Dietary protein is a key regulator of metabolic health in humans and rodents. Many of the benefits of protein restriction are mediated by reduced intake of dietary branched-chain amino acids (leucine, valine and isoleucine) and restriction of the branched-chain amino acids is sufficient to extend healthspan and lifespan in mice. Here we find that valine restriction (Val-R) improves metabolic health in C57BL/6J mice, promotes leanness and glycemic control across ages, and reduces frailty, cancer prevalence and senescent cell burden in both sexes while increasing median male lifespan by 23%. Assessing gene relationships across tissues, we identified a liver gene module enriched in mitochondrial pathways and increased mitochondrial respiration in Val-R-fed male mice. Our results demonstrate that Val-R improves multiple aspects of healthspan in mice of both sexes, extends lifespan in male mice and suggests that interventions that mimic Val-R may have translational potential for aging and age-related diseases.
Exercise-induced muscle-brain communication mediated by extracellular vesicles. Physical exercise stimulates skeletal muscle to release extracellular vesicles (EVs) into the circulation. These vesicles may reach the brain and transfer bioactive cargo such as miRNA, thereby supporting neuronal function and brain homeostasis and potentially protecting against the onset or progression of neurodegenerative diseases.
Bauxite residue (BR), characterized by fine particle size and persistent alkalinity, results in massive stockpiling causing soil occupation and environmental risks. This study innovatively proposes a "waste-treats-waste" strategy employing titanium white waste acid (FS) combined with waste mushroom compost to construct soil-like substrates, systematically comparing it with conventional calcium sulfate (CS) dealkalization. Results demonstrate that FS treatment effectively inhibits pH rebound (maintaining 7.0-8.2 for 50 days) by disrupting sodalite crystal structure, improves particle properties (19.23 % increase in median particle size versus CS), and enhances ryegrass growth (over 50.00 % germination rate, 9.62 times plant dry biomass versus CS) and nutrient retention capacity in FS-based soil-like substrate. Microbial analysis revealed significantly increased abundance of copiotrophic phyla (e.g., Proteobacteria) in FS-based soil-like substrate. Mechanistic investigations identified synergistic effects between complex iron oxides (35 % increase) and prosperous plant root system in promoting macroaggregate (> 2 mm) formation. This work presents a green sustainable solution for BR utilization and ecological rehabilitation.
Artificial intelligence enables surgical robots to perform certain actions without surgeon control or semi-autonomously. Patient willingness to undergo surgery via an automated machine is a key barrier to adoption of emerging robotic technology. Further, semi-autonomous surgical robots raise numerous ethical concerns, yet little is known about patients' perceptions of these issues. We assessed patients' perceptions of ethical issues in semi-autonomous robot-assisted surgery (RAS) and how their perceptions would affect decision-making about undergoing semi-autonomous RAS. Adult patients who underwent surgery within the prior three years, with a non-autonomous robot or without any robot, were recruited via email. We conducted semi-structured teleconference interviews that included open- and closed-ended questions, to assess factors affecting patient decision-making and ethical concerns about semi-autonomous RAS, and demographics. Quantitative data were analyzed using descriptive statistics. Qualitative data were analyzed using thematic analysis. Fifty patients participated. Most participants were female (62%), White (52%), and the mean age was 53. Most patients (56%) would undergo semi-autonomous RAS. However, willingness varied by which surgical process the robot would have control over. Many patients (46%) were highly willing to undergo semi-autonomous RAS when the robot has control over instruments. Four themes emerged about ethical concerns driving patients' willingness to undergo semi-autonomous RAS: (1) desire for informed consent to express self-determination, (2) semi-autonomous RAS introduces new risks to procedures, (3) doctor-patient relationship and trust can facilitate patients' willingness to undergo semi-autonomous RAS, and (4) semi-autonomous RAS comprises an important surgical innovation, conferring benefits. Our findings suggest that most patients would be willing to undergo semi-autonomous RAS. Willingness was related to ethical considerations of informed consent, perceived risks, level of surgeon versus robot control over surgical processes, doctor-patient relationship, and perceived benefits. Addressing patients' perceptions of semi-autonomous RAS may facilitate greater integration of surgical robots into clinical practice.
