Intensive blood pressure (BP) targets of less than 120 mm Hg have been shown to worsen functional outcomes after endovascular thrombectomy (EVT) for acute ischemic stroke. However, their effects on self-reported health-related quality of life (HRQoL) remain uncertain. This post-hoc exploratory analysis used data from ENCHANTED2/MT, an open-label, blinded-endpoint randomized trial conducted in 44 Chinese hospitals. Adults with elevated BP within 3 h after successful reperfusion were randomized to intensive (< 120 mmHg) or less intensive (140-180 mmHg) systolic BP targets. HRQoL at 90 days was assessed using the EQ-5D-3 L and EQ visual analogue scale (EQ VAS). Functional outcome was measured by the modified Rankin Scale (mRS). Treatment effects were estimated using adjusted regression models, and causal mediation analysis was performed to explore indirect and direct pathways. Of 816 randomized patients, EQ-5D data were available in 685. At 90 days, both EQ-5D index (0.66 vs. 0.72) and EQ VAS (73.01 vs. 76.84) were lower in the more intensive BP group. Adjusted mean differences favored the less intensive treatment group: 0.06 (95% CI, 0.01 ~ 0.11; P = 0.017) for EQ-5D index and 3.49 (95% CI, 0.38 ~ 6.60; P = 0.028) for EQ VAS. Mediation analysis showed that the association of intensive BP lowering with worse HRQoL was mainly indirect via worse mRS outcomes. Intensive BP lowering after EVT was associated with modestly worse HRQoL at 90 days. The observed differences were small in magnitude, particularly for EQ VAS relative to commonly reported thresholds for clinical importance. These findings are consistent with less intensive BP targets after EVT and highlight the importance of incorporating patient-reported outcomes in acute stroke trials. ClinicalTrials.gov number, NCT04140110 the Registration Date, 22/10/2019.
The competition for nursing faculty has reached a crisis point, with over 2000 schools of nursing vying for a shrinking pool of qualified candidates. This shortage hits research-intensive institutions hardest because nurses may delay entry into academic research careers following extended clinical practice. Although strategic faculty recruitment and development in research-intensive institutions is critical for advancing science, little is known about successful organizational strategies implemented within research-intensive schools of nursing. This article presents organizational strategies for recruiting and developing research-intensive nursing faculty through a mission-driven, human-centered approach at the Nell Hodgson Woodruff School of Nursing at Emory University. The authors highlight three key approaches: mission-aligned recruitment practices, human-centered approaches to creating supportive environments, and the integration of individual- and organization-centered approaches to faculty development. Success requires recruiting faculty with diverse disciplinary expertise, implementing transparent processes, and achieving a balance between individual career aspirations and institutional research, education, and service priorities. As federal research priorities rapidly evolve and the shortage of research-intensive nursing faculty deepens, institutions must invest in adaptive recruitment strategies, robust mentoring programs, and equitable resource allocation to build sustainable research capacity and leadership pipelines.
Intravenous (IV) albumin is widely used in intensive care units (ICUs), yet its use often deviates from evidence-based recommendations, leading to unnecessary costs. This study evaluates the indications for the use of IV albumin in critically ill patients, compliance with the 2024 "Use of Intravenous Albumin" guidelines, and the associated cost burden. A prospective, point prevalence-based observational study was conducted across seven hospitals in Türkiye over one week. Data on IV albumin utilization, guideline compliance, patient demographic and clinical characteristics, and associated costs were collected and analyzed. Statistical analyses included the Kruskal-Wallis test for comparisons of albumin utilization and logistic regression to assess factors influencing its use. Among 385 ICU patients monitored, 56 (14.5%) received IV albumin therapy. The median age was 68 years (Interquartile range-IQR: 54.2-77.7), and 67.9% were male. The most common physician-reported indications for initiating albumin therapy were low serum albumin levels (41.1%), fluid shifts or intravascular volume support (21.4%), and sepsis or septic shock (14.3%). The desired clinical target was achieved in 73.2% of cases; however, guideline compliance was 0%. Albumin use differed significantly across ICU types (p = 0.049), with a median consumption of 667 (IQR: 250-1,083) vials per 1,000 patient-days and an estimated cost of $70,617.86. Logistic regression identified total hospital stay (p = 0.028) and Acute Physiology and Chronic Health Evaluation (APACHE) II score (p = 0.040) as significant predictors, while mechanical ventilation (MV) duration showed borderline significance (p = 0.070). The model's classification accuracy was 78.6%. This study highlights widespread non-compliance with guidelines for IV albumin use in ICUs, resulting in substantial costs. These findings underscore the need to improve compliance with evidence-based guidelines to optimize albumin utilization and reduce economic burden. Future studies should explore the potential impact of targeted interventions, including pharmacist involvement, on improving prescribing practices. Not applicable. Not applicable.
