des Sciences in 1886. Until his death in 1894, he devoted himself to describing the effects of regenerative treatments using extracts from glands or organs (organotherapy or opotherapy), anticipating in particular-through his work on the adrenal glands-the field that would later become endocrinology. Together with d'Arsonval, he promoted this method among physicians before the press and the general public took hold of it, giving him a somewhat controversial reputation. A tireless worker, extremely courageous, selfless, eccentric, and stubborn in both error and truth, Brown-Séquard emerges as a nineteenth-century scientist as singular as he was endearing. The Société de Biologie, which he helped to found in 1848 (along with several scientific journals) and which he later presided over (1887-1891), owes him this tribute (abstract établi avec l'aide de Chat GPT). Un chercheur inspiré et vagabond : Charles-Édouard Brown-Séquard (1817–1894). Cet article vise à décrire quelques « soubresauts » de la vie tumultueuse de Charles-Édouard Brown-Séquard (1817–1894). Fils posthume d’un américain et d’une française dont il associera les noms, il naît et passe sa jeunesse à l’Île Maurice, alors possession anglaise mais largement francophone, avant de partir pour Paris où on lui conseille de se consacrer à la médecine plutôt qu’à la littérature, son ambition initiale. Ses études médicales sont interrompues par la mort subite de sa mère et un premier retour, provisoire, à Maurice ; reprises à Paris, elles aboutissent à une thèse de doctorat sur la physiologie de la moelle épinière. Malgré une situation matérielle précaire et pendant l’épidémie de choléra (1848), Brown-Séquard continue ses travaux de recherche sur des sujets très divers, notamment des greffes interspécifiques d’organes, mais il affine également la description des symptômes du syndrome de lésion spinale qui porte toujours son nom et démontre le croisement dans la moelle de certaines voies sensorielles ainsi que, sur l’oreille de lapin, le rôle de l’innervation vaso-motrice. Ne pouvant, par son statut de sujet britannique, obtenir en France de poste permanent, il va pendant trente ans multiplier les voyages et les séjours à l’étranger, notamment aux États-Unis (60 traversées transatlantiques), à Philadelphie, New York, Richmond puis à Londres et Dublin et à Boston (Harvard). C’est au moment de la mort de Claude Bernard qu’il obtient enfin sa naturalisation française, ce qui lui permet d’être candidat à la chaire de Médecine du Collège de France où il est élu en 1878 ainsi qu’à l’Académie des Sciences en 1886. Jusqu’à sa mort en 1894 il se consacre à la description des effets de traitements régénérateurs par des extraits de glandes ou d’organes (opothérapie) avec la prescience, en particulier sur les surrénales, de ce qui deviendra l’endocrinologie. Avec d’Arsonval il diffuse la méthode parmi les médecins avant que la presse et le grand public ne s’en emparent, lui conférant une renommée un peu sulfureuse de « savant fou ». Bourreau de travail (et de beaucoup d’animaux...), courageux à l’extrême, désintéressé, excentrique, entêté dans l’erreur comme dans la vérité, Brown-Séquard apparaît comme un savant du XIX e siècle aussi singulier qu’attachant. La Société de Biologie, qu’il a présidée de 1887 à 1891 et dont il avait participé en 1848 à la fondation ainsi qu’à celle de plusieurs revues scientifiques, se doit de lui rendre hommage.
Clostridioides difficile infection (CDI) epidemiology has evolved over the past 3 decades. In the early 2000s, incidence and severity surged, driven by hypervirulent strains, extensive use of broad-spectrum antibiotics, an aging population, suboptimal infection-control practices, and highly sensitive molecular diagnostics. During the same period, community-associated CDI (CA-CDI) emerged affecting a different population. Recent optimization of infection prevention, antimicrobial stewardship, and multi-step diagnostic algorithms have helped curb hospital-acquired CDI. However, CA-CDI accounts for approximately half of all CDI cases and is rising. These trends underscore the need for continued surveillance, targeted prevention strategies, and enhanced access to effective treatments.