Long-acting injectable buprenorphine (LAI-B) is an evidence-based medication for opioid use disorder (MOUD), but its implementation in community pharmacies has not been well studied. This study's objective was to assess southeastern North Carolina (NC) community pharmacist perspectives on the perceived acceptability, appropriateness, and feasibility of LAI-B administration and identify the barriers and facilitators to LAI-B administration in community pharmacies. We conducted an online survey of practicing community pharmacists between January 14 and March 14, 2026. The survey assessed knowledge of and willingness to administer LAI-B, perceived benefits and barriers, training needs, and perceived acceptability, appropriateness, and feasibility of administering LAI-B. Descriptive statistics are reported. Forty-four eligible responses were included in the analysis (response rate= 16%). On average, pharmacists were neutral to somewhat willing to administer LAI-B and also had neutral-to-positive perceptions of acceptability, appropriateness, and feasibility. The most frequently endorsed benefits of LAI-B were decreased diversion, supporting patients in recovery, reducing overdose deaths, and increasing revenue. The most prominent barriers involved reimbursement and payment. Other barriers included limited training, workflow constraints, and lack of provider referrals. Pharmacists reported low knowledge regarding LAI-B Risk Evaluation and Mitigation Strategy requirements, follow-up monitoring, and storage, and expressed interest in training on those topics. Pharmacy-based LAI-B administration could be a promising strategy to expand access to MOUD. However, implementation will require clearer reimbursement pathways, targeted training, and workflow support.
Livestock production contributes substantially to global greenhouse gas (GHG) emissions, yet the role of animal health in mitigating these emissions remains under-recognised within both research and policy frameworks. Diseases reduce productivity, impair reproductive performance, increase mortality and culling rates, and prolong production cycles, thereby increasing GHG emissions intensity. This review brings together current evidence linking animal health and GHG emissions across major disease categories and production systems, including parasitic infections, mastitis, and reproductive disorders. Available studies consistently demonstrate that improving animal health can reduce emissions intensity through gains in productivity and resource-use efficiency, although the magnitude of these effects varies among diseases, livestock systems, and regions. Evidence from sub-Saharan Africa, India, and South America highlights both the potential mitigation benefits of disease control and the substantial data gaps that remain, particularly in low- and middle-income countries. The review also examines how animal health is represented within current GHG accounting frameworks and discusses the limitations of existing Tier 1 and Tier 2 approaches in capturing disease-related impacts on emissions. While higher-tier methodologies offer greater biological realism, their application is often constrained by data availability. Improving the integration of animal health within emissions assessment frameworks, livestock development programmes, and climate policy could provide a practical pathway to reduce emissions intensity while delivering co-benefits for productivity, animal welfare, food security, and rural livelihoods.
Aiming at controllably fabricating Ni-Ce composite oxide catalysts for low-concentration methane combustion, a modulator-aided solvothermal tactics was employed. This was driven by that formic acid and terephthalic acid (1,4-BDC) as modulators differed in nucleophilicity towards metal centers and steric hindrance, which could tune the nucleation and crystallization process for Ce-Ni-BDC precursors, manipulating the synergism between NiO and Ce1-zNizO2-δ sosoloid over the derived Ni-Ce composite oxides. Consequently, the dimensions of NiO and Ce1-zNizO2-δ particles over the tailor-made catalyst were lowered, and more oxygen vacancy defects and interfaces were established, accelerating the transport for mobile oxygen from Ce1-zNizO2-δ to surface nickel centers. The capacity for surface lattice oxygen to extract H atoms and O-vacancy to activate aerial O2 were augmented; the desorption of water became easier and accessible NiO sites were enriched. These benefits helped the catalyst to fulfil a redox circulation in CH4 combustion, thus giving enhanced activity, and desirable reusability, stability and moisture-resistance.
