Despite men demonstrating high levels of grief and mental health difficulties after baby loss, support services predominantly focus on women. There is little known about the role of sport, football and targeted peer support for men who have experienced baby loss. To examine men's experiences of accessing football-based baby loss bereavement support and the self-reported impact of the sessions on men's grief and mental health. This project was designed with three men who have experienced baby loss. The study used a sequential QUAL-qual multimethod exploratory design. An online anonymous qualitative survey was distributed to all men who had attended a football session. A group discussion then considered the findings from the survey to add further depth to our understanding. Data were analysed using qualitative content analysis. Consent was obtained from all participants. Staff with mental health training were present during the discussion. Twenty-one survey responses were received, and 11 men participated in the group discussion. Participants reported the limited targeted support available for men after baby loss, and that the football sessions provided a safe space to talk with other men who had a shared journey and experiences and that the football focus helped break down barriers and challenge the myths surrounding men and grief. The football-based sessions were described as life-changing and life-saving. The study highlights the need to dispel myths surrounding men's grief after baby loss and emphasises the importance of football-based bereavement support in addressing men's mental health.
Diabetic kidney disease (DKD), the leading cause of end-stage renal disease, involves injury across multiple renal compartments. Autophagy dysregulation is a key pathogenic mechanism and may reduce Klotho, a renoprotective protein diminished in DKD. This study evaluated whether bone marrow-derived mesenchymal stem cells (MSCs), combined with empagliflozin and calorie restriction, could modulate autophagy and preserve Klotho expression in DKD. Male BTBRob/ob mice, a leptin-deficient model that develops diabetes and DKD in a progressive manner, were assigned to experimental groups and euthanized at 14-15 or 18-20 weeks. Kidney tissues were analyzed by qPCR, Western blot, and immunohistochemistry. MSCs therapy improved hyperglycemia in a time-dependent manner (p < 0.0001), decreased albuminuria, and modestly improved eGFR, though weight gain persisted. Treatment modulated LC3 protein expression in cortical and medullary regions (p < 0.05), suggesting attenuation of early autophagy hyperactivation. It also helped maintain Klotho expression, correlating with reduced oxidative stress (p < 0.05). Overall, MSCs combined with empagliflozin and calorie restriction show promise as a translational approach for DKD, warranting further long-term preclinical studies.
Norovirus and sapovirus (both Caliciviridae) are common causes of viral gastroenteritis and may pose clinical challenges, particularly in immunocompromised patients. We present 3 pediatric kidney transplant cases seen at Başkent University Hospital to highlight variability in clinical presentation and management of norovirus and sapovirus infection in transplant recipients. Case 1 (18-year-old male, transplant 13 years earlier)presented with acute onset watery diarrhea and mild dehydration. Direct microscopic stool examination was unremarkable, and norovirus was detected on viral panel testing. Supportive therapy proved effective without immunosuppression adjustment. Symptoms resolved within 1 week, with stable renal function. Case 2 (10-year-old male, transplant 1 year earlier) presented with prolonged diarrhea, weight loss, and worsening kidney functions. Polymerase chain reaction detected norovirus in stool. Severity and duration of symptoms required hospitalization and intravenous hydration. Temporary immunosuppression reduction helped control viral infection; recovery was slow (several weeks) with intermittent relapses. Clinical symptoms ameliorated with oral human immunoglobulin therapy, highlighting its potential to manage severe norovirus gastroenteritis in immunocompromised pediatric transplants. Case 3 (9-year-old male, transplant 5 years earlier) presented with watery diarrhea lasting for 3 months, dehydration, and weight loss. Laboratory analysis revealed increased serum creatinine. He was hospitalized with intravenous hydration. Stool polymerase chain reaction revealed sapovirus as the cause. His kidney function slowly recovered with extensive hydration and close monitoring. Norovirus and sapovirus are common enteric pathogens that usually cause acute gastroenteritis. In solid-organ transplant recipients, these viruses can cause prolonged, severe gastroenteritis, which can lead to dehydration, weight loss, and possible graft loss. Solid-organ transplant recipients are immunocompromised, so disease course can be severe and management can be difficult. Patients may need hospitalization and immunosuppression adjustment. Early diagnosis and tailored supportive treatment are necessary to avoid complications. In selected patients, other treatments (eg, orally administered human immunoglobulin) could be used.
