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Aortic pseudoaneurysm secondary to Mycobacterium tuberculosis infection is exceedingly rare. Extrinsic compression of the left main coronary artery by an aortic pseudoaneurysm is also uncommon, and cases attributable to tuberculosis are particularly rare. This report describes a mid-ascending aortic pseudoaneurysm causing left main coronary artery compression resulting in cardiac arrest in a patient with a history of tuberculosis, which was successfully managed with emergent surgical intervention. A 76-year-old man with a history of tuberculosis and radiologic findings suggestive of previous tuberculous disease experienced cardiac arrest prior to transfer and was referred to the authors' institution. Coronary angiography, performed because of chest pain and elevated cardiac biomarkers, demonstrated extrinsic compression of the left main coronary artery by an ascending aortic pseudoaneurysm. Return of spontaneous circulation was achieved after approximately 48 min of cardiopulmonary resuscitation. Upon arrival at our emergency department, computed tomography revealed a 6-cm pseudoaneurysm of the proximal-to-mid ascending aorta. Emergent surgical resection of necrotic ascending aortic tissue and graft replacement of the ascending aorta were performed, and the postoperative course was favorable. Ascending aortic pseudoaneurysm may cause sudden cardiac arrest through extrinsic compression of the left main coronary artery. In patients with a history or radiologic evidence of tuberculosis, tuberculosis-related involvement may be considered, but definitive surgical treatment should not be delayed in life-threatening presentations.
Systemic lupus erythematosus (SLE) is an autoimmune disease characterized by the emergence of autoantibodies and deposition of immune complexes. SLE presents with heterogeneous multi-organ involvement that varies among patients and its mechanisms have been investigated to facilitate appropriate stratification and treatment selection. Bulk RNA-seq and bulk ATAC-seq have provided important insights into the pathogenesis of SLE; however, these approaches are inherently limited by their reliance on predefined cell subsets and known markers, which can introduce bias and restrict their ability to fully resolve cellular heterogeneity. Recent advances in multi-omics analyses have enabled the investigation of multi-layered information beyond single-cell RNA sequencing (scRNA-seq) alone and have contributed substantially to elucidating the pathogenesis of SLE. Although the emergence of autoreactive B cells and the production of autoantibodies in SLE are well established, the mechanisms of evasion from negative selection remain unclear. Multi-omics analyses have revealed key aspects of SLE pathogenesis, particularly the expansion of atypical B cells (ABCs), an autoreactive population driven by extrafollicular pathways. Furthermore, beyond transcriptional profiling, multi-omics analysis has emerged as an additional investigative method, which combines scRNA-seq with other modalities. Spatial analyses, for instance, have provided critical insights into the tissue localization and persistence of autoreactive B cells within inflammatory niches in lupus nephritis, suggesting that local microenvironments contribute to treatment resistance. Additionally, B cell receptor (BCR) sequencing has revealed distinctive BCR features in SLE, such as reduced somatic hypermutation, increased repertoire naiveness, and increased immunoglobulin variable region heavy chain gene (IGHV4-34) usage in B cells in bone marrow and affected organs (not only in peripheral blood). Furthermore, emerging multimodal approaches integrating spatial, transcriptomic, and epigenomic information further highlight pathogenic cell-cell interactions and inflammatory circuits that cannot be captured by scRNA-seq alone. In this review, we summarize recent multi-omics studies that elucidate the origin, differentiation, and tissue localization of pathogenic B cells in SLE. We provide an overview of the multi-omics analyses focusing on B cells so far, especially at single-cell resolution, and discuss their possible applications in precision medicine.