Student engagement in music classrooms is important because it reflects students' active participation in listening, performing, and creative activities and is associated with academic, social, and psychological outcomes. Although teacher support has been widely linked to student engagement, the indirect association between perceived teacher support, music learning motivation, and engagement in music education remains underexplored, especially in general school settings. This mixed-methods study examined associations among students' perceived teacher support, music learning motivation, and engagement in junior high school music classrooms. Survey data were collected from 568 junior high school students in urban and rural areas of Liaoning Province, Northeast China. Quantitative analyses examined associations among perceived teacher support, music learning motivation, and student engagement, and the SPSS PROCESS macro with 5,000 bootstrap samples was used to estimate the statistical indirect association. Semi-structured interviews with 15 students were analyzed through a three-level coding procedure to explain students' learning experiences. The results showed significant positive associations among perceived teacher support, music learning motivation, and student engagement. Music learning motivation was statistically associated with the link between perceived teacher support and student engagement, and the bootstrap confidence interval for the indirect association did not include zero. Qualitative findings indicated that encouragement, emotional care, clear explanation, interactive support, and content aligned with students' interests and abilities helped explain how students translated supportive classroom experiences into confidence, interest, and willingness to participate. Because the study used cross-sectional self-report data, the findings should be interpreted as associational rather than causal.
Cognitive impairment is an inclusive term used to describe the impairment of different domains of cognition. It is a growing public health concern and it can be influenced by hyperthyroidism. While the association between hyperthyroidism and cognitive impairment had been documented in other settings, evidence from Ethiopia remains limited. The aim of this study was to determine the prevalence of cognitive impairment and the associated factors among hyperthyroid patients attending Bale zone hospitals, Southeast Ethiopia. An institution-based cross-sectional study was conducted from February to May 2024 among 406 hyperthyroid patients selected using a systematic random sampling technique. Cognitive impairment was assessed using the Mini Mental State Examination (MMSE) tool. Data were entered into EpiData Manager version 4.6.0.0 and exported to STATA version 17 for statistical analysis. The analysis began with descriptive statistics, followed by binary logistic regression. Variables with a p value < 0.25 in bivariable analysis were entered into multivariable binary logistic regression. The strength of association was determined by the adjusted odds ratio with a 95% confidence level. The prevalence of cognitive impairment was 29.06% (95% CI: 24.84-33.68). The odds of cognitive impairment were higher in females, rural residents, and those with primary education. Older age (AOR = 1.09), higher free triiodothyronine levels (FT3) (AOR = 1.03), poor sleep quality (AOR = 2.24), and lower wealth (middle: AOR = 0.18; rich: AOR = 0.19) were linked to higher odds of cognitive impairment. Avoiding alcohol consumption (AOR = 0.16) helped lower the odds of cognitive impairment. Cognitive impairment is a significant health problem among hyperthyroid patients in southeast Ethiopia. Old age, higher FT3 levels, poor sleep quality, and low socioeconomic status are the key associated factors.
Wubao capsule (WBC) possesses bleeding and relieving pain, with favourable clinical efficacy in asthma. This study aimed to investigate the molecular mechanisms of WBC in treating asthma. A total of 37 compounds were characterised in WBC using HPLC-Q-TOF-MS. WBC effectively alleviated pathological damage and inflammatory cell infiltration in the asthma model. Moreover, it decreased Th17 cells (CD4+IL-17A+) and the levels of IL-1β, IL-17, and IL-23 in PBMC, and increased Treg cells (CD4+CD25+Foxp3+) and IL-10 level. WBC effectively inhibited the EGFR-PI3K-AKT pathway. The efficacy of WBC exhibited a dose-dependent pattern and was comparable to that of Dexamethasone. WBC was found to contain 86 effective ingredients and 204 targets, including 66 targets related to asthma. Fourteen targets were associated with the EGFR-PI3K-AKT pathway. In conclusion, WBC ameliorated pathological damage and inflammatory cell infiltration in asthma and helped restore Th17/Treg homeostasis by inhibiting the EGFR-PI3K-AKT pathway.
