Breast cancer is the most common cancer among Canadian women, bringing complex demands for timely decision-making, coordination of multidisciplinary care, and efficient communication between patients and providers. The increasing reliance on fragmented and noninteroperable health information systems exacerbates workflow and documentation burdens, leading to inefficiencies and gaps in continuity of care. While nurse navigation programs partially bridge these gaps, most digital platforms remain poorly integrated into provider workflows, requiring manual tracking, which results in duplicated effort and reduced efficiency. Our team developed "MyJourney" at North York General Hospital (NYGH) in Ontario. It is a digital navigation platform that supports breast cancer care throughout the entire continuum, from diagnosis to survivorship. This study aimed (1) to map the breast cancer journey and workflow to inform the design and adaptation of MyJourney at 2 oncology settings at NYGH; (2) to identify barriers and guide local implementation; and (3) to evaluate the implementation, usability, and perceived utility of MyJourney's Clinical Navigation Tool for breast cancer care teams. A multimethod, 3-phase study was conducted at NYGH's Breast Diagnostic Centre (BDC) and Chemotherapy Clinic (CC) in Toronto, Canada. Phase 1 involved qualitative interviews with patients with breast cancer to map their care journey and inform user-centered platform design. Phase 2 included preimplementation interviews with nurses, pharmacists, and administrative staff to map workflows and customize MyJourney for the CC. Phase 3 evaluated MyJourney's implementation and usability over 6 weeks using the System Usability Scale, technology acceptance model surveys, and follow-up interviews with platform users. Data were analyzed via interpretive description and descriptive statistics. Ethics approval was obtained. In total, 13 patient interviews revealed distinct challenges and communication needs across prediagnosis, diagnosis, treatment, and survivorship phases, emphasizing the need for personalized, integrated resources (phase 1). A total of 8 participants (3 nurses and 5 pharmacists), providers, and clinic staff highlighted pain points in fragmented information systems, inefficient manual processes, and limited team coordination (phase 2). MyJourney's phased implementation led to high user acceptance, with mean System Usability Scale scores rated "excellent" (BDC: 81.3; CC: 86.3) at the 6-week follow-up (phase 3). The 4 participants (1 charge nurse, 1 administrative staff at the BDC, and 2 charge nurses at the CC) described the platform as intuitive, efficient, and well-organized, citing consolidated patient records, streamlined appointment management, and improved workflow as major benefits. Recommendations included improved interoperability, enhanced notifications, role-specific customization, and integration with electronic medical records for broader scalability. The iterative, interest-holder engaged design and phased implementation of MyJourney facilitated rapid uptake and high usability among breast cancer provider teams. The Clinical Navigation Tool component of the MyJourney platform reduced documentation burden, improved workflow efficiency, and facilitated care coordination across oncology settings.
Health care referral coordination remains one of the most persistent inefficiencies in the U.S. health care system, with millions of annual referrals still managed through phone calls, faxes, and manual spreadsheets. This article documents one computer science Ph.D. student's journey from personal frustration to building Carenector, an AI-powered care coordination platform. Drawing on knowledge graph modeling, privacy-preserving ephemeral computation, and simultaneous constraint satisfaction, the platform reframes the referral process as an engineering matching problem. The system's knowledge graph represents facilities and services across multiple regions, updating dynamically to reflect real-time availability, without storing any personally identifiable patient information. Initially deployed as a consumer-facing tool for individuals and families, the platform has since expanded to an institutional version targeting hospital discharge planning teams, with pilot results demonstrating significant time savings per referral. This work highlights how computational engineering principles, applied to workflow design, data modeling, and human-AI collaboration, can transform even the most entrenched manual processes in health care.
Today, HIV infection is considered among the most important infectious diseases worldwide. This study aimed to explore the challenges of people living with HIV (PLHIV) on treatment journey. This study was conducted using a qualitative approach and the content analysis method at the Behavioral Diseases Consultation Center and the Positive Club of Kerman, Iran, from September 2023 to August 2024. A total of 27 individuals, including 17 PLHIV, 5 caregivers, and 5 social work and HIV professionals, were recruited using purposive sampling. Data were collected using individual semistructured interviews, field attendance, and note-taking. Data analysis resulted in 1258 primary codes, which were categorized with the theme of challenges of living with HIV into 30 subcategories and 7 main categories, including emotional and psychological tensions, objective and behavioral reflections, social deprivation, unfavorable social policies, changes in life, labeling, poor quality, and insufficient medical services. Due to the numerous problems and challenges faced by PLHIV during their treatment, they need comprehensive support from their families, caregivers, and society. Ensuring access to appropriate medical services and enhancing public awareness and understanding of PLHIV and their caregivers through education are essential. Such measures can contribute to improved treatment adherence, better quality of life, and more effective patient-centered care for PLHIV.