Clinical decision support (CDS) systems can improve care quality, but their implications for equity remain uncertain. We examined whether provider response to CDS alerts differed by patient race and sex in primary care, and whether differences in alert exposure helped explain any observed variation. We conducted a retrospective study using EHR data from a New York City academic health system, focusing on alert-based CDS during outpatient primary care. Logistic regression was used to estimate the likelihood of alert engagement by patient race and sex, while adjusting for encounter and provider factors. We used a generalized structural equation model to assess mediation by alert type, decomposing direct and indirect effects of demographics on response.Direct effects suggest that providers may respond differently to alerts based on patient identity, consistent with interpersonal bias, in which implicit or explicit attitudes shape clinical behavior, and on the context of the visit. Indirect effects highlight disparities in how alerts are assigned across groups, indicating that algorithmic or systemic bias may be embedded within the technology itself. Estimated mediated pathways suggest that even when providers respond uniformly to alerts, unequal exposure can still produce inequitable outcomes. The findings highlight that the type of CDS triggered plays a significant role in differential CDS responses, with provider- and patient-related factors evident in these differences. These findings underscore the need to evaluate not only provider behavior but also the logic and distribution of CDS tools themselves, as both can contribute to disparities in care delivery. Further research should also focus on looking for the potential health impact of the differential response. Digital tools meant to standardize care can unintentionally contribute to which patients receiving care. We investigate whether providers' use of these tools is related to a patient's identity or influenced by the types of tools provided to them in primary care. Using electronic health record data from a large urban health system, we find that providers' responses to alerts are shaped not only by patient identity but also by the nature of the alert itself. Direct effects suggest that providers may engage differently with CDS based on patient demographics, indicating potential interpersonal bias. Indirect effects reveal that certain patient groups are more or less likely to receive specific types of alerts, indicating embedded algorithmic or systemic bias. These findings underscore the importance of evaluating both provider behavior and the design of CDS tools when assessing equity in digital health. Even when providers respond consistently, unequal exposure to alerts can produce inequitable outcomes. Our results underscore the need for more transparent and equity-aware CDS design and implementation strategies that consider both human and technological sources of bias.
Extracorporeal membrane oxygenation, although lifesaving, is invasive. Complications affecting all body systems mandate reevaluation of goals of care. When extracorporeal membrane oxygenation is nonbeneficial, planning for de-escalation/decannulation to allow natural death must occur. In a tertiary care facility with 64 beds using extracorporeal membrane oxygenation, practices varied regarding extracorporeal membrane oxygenation initiation, patient/family communication, futility determination, and symptom management during de-escalation. Symptom management during transition to comfort-directed care was suboptimal, increasing patient, family, and team discomfort. The goals of this quality improvement project were to mitigate practice variability and improve patient experience and communication, allowing for comfortable, natural death. Palliative care integration, literature review of best practices, and creation of an interprofessional task force were process improvements during extracorporeal membrane oxygenation de-escalation. New clinical guidelines provided structure, consistency, and evidence-based care processes mitigating practice variability during de-escalation/decannulation. Successful guideline implementation decreased practice variability, lessening patient/family stress and discomfort. After implementation, team member self-reports of secondary trauma and moral distress symptoms during extracorporeal membrane oxygenation de-escalation/decannulation decreased. Team members reported improved end-of-life care delivery with family education and support, patient advocacy, and symptom management. Family members appreciated attention to the patient's and their own well-being during end-of-life care. Structured debriefings helped staff members process feelings toward end-of-life care and identified opportunities for improvement. Guideline application decreased practice variability in extracorporeal membrane oxygenation de-escalation/decannulation, incorporating patient and family preferences. Death became more comfortable and dignified. Decreased practice variability and proactive symptom management improved patient/family experience.