Glucocorticoids remain an important anti-inflammatory therapy for IgA nephropathy but are associated with substantial treatment-related adverse effects, highlighting the urgent need for early prediction of treatment efficacy. We hypothesized that randomized controlled trial-based serum proteomic profiling could delineate glucocorticoid-modulated proteins and more accurately stratify patients likely to benefit from glucocorticoid therapy. We performed proteomic analyses of samples from the TESTING trial, in which patients with IgA nephropathy were randomized to receive methylprednisolone or placebo. 479 longitudinal serum samples from 241 Chinese participants collected at baseline and at 6 and 12 months were analyzed. Linear mixed effect models were used to identify glucocorticoid-modulated proteins and pathways in the methylprednisolone group relative to placebo. Cox proportional hazards and penalized ridge regression models were used to prioritize proteins and develop a prediction model for therapeutic efficacy. The candidate proteins were further validated by ELISA. Among more than 1,500 detected proteins, 302 were glucocorticoid-modulated and enriched in pathways of cytoskeletal stabilization and immunometabolism. Notably, pathways associated with long-term eGFR decline, such as complement activation and endothelial injury, were not modulated by glucocorticoids. Among the glucocorticoid-modulated proteins, Cox proportional hazards and penalized ridge regression models identified those whose baseline levels improved prediction of treatment efficacy compared to clinical variables alone. ELISA validated selected candidate proteins LEP and C1QTNF5. The prediction model incorporating these two proteins significantly outperformed the traditional clinical model in predicting glucocorticoid efficacy (5-year AUC, 0.85 [95% confidence interval (CI), 0.72 to 0.88] versus 0.80 [95% CI, 0.78 to 0.91]). Data from this randomized trial-based proteomic study helped delineate glucocorticoid-modulated proteins and pathways, and identified robust protein biomarkers that enabled stratification of patients likely to benefit from glucocorticoid therapy.
Diabetic kidney disease (DKD), the leading cause of end-stage renal disease, involves injury across multiple renal compartments. Autophagy dysregulation is a key pathogenic mechanism and may reduce Klotho, a renoprotective protein diminished in DKD. This study evaluated whether bone marrow-derived mesenchymal stem cells (MSCs), combined with empagliflozin and calorie restriction, could modulate autophagy and preserve Klotho expression in DKD. Male BTBRob/ob mice, a leptin-deficient model that develops diabetes and DKD in a progressive manner, were assigned to experimental groups and euthanized at 14-15 or 18-20 weeks. Kidney tissues were analyzed by qPCR, Western blot, and immunohistochemistry. MSCs therapy improved hyperglycemia in a time-dependent manner (p < 0.0001), decreased albuminuria, and modestly improved eGFR, though weight gain persisted. Treatment modulated LC3 protein expression in cortical and medullary regions (p < 0.05), suggesting attenuation of early autophagy hyperactivation. It also helped maintain Klotho expression, correlating with reduced oxidative stress (p < 0.05). Overall, MSCs combined with empagliflozin and calorie restriction show promise as a translational approach for DKD, warranting further long-term preclinical studies.
Despite men demonstrating high levels of grief and mental health difficulties after baby loss, support services predominantly focus on women. There is little known about the role of sport, football and targeted peer support for men who have experienced baby loss. To examine men's experiences of accessing football-based baby loss bereavement support and the self-reported impact of the sessions on men's grief and mental health. This project was designed with three men who have experienced baby loss. The study used a sequential QUAL-qual multimethod exploratory design. An online anonymous qualitative survey was distributed to all men who had attended a football session. A group discussion then considered the findings from the survey to add further depth to our understanding. Data were analysed using qualitative content analysis. Consent was obtained from all participants. Staff with mental health training were present during the discussion. Twenty-one survey responses were received, and 11 men participated in the group discussion. Participants reported the limited targeted support available for men after baby loss, and that the football sessions provided a safe space to talk with other men who had a shared journey and experiences and that the football focus helped break down barriers and challenge the myths surrounding men and grief. The football-based sessions were described as life-changing and life-saving. The study highlights the need to dispel myths surrounding men's grief after baby loss and emphasises the importance of football-based bereavement support in addressing men's mental health.