Candida species are major causes of hospital-acquired bloodstream infections associated with high mortality in critically ill patients. This study aimed to evaluate temporal changes in species distribution, antifungal resistance, clinical outcomes, and mortality predictors in ICU patients with candidemia. This retrospective study included 250 ICU patients with candidemia between January 2018 and January 2022. The study period was divided into two cohorts (2018-2020, n = 80; 2020-2022, n = 170). Clinical, laboratory, and microbiological characteristics were compared. Multivariable analysis was performed to identify independent predictors of mortality. The incidence density of candidemia significantly decreased from 4.32 to 3.10 per 1,000 ICU patient-days (IRR: 0.72; %95 CI: 0.55-0.94; p = 0,014). A shift toward non-albicans Candida species was observed, while antifungal resistance rates remained stable. Candida score values and empirical antifungal therapy rates were lower in the later period. Despite increased central venous catheter use, catheter-related candidemia decreased. Overall mortality was similar between periods; however, during the second period, mortality was higher in patients with SARS-CoV-2 infection than in those without infection [100/105 (95.2%) vs. 43/65 (66.2%), p < 0.001]. In multivariable analysis, SOFA score was independently associated with mortality in the early period (OR: 1.20, 95% CI: 1.01-1.43; p = 0.043), whereas SARS-CoV-2 infection (OR: 20.43, 95% CI: 3.53-118.14; p = 0.001), Candida score (OR: 0.19, 95% CI: 0.06-0.50; p = 0.003), lactate level at ICU admission (OR: 5.23, 95% CI: 1.55-17.57; p = 0.007), and urea level at ICU admission (OR: 1.01, 95% CI: 1.00-1.02; p = 0.030) were independent predictors in the later period. The high mortality observed among patients with SARS-CoV-2-associated candidemia underscores the need for heightened diagnostic awareness in deteriorating ICU patients. Early diagnostic work-up, timely initiation of antifungal therapy, and reassessment of treatment according to microbiological findings are important in this setting. Hospital-specific identification of preventable risk factors may also help optimize candidemia management and infection control strategies.
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Evidence on sex-related mortality differences in critically ill older adults is inconsistent, and frailty is rarely incorporated despite its major prognostic relevance in geriatric intensive care. We performed a pooled analysis of acute ICU admissions from three prospective multinational cohorts within the Very Old Intensive Care Patients project: VIP1 and VIP2, which enrolled patients aged 80 years or older, and COVIP, which enrolled patients aged 70 years or older with COVID-19. Frailty was assessed before the acute illness using the Clinical Frailty Scale. The primary endpoint was 30-day mortality. Associations between sex and mortality were examined using robust Poisson regression adjusted for age, frailty, Sequential Organ Failure Assessment score, organ support, and treatment limitations, with Bayesian models used to estimate posterior probabilities of clinically relevant effect sizes. Among 10,363 acute ICU admissions, 43% were women. Women were older and more often frail, whereas men more frequently received invasive mechanical ventilation, vasopressors, and renal replacement therapy. Crude 30-day mortality was higher in men than in women (44%vs. 40%). Frailty was a strong independent predictor of mortality, with each 1-point increase in the Clinical Frailty Scale associated with an 8% increase in adjusted mortality risk (incidence-rate ratio 1.08, 95% CI 1.06-1.10). After multivariable adjustment for frailty and clinical covariates, male sex remained associated with a small residual increase in 30-day mortality (incidence-rate ratio 1.08; 95% CI 1.01-1.15). This association was attenuated with greater illness severity and more intensive organ support. Bayesian analyses yielded adjusted posterior median incidence-rate ratios of 1.04 to 1.06, and the probability of at least 10% excess mortality in men was low after adjustment (2% to 13%). In older critically ill adults, pre-admission frailty is a major driver of mortality. After explicit adjustment for frailty and illness severity, male sex was associated with only a small residual increase in 30-day mortality. Bayesian analyses suggest that large clinically meaningful sex-based mortality differences are unlikely after accounting for case mix and treatment intensity.