Navigation requires estimating heading and transforming these estimates into actions. Prior models explain how self-motion and landmark cues are combined into heading estimates, but less is known about how these estimates are iteratively transformed into motor commands to reach a goal. Here, we hypothesized that navigation operates as a closed-loop process in which ongoing movement is updated by sensory prediction errors. To test this hypothesis, participants performed a goal-directed rotation task in virtual reality. On select trials, visual landmarks were shifted during movement, inducing a prediction error between the heading expected from self-motion estimates and the heading observed from the shifted landmarks. In parallel, we developed a closed-loop model of turning behavior that represents heading and angular velocity as jointly estimated states over time. This model accounts not only for final position-the destination-but also for the movement dynamics that produce it-the journey. The model predicts that landmark-induced visual prediction errors should produce rapid corrective changes in movement. Participant turning behavior qualitatively paralleled these model dynamics: acceleration changed after visual feedback, with larger landmark mismatches producing larger corrective responses. Together, these findings suggest that naturalistic movement depends on continuously transforming heading estimates into motor command through closed-loop control.
Maternal health is a global public health priority and a key determinant of generational and societal well-being. Healthy lifestyle behaviors from preconception through postpartum can be promoted by mobile applications, telehealth and chatbots, but evidence on their effectiveness remains limited despite their growing acceptance and use. To assess the effectiveness of digital tools targeting lifestyle and health-related outcomes across the maternal journey. Following the PRISMA 2020 guidelines, a comprehensive search was conducted across PubMed, Scopus, Web of Science, and CENTRAL from January 2020 to May 2025. Eligible studies involved randomized controlled trials (RCTs) with digital components targeting nutrition, physical activity, sleep, smoking, and/or alcohol consumption among women during preconception, pregnancy, or up to six months postpartum. Risk of bias was assessed using the RoB2 tool (PROSPERO: CRD420251075108). Thirty-one RCTs (n = 7,153 women) were included, conducted during preconception (n = 3), pregnancy (n = 20), and postpartum (n = 15). Across interventions, reminders (64.5%), self-monitoring (58.1%), and goal-setting (48.4%) were the most commonly used behavior change features. Digital interventions showed beneficial effects related to nutrition (e.g., improved dietary intake, micronutrient supplementation), physical activity, sleep quality, and insomnia during pregnancy. Among women with overweight/obesity who used digital tools, consistent reductions in gestational weight gain were observed. In contrast, preconception and postpartum interventions demonstrated only modest or inconsistent effects, particularly for anthropometrics and metabolic outcomes. Surprisingly, very few studies reported engagement or usage statistics. Digital health tools may improve lifestyle behaviors during pregnancy, but evidence for sustained preconception or postpartum benefits remains limited. The heterogeneity in study design and high risk of bias drive the need for long-term RCTs with standardized measures and engagement metrics to optimize digital strategies for maternal health promotion.
Domestic violence and abuse (DVA) remains a major public health and human rights concern, with profound consequences for women's physical, psychological, and socioeconomic well-being. We report the case of a 32-year-old married woman and mother of two who experienced prolonged domestic violence, including physical, emotional, and economic abuse, compounded by her husband's alcohol dependence. Economic abuse escalated when debt incurred through a self-help group loan, intended to support the family's livelihood, was transferred to the survivor, reinforcing financial dependency and coercive control. Following a severe episode of physical violence that resulted in her displacement from the marital home, she sought support through a hospital-based crisis center established within a tertiary care women's hospital. Through crisis intervention, structured counseling, legal guidance, child welfare support, and employment assistance, the survivor achieved financial independence, secured safe accommodation, and initiated steps toward legal separation. This case highlights the often-overlooked role of economic abuse and debt bondage as mechanisms of control within abusive relationships. It also demonstrates the value of integrated, hospital-based crisis services and intersectoral collaboration in supporting survivors of violence. Strengthening routine identification of DVA within healthcare settings, expanding access to crisis centers, and promoting women's economic empowerment may contribute to improved safety and long-term recovery for survivors.
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Behavioural cough suppression therapy by speech pathologists for refractory chronic cough exhibits different trajectories of improvement that are independent of sex, age and duration of cough but affected by comorbid asthma and history of smoking https://bit.ly/4b0JPxi.