Drug-related problems (DRPs) are important medication management issues that are associated with adverse health outcomes. Limited studies have assessed the frequency of DRPs in primary healthcare in Jordan. The present study aimed to apply an innovative approach to identify DRPs utilizing a pretested survey. A cross-sectional observational study was conducted to assess the presence of DRPs among attendees of several primary healthcare centers in Jordan. A pretested survey was used to identify DRPs in a user-friendly, simple way, and the identified DRPs were classified using the Hepler and Strand classification system. Factors associated with having a DRP were assessed using logistic regression analysis. The present study included 582 patients. Among the patients included, 59.4% had at least one DRP. The most frequently encountered DRPs were patient-reported ineffective medicine (28.7%) and non-adherence to medications (21.4%). Independent predictors of having a DRP were patients who attended the healthcare center for a routine checkup (odds ratio 2.112, P < .001) and those who were prescribed multivitamins (odds ratio 2.882, P = .044). Knowledge about medication indication for all medications was a protective predictor of having a DRP as opposed to no knowledge about the medication indication (odds ratio 0.134, P = .010). Our results highlighted that the use of this simple survey helped identify DRPs within the healthcare centers, and indeed, it documented the significance of the DRPs in primary healthcare centers, as such efforts are highly recommended for increased provision of pharmaceutical care interventions in this healthcare setting.
BackgroundHIV-associated lipodystrophy, a complication of combined antiretroviral therapy (CART), causes significant physical and psychological distress in people living with HIV (PLWH), compromising treatment adherence. Tesamorelin, a growth hormone-releasing hormone (GHRH) analogue, has emerged as a therapeutic option.ObjectiveTo systematically evaluate the efficacy and safety of tesamorelin in HIV-infected individuals with lipodystrophy receiving CART, incorporating GRADE assessment.MethodsWe searched PubMed, https://ClinicalTrials.gov, and Scopus from inception to February 9, 2026, for randomized controlled trials evaluating tesamorelin in HIV-associated lipodystrophy. Mean differences (MD) and risk ratios (RR) with 95% confidence intervals (CI) were calculated using random-effects models with heterogeneity assessed by I2.ResultsFour RCTs (909 patients) were included. Tesamorelin 2mg significantly reduced visceral adipose tissue (MD= -21.47, 95%CI[-34.73,-8.22],I2=74%,p=0.002), waist circumference (MD-1.61cm,95% CI[-2.28,-0.95],I2=0%,p<0.00001), trunk fat (MD-1.20kg, 95%CI[-1.47,-0.93],I2=0%,p<0.00001), and increased lean body mass (MD1.42kg,95% CI[1.13,1.71],I2=0%,p<0.00001). Modest lipid improvements occurred in total cholesterol (MD-0.16mmol/L,95%CI[-0.27,-0.06],I2=0%,p=0.003). Growth hormone-related adverse effects and higher discontinuation rates (RR2.25,95%CI[0.98,5.17],p=0.06) were observed.ConclusionsTesamorelin demonstrates efficacy in reducing visceral adiposity in PLWH with lipodystrophy on CART. However, limited data on long-term safety, optimal dosing strategies, and durability of treatment effects warrant caution. Future research should evaluate extended treatment duration, dose-response relationships, and patient-reported outcomes to establish comprehensive clinical utility. Rarely, people living with HIV can develop changes in their normal body fat distribution, known as lipodystrophy, as a side effect of their treatment with cART. This can cause physical discomfort and emotional distress, and may affect their will to continue their medication. Tesamorelin is a medication that may help reduce these fat changes. In this study, we reviewed and combined results from four clinical trials involving 909 people with HIV. We found that tesamorelin helped reduce harmful fat around the abdomen, and reduced waist size and trunk fat. It also increased lean body mass and slightly improved cholesterol levels. However, some side effects related to growth hormone were reported, and more people stopped treatment compared to those not receiving the drug. Overall, tesamorelin appeared quite useful as long as it is continued, but more research is needed to understand its long-term safety and benefits.