Whereas correlates of cyberbullying have been studied extensively, there has been comparatively less work examining predictors of the different ways in which bystanders to cyberbullying might respond. Adopting a person-situation interaction approach, this study investigated the extent to which the Big Five personality traits and severity of cyberbullying interactively predict the likelihood of different cyberbystander behaviors. Adults in the U.S. (N = 303) took part in an online survey in which they were presented with a series of nine simulated social media interactions in the form of screenshots that involved exchanges between two social media users. Each screenshot depicted one of three distinct levels of cyberbullying severity: none, low severity, and high severity. For each screenshot, participants were asked to report the likelihood that they would respond in a range of ways as a bystander, including remaining a passive observer, confronting a bully, reinforcing a bully, supporting a victim, and flagging or reporting a post. Participants then completed a measure of the Big Five personality traits. Regardless of cyberbullying severity, participants were significantly more likely to indicate that they would remain a passive observer in response to the depicted social media interactions than any other cyberbystander behavior. Informative two-way interactions did, however, emerge between cyberbullying severity and cyberbystander behavior and between these variables and Big Five traits across a series of mixed effects models. A significant three-way interaction emerged for agreeableness, such that participants higher in agreeableness reported a greater likelihood of bystander action in response to high severity cyberbullying than those with moderate or lower levels of agreeableness. This research offers support for the predictive value of both individual differences in the Big Five personality traits and cyberbullying severity for understanding diverse forms of cyberbystander behavior.
To secure the stable operation of seawater reverse osmosis during harmful algal blooms (HABs), this pilot-scale study evaluated an emergency pretreatment strategy combining sodium hypochlorite (NaClO) pre-oxidation, dissolved air flotation (DAF) and postsand filtration (SF) to optimize algae and turbidity removal. Results demonstrated that moderate NaClO pre-oxidation effectively avoided the risk of flocculant oxidation while enhancing algal and turbidity removal by approximately 6% and 18% after DAF, respectively. About 12 mg/L polyaluminum chloride (PAC) and 15 mg/L FeCl3 showed optimal algae removal performance, but PAC had a better coagulation effect on DAF than FeCl3, which was 26.8% higher than FeCl3. Low-dose cationic polyacrylamide (PAM) could further enhance flocculation. The SF unit after DAF served as a key physical barrier, elevating overall algae removal to > 95% and achieving 100% turbidity removal under the optimal dosing process (0.5 mg/L NaClO + 12 mg/L PAC + 0.2 mg/L PAM). This study provided a technically feasible emergency strategy for seawater desalination pretreatment against HABs shocks, ensuring water supply security.
A 0/2-h algorithm for the i-STAT point-of-care (POC) high sensitivity troponin I (hs-cTnI) assay was recently derived in Australia. The objective of this study was to validate and optimize the performance of the 0/2-h algorithm in a multisite U.S. Emergency Department (ED) cohort. A prospective cohort study was conducted at three U.S. EDs (February-September 2025). Adults without STEMI and at least one hs-cTnI ordered were accrued. Blood samples were collected simultaneously for POC hs-cTnI measurement on an i-STAT 1 analyzer (Abbott Laboratories) and central laboratory hs-cTnI measurement (Beckman Coulter). The primary outcome was index myocardial infarction (MI), adjudicated by experts using clinical hs-cTnI measures. Diagnostic performance of the Australian 0/2-h algorithm was assessed by calculating negative and positive predictive values (NPV, PPV) with associated 95% confidence intervals. Efficacy, defined as the proportion of patients classified into the rule-out zone, was calculated. Algorithm optimization tested modified cut points to increase efficacy while maintaining NPV ≥ 99% and achieving PPV ≥ 65%. During the study period, 578 patients with complete 0/2-h algorithm assessments were accrued. These patients were 48% (279/578) female, 40% (233/578) non-White, with a median age of 60 years (IQR: 50-70). Index MI occurred in 7.4% (43/578). Algorithm efficacy was 54.8% (317/578) and 8.8% (51/578) were classified to the rule-in zone. Among patients ruled-out, the NPV was 99.4% (95% CI: 97.7%-99.9%). The rule-in zone was associated with a PPV of 62.7% (95% CI: 48.1%-75.9%). Among 36.3% (210/578) patients classified to the observation zone, 4.3% (9/210) had an adjudicated index MI. An optimized 0/2-h algorithm increased efficacy to 60.0% (347/578) while achieving an NPV of 99.4% (95% CI: 97.9%-99.9%) and PPV of 74.4% (95% CI: 58.8, 86.5%) for index MI. The original Australian and optimized 0/2-h algorithms for i-STAT POC hs-cTnI measurement had high NPV and efficacy in a multisite U.S. Trial Registration: NCT06899776.
