Esthetic dentistry increasingly emphasizes patient-centered treatment planning and effective communication between clinicians and patients. Conventional consultation methods often rely on verbal explanations and static images, which may not adequately convey the expected esthetic outcomes. Digital Smile Design (DSD) has emerged as a modern digital tool that allows clinicians to simulate potential smile outcomes. This digital approach may improve patient understanding, enhance confidence in treatment planning, and increase patient satisfaction with the consultation process. This study aimed to evaluate the impact of DSD on patient satisfaction and treatment acceptance during esthetic dental consultation. This prospective clinical study was conducted in the Department of Restorative Dentistry and included 80 patients who sought esthetic dental treatment. Following a conventional consultation involving a clinical examination and verbal explanation of the treatment plan, patient perceptions were recorded. A digital smile simulation was then generated using the Smile Designer Pro software (Tasty Tech Ltd., London, United Kingdom) and presented to the patients. Patient understanding of the treatment plan and confidence in the proposed treatment were assessed before and after the digital smile simulation using a 5-point Likert scale. Overall satisfaction with the consultation process was evaluated using a 10-point Visual Analog Scale (VAS). Statistical analysis was performed using IBM SPSS Statistics for Windows, Version 20 (Released 2015; IBM Corp., Armonk, New York). Descriptive statistics were calculated, and pre- and post-consultation scores were compared using a paired t-test with a significance level set at p < 0.05. A significant improvement in patient understanding and confidence was observed following the DSD consultation. Scores related to the clarity of procedures, understanding of treatment duration, costs, and limitations increased significantly after digital visualization (p < 0.001). Patient confidence in the anticipated final smile, confidence in the dentist, certainty of proceeding with treatment, and ability to visualize the expected outcome also improved significantly (p < 0.001). Overall, satisfaction with the consultation process was high, with the majority of participants reporting improved communication and greater involvement in treatment planning. In addition, 85% of the patients accepted the proposed treatment following digital smile simulation. DSD significantly enhanced patient understanding, confidence, satisfaction, and treatment acceptance during esthetic dental consultation. Its integration into clinical practice may improve communication and promote predictable patient-centered treatment planning in esthetic dentistry.
This study examined the relationship between alarm fatigue and turnover intention among dialysis nurses and investigated the mediating role of professional quality of life (ProQOL). An analytical cross-sectional study was conducted. This study employed a nonprobability sample of 140 dialysis nurses from hospitals affiliated with Shahid Beheshti University of Medical Sciences in Iran in December 2024. Data for this study were collected via a multi-section survey. This research initially focused on identifying demographic and occupational variables. Section two employed the Alarm Fatigue Questionnaire; section three, the ProQOL scale; and section four, the Turnover Intention Questionnaire. Data analysis was carried out using IBM SPSS Statistics, version 27.0. The mean scores for alarm fatigue and turnover intention were 34.02 (SD = 8.50) and 48.70 (SD = 11.66), respectively. Item-level means for alarm fatigue were 2.62 (SD = 0.65) on a 0-4 scale. Also, scores were 3.30 (SD = 0.81) for secondary traumatic stress (STS), 3.61 (SD = 0.90) for compassion fatigue (CF), 3.01 (SD = 0.78) for compassion satisfaction (CS), and 3.25 (SD = 0.78) for turnover intention on 1-5 Likert-type scales. Pearson's correlation showed that alarm fatigue was positively correlated with STS, CF and turnover intention, and negatively correlated with CS. Multiple linear regression explained 62.9% of the variance in turnover intention; single marital status, CS, CF and STS were significant independent predictors. Path analysis showed a significant total association between alarm fatigue and turnover intention, a non-significant direct association, and a significant indirect association through ProQOL components, a pattern consistent with mediation by ProQOL. Path analysis showed a pattern of associations consistent with ProQOL mediating the relationship between alarm fatigue and turnover intention. The association between alarm fatigue and turnover intention appeared to operate primarily in association with STS, compassion fatigue, and compassion satisfaction, although the cross-sectional design precludes causal inference. These findings are consistent with the hypothesis that improving ProQOL may be associated with a weaker link between alarm fatigue and turnover intention, though this should be confirmed in longitudinal studies.