Positron emission tomography (PET) and computed tomography (CT) are non-invasive imaging techniques that utilise radionuclide pharmaceuticals to evaluate biochemical and functional processes within the human body. In the United Kingdom (UK), PET-CT services are delivered by a multidisciplinary workforce. As demand increases annually, adaptable departmental leadership is essential. This was a two-phase mixed-methods workplace culture study appling the Context Assessment Index (CAI) tool (n = 37 question quantitative survey) to assess workplace culture, leadership, and evaluation. The second phase involved observational visits (n = 6 sites in the southwest of England), utilising the Workplace Culture Critical Analysis Tool (WCCAT) to observe the workplace culture, context, values, communication, and daily tasks. Data analysis included descriptive statistics for the CAI data and thematic coding and text analysis for the WCCAT data to identify recurring themes and patterns. The phase one CAI characteristics were scored as 78.8% for culture, 77.7% for leadership and 76.8% for evaluation. Phase two WCCAT observations identified nine common themes across all sites: leadership support, physical environment issues, cross-team and interdisciplinary communication and cohesion, career progression, workload balance, and resources and equipment. The study's limitations acknowledge the constraints of the sample size and geographic representation. The findings provide an insight into the workplace culture, leadership and evaluation of PET-CT departments in the southwest of England. The observational data helped identify where future improvements to service delivery and patient experience could be implemented. Communication within and between sites provided strong evidence of staff cohesion, ensuring continuous service delivery. The potential for transformative leadership support for workforce career development might mitigate future staff burnout and attrition and promote career progression.
Norovirus and sapovirus (both Caliciviridae) are common causes of viral gastroenteritis and may pose clinical challenges, particularly in immunocompromised patients. We present 3 pediatric kidney transplant cases seen at Başkent University Hospital to highlight variability in clinical presentation and management of norovirus and sapovirus infection in transplant recipients. Case 1 (18-year-old male, transplant 13 years earlier)presented with acute onset watery diarrhea and mild dehydration. Direct microscopic stool examination was unremarkable, and norovirus was detected on viral panel testing. Supportive therapy proved effective without immunosuppression adjustment. Symptoms resolved within 1 week, with stable renal function. Case 2 (10-year-old male, transplant 1 year earlier) presented with prolonged diarrhea, weight loss, and worsening kidney functions. Polymerase chain reaction detected norovirus in stool. Severity and duration of symptoms required hospitalization and intravenous hydration. Temporary immunosuppression reduction helped control viral infection; recovery was slow (several weeks) with intermittent relapses. Clinical symptoms ameliorated with oral human immunoglobulin therapy, highlighting its potential to manage severe norovirus gastroenteritis in immunocompromised pediatric transplants. Case 3 (9-year-old male, transplant 5 years earlier) presented with watery diarrhea lasting for 3 months, dehydration, and weight loss. Laboratory analysis revealed increased serum creatinine. He was hospitalized with intravenous hydration. Stool polymerase chain reaction revealed sapovirus as the cause. His kidney function slowly recovered with extensive hydration and close monitoring. Norovirus and sapovirus are common enteric pathogens that usually cause acute gastroenteritis. In solid-organ transplant recipients, these viruses can cause prolonged, severe gastroenteritis, which can lead to dehydration, weight loss, and possible graft loss. Solid-organ transplant recipients are immunocompromised, so disease course can be severe and management can be difficult. Patients may need hospitalization and immunosuppression adjustment. Early diagnosis and tailored supportive treatment are necessary to avoid complications. In selected patients, other treatments (eg, orally administered human immunoglobulin) could be used.