Disparities in breast cancer care access and outcomes are persistent and globally recognized issues driven by a complex interplay of socioeconomic, geographical, and systemic factors. Given the complex psychosocial effects on this patient group, it is crucial to incorporate Patient and Public Involvement and Engagement (PPIE) into care models. PPIE is a collaborative approach that involves patients, caregivers, and community members. It engages diverse populations and addresses the needs of underrepresented and disadvantaged groups, thereby promoting health equity. However, the multifaceted connection between health equity and PPIE programs must be strengthened. This narrative review critically explores research and organizational models that describe how PPIE informs health equity in breast cancer care. Our focus is on adaptability: as patient needs, treatments, and technologies evolve, so must the strategies employed to ensure equitable care. We discuss how PPIE is crucial for tailoring efforts to provide equity in two areas of intervention: community-driven and data and targeted-driven approaches. Integrating PPIE into flexible organizational models and research projects has emerged as a critical driver for achieving health equity in breast cancer care in both areas. Community-led initiatives ensure that interventions are culturally relevant and address fundamental social determinants of health. Conversely, data-driven approaches provide the evidence needed to target resources effectively and measure progress. Advancing PPIE reporting in rigorous study designs is the first step to ensuring effective and reproducible implementation. Furthermore, the models' adaptive features may reduce health inequities, increasing their reach, and strengthening community collaborations. PPIE can address several reasons for inequities in breast cancer care, such as a lack of health literacy, supportive infrastructure and policy priority. Regardless of whether the initial approach was more community- or data-oriented, PPIE has informed health equity by promoting the dynamism and appropriateness of interventions, and by revealing actionable barriers. These models emphasise bottom-up participation, multi-stakeholder partnerships, co-designed projects and the use of health data and targets to build equity. Advancing PPIE reporting in rigorous study designs is the first step to ensuring effective and reproducible implementation. Furthermore, the models' adaptive features may reduce health inequities, increasing their reach, and strengthening community collaborations.
Postoperative bleeding is a common and potentially life-threatening complication following cardiac surgery, often exacerbated by multifactorial coagulopathy from cardiopulmonary bypass, hypothermia, and platelet dysfunction. While fresh frozen plasma (FFP) has traditionally been used for coagulation correction, it has significant limitations, including large volume requirements, slow onset, and increased risk of transfusion-related complications. Prothrombin complex concentrate (PCC) has emerged as a potential alternative, offering rapid coagulation correction with reduced volume load and no ABO compatibility requirements. This systematic review and meta-analysis compared the efficacy and safety of PCC versus FFP in managing coagulopathic bleeding in adult cardiac surgery patients. We conducted a systematic review and meta-analysis following PRISMA guidelines. Electronic databases (MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials) were searched using MeSH terms and keywords related to "Cardiothoracic Surgery", "Prothrombin Complex Concentrate", and "Fresh Frozen Plasma", from inception to Jan 2026. Cohort studies and randomized controlled trials comparing PCC and FFP in patients aged > 18 years undergoing cardiac surgery complicated by bleeding or coagulopathy were included. Primary outcomes were RBC transfusion requirement, chest tube drainage, and thromboembolic events. Secondary outcomes included surgical re-exploration for bleeding, stroke, duration of mechanical ventilation, hospital and ICU stays, and acute kidney injury. Risk of bias was assessed using the Cochrane Risk of Bias Tool 2.0 for RCTs and the Newcastle-Ottawa Scale for observational studies. Statistical analysis was conducted using Review Manager (RevMan) version 5.4, applying risk ratios (RR) for dichotomous outcomes and mean differences (MD) for continuous outcomes, both with 95% confidence intervals. The meta-analysis protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under protocol number CRD420251088737. This meta-analysis included ten studies