Cognitive impairment is an inclusive term used to describe the impairment of different domains of cognition. It is a growing public health concern and it can be influenced by hyperthyroidism. While the association between hyperthyroidism and cognitive impairment had been documented in other settings, evidence from Ethiopia remains limited. The aim of this study was to determine the prevalence of cognitive impairment and the associated factors among hyperthyroid patients attending Bale zone hospitals, Southeast Ethiopia. An institution-based cross-sectional study was conducted from February to May 2024 among 406 hyperthyroid patients selected using a systematic random sampling technique. Cognitive impairment was assessed using the Mini Mental State Examination (MMSE) tool. Data were entered into EpiData Manager version 4.6.0.0 and exported to STATA version 17 for statistical analysis. The analysis began with descriptive statistics, followed by binary logistic regression. Variables with a p value < 0.25 in bivariable analysis were entered into multivariable binary logistic regression. The strength of association was determined by the adjusted odds ratio with a 95% confidence level. The prevalence of cognitive impairment was 29.06% (95% CI: 24.84-33.68). The odds of cognitive impairment were higher in females, rural residents, and those with primary education. Older age (AOR = 1.09), higher free triiodothyronine levels (FT3) (AOR = 1.03), poor sleep quality (AOR = 2.24), and lower wealth (middle: AOR = 0.18; rich: AOR = 0.19) were linked to higher odds of cognitive impairment. Avoiding alcohol consumption (AOR = 0.16) helped lower the odds of cognitive impairment. Cognitive impairment is a significant health problem among hyperthyroid patients in southeast Ethiopia. Old age, higher FT3 levels, poor sleep quality, and low socioeconomic status are the key associated factors.
Glucocorticoids remain an important anti-inflammatory therapy for IgA nephropathy but are associated with substantial treatment-related adverse effects, highlighting the urgent need for early prediction of treatment efficacy. We hypothesized that randomized controlled trial-based serum proteomic profiling could delineate glucocorticoid-modulated proteins and more accurately stratify patients likely to benefit from glucocorticoid therapy. We performed proteomic analyses of samples from the TESTING trial, in which patients with IgA nephropathy were randomized to receive methylprednisolone or placebo. 479 longitudinal serum samples from 241 Chinese participants collected at baseline and at 6 and 12 months were analyzed. Linear mixed effect models were used to identify glucocorticoid-modulated proteins and pathways in the methylprednisolone group relative to placebo. Cox proportional hazards and penalized ridge regression models were used to prioritize proteins and develop a prediction model for therapeutic efficacy. The candidate proteins were further validated by ELISA. Among more than 1,500 detected proteins, 302 were glucocorticoid-modulated and enriched in pathways of cytoskeletal stabilization and immunometabolism. Notably, pathways associated with long-term eGFR decline, such as complement activation and endothelial injury, were not modulated by glucocorticoids. Among the glucocorticoid-modulated proteins, Cox proportional hazards and penalized ridge regression models identified those whose baseline levels improved prediction of treatment efficacy compared to clinical variables alone. ELISA validated selected candidate proteins LEP and C1QTNF5. The prediction model incorporating these two proteins significantly outperformed the traditional clinical model in predicting glucocorticoid efficacy (5-year AUC, 0.85 [95% confidence interval (CI), 0.72 to 0.88] versus 0.80 [95% CI, 0.78 to 0.91]). Data from this randomized trial-based proteomic study helped delineate glucocorticoid-modulated proteins and pathways, and identified robust protein biomarkers that enabled stratification of patients likely to benefit from glucocorticoid therapy.