Clinical decision support (CDS) systems can improve care quality, but their implications for equity remain uncertain. We examined whether provider response to CDS alerts differed by patient race and sex in primary care, and whether differences in alert exposure helped explain any observed variation. We conducted a retrospective study using EHR data from a New York City academic health system, focusing on alert-based CDS during outpatient primary care. Logistic regression was used to estimate the likelihood of alert engagement by patient race and sex, while adjusting for encounter and provider factors. We used a generalized structural equation model to assess mediation by alert type, decomposing direct and indirect effects of demographics on response.Direct effects suggest that providers may respond differently to alerts based on patient identity, consistent with interpersonal bias, in which implicit or explicit attitudes shape clinical behavior, and on the context of the visit. Indirect effects highlight disparities in how alerts are assigned across groups, indicating that algorithmic or systemic bias may be embedded within the technology itself. Estimated mediated pathways suggest that even when providers respond uniformly to alerts, unequal exposure can still produce inequitable outcomes. The findings highlight that the type of CDS triggered plays a significant role in differential CDS responses, with provider- and patient-related factors evident in these differences. These findings underscore the need to evaluate not only provider behavior but also the logic and distribution of CDS tools themselves, as both can contribute to disparities in care delivery. Further research should also focus on looking for the potential health impact of the differential response. Digital tools meant to standardize care can unintentionally contribute to which patients receiving care. We investigate whether providers' use of these tools is related to a patient's identity or influenced by the types of tools provided to them in primary care. Using electronic health record data from a large urban health system, we find that providers' responses to alerts are shaped not only by patient identity but also by the nature of the alert itself. Direct effects suggest that providers may engage differently with CDS based on patient demographics, indicating potential interpersonal bias. Indirect effects reveal that certain patient groups are more or less likely to receive specific types of alerts, indicating embedded algorithmic or systemic bias. These findings underscore the importance of evaluating both provider behavior and the design of CDS tools when assessing equity in digital health. Even when providers respond consistently, unequal exposure to alerts can produce inequitable outcomes. Our results underscore the need for more transparent and equity-aware CDS design and implementation strategies that consider both human and technological sources of bias.
The substantial underrepresentation of American Indian, Alaskan Native, and Native Hawai'ian (AI/AN/NH) students in Science, Technology, Engineering and Mathematics (STEM) majors at United States colleges and universities results from systemic barriers in higher education. Efforts to address inequities have thus far not led to increases in AI/AN/NH student participation in STEM at the national level. In fact, while the AI/AN/NH population in the United States is increasing, there was a 17.0% decrease in the number of bachelor's degrees awarded to Indigenous students in STEM during the period 2012-2021. This work reports on steps that can be taken in a variety of types of institutions of higher education to serve our Native students in STEM more effectively. These steps are reported as a series of rationales, followed by practical descriptions of implementations. Ideas for enhancing the Indigenous experience in the academy, together with examples of successful programs, are detailed. These include raising faculty and institutional cultural competency, addressing inequities in college preparation within the K-12 system, making college STEM courses more inclusive, improving one-on-one advising and mentoring, engaging students in research, helping students overcome isolation, and providing physical spaces to build community. Implementation of these strategies will bring vast new talent to the STEM workforce, contributing to increased technical innovation and economic growth.