with 2,643 patients. PCC use moderately reduced RBC transfusion in the first 24 h (RR = 0.84; 95% CI: 0.76-0.93; p = 0.05; I2 = 47%), 12-24-h chest tube drainage (MD =  - 188.89 mL; 95% CI: - 248.48 to - 125.30; p < 0.00001; I2 = 50%), and hospital stay (MD =  - 1.19 days; 95% CI: - 2.21 to - 0.18; p = 0.004; I2 = 67%). No significant differences were observed for surgical re-exploration (RR = 0.81; 95% CI: 0.66-1.00; p = 0.05; I2 = 0%), mechanical ventilation (MD =  - 0.08; 95% CI: - 0.34 to 0.19; p > 0.05; I2 = 73%), ICU stay (MD =  - 0.07 days; 95% CI: - 0.59 to 0.45; p = 0.78; I2 = 59%), all-cause mortality (RR = 1.10; 95% CI: 0.82-1.50; p = 0.51; I2 = 0%), thromboembolic events (RR = 1.22; 95% CI: 0.80-1.85; p = 0.35; I2 = 0%), stroke (RR = 1.10; 95% CI: 0.75-1.63; p = 0.63; I2 = 0%), acute kidney injury (RR = 1.08; 95% CI: 0.74-1.56; p = 0.70; I2 = 77%), serious adverse events (RR = 0.78; 95% CI: 0.56-1.09; p = 0.15; I2 = 35%), and any adverse event (RR = 0.95; 95% CI: 0.81-1.11; p = 0.54; I2 = 53%). Moderate to high heterogeneity was noted in several outcomes, for which subgroup analyses were performed. This meta-analysis demonstrates that PCC is superior to FFP in reducing RBC transfusion requirements, 12-24-h chest tube drainage, and hospital length of stay in adult cardiac surgery patients, while maintaining a comparable safety profile. Further large-scale, high-quality RCTs are warranted to strengthen the evidence base and inform future guidelines.
Autism spectrum disorder manifests through dysbiosis across the microbiota-gut-brain-immune axis, characterized by depletion of short-chain fatty acid (SCFA)-producing taxa like Bifidobacterium, Faecalibacterium, and Roseburia, along with an increase in endotoxin-producing taxa like Desulfovibrio and Bacteroides. SCFA emerge as one of the regulators of neuroimmune homeostasis by governing microglial maturation through GPR43/GPR109A-dependent histone deacetylase inhibition, modulating astrocytic tryptophan-aryl hydrocarbon receptor signaling, and preserving tight junction integrity at blood-brain and blood-CSF barriers. SCFA insufficiency constitutes the upstream metabolic defect linking gut dysbiosis to ASD neuropathology, such as impaired microglial priming and brain-resident CD4+ T cell differentiation, reactive astrocytosis with kynurenine neurotoxicity superseding protective signaling, barrier breakdown enabling LPS-driven TLR4-NF-κB neuroinflammation, and excitatory/inhibitory imbalance from reduced glutamate decarboxylase and astrocyte glutamate dysregulation. This review advances an integrative SCFA-centric framework repositioning ASD as metabolite-dependent neuroimmune dysregulation during brain development. Preclinical and early clinical data demonstrate that SCFA restoration through prebiotic fiber/resistant starch, probiotics, or direct SCFA supplementation normalizes gastrointestinal symptoms, behavioral deficits, microglial morphology, and neurotransmitter ratios. This guides mechanistically targeted microbiota interventions with fecal/plasma SCFA profiling as stratification biomarkers, establishing precision therapeutic regimens for ASD.
Emotional difficulties are common among individuals with Eating Disorders (EDs). Following Panksepp's theoretical model, which conceptualises primary emotional systems as the evolutionary foundation of personality, this study aimed to identify distinct profiles of primary emotional systems within a clinical eating disorder (ED) sample. It further examined differences in sociodemographic, clinical, and psychopathological characteristics across profiles, as well as associations between clinical features and profile membership. In this cross-sectional study, data were obtained from the Regional Centre for ED registry at the University Hospital of Verona. Measures included the Affective Neuroscience Personality scales, the Eating Disorder Examination, the Symptom CheckList-90-Revised, the Life Stressor Checklist-Revised, and the Impact of Event Scale-Revised. A Latent Profile Analysis was conducted, followed by inferential analyses. Among 122 patients, three profiles emerged: (1) high FEAR and SADNESS, and low SEEKING and PLAY; (2) low negative primary emotional systems and CARE; (3) high positive primary emotional systems and high SADNESS and ANGER. Profiles differed by age, sex, illness duration, trauma burden, depressive-anxiety symptoms, and ED severity. Findings revealed emotional heterogeneity among ED patients, underscoring the importance of considering individual emotional differences in treatment planning. Study limitations and directions for future research are discussed.