Bariatric surgery is the most effective intervention for severe obesity, yet challenges such as perioperative risks in super-obesity and long-term weight regain persist. This narrative review proposes a novel multimodal framework for integrating GLP-1 receptor agonists (GLP-1 RAs) into surgical pathways. Drawing a conceptual analogy from oncologic "neoadjuvant" and "adjuvant" treatment models, we explore how pharmacotherapy can optimize surgical safety and reinforce long-term metabolic control. Emerging clinical data from prospective trials demonstrate that a short-term "neoadjuvant" course of GLP-1 receptor agonists can significantly enhance early weight loss and dyslipidemia remission without compromising perioperative safety. Conversely, retrospective analyses suggest that while preoperative weight loss is achievable, it requires careful management to mitigate potential early metabolic adaptation and prevent the "ceiling effect" on postoperative outcomes. Regarding postoperative care, recent meta-analyses confirm that adjuvant pharmacotherapy effectively addresses weight regain and sustains metabolic improvements in suboptimal responders, supporting the implementation of a structured perioperative management ladder. Obesity management is shifting from a procedure-centric approach toward a chronic, multimodal disease model. The neoadjuvant/adjuvant paradigm encourages clinicians to leverage pharmacologic tools to enhance surgical efficacy ("downstaging" risk) and prevent disease recurrence. While primarily hypothesis-generating, this framework provides a structured foundation-including a proposed perioperative management ladder-for future randomized controlled trials to establish integrated, multidisciplinary clinical standards.
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More than 25 years ago, researchers began to question whether budding yeast, a unicellular eukaryote, could undergo a cell death process similar to mammalian apoptosis. We and others pursued this inquiry to enhance our understanding of yeast's endogenous cell death mechanisms and to exploit yeast as a simple cell model for potential translation to and from the mammalian apoptosis field. Initially, there was skepticism, as apoptosis was thought to be exclusive to multicellular organisms, and key regulators of mammalian apoptosis were absent from yeast. Over the years, the study of cell death using different cell/organism models has evolved, with cell death processes now broadly categorized into accidental cell death (ACD) and regulated cell death (RCD). According to this classification, unlike ACD, RCD can be pharmacologically and genetically controlled. This chapter provides a historical retrospective of yeast RCD (yRCD) research, examining conserved molecular components, organelles, signaling pathways, and posttranslational modifications that regulate cellular commitment to death. By revisiting early interpretations in light of contemporary evidence, we highlight how several initial dogmas have been refined or overturned, while conceptual and methodological challenges remain. We anticipate that less explored and novel experimental approaches and technologies, particularly those offering temporal, single-cell, and systems-level resolution, will continue to advance the field, enabling relevant biotechnological and biomedical applications and helping to address current challenges associated with sustainable development.
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Narrative medicine is defined as medicine practiced with the competence to absorb, interpret, and respond to narratives. We hereby present a resource compiling narrative medicine texts, aiming to make narratives created by patients and/or their families fully accessible to citizens, by developing a documentary database and describing its characteristics. Active bibliographic search, March-June 2022 for narratives in Spanish and/or Catalan written after the year 2000 by patients and/or their companions. Subsequently, narratives up to June 2024 were included. The compilation is available in a searchable and open-source web ( https://osf.io/pk9b3/ ). Three hundred seventeen narratives, 50.14% written by women, are showing an increase from 2020 onwards. Texts are related to cancer/hematological diseases (45.11%), mental illnesses (10.41%), neurodegenerative diseases (9.4%). Personal stories (28.7%), autobiographical (11.29%), companion stories (5%), children's or young adult stories/narratives (8.87%). There are studies, websites, and digital platforms that recognize the importance of narrative as part of the therapeutic process and how it improves the experience of illness (either one's own or that of a family member). Despite this, to date, no one had compiled a collection of patient texts in Spanish and Catalan. For this reason, we believe our database is innovative and can pave the way for improving the patient-professional relationship.
Neurons achieve their highly polarized architecture by coordinating cytoskeletal systems across space and time, enabling axons to extend over remarkable distances and dendrites to elaborate complex arbours. Early neuroanatomists described intracellular "neurofibrils," yet these structures remained poorly understood until electron microscopy resolved them into three distinct polymer systems: microtubules, actin filaments, and intermediate filaments. Although this framework clarified neuronal ultrastructure, it simultaneously established a conceptual hierarchy in which microtubules and actin were regarded as the principal drivers of neurite growth, while intermediate filaments were relegated to a passive, supportive role. Unlike prior reviews that document vimentin dynamics primarily from a cell-biological standpoint, this review integrates historical, conceptual, and epistemological perspectives to examine both how and why that hierarchy arose and how it has been dismantled. This review traces how that hierarchy arose and why it has been increasingly reconsidered in favour of intermediate filaments, focusing on vimentin as a case study. Evidence from live cell imaging, molecular manipulation, and genetic models shows that vimentin is dynamically regulated rather than static. Vimentin networks remodel continuously, exchange subunits with soluble pools, and move in coordination with microtubules. Most recently, sparse single-filament labelling combined with correlative volume electron microscopy has demonstrated that individual vimentin filaments remain motile even within dense perinuclear networks previously assumed to be static, a finding that fundamentally redefines what filament density implies about cytoskeletal organization. In neural and neural precursor cells, vimentin expression is developmentally regulated and is prominent during early differentiation stages associated with neurite initiation giving way to neurofilaments in mature neurons. Functional studies further link vimentin to neurite formation and extension, cytoskeletal coordination, organelle positioning, and cellular stress responses. Philosophical analysis reveals that these empirical advances were inseparable from shifts in imaging technology and conceptual framing, and that epistemic risks including model dependency and confirmation bias can be mitigated through methodological pluralism and explicit model disclosure. Taken together, these findings support a revised understanding of intermediate filaments as active, context-dependent contributors to neuronal development and plasticity, and illustrate the value of integrating biological evidence with historical and philosophical reflection.