Thermal sterilization often compromises beverage quality, making non-thermal sterilization a potential alternative. This study systematically compared the effects of high pressure processing (HPP) and ultra-high temperature (UHT) sterilization on the quality of Longjing peach tea beverage. Through sensory evaluation, physicochemical analysis, and multi-platform metabolomics combined with multivariate statistics, it was found that UHT significantly reduced acceptability, enhanced cooked off-flavor and astringency, and accelerated browning. In contrast, compared to UHT, HPP resulted in a sensory profile that was markedly closer to that of the untreated control, albeit with some observable quality deviations such as slight changes in flavor and specific metabolites. The L*, a*, and b* values of the beverage served as effective indicators for distinguishing sterilization methods and monitoring quality changes. UHT induced substantially greater alterations in metabolites than HPP, leading to a notable "flavor imbalance." Thirty-one flavor compounds associated with key sensory attributes were identified, revealing that the quality deterioration caused by UHT was mainly attributed to the loss of heat-sensitive flavor substances and the formation of Maillard reaction and thermal oxidation products. The impact of HPP, however, primarily resulted from the release and complexation of compounds under high pressure. This research elucidated the differential effects of the two sterilization techniques at both sensory and compositional levels, providing a scientific basis for process selection and quality monitoring in the production of high-quality fruit tea beverages.
A higher urinary sodium-to-potassium (Na/K) ratio has been associated with increased risk of hypertension and cardiovascular diseases, which are known risk factors for Alzheimer's Disease (AD). Mendelian Randomization (MR), which uses genetic variants as instrumental variables to infer causality while reducing confounding and reverse causation, was applied to investigate whether the urinary Na/K ratio is causally associated with AD risk. A two-sample MR study was conducted using 31 single-nucleotide polymorphisms associated with urinary Na/K ratio as instrumental variables. The primary analysis employed Genome- Wide Association Study (GWAS) summary statistics for AD (n=85,934 individuals, including ADby- proxy). For sensitivity analysis, GWAS data specific to clinically diagnosed late-onset AD (n=21,982 individuals) were analyzed. Genetically predicted urinary Na/K ratio was not statistically significantly associated with AD risk in the primary analysis; odds ratio (OR per 1 mol/mol increase) = 1.02, 95% confidence interval (CI): 0.77-1.36. In the sensitivity analysis using clinically diagnosed late-onset AD, the point estimate was higher (OR = 1.49, 95% CI: 0.99-2.24), although the association was not statistically significant. Although no statistically significant causal association was observed, the study's findings may be consistent with previous observational studies linking higher sodium intake or a higher urine Na/K ratio to poorer cognitive performance. However, the sensitivity analysis suggested a possible association that warrants further investigation in larger MR studies using clinically confirmed AD datasets. As all data were derived from individuals of European ancestry, generalizability to other populations may be limited. This MR study did not provide clear evidence supporting a causal association between urinary Na/K ratio and AD risk.
Respectful maternity care (RMC) ensures that every childbearing woman is treated with dignity, safety, and respect. Health care professionals play a critical role in RMC but can also contribute to disrespectful and abusive practices, inflicting lasting trauma. Educating pre-service health care learners is one promising strategy for change. As part of our larger Mothering and Albinism research project, we sought timely evidence to develop educational resources supporting RMC for people impacted by albinism. Our international team conducted a rapid scoping review to answer the question, "What curriculum resources are available for integrating RMC into the education of nursing, midwifery, medical, and other health care students, and what are their key pedagogical components and contextual factors shaping implementation?" We searched key databases and online sources for qualitative, quantitative, and mixed-methods studies of RMC education initiatives and curriculum resources relevant to teaching RMC to pre-service learners. Two reviewers screened abstracts/full texts, and data were charted and synthesized using descriptive statistics and content analysis. Our diverse author network was consulted to ensure rigor and relevance for a range of populations. Our analysis of 25 research reports and 8 curriculum resources produced 5 synthesized categories. The first 4 categories illuminate how RMC education initiatives are conceptualized, their core content, effective pedagogical strategies, and how researchers studied the impact of RMC education. The fifth category addresses contextual influences and the need for taking a systems perspective within RMC education initiatives. Significant gaps remain with few initiatives addressing the unique needs of structurally disadvantaged groups or including trauma-informed, violence-informed, or equity-oriented approaches. RMC education has potential, but it must be paired with systemic change and attention to equity for meaningful change. These findings lay the groundwork for developing context-specific, effective educational resources to support RMC for all women, including those impacted by albinism.
To compare the ratings of quality and risk of bias of systematic reviews/meta-analyses (SRs/MAs) in bariatric research published in 2016 and 2017 using the AMSTAR 2 and ROBIS tools. The methodology is described in detail in our first publication (Obes Rev. 2020; https://doi.org/10.1111/obr.12994). A systematic survey by searching three electronic databases was conducted to identify SRs/MAs assessing any outcome in patients with morbid obesity undergoing or scheduled for bariatric surgery published in 2016 and 2017. Pairs of reviewers independently screened titles and abstracts, assessed full texts, extracted data, and evaluated the quality and risk of bias using the AMSTAR 2 and ROBIS tools. Discrepancies were resolved by a third reviewer. Agreement between reviewers and between the instruments was assessed using Fleiss' kappa and Gwet's statistics. Matching between AMSTAR 2 items (critical and noncritical) and ROBIS signaling questions was also examined. Of the 78 included SRs/MAs, 77 (98.7%) were assessed as critically low methodological quality by AMSTAR 2, while ROBIS classified five reviews (6.4%) as low risk of bias, 61 (78.2%) as high, and 12 (15.4%) as unclear. Both tools demonstrated moderate inter-rater reliability for individual items and overall judgments. The methodological quality of SRs/MAs in bariatric research was predominantly critically low. Calibration exercises are strongly recommended before applying either tool. AMSTAR 2 and ROBIS each address a distinct research question, and tool choice should be guided by the specific study objective. PROSPERO Registration: CRD42017080394.