Supraventricular tachycardia (SVT) is a common arrhythmic disorder characterized by abnormal electrical impulses arising from supraventricular tissues, most commonly the atria or atrioventricular node. This study aimed to investigate the association between G protein-coupled estrogen receptor (GPER) levels and biomarkers of oxidative stress and neurodegeneration in the pathophysiology of SVT. This study included 51 patients diagnosed with SVT and 30 healthy controls. Plasma levels of the oxidative stress marker 8-iso-prostaglandin F2α (8-iso-PGF2α), the neurodegeneration-associated protein Tau, and GPER were measured using ELISA kits. Correlations between GPER and the studied biomarkers were analyzed, and the diagnostic performance of each biomarker was evaluated using ROC analysis. Pro-BNP levels were higher in patients with SVT compared to the control group (P = .05). GPER, Tau, and 8-iso-PGF2α levels were significantly higher in the SVT group compared to the control group (P < .001 for all 3 biomarkers). ROC analysis demonstrated that 8-iso-PGF2α had the highest diagnostic accuracy, while Tau (AUC = 0.986) and GPER (AUC = 0.981) also showed strong discriminative performance. GPER, a well-established marker of estrogen-mediated cellular signaling, emerges as a significant biomarker in patients with SVT. These findings suggest that GPER-mediated signaling pathways may be associated with systemic oxidative damage and neuronal effects in the pathophysiology of SVT.
Coronary artery lesions (CAL) complicating Kawasaki disease (KD) are a central concern affecting the long-term cardiovascular health of affected children. This study aimed to systematically depict the macro landscape, knowledge structure, and evolutionary dynamics of this field through bibliometric and knowledge graph methods, providing strategic guidance for future research. Literature related to KD-CAL was retrieved from the Web of Science Core Collection. Quantitative and visual analyses of publication trends, countries/regions, institutions, authors, journals, references, and keywords were conducted using CiteSpace 6.3.R1, VOSviewer 1.6.20, and the Bibliometrix R package. A total of 2655 publications were included. The annual publication volume showed an increasing trend, with acceleration after 2015. The United States emerged as the country with the highest productivity and influence (citation frequency, centrality), while China ranked first in publication output (909 articles) but had a lower rate of international collaboration (MCP_Ratio = 0.08). The core journal cluster comprised Circulation, Journal of Pediatrics, and Pediatric Cardiology, among others. A close international collaboration network was formed around key figures like Jane Carleton Burns and Adriana H. Tremoulet. Keyword and document co-citation analyses revealed 5 major research clusters: acute-phase management, immunopathological mechanisms, coronary complications, treatment of intravenous immunoglobulin resistance, and long-term follow-up. The research frontier has evolved from "epidemiology" and "diagnosis" to "biomarkers" and "IVIG resistance," and is now predominantly focused on "biologics" (e.g., infliximab, anakinra) and "artificial intelligence/machine learning." The new phase of KD-CAL research may focus on precision medicine. Future efforts may focus on deepening immunological mechanism studies to develop targeted therapies, utilizing artificial intelligence to optimize risk stratification and imaging assessment, and establishing globally collaborative long-term cohorts to clarify cardiovascular outcomes in adulthood. Strengthening basic and clinical translation is essential to advance KD-CAL diagnosis and treatment into a new era of precision and efficiency.