Structural transitions in the energy and industrial sectors are reshaping air quality in the Yangtze River Delta (YRD). Interprovincial NO₂ fluxes over the YRD are quantified using a closed-loop integration method that combines TROPOMI, ERA5, and GEOS-CF datasets. Regional NO₂ column concentrations show a marked decline of (-3.16 ± 1.08) %/yr, with the steepest decreases in Anhui and Jiangsu. Flux analysis reveals weakening trends in both overall and interprovincial NO₂ transport in the YRD. The western segment shows a net influx of 3.29 kg/s, while the eastern segment exhibits a dominant net efflux of 15.25 kg/s. Interprovincial exchanges are also notable, with mean fluxes of 0.68 kg/s, 0.37 kg/s, and 0.20 kg/s for Jiangsu-to-Anhui, Anhui-to-Zhejiang, and Jiangsu-to-Zhejiang, respectively; of which, the Jiangsu-to-Anhui flux shows the fastest decline ((-5.87 ± 1.79 ) %/yr), forming a progressively weakening northwest-to-southeast transport chain. Surface NO₂ concentrations in eight major cities show steady declining trends ((-3.54 ± 0.45) %/yr to (-6.1 ± 0.31) %/yr), with Suzhou and Nanjing exhibiting the steepest declines. The synchronous decline of surface and column NO₂ concentrations, along with transport fluxes, highlights the potential of structural emission mitigation to deliver air-quality benefits across administrative boundaries via regional atmospheric circulation. Our findings underscore that achieving sustainable improvements in air quality in megaregions such as the YRD requires coordinated structural transitions, where the synergy between reforms in the industrial and energy sectors ensures that emission reductions translate into tangible decreases in both local burdens and cross-boundary pollutant fluxes.
Pig welfare around slaughter remains a sensitive issue, as animals are exposed to multiple hazards within a short period. The objective of this review was to provide a comprehensive assessment of the key factors affecting pig welfare in commercial slaughterhouses, to evaluate their impact on meat quality, and to examine contemporary alternatives to high-concentration CO2 stunning with respect to their implications for both animal welfare and meat quality. During lairage, exposure to a novel environment and unfamiliar animals can hinder recovery from transport stress. Limited space allowance negatively impacts welfare by impairing rest, exacerbating heat stress, and increasing agonistic behaviours. Cooling strategies, such as intermittent water spraying, can improve thermal comfort and reduce stress within groups. Although feed withdrawal is necessary for food safety, it should be limited to less than 16 h to avoid prolonged hunger and additional stress. Handling practices during movement to the stunning point are another significant source of stress when poorly executed. Effective stunning is essential to ensure that pigs are rendered unconscious without pain before exsanguination. While electroencephalography remains the most accurate method to assess consciousness, practical evaluation in commercial settings relies on animal- and resource-based indicators, whose reliability depends on standardised protocols and proper training. The two most widely used stunning methods are electrical stunning and exposure to high concentrations of CO2. Electrical stunning induces immediate unconsciousness but raises welfare concerns due to handling and restraint, particularly in high-throughput systems. In addition, the use of electric goads to move pigs from groups into raceways, although reducible, cannot yet be eliminated, highlighting the need for improved facility design. CO2 stunning, although widely adopted, is aversive, as it induces hyperventilation and irritation of mucous membranes. Alternatives such as improved electrical systems and inert gas stunning using argon, nitrogen, or helium at residual oxygen levels below 2% show potential welfare benefits by reducing pain, fear, and respiratory distress. However, these systems typically result in slower induction of unconsciousness and faster recovery, posing practical challenges. Preslaughter stress significantly affects carcass and meat quality, leading to defects such as bruising, blood spots, and alterations in colour, firmness, and water-holding capacity. In severe cases, this results in conditions such as pale, soft, and exudative or dark, firm, and dry pork, reducing product quality and economic value. Implementing low-stress handling and optimised stunning practices can improve both animal welfare and meat quality outcomes.