The Parent Support Team (PST) is an intensive early intervention home visiting programme delivered by child and family health nurses to families with infants aged 0-6 months experiencing psychosocial and health vulnerabilities. In contrast, mainstream services provide universal clinic-based care and scheduled developmental checks. This mixed-methods study aimed to: (1) describe demographic and psychosocial characteristics, service activity and well-baby check attendance among PST clients compared with mainstream service clients; (2) evaluate changes in maternal depressive symptoms following PST engagement; and (3) explore client experiences, including perceived outcomes and facilitators and barriers to change. Convergent parallel mixed-methods study. Retrospective data were extracted from electronic medical records for PST clients (909 mothers; 1038 children) and mainstream service clients (17,707 mothers; 21,764 children) between August 2019 and December 2022. Quantitative analyses described demographics, psychosocial characteristics, service use and maternal depressive symptoms. PST client experience surveys (166 mothers) were analysed using descriptive statistics and thematic analysis. PST clients demonstrated greater psychosocial complexity and higher maternal depressive symptoms at entry than mainstream clients. PST mothers had more frequent service contacts and maintained stronger engagement with services after discharge. The proportion of mothers with clinically significant depressive symptoms decreased following programme participation. Survey findings indicated improved parenting confidence and practical skills. Positive outcomes were attributed to nurse qualities, opportunities to discuss concerns, a holistic care approach and the service model. Reported barriers included accessibility, scope of education topics and communication challenges. The PST programme effectively engages vulnerable families, supports maternal mental health and promotes sustained connection with child and family health services. Intensive early intervention home visiting programmes may improve outcomes for families with complex needs and warrant broader implementation. SRQR guidelines were followed. None.
The development of efficient catalysts for nitrogen conversion to ammonia is critical for a sustainable alternative to the energy-intensive Haber-Bosch process. Yet, rational catalyst design remains highly challenging, compounded by complex structure-function relationships within realistic conditions. Herein, we present an integrated computational framework combining quantum chemical calculations with 27 machine learning models to predict experimental catalytic metrics in metal-ligand complexes. The models are trained and validated on a large experimental database and demonstrate high predictive accuracy across multiple tasks. For classification, family 1 and family 2 catalysts achieved test accuracies up to 1. Regression models yield test R2 values of 0.91 and 0.88 for turnover frequency (TOF) and turnover number (TON) predictions in family 1, and 0.96 and 0.99 in family 2. Notably, the models accurately capture time-dependent variability of TOF and TON for new complexes, with predicted values closely matching experimental results. Moreover, strong transfer learning capability is observed for structurally distinct coordination architectures. Feature interpretation reveals clear design principles for optimal catalysts involving metal spin state, ligand geometry, charge distribution, and experimental conditions. Together, this study established an efficient and practical framework for discovery and inverse design of high-performance catalysts under realistic conditions, with broader relevance to electrocatalysis.
The intimate coupling of photocatalysis and biodegradation (ICPB) serves as a promising alternative for rapid, enhanced antibiotics removal, while the concurrent induction of antibiotic resistance genes (ARGs) accumulation has become a critical barrier restricting its further industrial popularization. Here, we tracked ARGs fates in an ICPB reactor treating sulfamethoxazole (SMX) over 30 days, with emphasis on how microbial succession and functional adaptation within algae-bacteria consortia shape ARG dynamics. The ICPB system removed more than 71.7% of SMX within the first 7 days, yet this early-stage performance coincided with increased abundance of sul genes and the overall resistome, likely driven by folate biosynthesis and oxidative stress responses. With prolonged operation to 30 days, total ARGs abundance declined unexpectedly, even though SMX residuals accumulated. This shift was closely associated with sustained illumination that promoted algal proliferation, particularly Cyanobacteria. In parallel, carotenoid production was markedly enhanced through activation of the ε-carotene biosynthesis pathway, which reinforced oxidative stress scavenging and relieved folate-associated selective pressure, thereby mitigating ARGs dissemination. In addition, cyanobacteria-derived photosynthate favored autotrophic metabolism within the bacterial consortium, which reduced the abundance of genes encoding energy-dependent efflux pump transporters and consequently constrained the propagation of energy-intensive ARGs. Collectively, these findings highlight a cyanobacteria-mediated route to attenuate ARGs during prolonged ICPB operation and provide guidance for designing photocatalysis-coupled cyanobacterial biofilms for sustainable wastewater treatment.