Health literacy (HL) is considered as one of the most important approaches for individual, societal, and systemic behavior changes that promote drug adherence. This study conducted to examined the association between health literacy and medication adherence among hypertension patients. A cross-sectional design was utilized among 175 hypertensive patients from three public hospitals. The data collection was done for a duration of six weeks between February and March 2025, by using two tools High Blood Pressure Health Literacy Scale (HBP-HLS) and the Medication Adherence Report Scale (MARS-5), via self-reported methods. Descriptive statistics, Pearson's correlation coefficients, and multiple linear regression were performed. The majority of the respondents were female (n = 100, 57.1%), with mean age was 58.4 years. The mean blood pressure readings of 142.3/87.1 mmHg. The mean total score was 22.56 (SD = 3.12) out of a possible 25, indicating a relatively high average level of self-reported adherence. In terms of total health literacy, participants had a mean total score of 30.76 out of 43 (SD = 6.42). A statistically significant with positive correlation between health literacy and medication adherence (r = 0.28, p < 0.01). Comorbidities, number of medications, educational level, income, and BMI were strong independent predictor for health literacy. Policymakers are advised to prioritize health literacy improving interventions through tailored education, simplified treatment regimens, and community-based support systems to promote sustainable, equitable hypertension care across diverse populations. • Patients with higher health literacy were more likely to take their blood pressure medications correctly, showing a significant positive relationship between the two.• Medication adherence was generally high, while health literacy was moderate, and factors like education, income, number of medications, BMI, and other illnesses influenced health literacy levels.• Improving health literacy through simple education, easier treatment plans, and community support can help patients better manage hypertension.
Genitourinary infections (GUIs) during pregnancy are a significant clinical concern linked to maternal morbidity. To investigate the potential causal effect of gut Streptococcus abundance on the risk of maternal genitourinary infection during pregnancy using Mendelian randomization (MR), we performed a two-sample MR analysis using publicly available genome-wide association study (GWAS) summary statistics. Genetic instruments for gut Streptococcus abundance were obtained from the MiBioGen consortium (N = 18,340). Outcome data for maternal genitourinary infection (ICD-10 O23.x) were sourced from the FinnGen consortium (N = 111,731). The inverse-variance weighted (IVW) method was used as the primary analysis, supplemented by sensitivity analyses including MR-Egger, weighted median, and MR-PRESSO to assess pleiotropy. We further assessed potential mediation via systemic inflammation (C-reactive protein, interleukin-6) and associations with adverse pregnancy outcomes (APOs). Genetically predicted higher gut Streptococcus abundance was associated with a reduced risk of maternal genitourinary infection (IVW odds ratio [OR] = 0.63, 95% confidence interval [CI]: 0.43-0.93, p = 0.020). Sensitivity analyses supported this protective association, with no evidence of horizontal pleiotropy (MR-Egger intercept p = 0.942) or significant heterogeneity. No causal effects were observed on systemic inflammatory markers (CRP, IL-6, all p > 0.05) or on major APOs, including postpartum haemorrhage and placental abruption. This MR study provides genetic evidence supporting a causal, protective role of gut Streptococcus against the risk of clinically diagnosed genitourinary infection during pregnancy. This effect appears specific and is not mediated through the systemic inflammatory pathways examined, suggesting a localized mechanism within the genitourinary tract.
Forced alignment is a common tool to align audio with orthographic and phonetic transcriptions. Most forced alignment tools provide only point-estimates of boundaries. The present project introduces a method of producing gradient boundaries by deriving confidence intervals using neural network ensembles. Ten different segment classifier neural networks were previously trained, and the alignment process is repeated with each classifier. The ensemble is then used to place the point-estimate of a boundary at the median of the boundaries in the ensemble, and the gradient range is placed using a 97.85 % confidence interval around the median constructed using order statistics. Gradient boundaries are taken here as a more realistic representation of how segments transition into each other. Moreover, the range indicates the model uncertainty in the boundary placement, facilitating tasks like finding boundaries that should be reviewed. As a bonus, on the Buckeye and TIMIT corpora, the ensemble boundaries show a slight overall improvement over using just a single model. The gradient boundaries can be emitted during alignment as JSON files and a main table for programmatic and statistical analysis. For familiarity, they are also output as Praat TextGrids using a point tier to represent the edges of the boundary regions.