More than 90% of graduating orthopaedic residents pursue fellowship, although prior return-on-investment analyses show limited financial advantage. Contemporary compensation, evolving loan policies, and military-funded education may alter these outcomes, yet no prior analysis of which we are aware has integrated contemporary subspecialty compensation, academic versus nonacademic practice, and military-funded education into a single career-long financial model, leaving trainees and advisors without an up-to-date estimate of what each pathway costs or returns. (1) What is the lifetime net present value (NPV) and internal rate of return (IRR) of orthopaedic subspecialty fellowship training relative to nonacademic general orthopaedic practice, both with and without adjustment for work hours? (2) What is the lifetime financial impact of military-funded medical education pathways (Health Professions Scholarship Program [HPSP] and Uniformed Services University of the Health Sciences [USUHS]) relative to civilian general orthopaedic practice? (3) What is the lifetime financial impact of academic practice relative to nonacademic practice across orthopaedic subspecialties? A cross-sectional economic model was developed using 2025 compensation data from the American Medical Group Association, Association of American Medical Colleges, and Defense Finance and Accounting Service. We calculated the NPV (the difference in lifetime earnings between a pathway and nonacademic general orthopaedic practice in today's dollars) and the IRR (the effective annual return a pathway earns on the income given up to pursue it) over a 34-year career. Because a dollar today is worth more than a dollar in the future, future earnings were discounted at 5% annually; to confirm that our conclusions did not depend on this assumption, we repeated all calculations at 7.5% and 10% (sensitivity analyses). Fellowship opportunity cost was defined as the general orthopaedic income given up during the additional training year minus the fellowship stipend. Military pathways incorporated in-training compensation and each program's active-duty service obligation, with the model assuming a 4-year (HPSP) or 7-year (USUHS) military career followed by separation to civilian practice. Matched retirement contributions under the Blended Retirement System were evaluated but not included in the primary model because analogous civilian retirement benefits were also excluded; nonmonetary aspects of military service, such as time away from family and risk to life and limb, cannot be credibly expressed in dollars and were not modeled. As subspecialists report longer workweeks than generalists, subspecialty earnings were also normalized to generalist-equivalent work hours (approximately 48 hours per week for generalists versus 54 for subspecialists, according to the American Academy of Orthopaedic Surgeons census), allowing comparison on a per hour basis. At a 5% discount rate, spine surgery was the only subspecialty with a positive lifetime NPV, achieving break-even 6 years after fellowship. Joint replacement and trauma demonstrated IRRs of 2.6% and 1.2%, respectively; because these fall below the 5% discount rate, the income given up during fellowship would have grown more if simply invested, making them financially unfavorable despite higher eventual earnings. All other subspecialties yielded negative NPVs, that is, less lifetime earning, in today's dollars than general orthopaedic practice. After work-hours adjustment, all subspecialties (including spine surgery) demonstrated negative NPVs, so on a per hour basis no fellowship pathway out-earned general orthopaedic practice. Relative to civilian general orthopaedic practice, and regardless of subsequent subspecialty choice, military-funded education was associated with lifetime NPV reductions of approximately USD 1.7 million for HPSP and USD 3.0 million for USUHS. Academic practice demonstrated a lower lifetime NPV than nonacademic practice across all subspecialties, with the largest reduction (approximately USD 2.4 million) in trauma. As all model inputs were national mean (or fixed military) figures rather than individual-level data, confidence intervals could not be calculated; sensitivity analyses at higher discount rates served as the robustness test and left these findings unchanged. Under contemporary compensation conditions, spine surgery remains the only subspecialty with a positive financial return relative to general orthopaedic practice; most fellowship, academic, and military-funded pathways carry measurable long-term financial trade-offs. Medical schools and residency programs should present career-long earnings comparisons alongside the nonfinancial rewards of each pathway, and trainees may be best served by choosing fellowships based on clinical interest, lifestyle, and job-market realities rather than expected financial gain. Level III, economic and decision analysis.
There has been an increased interest in the development and use of digital health technologies (DHTs) to help treat patients with opioid use disorder (OUD), but information on the needs and preferences of the patients seeking treatment for it is lacking. This study's objective was to collect data on preferences for DHTs that are intended to support patients with OUD. A discrete choice experiment was conducted with 500 respondents who self-reported a diagnosis of OUD. The experiment included 6 attributes identified based on earlier phases of the study. These attributes included the benefit of the DHT, data sharing with one's care team, data sharing with third parties, personalized goal tracking, community support, and health care support. Tools that allow patients to connect with their care team, connect with peers, or set and track their own goals were highly valued by respondents. In general, respondents who participated in the study preferred DHTs that improve the chance of abstaining from nonprescribed opioid use over those that improve the chance of staying in treatment or reducing the chance of opioid overdose. However, we also observed heterogeneity in preferences for benefits and data-sharing features within OUD treatment, suggesting that different patients may exhibit different preferences for OUD treatment in clinical settings. DHTs can be designed to target different outcomes and can include various features that support patients being treated for OUD. Although some outcomes and features emerged as being preferred by respondents, there was significant heterogeneity in the results. It will be important for developers to think about the various needs and preferences of target users (eg, patients) for their specific DHT rather than viewing the patient population with OUD as homogenous.