Conversational agents for women's health often fail to meet user needs, offering either clinically sterile advice or unreliable peer anecdotes. This limitation creates a tension between the need for factual safety and emotional resonance in sensitive health contexts. We aimed to address this gap by developing and conducting a formative evaluation of HerCare, a conversational agent built on a novel dual-source retrieval-augmented generation architecture. The system integrates expert medical knowledge with peer narratives and makes the provenance of each response visible to users, enabling trust calibration through transparent source attribution. We conducted a remote, web-based single-session field study (December 2024 to January 2025; North Dakota State University Institutional Review Board Protocol #IRB0005368) with 243 completers (from 335 eligible, consenting visitors) recruited via social media (Facebook [Meta], Reddit, and Instagram [Meta]) and university mailing lists. Eligible participants self-identified as women aged 18-45 years with English proficiency and internet access. We used a quantitative multimethod evaluation, combining standardized self-report metrics-the Chatbot Usability Questionnaire and net promoter score (NPS)-with computational linguistic analyses (VADER [Valence Aware Dictionary and Sentiment Reasoner] sentiment analysis and NRC [National Research Council] Emotion Lexicon) of 1191 conversational turns. Among the 243 participants who completed the protocol, reported usability was high (Chatbot Usability Questionnaire median 78.1, IQR 65.2-87.5; mean 75.67, SD 15.50) and advocacy was strong (NPS 60.0; 171/243, 70.4% promoters, 25/243, 10.3% detractors), though this NPS reflects completers only. Postinteraction ratings were high (all facets median 4-5 on a 5-point scale; helpfulness, ease of use, and clarity median 5, IQR 4-5). Computational analysis revealed a consistent polarity shift from neutral to negative user queries (compound -0.18 to +0.15) to strongly positive agent responses (compound +0.55 to +0.83), with a recurring validate-then-redirect empathy pattern in which the agent acknowledges user distress before pivoting to constructive guidance. Among completers, the dual-source architecture was associated with high perceived empathy and trust, suggesting it can combine clinical accuracy with emotional support. These formative findings indicate the feasibility of weaving clinical sources with lived experiences toward safer, more resonant health AI and surface a candidate design pattern for future empathy-attuned systems that warrants controlled evaluation.
Spinal muscular atrophy (SMA) research has focused predominantly on paediatric populations, with limited adult data from low- and middle-income countries (LMICs). We prospectively recruited suspected SMA patients (age ≥ 12 years) into a neuromuscular disease cohort at a tertiary centre in northern India, using phenotyping, creatine kinase, electrophysiology and genetic testing. Forty genetically confirmed patients were included (median age 20.5 years; mean symptom duration 14.7 ± 10.9 years). Proximal lower-limb weakness was the commonest presentation (82.5%). Forty-five percent were misdiagnosed as muscular dystrophy or congenital myopathy. Three SMA patients received risdiplam. Our cohort highlights the diagnostic challenges of adult SMA and supports a genetics-first approach. Early genetic confirmation shortens diagnostic delay, reduces misclassification and helps eligible patients benefit as disease-modifying therapies become more affordable in resource-limited settings.
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Patients with advanced TNBC with PD-L1 CPS < 10 are typically treated with chemotherapy and experience poor outcomes. Sacituzumab tirumotecan (sac-TMT; MK-2870/SKB264) is a trophoblast cell-surface antigen 2 (TROP2)-directed antibody-drug conjugate with a unique, bifunctional linker that maximizes payload delivery to tumor cells. Combining sac-TMT with immunotherapy may improve outcomes given their complementary respective direct cytotoxic and immune-mediated antitumor effects regardless of tumor PD-L1 expression. The TroFuse-011 study evaluates sac-TMT with/without pembrolizumab versus treatment of physician's choice (TPC; paclitaxel, nab-paclitaxel, or gemcitabine plus carboplatin) in previously untreated, centrally confirmed, locally recurrent unresectable or metastatic TNBC with PD-L1 CPS <10. Eligible adults with measurable disease per RECIST version 1.1, ECOG PS 0/1, and tumor tissue sample for central PD-L1 and TROP2 testing will be randomized to receive sac-TMT (arm A), sac-TMT plus pembrolizumab (arm B), or TPC (arm C). Primary endpoints include progression-free survival (PFS; arm A vs C and arm B vs C) and overall survival (OS; arm A vs C). Secondary endpoints include PFS (arm B vs A), OS (arm B vs C and arm B vs A), objective response rate (arm A vs C and arm B