To report a case of fulminant bilateral multifocal choroiditis as the presenting manifestation of sarcoidosis despite normal serum angiotensin-converting enzyme (ACE) and unremarkable thoracic imaging. An immunocompetent 32-year-old man was admitted with a systemic inflammatory illness and peripheral lymphadenopathy. Given the acute systemic symptoms and recent international travel to Southeast Asia, an infectious cause was initially suspected. Two days after admission, he developed rapidly progressive bilateral central scotomas, floaters, and photophobia. Examination demonstrated bilateral granulomatous keratic precipitates, anterior chamber and vitreous inflammation, and multifocal yellowish deep retinal lesions with indistinct margins involving the posterior pole and midperiphery. Fundus autofluorescence demonstrated hypoautofluorescent lesions with surrounding hyperautofluorescence, and optical coherence tomography (OCT) showed retinal thickening with outer retinal disorganization, subretinal and intraretinal fluid, retinal pigment epithelium (RPE) hyperreflectivity and elevation, and choroidal thickening. Infectious investigations, neuroimaging, serum ACE, and thoracic imaging were unrevealing. Although vision deteriorated despite intensive topical therapy, it improved rapidly after high-dose systemic corticosteroids. Excisional biopsy of a palpable inguinal lymph node showed well-formed non-necrotizing granulomas with negative fungal and mycobacterial stains, findings considered in keeping with sarcoidosis. Methotrexate was commenced as steroid-sparing therapy. Quiescence was achieved within three weeks, and visual acuity recovered to 20/20 bilaterally by two months. Sarcoidosis may present as fulminant bilateral multifocal choroiditis even when serum ACE and thoracic imaging are normal. Careful general examination for peripheral lymphadenopathy, including inguinal nodes, may help identify an accessible extrathoracic biopsy target, facilitating timely tissue confirmation and early immunosuppression.
Semi-quantitative positron emission tomography (PET) analysis, particularly Centiloid and CenTauRz scaling, is essential for Alzheimer's disease (AD) research and diagnosis. However, standard quantification workflows often depend on structural MRI for spatial normalization (SN) or rely on computationally intensive software, limiting clinical accessibility. In this retrospective, multi-center study (3,539 patients; 6,531 scans; 2005-2025), we compiled data across 7 modalities and 13 tracers to develop and validate the Deep Cascaded Cerebral Calculator (DCCC). This fully automated, PET-only framework employs cascaded CNN-based rigid/affine and VoxelMorph-based elastic registration modules for rapid SN. We benchmarked DCCC against the standard MRI-guided SPM12 pipeline and other PET-only tools using meta region-of-interest (ROI) Standard Uptake Value ratio (SUVr) and correlation analyses. DCCC achieved a mean absolute relative SUVr error of 1.34±0.59% and a Pearson correlation of 0.96±0.02, demonstrating robust generalization to unseen tracers and modalities including neuroinflammation and methionine metabolism imaging, with superior consistency compared to conventional template-based PET-only methods. Centiloid and CenTauRz estimates were highly accurate (R²>0.97) with a processing speed of 1.22±0.64 s per image. We further demonstrated DCCC's utility across 3 scenarios: (1) longitudinal tracking, where it identified a distinct low-Centiloid AD subgroup; (2) deep learning preprocessing, yielding classification AUCs comparable to standard methods (P=0.36); and (3) exploratory clinical support, where DCCC-derived metrics were adopted in 79% Aβ and 61% tau cases and were associated with changes in interpretation and increased agreement with reference labels in a multi-reader survey. Collectively, DCCC provides accurate, PET-only standardization, facilitating harmonized biomarker estimation without MRI and enabling large-scale, tracer-agnostic analyses in AD neuroimaging. A free standalone command-line interface program and a 3D Slicer plugin are provided.