The Generalized Anxiety Disorder 7-item scale (GAD-7) could provide currently lacking data on anxiety levels among adolescents and young adults in Sweden. However, psychometric assessments of the scale are scarce in this population. Additionally, the structural validity of the scale needs to be examined further, given conflicting findings in other populations. The aim of this study was to psychometrically evaluate the GAD-7 among 15-29-year-olds using Rasch analysis and confirmatory factor analysis in a Swedish, general population sample. In addition, an iterative process explored if revised versions of the scale could be identified that fit the Rasch model in this sample. A random, age- and sex-stratified sample of 15-29-year-olds from the Swedish population register was drawn, from which stratified groups were randomly invited to participate. Data (n = 590) were collected through a study-specific app. Rasch analyses included investigation of item fit, local independence, principal components analysis of standardized Rasch model residuals, response category functioning, measurement invariance, scale-to-sample targeting, and reliability. In addition, confirmatory factor analyses (CFA) were conducted and interpreted using dynamic, data-adaptive cutoffs. An exploratory, iterative process was undertaken aiming at scale refinement based on results for the GAD-7. No Rasch analyses provided support for the unidimensionality of the GAD-7, which also displayed issues with disordered response categories and measurement invariance. The CFA found substantial misfit for the one-factor model. The exploratory scale refinement resulted in two abbreviated scales warranting further investigation: Items 1-3 fit the Rasch model as a unidimensional scale and demonstrated acceptable to good reliability. Items 5-7 had good fit after merging the two highest response categories, although demonstrated poor reliability. No analyses provided support for the unidimensionality of the GAD-7 among 15-29-year-olds in Sweden. While these findings do not support the use of a single sum score, they require confirmation in independent samples. Future research should evaluate whether the abbreviated, candidate scale comprising items 1-3 could be useful to assess anxiety in this population, including examination of criterion validity and the potential benefits of adding a response category to enhance both reliability and scale-to-sample targeting.
Microcystin-LR (MC-LR) is a highly toxic cyanobacterial metabolite whose potent hepatotoxicity is well recognized. Probiotic Lactobacillus rhamnosus (LGG) has been demonstrated to adjust intestinal microecology and alleviate multi-organ toxicity in fish induced by environmental water pollutants. However, its potential in alleviating MC-LR-induced hepatotoxicity remains poorly explored. This study assessed the benefits of LGG on zebrafish liver after MC-LR exposure and explored the key role of intestinal metabolism within it. Histopathology and liver damage marker results showed that LGG dietary supplementation significantly alleviated liver damage in zebrafish exposed to MC-LR (0, 2.2, and 22 μg/L) for 28 days. Liver transcriptomic analysis confirmed that LGG mitigated liver inflammation and oxidative stress, which are closely related to liver damage. Furthermore, gut metabolomic analysis revealed that LGG restored disorders of lipid and organic acid metabolism induced by MC-LR. This restoration contributes to relieving hepatotoxicity through the gut-liver axis. The improvement of intestinal metabolism by LGG also helps maintain the homeostasis of the hypothalamic-pituitary-thyroid axis, affecting the levels of thyroid hormones and their specific receptors to effectively regulate liver health. This study offers scientific validation for utilizing probiotics to address MC-LR-related environmental pollution and protect aquatic organisms.
Breastfeeding is increasingly recognized as a powerful biologic intervention associated with positive infant and maternal health outcomes. Emerging evidence continues to expand our understanding of the mechanisms through which human milk promotes health, including via immune system development and modulation of antimicrobial resistance. Yet despite the robust scientific evidence supporting breastfeeding as critical to public health, many families in the US face structural barriers to achieving their breastfeeding goals. In the US, paid family leave has been strongly associated with both the initiation of breastfeeding and its duration. Paid family leave has also been associated with improved maternal and infant health, including reduced infant mortality. These findings suggest that paid family leave should be viewed not solely as a labor policy, but as a maternal-child health policy. The US remains one of the few high-income nations without a federal paid family leave program, relying instead on a fragmented patchwork of state policies. State experiences demonstrate that paid family leave can be implemented without major labor market disruption, while public support for a national program remains high. As breastfeeding science continues to advance, federal paid family leave represents overdue public health infrastructure necessary to translate evidence into population-level health improvements. IMPACT: Paid family leave is one of the most effective and well-supported policy mechanisms for promoting breastfeeding success and improving maternal and infant health. This article synthesizes emerging breastfeeding science, including new evidence regarding human milk's influence on neonatal immunity and antimicrobial resistance. We then link breastfeeding research with research on the policy that most supports widespread breastfeeding at a population level: paid family leave. Translating the benefits of breastfeeding into improved public health will require national policies that enable families to achieve breastfeeding goals. Federal paid family leave is among the most evidence-based policy strategies to achieve such goals.