Drug-related problems (DRPs) are important medication management issues that are associated with adverse health outcomes. Limited studies have assessed the frequency of DRPs in primary healthcare in Jordan. The present study aimed to apply an innovative approach to identify DRPs utilizing a pretested survey. A cross-sectional observational study was conducted to assess the presence of DRPs among attendees of several primary healthcare centers in Jordan. A pretested survey was used to identify DRPs in a user-friendly, simple way, and the identified DRPs were classified using the Hepler and Strand classification system. Factors associated with having a DRP were assessed using logistic regression analysis. The present study included 582 patients. Among the patients included, 59.4% had at least one DRP. The most frequently encountered DRPs were patient-reported ineffective medicine (28.7%) and non-adherence to medications (21.4%). Independent predictors of having a DRP were patients who attended the healthcare center for a routine checkup (odds ratio 2.112, P < .001) and those who were prescribed multivitamins (odds ratio 2.882, P = .044). Knowledge about medication indication for all medications was a protective predictor of having a DRP as opposed to no knowledge about the medication indication (odds ratio 0.134, P = .010). Our results highlighted that the use of this simple survey helped identify DRPs within the healthcare centers, and indeed, it documented the significance of the DRPs in primary healthcare centers, as such efforts are highly recommended for increased provision of pharmaceutical care interventions in this healthcare setting.
This article aims to describe several "ups and downs" in the tumultuous life of Charles-Édouard Brown-Séquard (1817-1894). The posthumous son of an American father and a French mother-whose surnames he combined-he was born and spent his youth on the island of Mauritius, then a British possession but largely French-speaking, before leaving for Paris, where he was advised to devote himself to medicine rather than literature, his first ambition. His medical studies were interrupted by the sudden death of his mother and a first, temporary return to Mauritius. When resumed in Paris, they culminated in a doctoral thesis on the physiology of the spinal cord. Despite precarious financial circumstances and a cholera epidemic (1848), Brown-Séquard continued his research on a wide range of subjects, including some rather unusual interspecific organ grafts. At the same time, he refined the description of the symptoms of the spinal cord lesion syndrome that still bears his name, demonstrated the crossing of sensory pathways within the spinal cord, and, through experiments on the rabbit's ear, showed the role of vasomotor innervation. Unable, because of his status as a British subject, to obtain a permanent position in France, he spent thirty years traveling and working abroad, particularly in the United States (with 60 transatlantic crossings), in Philadelphia, New York, and Richmond, and later in London or Dublin and Boston at Harvard. After the death of Claude Bernard, he obtained French naturalization, which allowed him to stand for the Chair of Medicine at the Collège de France, to which he was elected in 1878, as well as to the Académie des Sciences in 1886. Until his death in 1894, he devoted himself to describing the effects of regenerative treatments using extracts from glands or organs (organotherapy or opotherapy), anticipating in particular-through his work on the adrenal glands-the field that would later become endocrinology. Together with d'Arsonval, he promoted this method among physicians before the press and the general public took hold of it, giving him a somewhat controversial reputation. A tireless worker, extremely courageous, selfless, eccentric, and stubborn in both error and truth, Brown-Séquard emerges as a nineteenth-century scientist as singular as he was endearing. The Société de Biologie, which he helped to found in 1848 (along with several scientific journals) and which he later presided over (1887-1891), owes him this tribute (abstract établi avec l'aide de Chat GPT). Un chercheur inspiré et vagabond : Charles-Édouard Brown-Séquard (1817–1894). Cet article vise à décrire quelques « soubresauts » de la vie tumultueuse de Charles-Édouard Brown-Séquard (1817–1894). Fils posthume d’un américain et d’une française dont il associera les noms, il naît et passe sa jeunesse à l’Île Maurice, alors possession anglaise mais largement francophone, avant de partir pour Paris où on lui conseille de se consacrer à la médecine plutôt qu’à la littérature, son ambition initiale. Ses études médicales sont interrompues par la mort subite de sa mère et un premier retour, provisoire, à Maurice ; reprises à Paris, elles aboutissent à une thèse de doctorat sur la physiologie de la moelle épinière. Malgré une situation matérielle précaire et pendant l’épidémie de choléra (1848), Brown-Séquard continue ses travaux de recherche sur des sujets très divers, notamment des greffes interspécifiques d’organes, mais il affine également la description des symptômes du syndrome de lésion spinale qui porte toujours son nom et démontre le croisement dans la moelle de certaines voies sensorielles ainsi que, sur l’oreille de lapin, le rôle de l’innervation vaso-motrice. Ne pouvant, par son statut de sujet britannique, obtenir en France de poste permanent, il va pendant trente ans multiplier les voyages et les séjours à l’étranger, notamment aux États-Unis (60 traversées transatlantiques), à Philadelphie, New York, Richmond puis à Londres et Dublin et à Boston (Harvard). C’est au moment de la mort de Claude Bernard qu’il obtient enfin sa naturalisation française, ce qui lui permet d’être candidat à la chaire de Médecine du Collège de France où il est élu en 1878 ainsi qu’à l’Académie des Sciences en 1886. Jusqu’à sa mort en 1894 il se consacre à la description des effets de traitements régénérateurs par des extraits de glandes ou d’organes (opothérapie) avec la prescience, en particulier sur les surrénales, de ce qui deviendra l’endocrinologie. Avec d’Arsonval il diffuse la méthode parmi les médecins avant que la presse et le grand public ne s’en emparent, lui conférant une renommée un peu sulfureuse de « savant fou ». Bourreau de travail (et de beaucoup d’animaux...), courageux à l’extrême, désintéressé, excentrique, entêté dans l’erreur comme dans la vérité, Brown-Séquard apparaît comme un savant du XIX e siècle aussi singulier qu’attachant. La Société de Biologie, qu’il a présidée de 1887 à 1891 et dont il avait participé en 1848 à la fondation ainsi qu’à celle de plusieurs revues scientifiques, se doit de lui rendre hommage.
Positron emission tomography (PET) and computed tomography (CT) are non-invasive imaging techniques that utilise radionuclide pharmaceuticals to evaluate biochemical and functional processes within the human body. In the United Kingdom (UK), PET-CT services are delivered by a multidisciplinary workforce. As demand increases annually, adaptable departmental leadership is essential. This was a two-phase mixed-methods workplace culture study appling the Context Assessment Index (CAI) tool (n = 37 question quantitative survey) to assess workplace culture, leadership, and evaluation. The second phase involved observational visits (n = 6 sites in the southwest of England), utilising the Workplace Culture Critical Analysis Tool (WCCAT) to observe the workplace culture, context, values, communication, and daily tasks. Data analysis included descriptive statistics for the CAI data and thematic coding and text analysis for the WCCAT data to identify recurring themes and patterns. The phase one CAI characteristics were scored as 78.8% for culture, 77.7% for leadership and 76.8% for evaluation. Phase two WCCAT observations identified nine common themes across all sites: leadership support, physical environment issues, cross-team and interdisciplinary communication and cohesion, career progression, workload balance, and resources and equipment. The study's limitations acknowledge the constraints of the sample size and geographic representation. The findings provide an insight into the workplace culture, leadership and evaluation of PET-CT departments in the southwest of England. The observational data helped identify where future improvements to service delivery and patient experience could be implemented. Communication within and between sites provided strong evidence of staff cohesion, ensuring continuous service delivery. The potential for transformative leadership support for workforce career development might mitigate future staff burnout and attrition and promote career progression.