vs C), duration of response, patient-reported outcomes, and safety. Enrollment is ongoing.Clinical trial registration: www.clinicaltrials.gov identifier is NCT06841354. Triple-negative breast cancer (TNBC), a type of breast cancer which lacks expression of the estrogen receptor, the progesterone receptor, and the human epidermal growth factor receptor 2, represents approximately 10% to 20% of all breast cancers. Chemotherapy is a current first-line standard-of-care treatment for patients with advanced TNBC that has no or a low amount of a protein called PD-L1. However, many patients experience poor outcomes and additional treatment options are needed. A drug called sacituzumab tirumotecan (sac-TMT) binds to a protein on the surface of cancer cells called trophoblast cell-surface antigen 2 and carries chemotherapy to those cells; this kills the cancer cells while minimizing the killing of healthy cells. This phase III study is investigating sac-TMT, either alone (treatment arm 1) or in combination with pembrolizumab (a drug that helps the immune system fight cancer; treatment arm 2) versus treatment of physician’s choice (treatment arm 3) in females or males 18 years of age or older who have advanced TNBC and have PD-L1 protein on less than 10% of cells in their tumors. Participants are randomly assigned to study treatment. Participants will be assessed for how long they live without their disease getting worse, how long they live overall, whether the tumor shrinks or goes away completely, and how long they respond to treatment; safety and quality of life will also be evaluated. This study is currently enrolling participants.
Mind mapping is a visual, non-linear learning technique in which information is organized around a central concept with related topics and subtopics arranged as branches. It promotes active learning by helping students organize, understand, and recall information. In medical education, where students are required to learn large volumes of conceptual content, mind mapping may serve as a useful self-directed learning tool. This study aimed to evaluate the effectiveness of mind mapping as a self-directed learning method among first-year Bachelor of Medicine, Bachelor of Surgery (MBBS) students and to assess students' perceptions regarding its use in the context of physiology. This quasi-experimental, non-randomized controlled crossover study was conducted among 100 first-year MBBS students at All India Institute of Medical Sciences (AIIMS) Jammu in Jammu, India. Students were divided into two routine practical batches of 50 each. In Phase 1, Batch A served as the mind mapping group and Batch B as the traditional learning group for the topic "Acid-Base Disorders". All students were first trained in mind map preparation using a topic unrelated to the study intervention. Students in the mind mapping group studied the assigned topic by preparing mind maps, while students in the traditional learning group used their usual study methods. Immediate and delayed post-tests were conducted, with the delayed test performed one month after the intervention. In Phase 2, crossover was performed using the topic "Physiology of EEG and Clinical Relevance", and the same process was repeated. At the end of the study, students' perceptions were assessed using a structured five-point Likert scale questionnaire. Data were analyzed using IBM SPSS Statistics for Windows, Version 15.0 (SPSS Inc., Chicago, Illinois, United States), and a p-value of ≤0.05 was considered statistically significant. Immediate assessment scores did not differ significantly between the mind mapping and traditional learning groups in either phase or in the combined analysis. In the delayed assessment for Phase 2, the mind mapping group scored significantly higher than the traditional learning group. The combined delayed assessment analysis also showed significantly higher scores in the mind mapping group compared with the traditional learning group, with 100 observations in each group (6.97±1.97 vs. 6.30±2.28; p=0.029; Cohen's d=0.313). Student perception was favorable, with most students reporting that mind mapping improved understanding, organization of concepts, engagement, confidence, active participation, and independent learning. These findings suggest that mind mapping was well accepted by students as a self-directed learning strategy and may contribute positively to independent learning, engagement, and the overall learning experience in undergraduate medical education. Mind mapping did not significantly improve immediate assessment performance compared with traditional learning; however, it was associated with better delayed assessment scores, suggesting a potential benefit in long-term retention. Students perceived mind mapping as an engaging and useful self-directed learning tool. Mind mapping may be incorporated as an adjunct to traditional teaching-learning methods in undergraduate medical education.