Randomized trials from high-income countries have shown that endovascular treatment (EVT) yields similar benefits in elderly and non-elderly patients with large vessel occlusion stroke (LVOS). However, evidence from low/middle-income countries remains scarce. We aimed to assess the impact of age on outcomes and determine whether age modifies the effect of EVT under the resource-limited conditions of a public healthcare system in a developing country. Pre-specified subgroup analysis of the RESILIENT trial, a multicenter, randomized, controlled trial in Brazil comparing EVT versus medical treatment alone in anterior circulation LVOS. Patients were categorized as non-elderly (<70 years), elderly (≥70 years), and very elderly (≥80 years). The primary endpoint was functional independence (modified Rankin scale 0-2) at 90 days. Logistic regression was performed to identify independent predictors of outcome and to assess age as an effect modifier. Among 221 randomized patients (47.1% females; median [IQR] National Institutes of Health Stroke Scale, 18 [14-21]), 89 (40.2%) were elderly and 37 (16.7%) very elderly. Increasing age was independently associated with lower odds of functional independence in the entire study population (odds ratio [OR]: 0.97; 95% confidence interval [CI]: 0.95-0.99, p = 0.01). Age significantly modified the treatment effect of EVT. Non-elderly patients derived substantial benefit from EVT (OR: 4.08; 95% CI: 1.71-9.76), whereas the benefit was attenuated in elderly (OR: 0.90; 95% CI: 0.17-5.42; pinteraction = 0.03) and very elderly (OR: 0.36; 95% CI: 0.11-3.21; pinteraction = 0.03). The effect of EVT appears significantly diminished among elderly patients in a public healthcare system in a developing country. Further studies are needed to understand the mechanism underlying these findings and properly assess the efficacy of EVT in this vulnerable population. ANN NEUROL 2026.
Anthracyclines such as doxorubicin (DOXO) remain a cornerstone of cancer therapy but are associated with a high risk of cardiotoxicity and subsequent heart failure (HF). Impairment of NO/soluble guanylyl cyclase (sGC)/cGMP pathway has been reported in anthracycline-induced cardiomyopathy. This raises the hypothesis that increasing cGMP by sGC stimulation could preserve cardiac function even after HF has developed. This study aimed to evaluate the long-term effects of treatment with sGC stimulator BAY 41-8543 in a model of DOXO-induced HF with nephrotic syndrome in hypertensive rats. Male Ren-2 transgenic rats received five weekly intravenous injections of DOXO (cumulative dose 10 mg·kg-1) to induce cardiomyopathy. After two additional weeks, animals were treated with either BAY 41-8543 (10 mg·kg-1·day-1) or an ACE inhibitor (ACEi; trandolapril, 0.25 mg·kg-1·day-1). Echocardiography, blood and urine collection were performed at baseline (week -1) and 4 weeks after the treatment started to assess cardiac ventricular function, cardiac and renal biomarkers; survival at 20 weeks. Treatment with BAY 41-8543 improved long-term survival, preserved left and right ventricular systolic function and reduced myocardial expression of inflammation-related genes, particularly those linked to type I interferon signalling. ACEi provided stronger benefits in survival and structural remodelling. Kidney damage and function was not improved by any treatment compared to placebo. The sGC stimulator BAY 41-8543 exerted significant cardioprotective effects in DOXO-induced HF. Therefore, sGC stimulators may represent a promising therapeutic option for anthracycline-induced cardiomyopathy, although additional studies are required to fully investigate their therapeutic potential.