BackgroundHIV-associated lipodystrophy, a complication of combined antiretroviral therapy (CART), causes significant physical and psychological distress in people living with HIV (PLWH), compromising treatment adherence. Tesamorelin, a growth hormone-releasing hormone (GHRH) analogue, has emerged as a therapeutic option.ObjectiveTo systematically evaluate the efficacy and safety of tesamorelin in HIV-infected individuals with lipodystrophy receiving CART, incorporating GRADE assessment.MethodsWe searched PubMed, https://ClinicalTrials.gov, and Scopus from inception to February 9, 2026, for randomized controlled trials evaluating tesamorelin in HIV-associated lipodystrophy. Mean differences (MD) and risk ratios (RR) with 95% confidence intervals (CI) were calculated using random-effects models with heterogeneity assessed by I2.ResultsFour RCTs (909 patients) were included. Tesamorelin 2mg significantly reduced visceral adipose tissue (MD= -21.47, 95%CI[-34.73,-8.22],I2=74%,p=0.002), waist circumference (MD-1.61cm,95% CI[-2.28,-0.95],I2=0%,p<0.00001), trunk fat (MD-1.20kg, 95%CI[-1.47,-0.93],I2=0%,p<0.00001), and increased lean body mass (MD1.42kg,95% CI[1.13,1.71],I2=0%,p<0.00001). Modest lipid improvements occurred in total cholesterol (MD-0.16mmol/L,95%CI[-0.27,-0.06],I2=0%,p=0.003). Growth hormone-related adverse effects and higher discontinuation rates (RR2.25,95%CI[0.98,5.17],p=0.06) were observed.ConclusionsTesamorelin demonstrates efficacy in reducing visceral adiposity in PLWH with lipodystrophy on CART. However, limited data on long-term safety, optimal dosing strategies, and durability of treatment effects warrant caution. Future research should evaluate extended treatment duration, dose-response relationships, and patient-reported outcomes to establish comprehensive clinical utility. Rarely, people living with HIV can develop changes in their normal body fat distribution, known as lipodystrophy, as a side effect of their treatment with cART. This can cause physical discomfort and emotional distress, and may affect their will to continue their medication. Tesamorelin is a medication that may help reduce these fat changes. In this study, we reviewed and combined results from four clinical trials involving 909 people with HIV. We found that tesamorelin helped reduce harmful fat around the abdomen, and reduced waist size and trunk fat. It also increased lean body mass and slightly improved cholesterol levels. However, some side effects related to growth hormone were reported, and more people stopped treatment compared to those not receiving the drug. Overall, tesamorelin appeared quite useful as long as it is continued, but more research is needed to understand its long-term safety and benefits.
Wubao capsule (WBC) possesses bleeding and relieving pain, with favourable clinical efficacy in asthma. This study aimed to investigate the molecular mechanisms of WBC in treating asthma. A total of 37 compounds were characterised in WBC using HPLC-Q-TOF-MS. WBC effectively alleviated pathological damage and inflammatory cell infiltration in the asthma model. Moreover, it decreased Th17 cells (CD4+IL-17A+) and the levels of IL-1β, IL-17, and IL-23 in PBMC, and increased Treg cells (CD4+CD25+Foxp3+) and IL-10 level. WBC effectively inhibited the EGFR-PI3K-AKT pathway. The efficacy of WBC exhibited a dose-dependent pattern and was comparable to that of Dexamethasone. WBC was found to contain 86 effective ingredients and 204 targets, including 66 targets related to asthma. Fourteen targets were associated with the EGFR-PI3K-AKT pathway. In conclusion, WBC ameliorated pathological damage and inflammatory cell infiltration in asthma and helped restore Th17/Treg homeostasis by inhibiting the EGFR-PI3K-AKT pathway.
Pediatric nurses carry heavy emotional and clinical demands that leave them vulnerable to burnout. Trauma-Informed Care (TIC) has helped ease burnout in the workplace, but psychological factors like Impostor Syndrome (IS) may weaken these benefits. Whether IS mediates the TIC-burnout link has not been well studied. To examine the mediating effect of impostor syndrome on the association of trauma-informed care with burnout in pediatric nurses. A descriptive cross-sectional study was conducted in six hospitals of Mansoura City, Egypt, between October 2024 and January 2025, with a sample size of 251 pediatric critical care nurses (96.5% response rate). Instruments included Trauma-Informed Care Scale, Maslach Burnout Inventory, and Clance Impostor Syndrome Scale. Data were analyzed by means of Pearson correlation, multiple linear regression, and mediation analysis through PROCESS macro with 5000 bootstrap samples. Impostor syndrome was the strongest predictor of burnout (β = 0.383, p < .001), followed by attitude toward TIC (β = 0.234, p = .047). Female nurses reported lower burnout, though only IS acted as a mediator. IS partially mediated the association of TIC with burnout (indirect effect = 0.15, 95% CI (0.06, 0.24)), with the model explaining 50.3% of burnout variance. Impostor syndrome has the potential to alter the work requirements of TIC into further vulnerability to burnout. Comprehensive support for pediatric nurses should incorporate trauma-informed practices alongside programs and strategies to ameliorate the experience of self-doubt, thus improving well-being and care quality.