Intubation is a critical aspect of airway management and supportive care for intensive care unit (ICU) patients. Inappropriate size of endotracheal tubes (ETT) affects the patient's airway, it is crucial to choose an appropriate size for each patient. This study aimed to assess current practices of ETT size. for adult ICU patients and to explore factors associated with it. Single-center, retrospective cohort study at King Fahad Hospital of the University, Saudi Arabia. A retrospective review was conducted for adult patients admitted to ICU from January 2020 to January 2024 at King Fahad Hospital of the University. Inclusion criteria included patients aged 18 years or older, underwent intubation and was followed by tracheostomy. Those with missing data, had laryngeal or thyroid masses, had upper airway obstruction by any cause and upper airway surgery were excluded. The primary outcome was compliance of ETT size selection with established guidelines. Secondary outcomes included associations between ETT size (mm), patient demographics and intubation indications. A total of 228 ICU patients were analysed [mean (standard deviation) age of 61.8 (19.6) years]. The median internal diameter of the ETT size was 7.5 mm, with neurological causes being the most common indication for intubation. ETT size showed a significant positive correlation with height (rs=.341; P<.001) and weight (rs=0.190; p=0.004), but not with body mass index (rs=.050; P=.456). In multivariable analysis, larger ETT size was significantly associated with male sex (adjusted odds ratio, aOR 2.38, 95% confidence interval, CI 1.12-5.05), pulmonary indication for intubation (aOR 2.31, 95% CI 1.10-4.86), older age (aOR 1.20 per 10 years, 95% CI 1.02-1.42), and height (aOR 1.95 per 10 cm, 95% CI 1.20-3.16), whereas weight was not independently associated after adjustment (aOR 1.04 per 10 kg, 95% CI 0.85-1.26). Overall, 77% of ETT size selection did not comply with height-based guidelines. No standardized ETT size selection guidelines were followed for adult ICU patients. Male sex, height, older age, and pulmonary indication were independent predictors of larger ETT size, supporting the implementation of more structured, height-informed ETT sizing protocols.
While most adolescent self-harm (SH) is transient, a substantial minority of adolescents repeat and continue it, requiring intensive care. Although social environmental factors play an important role in adolescent psychological development, little is known about their role in the persistence of SH. Moreover, few studies have focused specifically on early adolescence, when SH often begins, hospital presentations after SH increase sharply, and many preventive programs typically commence. We aimed to identify social environmental risk factors at age 12 that predict the persistence of SH through ages 14 and 16 in a population-based cohort. We used data from the Tokyo Teen Cohort study (N = 1501). The experience of SH was self-reported at three timepoints (12, 14 and 16 years of age), and categorized as none, transient (one timepoint), or persistent (≥ 2 timepoints). Potential risk factors were assessed at age 12, including family related factors, school and peer related factors, sociodemographic and developmental characteristics, and psychopathological experiences. Multivariable and multinomial logistic regression analyses were conducted to examine the associations of potential risk factors with transient and persistent SH. Of the 1501 participants 195 (13.0%) experienced transient SH and 53 (3.5%) experienced persistent SH. In fully adjusted models, maternal depressive/anxious symptoms and female sex predicted persistent SH (maternal depressive/anxious symptoms: OR 1.47, 95% CI 1.13-1.92, female: OR 4.74, 95% CI 2.18-10.29), whereas companionship with mother predicted lower likelihood (OR 0.50, 95% CI 0.28-0.89). Depressive symptoms and psychotic experiences (PEs) predicted both transient (depressive symptoms: OR 1.77, 95% CI 1.50-2.10, PEs: OR 1.57, 95% CI 1.36-1.82) and persistent SH (depressive symptoms: OR 2.03, 95% CI 1.55-2.66, PEs: OR 1.89, 95% CI 1.48-2.41). Maternal depressive/anxious symptoms were the risk factor of persistent SH and companionship with mother was protective against persistence even after adjustment for other factors. Care for maternal depressive/anxious symptoms and support for mother-child relationships would be required to prevent the persistence of SH, in addition to the care for children's depressive symptoms and PEs.