Home mechanical ventilation (HMV) improves survival in Amyotrophic lateral sclerosis (ALS) and may be provided non-invasively (NIV) or invasively (IV). While NIV is guideline-recommended, the role of IV remains controversial, and data on long-term outcomes and NIV-to-IV transitions are limited. To examine survival across HMV strategies in people with ALS (pwALS) in Sweden over 27 years, factors associated with IV initiation, temporal trends in IV use and survival, and regional variation in IV utilisation. A longitudinal cohort study of pwALS in the Swedish National Registry of Ventilatory Failure (Swedevox) 1996-2022, cross-linked with national registries. Factors associated with mortality and treatment patterns were assessed using multivariable regression models. Among 1,360 pwALS, initial NIV was most common (92%), followed by IV (5%) and NIV-to-IV transitions (3%). Most IV initiations were non-elective (77% vs. 18% NIV, p < 0.001). NIV-to-IV transitions occurred mainly in metropolitan areas (OR 5.11; 95% CI 2.30-11.4). Median survival differed across observed treatment pathways (p < 0.001): 1.7 years with NIV, 4.9 years with IV, and 6.5 years with NIV-to-IV. Mortality was associated with higher age (aHR 1.33 per decade; 95% CI 1.26-1.41), female sex (aHR 1.15; 95% CI 1.02-1.29), and acute initiation (aHR 1.26; 95% CI 1.08-1.47). Longer time from diagnosis to NIV initiation was associated with reduced mortality risk (aHR 0.58 per year; 95% CI 0.55-0.62). Over time, patients initiated HMV at older age with better lung function and lower PaCO2 values among those with available measurements, whereas overall survival remained unchanged. Patients receiving IV had longer observed survival, likely reflecting the benefits of a secured airway as well as patient selection and underlying disease trajectory. Most IV initiations were unplanned. Over three decades, HMV was initiated in older patients at an earlier stage of respiratory decline, but overall survival remained unchanged. IV use increased with marked regional variation.
Patients and health care organizations alike can benefit from interprofessional teams in the intensive care unit to manage infectious diseases. Interprofessional team frameworks within organizations bring these teams to fruition and have shown positive benefits. These teams not only promote antimicrobial stewardship and recognition of the whole-patient care needs, but also can be a cost-saving way to manage these complex patients. Each team member brings a specific skill set and competencies to create an optimized approach to treating infections with antibiotics and antivirals.
The benefits of sufficient high-quality sleep are well documented; however, hospitalized patients frequently experience inadequate sleep due to standard care practices requiring frequent assessments. Patient surveys identify staff interruptions and environmental noise as primary contributors. Institutional barriers, including the absence of formal sleep-promoting policies and limited staff training, further exacerbate the issue. Both pharmacologic and nonpharmacologic interventions have been developed to enhance sleep and improve outcomes such as length of stay and patient experience, though findings remain inconsistent. Evidence suggests these interventions are generally safe and further research is needed to optimize inpatient sleep quality.
On 16 January 2025, the U.S. Food and Drug Administration (FDA) authorised marketing of 20 Zyn oral nicotine pouch products, the first US authorisation of this category. Public interpretation may shape perceptions of safety and nicotine use. This study examined discourse on X following authorisation. Posts containing 'Zyn' or '#Zyn' were extracted from X from 16-23 January 2025. After excluding reposts, quote posts, non-English posts and unrelated content, 549 posts were analysed. Using an inductive approach, four coders classified posts into 10 themes and coded sentiment as supportive, opposed or neutral. Negative binomial regression models estimated associations between themes and engagement, reported as incidence rate ratios (IRRs) for views, likes, replies, reposts and quotes. Most posts were neutral (58.1%), followed by supportive (28.6%) and opposed (13.3%). The most prevalent themes were news (68.7%) and public health benefits (41.0%), followed by government distrust (16.0%) and potential harms (11.1%). Supportive posts emphasised harm reduction, whereas opposed posts highlighted regulatory distrust and concerns about addiction and youth uptake. Flavour discussion (9.5%) was strongly associated with higher engagement across metrics (all p<0.01). Posts addressing potential harms or policy inconsistencies generated lower engagement on selected metrics. Discourse was dominated by informational sharing and harm reduction framing, alongside regulatory scepticism. The strong association between flavour discussion and engagement indicates that flavour-related content was highly visible in the immediate X discourse surrounding the FDA authorisation. Clear communication about FDA marketing authorisation is needed to prevent misinterpretation as endorsement of safety.