Olfactory dysfunction (OD) and Alzheimer disease (AD) represent significant global public health challenges. Growing evidence underscores the need to clarify the neuropathological mechanisms underlying their association. Our study intends to analyze global research trends and overlapping molecular mechanisms underlying OD and AD. Reviews and articles on OD and AD published between 2008 and 2024 were extracted from the Web of Science Core Collection. CiteSpace and VOSviewer were applied to for the analysis and visualization of the publication outputs, as well as the distribution of countries/regions, institutions and authors, the journals output, keywords co-occurrence, and reference citations. Molecular targets and associated pathways were investigated by GeneCards, STRING, and Metascape databases. One thousand nine hundred sixteen publications were identified, demonstrating steady growth in research output across 7006 institutions from 398 countries. The USA emerged as the top contributor, excelling in both publication output and citation impact. The University of Pennsylvania, University of California San Francisco, and Chinese Academy of Sciences stood out as the top influential institutions. Among 10,476 authors, Thomas Hummel from Technische Universität Dresden, Germany, emerged as the most prominent scholar. In terms of journals, Journal of Alzheimer's Disease leaded in publications in this field. Keywords including "Alzheimer's disease," "olfactory bulb," and "cognitive impairment" represent the current research focuses. A total of 1779 overlapping genes were identified between OD and AD. ACTB, AKT1, TP53, CTNNB1, and INS were identified as the most central regulatory genes. Enrichment analyses revealed involvement in PI3K-Akt, mitogen-activated protein kinases, and cyclic adenosine monophosphate signaling pathways, as well as biological functions related to signaling receptor activator activity, growth factor activity, and cytokine activity. Our study uncovers the dynamic research trends on OD and AD, while we further identified shared molecular mechanisms underlying these 2 disorders. Early olfactory risk assessment, diagnosis, and intervention may serve as critical components in the prevention and management in AD.
Inflammation plays a key role in complications and organ damage in type 2 diabetes mellitus (T2DM). The Aggregate Index of Systemic Inflammation (AISI) and Systemic Inflammation Response Index (SIRI) have emerged as potential markers for inflammation and prognosis. This study aimed to assess the association between AISI, SIRI levels, and mortality in T2DM patients. This study combined a population-level time-trend analysis using Global Burden of Disease data from 1990 to 2021 with a retrospective cohort study using National Health and Nutrition Examination Survey data from 1999 to 2018 linked to the National Death Index mortality files. The Global Burden of Disease data revealed an upward trend in T2DM incidence, with a slight decline in mortality rates from 2003 onward. In the National Health and Nutrition Examination Survey cohort, higher AISI and SIRI levels correlated with increased risks of cardiovascular disease (CVD) and all-cause mortality. After adjusting for confounders, the highest quartile of both indices (Q4) showed significantly higher mortality risks: for AISI quartile 4 (Q4) vs Q1, hazard ratio (HR) = 1.46 for CVD and HR = 1.71 for all-cause mortality; for SIRI Q4 vs Q1, HR = 1.98 for CVD and HR = 2.13 for all-cause mortality. These findings suggest AISI and SIRI may serve as simple markers for risk stratification in T2DM.
To evaluate whether centralized appointment scheduling and same-day virtual clinician evaluation improved appointment timeliness and follow-up after nurse triage. We also assessed whether these changes were associated with differences in downstream utilization, costs, reach, and Veteran experience. Retrospective quasi-experimental evaluation of Veteran Administration Health Connect (VAHC) modernization across 18 regions between October 1, 2018, and September 30, 2024. Staggered rollout enabled difference-in-differences and event-study analyses comparing outcomes before and after modernization. Data were drawn from the Veterans Administration Corporate Data Warehouse, Telecare Record Manager, and Customer Relationship Management platforms, and VSignals Veteran experience surveys. The analytic sample comprised 11,118,916 encounters (4,560,677 pre-modernization; 6,558,239 post-modernization). Centralized scheduling was associated with modest and mixed improvements in appointment access. Same-day scheduling increased by 14.3 percentage points (95% CI, 10.1 to 18.5). Time from call to scheduled appointment decreased by 0.37 days (95% CI, -0.49 to -0.26), while time to completed appointment increased by 2.9 days (95% CI, 0.2 to 5.7). Following modernization, time from nurse triage to any subsequent care decreased by 0.28 days (95% CI, -0.45 to -0.11), and the proportion of callers receiving no follow-up care within 7 days declined by 2.3 points (95% CI, -4.0 to -0.5). Modernization was not associated with changes in the proportion of all emergency department (ED) visits preceded by a nurse triage call or in total ED visit volume. Seven-day ED visits, admissions, and total costs did not change meaningfully. Veteran satisfaction was high for post-modernization virtual encounters. VAHC modernization improved appointment access and follow-up after nurse triage but was not associated with short-term changes in ED use or costs, highlighting gains in navigation and experience without immediate shifts in downstream utilization.