To evaluate the effects of cardiopulmonary bypass (CPB) on peripheral white blood cell counts, neutrophil surface marker expression, and neutrophil function by comparing patients undergoing on-pump CABG (ONCAB) versus off-pump CABG (OPCAB), and to identify CPB-related immunological and inflammatory alterations. Patients undergoing on-pump CABG (ONCAB) or off-pump CABG (OPCAB) were recruited. Blood samples were collected preoperatively and at 24 h postoperatively. The primary outcome was the neutrophil-to-lymphocyte ratio (NLR) measured at 24 h after surgery. Secondary outcomes included monocyte Human leukocyte antigen-DR (HLA-DR) expression, lymphocyte programmed cell death protein-1 (PD-1) expression, and neutrophil surface markers (CD11b, CD18, CXCR2, CD35, CD63, CD66b, CD88, and programmed cell death-ligand 1). Neutrophil apoptosis, reactive oxygen species (ROS) production, and plasma inflammatory mediators (interleukin-6, tumor necrosis factor-alpha, interleukin-10) were also measured. Postoperative clinical outcomes and laboratory parameters were recorded. Data from 36 ONCAB patients and 18 OPCAB patients were analyzed. Postoperative NLR was significantly higher in the ONCAB group than in the OPCAB group (16.6 ± 6.1 vs. 13.1 ± 3.9; p = 0.015). This difference was attributable to lower lymphocyte counts in the ONCAB group (0.7 ± 0.2 vs. 0.8 ± 0.2 × 109/L; p = 0.002), whereas neutrophil counts did not differ significantly between groups. In both groups, monocyte HLA‑DR expression decreased and lymphocyte PD-1 expression increased after surgery. CPB did not result in significant alterations in neutrophil adhesion, chemotaxis, degranulation markers, ROS production, or apoptosis. ONCAB patients had higher postoperative levels of aspartate aminotransferase (AST), cardiac troponin I (cTnI), and procalcitonin (PCT), as well as longer durations of mechanical ventilation and intensive care unit stay. CPB elevates the NLR after CABG primarily, accompanied by reduced level of lymphocyte count, but not neutrophil count or molecular markers of neutrophil functional. These results might reflect a higher risk of short-term complications after on-pump CABG.
Visual field testing is essential for monitoring field defects, but traditional devices are bulky and resource intensive. This study evaluated the agreement and usability of the RetinaLogik RVF100 virtual reality perimetry device compared with the Humphrey visual field analyzer (HVF) among Filipino adults. A comparative cross-sectional study. Participants were Filipino adults presenting to 2 major eye centres in the Philippines from January to October 2024. A total of 46 participants (76 eyes) were included. Participants were categorized as normal, glaucoma, or other diagnoses (e.g., optic neuritis, ocular hypertension). Both devices tested visual fields using the 30-2 grid, measuring mean deviation (MD), pattern standard deviation (PSD), fixation losses (FL), false positives (FP), false negatives, and test duration. Agreement was assessed using Bland-Altman analysis and Pearson correlation. Pointwise analyses with heatmap visualizations were also used. Usability was evaluated using a postexamination Likert-scale questionnaire. RVF100 demonstrated strong agreement with HVF (MD: r = 0.979, PSD: r = 0.837; p < .0001). The Bland-Altman analysis showed a mean difference in sensitivity of -1.06 decibels (dB) (95% CI: -4.2 to 2 dB). RVF100 had shorter test durations (5.41 vs 6.96 min; p < 0.001), fewer FL (1.79% vs 5.59%; p < 0.001), and slightly higher FP rates (3.44% vs 1.92%; p < 0.001). Usability results showed 90% preferred RVF100 over HVF for comfort (86.4%) and engagement (95.3%). RVF100 is a comparable alternative to HVF, offering comparable accuracy with improved patient comfort. Further research is warranted to assess its efficacy in detecting early and advanced disease stages and in broader populations.