Student engagement in music classrooms is important because it reflects students' active participation in listening, performing, and creative activities and is associated with academic, social, and psychological outcomes. Although teacher support has been widely linked to student engagement, the indirect association between perceived teacher support, music learning motivation, and engagement in music education remains underexplored, especially in general school settings. This mixed-methods study examined associations among students' perceived teacher support, music learning motivation, and engagement in junior high school music classrooms. Survey data were collected from 568 junior high school students in urban and rural areas of Liaoning Province, Northeast China. Quantitative analyses examined associations among perceived teacher support, music learning motivation, and student engagement, and the SPSS PROCESS macro with 5,000 bootstrap samples was used to estimate the statistical indirect association. Semi-structured interviews with 15 students were analyzed through a three-level coding procedure to explain students' learning experiences. The results showed significant positive associations among perceived teacher support, music learning motivation, and student engagement. Music learning motivation was statistically associated with the link between perceived teacher support and student engagement, and the bootstrap confidence interval for the indirect association did not include zero. Qualitative findings indicated that encouragement, emotional care, clear explanation, interactive support, and content aligned with students' interests and abilities helped explain how students translated supportive classroom experiences into confidence, interest, and willingness to participate. Because the study used cross-sectional self-report data, the findings should be interpreted as associational rather than causal.
Clostridioides difficile infection (CDI) epidemiology has evolved over the past 3 decades. In the early 2000s, incidence and severity surged, driven by hypervirulent strains, extensive use of broad-spectrum antibiotics, an aging population, suboptimal infection-control practices, and highly sensitive molecular diagnostics. During the same period, community-associated CDI (CA-CDI) emerged affecting a different population. Recent optimization of infection prevention, antimicrobial stewardship, and multi-step diagnostic algorithms have helped curb hospital-acquired CDI. However, CA-CDI accounts for approximately half of all CDI cases and is rising. These trends underscore the need for continued surveillance, targeted prevention strategies, and enhanced access to effective treatments.
Introductory biology instructors contend with the tension between the inherent complexity of the discipline and cognitively overloading their students. While oversimplification may promote misconceptions, without sufficient simplification, students may fail to grasp a basic understanding of disciplinary concepts. In genetics education, evidence is mounting that the risks associated with oversimplifying far outweigh the benefits, as emphasizing Mendelian principles while neglecting the role of environment not only fails to reflect our current understanding of genes and genomes but can also inadvertently reinforce the misinformed belief that genes alone determine people's physical, cognitive, and behavioral characteristics. Examples and activities featuring human pedigrees can be particularly insidious. While excellent tools for helping students apply fundamental genetics concepts and practice analytical skills, they reduce phenotypic variation to a dichotomous "affected" vs. "unaffected" model with perfectly Mendelian inheritance and the underlying, unspoken assumption that phenotype is entirely determined by genotype. There is a need for instructional resources that present genetics in a way that better reflects present-day knowledge, make light of the complexities hidden behind pedigree charts, and allow students to appreciate the multifactorial nature of phenotypic variation, and the challenges of classifying individuals into discrete categories. To help fill this gap, we offer an engaging lesson that promotes critical pedigree analysis skills and honors the complexities of phenotypic variation.