This research provides the first quasi-experimental and longitudinal examination of the Social Identity Model of Traumatic Identity Change among individuals affected by the September 2024 flood in Poland. Advancing the state of the art, we analyzed the emergence of identification with flood-affected people and extended the model by incorporating the sense of shared experience (SSE) within this group. Surveys were completed 3 months (N = 630) and 7 months after the flood (N = 315). The results indicated that the severity of flood exposure was linked with higher post-traumatic stress (PTS) and post-traumatic growth (PTG). Repeated trauma strengthened both identification and SSE with those affected by the flood. Over time, SSE remained stable, whereas identification decreased, suggesting that SSE serves as a more enduring psychosocial resource than group identification. SSE predicted the subsequent PTG but not the PTS, highlighting its positive role in adaptive coping, while PTS contributed to later increases in SSE. Multi-group analyses comparing participants from flood-prone areas who were at risk but had not experienced flooding, those with less recent flood exposure, those with recent flood exposure, and those experiencing re-traumatization from both past and recent floods revealed that the pathways linking identification, SSE, and post-traumatic outcomes differed across these groups. These findings demonstrate the differential function of social processes under varying trauma contexts. Overall, this research underscores the importance of considering exposure history in post-disaster interventions and highlights how social identity and shared experience can both support resilience and shape recovery trajectories.
Post-traumatic stress disorder (PTSD) is maintained by dysfunctional trauma-related appraisals. Cognitive Bias Modification for Appraisals (CBM-APP) aims to train more functional trauma-related appraisals and has been shown to reduce PTSD symptoms. However, little is known about how this training affects the interrelations among symptoms and cognitive appraisals. In this secondary analysis of a randomized controlled trial involving 77 adult patients diagnosed with PTSD (CBM-APP: n = 37; control training: n = 40), we applied repeated cross-sectional network analysis to examine changes in the structure and centrality of associations among PTSD symptom clusters (re-experiencing, avoidance, negative cognition and mood, hyperarousal, assessed with the PTSD Checklist for DSM-5) and trauma-related cognitive measures, all assessed at both pre- and post-training. To capture multiple levels of cognitive processing, we included responses during a scenario task (reflective, idiosyncratic, spontaneous appraisals) and the Implicit Association Test (automatic self-associations). Four cross-sectional Gaussian Graphical Models were estimated for the training and control group and both timepoints (pre-/post-training × CBM-APP vs. control group). While overall network connectivity did not differ significantly across networks, descriptive patterns indicated that Alterations in Cognition and Mood emerged as the most central node in both groups at post-training assessment. Further, in the CBM-APP group, the centrality of implicit trauma-related associations decreased pre- to post-training, suggesting potential weaker associations of automatic negative self-associations with symptom activation. Given the small sample and moderate network stability, findings are preliminary but suggest that CBM-APP may influence the relational structure of PTSD symptoms and cognitions.