The prevalence of diabetes in Belgium has steadily increased since 2001, reaching 6.9% in 2024, with type 2 diabetes (T2D) accounting for approximately 90% of cases. Diabetes-related healthcare expenditures were estimated at €2 billion in 2022. The European Care4Diabetes Joint Action aimed to transfer and adapt the evidence-based Dutch lifestyle program Reverse Diabetes2 Now to 12 European countries. This study evaluated the transferability and potential effectiveness of the Care4Diabetes lifestyle intervention on metabolic, behavioral, and subjective health outcomes among Belgian adults with T2D in primary care. This quasi-experimental implementation study was conducted in two primary care centers in Wallonia. Forty-three participants initiated the program and 37 completed the 12-month follow-up. The intervention included a 6-month intensive phase with five thematic group sessions and one individual check-up, followed by an additional check-up and a refresher session at Month 12. Primary outcomes were changes in HbA1c and T2D medication use. Secondary outcomes included anthropometric measures, lipid profile, behavioral outcomes, and subjective health indicators. Linear mixed models were used to assess changes over time, accounting for repeated measures. At Month 12, 46% of participants had no change in T2D medication, 43% underwent medication de-intensification, and 11% required intensification. After adjustment for T2D medication changes, HbA1c decreased significantly from baseline to Month 6 by 5.4 mmol/mol (0.49%; p = 0.002), but the reduction was attenuated at Month 12 to 2.8 mmol/mol (0.26%; p = 0.06). Sensitivity analyses restricted to participants without T2D medication changes showed significant decreases in HbA1c at Month 6 and Month 12. Body weight decreased significantly (- 3.6 kg at Month 12, p < 0.001). Improvements were also observed in dietary behaviors and perceived general health, and satisfaction among participants and healthcare providers was high. The Care4Diabetes program demonstrated good transferability and promising effectiveness in primary care in Wallonia. Larger studies across Belgium are needed to further assess clinical effectiveness and potential economic benefits.
Despite the association between sepsis and carotid-femoral pulse wave velocity, the relationship between estimated pulse wave velocity (ePWV) and sepsis remains unclear. This study investigated the correlation between ePWV and 28-day mortality in patients with sepsis. Using data from the Medical Information Mart for Intensive Care IV database between 2008 and 2019, the association between ePWV and 28-day mortality was analysed with Kaplan-Meier curves, Cox models, and res-tricted cubic splines (RCS). Subgroup analysis was performed to validate the findings. A combined model was constructed by screening variables via Cox-least absolute shrinkage and selection operator (LASSO), with its incremental predictive value evaluated using receiver operating characteristic (ROC) curves and decision curve analysis (DCA). Survival analysis showed an inverse association between ePWV and survival rates (log-rank test P<0.001). Cox analysis demonstrated that each increase in ePWV was associated with a significantly higher risk of 28-day mortality in patients with sepsis (hazard ratio 1.905, 95% confidence interval 1.672-2.169, P<0.001), with linearity confirmed by RCS analysis (P-nonlinear=0.3313). Subgroup analysis indicated significant interaction effects of invasive ventilation (P-interaction <0.001) and a history of malignant tumours (P-interaction =0.005) on mortality. The combined model optimised by LASSO demonstrated the best discriminative performance (ROC=0.823) and an improved net clinical benefit with the inclusion of ePWV, as confirmed by DCA. ePWV was linearly and positively correlated with the risk of 28-day mortality in patients with sepsis.
Groundwater quality in arid/semi-arid coal-mining areas is increasingly threatened by intensive human activities. However, quantitatively linking specific pollution sources to health risks and translating this into risk-based management priorities remains a critical challenge. This study addresses this gap by proposing an integrated framework combining self-organizing maps (SOM), positive matrix factorization (PMF), and Monte Carlo simulation to systematically decipher groundwater contamination sources and prioritize associated health risks, using the Huolingol mining area in Inner Mongolia, China, as a representative case. SOM analysis recognized three hydrochemical clusters: Cluster 1 (Na-HCO3/Ca-Na-HCO3 type), influenced by cation exchange and silicate weathering under alkaline conditions, exhibited elevated F- and NH4+-N concentrations. Cluster 2 (Ca-Na-SO4/Ca-Na-HCO3 type) was characterized by elevated TDS, TH, SO42-, and NO3-, indicating significant anthropogenic impact. Cluster 3 (Ca-HCO3 type) represented the natural background with minimal contamination. Source apportionment using PMF revealed that human-driven composite pollution is the main cause of water quality evolution, with the mixed source of coal mine drainage and industrial/domestic wastewater contributing the highest proportion (22.42%), highlighting the overwhelming impact of mining and industrial activities. Monte Carlo simulation showed children faced a 33.9% probability of exceeding the safe health threshold (HI > 1), 1.75 times higher than adults (19.4%). F- and SO42- were the main risk drivers. Source-specific analysis indicated geogenic fluoride (Factor 1) contributes ∼48% of total health risk, followed by organic degradation (∼26%) and anthropogenic sulfate (∼23%). This framework quantitatively links sources to health risks and provides actionable guidance for groundwater management in water-stressed mining regions.