Organ transplantation functions as a critical medical procedure that serves patients with severe multiorgan conditions and chronic diseases. Early and accurate predictions of requirements for transplant enhance patient care through better clinical choices and improved resource allocation and treatment selection. We developed a complex artificial intelligence forecasting system to determine organ transplant needs, specifically kidney diseases by analyzing clinical data. Accurate and timely prioritization of patients for kidney transplant is a critical challenge due to organ scarcity and the complexity of clinical decision -making. In this study, we propose an artificial intelligence -driven predictive framework to assess kidney transplant necessity by integrating patient demographics, clinical severity indicators, donor matching status, and real -time organ condition data. We analyzed a structured dataset consisting of 1000 kidney transplant records with 25 attributes by using ensemble learning models, including random forest and gradient boosting, and a deep neural network model. The prediction task was formulated as a binary classification problem reflecting real -world transplant outcomes. Experimental results demonstrated that the deep neural network consistently outperformed ensemble -based models, achieving superior accuracy, precision, recall, and F1 -score with an area under the receiver operator characteristic curve of 0.95. Threshold -based sensitivity analysis confirmed that the deep learning model provided a clinically favorable trade -off between high sensitivity and acceptable specificity. The proposed approach shows promising results in helping medical professionals detect organ transplant candidates through complex risk evaluation assessments.
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Center-based cardiac rehabilitation (CR) is the standard of care for patients with cardiovascular disease. However, access limitations have led to increased interest in home-based alternatives. This study aimed to compare the effects of home-based and center-based CR in an Iranian population. In this randomized controlled trial, 236 patients with cardiovascular disease were randomized to receive either home-based (n = 107) or center-based (n = 129) CR. Interventions lasted 8 weeks, with outcomes assessed at baseline and 6 months. The primary outcome was the change in exercise capacity. Secondary outcomes included exercise capacity, maximum heart rate, blood pressure (BP), lipid profile, fasting blood sugar, body mass index, and waist circumference. Between-group analysis using ANCOVA, adjusting for baseline values, showed that center-based CR was significantly more effective in improving exercise capacity (11.49 ± 0.22 vs 13.65 ± 0.19, p < 0.001), systolic BP (122.08 ± 1.33 vs 116.58 ± 1.17, P = 0.005), and diastolic BP (79.83 ± 0.84 vs 74.35 ± 0.74, p < 0.001). No significant between-group differences were observed in other variables. Both home-based and center-based CR improved exercise capacity; however, center-based CR achieved superior gains and better blood pressure control. Home-based CR may be a practical alternative when access to supervised programs is limited. www.IRCT.iridentifier:IRCT20201028049181N1. Cardiac rehabilitation is a structured program that helps people recover after heart disease or heart surgery. It usually includes supervised exercise, lifestyle advice, and support to reduce the risk of future heart problems. These programs are often delivered in hospitals or specialized centers, but some patients cannot attend because of distance, cost, work commitments, or other barriers. Home-based rehabilitation may offer an alternative.In this study, we compared home-based and center-based cardiac rehabilitation in patients with heart disease in Iran. Participants were followed for six months, and we measured their physical fitness, blood pressure, and other heart-related risk factors.Both types of rehabilitation improved physical fitness. However, patients in the center-based program showed greater improvement in physical fitness and better blood pressure control. For other risk factors, such as cholesterol and blood sugar, results were similar between the two groups.These findings suggest that while center-based programs may provide greater overall benefit, home-based rehabilitation can still be a helpful option for patients who are unable to attend supervised sessions.
Spinal muscular atrophy (SMA) research has focused predominantly on paediatric populations, with limited adult data from low- and middle-income countries (LMICs). We prospectively recruited suspected SMA patients (age ≥ 12 years) into a neuromuscular disease cohort at a tertiary centre in northern India, using phenotyping, creatine kinase, electrophysiology and genetic testing. Forty genetically confirmed patients were included (median age 20.5 years; mean symptom duration 14.7 ± 10.9 years). Proximal lower-limb weakness was the commonest presentation (82.5%). Forty-five percent were misdiagnosed as muscular dystrophy or congenital myopathy. Three SMA patients received risdiplam. Our cohort highlights the diagnostic challenges of adult SMA and supports a genetics-first approach. Early genetic confirmation shortens diagnostic delay, reduces misclassification and helps eligible patients benefit as disease-modifying therapies become more affordable in resource-limited settings.