Trust is essential to effective healthcare relationships with service users and a key mechanism for successful implementation of service improvements. In rural settings, systemic barriers, such as workforce shortages, fragmented services, and access inequities, can erode trust in the healthcare system. Integrated care models that prioritise relational approaches may help build trust, particularly for families of children with medical complexity (CMC) who frequently navigate multiple healthcare services. This study explored how trust was operationalised between families of CMC and care coordinators in the Rural Kids Guided Personalised Service (RuralKidsGPS) model, and how relational and contextual factors shaped trust-building processes. Semi-structured interviews with parents (n = 13), family groups (n = 9), and Paediatric Care Coordinators (PCCs) (n = 8). A hybrid inductive/deductive thematic analysis guided by the Consolidated Framework for Implementation Research (CFIR), was used to evaluate the implementation barriers and enablers of RuralKidsGPS. Drawing on established theories, including the Trust Triangle and leveraging validated frameworks, we developed the Trust in Implementation Practice (TIP), comprising five relational constructs: Authenticity, Empathy, Competency, Vulnerability, and Reciprocity. These constructs guided analysis of trust-building mechanisms across families, PCCs, and the healthcare system. Factors enabling or undermining trust-building emerged as key themes from the CFIR-guided thematic analysis. Trust was fostered through PCCs' relational competencies, authenticity, empathy, and local knowledge, enabling responsive care and sustained healthcare relationships. Trust dynamics were shaped by psychosocial and economic disadvantage, geographic isolation, systemic inequities in service access, and previous adverse healthcare experiences. PCCs were perceived as trustworthy intermediaries who promoted equity, continuity, and access to care. Thematic findings identified six key contextual modifiers, leading to expansion into the TIP-Context (TIP-C) framework. Trust operates as both a mechanism and an outcome in the implementation of integrated care. The TIP-C framework offers a novel, theory-informed lens for understanding and operationalising trust-building in healthcare implementation. Future research is needed to validate and/or amend the TIP-C in other implementation settings.
Traumatic pneumothorax (TP) is considered a prevalent pathology involved in chest trauma. Higher the number of accompanying pathologies, higher the rates of prolonged length of hospital stays and mortality. This study aimed to investigate the effect of accompanying pathologies on mortality in patients with TP. This study followed a single-center retrospective design. Patients with trauma who were diagnosed with pneumothorax in a tertiary emergency department in Turkey between January 1, 2022 and December 31, 2023, were included in the study. Logistic regression analysis was used to investigate the factors affecting mortality. During the study period, 252 patients were diagnosed with TP. The median age of these patients was 56 years, and the median length of hospital stay was 4 days. The most prevalent accompanying pathologies in patients with TP included rib fracture, hemothorax, and fracture of any of the extremities. The most prevalent pathologies associated with mortality were hemothorax, lung contusion, lower extremity fracture, traumatic brain injury and abdominal injury (P = .007, P = .036, P = .027, P = .005, and P = .002, respectively). Accompanying pathologies associated with an increased risk of mortality included bilateral pneumothorax, traumatic brain injury and abdominal injury (P < .001, P = .035, and P = .001, respectively). TP is considered one of the most prevalent chest traumas that can cause mortality. While accompanying pathologies such as hemothorax, lung contusion, and lower extremity fractures are associated with higher mortality in univariate analyses, they do not independently predict death. The independent predictors that substantially increase the risk of mortality in patients with TP are bilateral pneumothorax, traumatic brain injury, and abdominal injury.
Prehospital transfusion improves survival in traumatic and medical hemorrhage, but the blood supply implications of scaling this capability across U.S. emergency medical services (EMS) systems are unclear. We developed an analytic model incorporating national estimates of prehospital transfusion demand, EMS station deployment, product shelf life, hospital rotation practices, donor availability, and unit costs. We modeled deployment to 10% (approximately 4200) and 50% (approximately 21,000) of U.S. EMS stations. Low-titer group O whole blood (LTOWB) and liquid plasma (LP) were evaluated separately. Outcomes included units shipped to EMS, units rotated to hospitals, total units collected, discard with and without hospital rotation, LTOWB donor requirements, and annual product costs. Implementation required approximately 148,000-220,000 units annually at 10% deployment and 741,000 to 1.1 million at 50%, representing an 8%-24% increase over current U.S. whole-blood collections. LTOWB was the principal constraint, requiring about 110,000 new donors at 10% deployment and up to 550,000 at 50%. LP demand could be met through redistribution from existing collections without new donor recruitment. Hospital rotation substantially reduced discard. At 50% deployment, annual costs exceeded $540 million for LTOWB versus approximately $47 million for LP. National-scale prehospital transfusion will require coordinated EMS-hospital rotation, major donor recruitment for LTOWB, and targeted investment. A hybrid LTOWB-LP strategy may provide the most feasible path to broader implementation.