Severe pertussis in children can deteriorate rapidly, and early identification of patients likely to require intensive care remains challenging. We aimed to develop and internally validate an admission-time prediction model for ICU admission among hospitalized children with PCR-confirmed pertussis. We conducted a single-center retrospective prediction-model study based on a hospitalized cohort at a provincial pediatric infectious disease center. Consecutive hospitalized children with PCR-confirmed pertussis between 6 June 2020 and 24 June 2025 were screened. Two children were excluded because admission white blood cell count (WBC), a prespecified core predictor, was unavailable in the retrievable admission-time record, leaving 662 children aged 24 days to 14 years for analysis. The primary outcome was ICU admission, defined a priori as ICU length of stay > 0 days. We prespecified a multivariable logistic regression model using seven admission-time predictors: age (months), sex, symptom duration before admission (days), paroxysmal cyanosis documented at presentation, imaging consolidation/atelectasis, admission WBC scaled per 5 × 109 /L, and any recorded pertussis-containing vaccine dose. Internal validation used 5-fold cross-validation with out-of-fold predictions; model performance was assessed by discrimination (AUC), overall prediction error (Brier score), calibration, and decision curve analysis. ICU admission occurred in 61/662 (9.2%) children. Compared with non-ICU patients, ICU-admitted children were younger (median 2.0 vs 60.0 months) and had higher admission WBC (median 18.7 vs 10.0 × 109 /L). Paroxysmal cyanosis (49.2% vs 6.0%) and imaging consolidation/atelectasis (23.0% vs 10.5%) were more frequent, whereas recorded vaccination was less common (23.0% vs 87.9%). On internal validation, the model showed excellent discrimination (AUC 0.953; 95% CI 0.933-0.972) with low overall prediction error (Brier score 0.045). Calibration was good (intercept -0.017; slope 0.992), and decision curve analysis suggested positive net benefit over clinically relevant threshold probabilities. An admission-time multivariable model showed good internal performance for predicting ICU admission in pediatric pertussis and may support early risk stratification. External validation is required before routine implementation.
Pediatric death can lead to long-term adverse effects on parents' health. To describe the trajectory of parental mental and physical health burden within 24 months before and after a child's death and to evaluate the impact of specialized pediatric palliative care (SPPC) and several a priori selected factors on new mental or physical health burden in bereaved parents within 12 months following the death of a child. Retrospective cohort study of biological parents of children (0-21 y) who died in or out of the hospital within 6 months of receiving care in the intensive care units (ICUs) of a free-standing quaternary care children's hospital in the Mountain West region between January 2013 and December 2019. Parental mental and physical health burden were assessed within 24 months before and after a child's death in six-month intervals. Multivariable logistic regression models evaluated the associations between new parental health burden within 12 months following a child's death with SPPC consultation and several a priori factors. Of 776 deceased children linked to 773 mothers and 711 fathers, 36.1% received a SPPC consultation prior to death. Higher rates of mental and physical health burden were observed in mothers than fathers across all time points. Lack of SPPC was associated with increased risks for new mental and physical health burden for mothers within 12 months after the child's death (adjusted odds ratios [95% CIs] 1.77 [1.03-3.03] and 2.63 [1.07-6.46], respectively). Bereaved parents, especially mothers, experienced new mental and physical health burden up to 24 months after a child's death. SPPC may be helpful in reducing the development of new health burdens in mothers within 12 months after a child's death.