[⁸⁹Zr]Zr-DFO-trastuzumab has emerged as a powerful tool to visualise non-invasively HER2 expression across metastatic lesions, complementing conventional pathological HER2 evaluation and helping to identify patients unlikely to benefit from therapy with trastuzumab-based therapies. This paper outlines the roadmap of the manufacturing implementation of [89Zr]Zr-DFO-trastuzumab at our centre in Germany. In this paper, we describe the key questions encountered during implementation of the manufacturing process for [89Zr]Zr-DFO-trastuzumab and how these were addressed through discussions between academia, hospital departments, teams experienced in the radiolabelling of antibodies and regulatory authorities. Discussions with multiple institutions were essential for the implementation of the GMP-compliant radiosynthesis of [⁸⁹Zr]Zr-DFO-trastuzumab at our manufacturing site. Example decisions included shortening the shelf-life of [⁸⁹Zr]Zr-DFO-trastuzumab to 24 hours to mitigate container-closure integrity concerns and adoption of a bead-based method to determine the immunoreactive fraction. This work presents a practical overview of operational considerations relevant to the clinical implementation of [⁸⁹Zr]Zr-DFO-trastuzumab, with potential applicability to other ⁸⁹Zr-labelled high-molecular-weight radiotracers in Germany. By sharing these practical insights, we aim to support broader patient access to established radiopharmaceuticals and encourage dialogue around open regulatory and practical questions, particularly in anticipation of future clinical trials.
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Chronic wounds are characterized by long course, difficult healing, and severe impact on patients' quality of life. Negative Pressure Wound Therapy (NPWT) is a commonly used effective intervention in clinical practice, but systematic synthesis of patients' real experiences during NPWT is insufficient. To synthesize the lived experiences of patients with chronic wounds undergoing NPWT, providing a foundation for enhancing standardized care, treatment efficacy, and quality of life. We systematically searched 9 databases from inception to August 2023 for qualitative studies on patient experiences, preferences, and needs regarding NPWT for chronic wounds. Study quality was assessed using the JBI Critical Appraisal Tool, and findings were analyzed via meta-synthesis. Eleven studies were included. Analysis yielded 45 findings, categorized into 10 themes and further synthesized into four overarching themes: altered routine of life: limitations, stress, and challenges; complex emotional experiences: differences and diversity; facing uncertainty: distress and acceptance; evaluation and expectations: benefits and improvement. Patients on NPWT face multifaceted challenges, including major life disruptions, psychological distress, and adaptation to uncertainty. A paradigm shift towards holistic, patient-centered care is essential. Integrating psychological support, education, and practical management strategies is crucial for improving adherence, outcomes, and quality of life.
Alcohol use disorder (AUD) and non-suicidal self-injury (NSSI) frequently co-occur in adolescents. However, the underlying phenomenological mechanisms and the dynamic spatial-temporal evolution of this complex comorbidity remain significantly under-explored in current literature. This study aims to explore the perceived experiential processes of comorbid AUD and NSSI in adolescents and to dynamically map their disease journey across different physical and medical spaces. A qualitative descriptive study design was utilized. In-depth semi-structured interviews were conducted with eighteen adolescents formally diagnosed with AUD and comorbid NSSI. The interview transcripts were analyzed using rigorous inductive thematic analysis. A patient-reported disease journey map was subsequently constructed to visualize the phenomenological trajectory without researcher inference. Three highly nested core themes emerged from the data encompassing the illusory pursuit of emotional numbing, the cognitive tunnel effect driven by alcohol disinhibition, and the pathological closed loop reinforced by secondary shame. The constructed disease journey map delineated three critical transitional phases including the covert pre-hospital incubation, the in-hospital emergency exposure with closed withdrawal, and the post-hospital isolated recovery. Participants experienced intense environmental deprivation during medical spatial transitions and highlighted a severe deprivation of continuous professional support during late-night emotional micro-crises upon returning home. The comorbidity of AUD and NSSI functions as a maladaptive survival strategy fueled by emotional avoidance and cognitive tunneling. Clinical psychiatric nursing urgently requires a paradigm shift towards trauma-informed care and is recommended to develop digital continuous networks to provide immediate psychological safety nets at high-risk relapse nodes.