The decriminalization of suicide under Section 115 of the Mental Healthcare Act (MHCA), 2017 marked a paradigm shift in India, reframing suicide attempts as manifestations of severe stress requiring care rather than punishment. However, gaps in clinician awareness and ambiguity regarding medico-legal responsibilities may hinder effective implementation of the law in clinical settings. This study aimed to assess non-psychiatric clinicians' awareness and attitudes regarding the decriminalization of suicide under the MHCA, 2017, and to explore potential implementation gaps. A cross-sectional questionnaire-based study was conducted among 134 clinicians from non-psychiatric departments at a tertiary-care center in central India. A structured, self-administered questionnaire assessed sociodemographic characteristics, awareness of legal provisions related to decriminalization, and attitudes toward its impact on stigma, help-seeking, and clinical practice. Descriptive statistics were computed, and subgroup comparisons based on years of clinical experience (≤1 year vs. >1 year) were performed using the chi-square test. Most clinicians were aware that suicide has been decriminalized in India (76.1%) and that individuals attempting suicide are presumed to be under severe stress (84.3%). Nearly four-fifths (79.1%) recognized the government's obligation to provide care and rehabilitation. However, 80.6% believed that reporting suicide attempts to legal authorities remains mandatory, and only 51.5% were aware of professional immunity from civil or criminal liability. Attitudes toward decriminalization were largely positive: 55.2% agreed that it reduces stigma, 56.8% felt it encourages help-seeking, and 88.8% reported a greater likelihood of psychiatric referral following decriminalization. Subgroup analysis did not reveal significant differences across experience levels. Non-psychiatric clinicians demonstrated generally favorable awareness and supportive attitudes toward the decriminalization of suicide. However, persistent misconceptions regarding medico-legal obligations suggest an implementation gap. Targeted training, legal-literacy initiatives, and clear institutional protocols are needed to ensure consistent, rights-based care in alignment with the MHCA 2017.
Predicting suicide risk remains a challenge. We examined whether neurocognitive performance on implicit associations toward suicide, motor speed, response inhibition, and executive functioning predicts suicide attempt and behavior in high-risk psychiatric patients. Our sample (N = 298) consisted of inpatients (n = 161) and outpatients (n = 83) admitted for a suicide attempt (SA; n = 78), for suicidal ideation (SI; n = 76), or were non-suicidal psychiatric controls (PC; n = 90), and healthy controls (HC; n = 54). Participants were followed for 12 months, with follow-up assessments at 3-, 6-, and 12-months. Neurocognitive tasks were administered at baseline. Clinical symptom measures, suicidality, and electronic health record data were collected at each timepoint. ANCOVA was used to compare groups on neurocognitive performance, and logistic and Cox regressions examined whether neurocognitive performance predicted future actual suicide attempt and suicidal behaviors. Participants had a mean age of 24.34 years (SD = 3.71). A total of 19 participants made an actual suicide attempt during the study. On neurocognitive tasks at baseline, the SA group had stronger implicit associations with death- and suicide-related words compared to the HC (d = 0.88, p < 0.001) and SI (d = 0.63, p = 0.005) groups and poorer executive functioning than the SI (d = 0.44, p = 0.043) group in multivariate models. Stronger implicit associations with death/suicide predicted higher risk of suicide attempts at the univariate (HR = 1.68 p = 000), but not multivariate level (HR = 1.17 p = 000), while slower motor speed predicted actual suicide attempts (HR = 1.81 p = 000) at the multivariate level. Slower motor speed predicts actual suicide attempt and may help identify psychiatric patients who are at high risk for suicidal behavior.
Perfluoroalkyl substances (PFAS) are pollutants with relevant accumulation in humans, and the enterohepatic circulation of PFAS secreted in bile sustains their persistence. A significant increase in fecal excretion has been experimentally assessed with the use of oral adsorbents with negligible gut absorption. Here, we evaluated in vitro the use of activated charcoal (AC) for human consumption, as sorption material for a panel of PFAS, such as, perfluoro-butanoic acid (PFBA), perfluoro-butanesulfonic acid (PFBS), perfluoro-hexanoic acid (PFHxA), perfluoro-hexanesulfonic acid (PFHxS), perfluoro-octanoic acid (PFOA), and perfluoro-octanesulfonic acid (PFOS), in an experimental simulated bile juice (SBJ). The aim was to obtain preliminary data for possible clinical applications to reduce PFAS blood levels in humans. PFAS concentrations in experimental samples were quantified by liquid chromatography-mass spectrometry. In kinetic tests, equimolar solutions of single PFAS in SBJ were incubated with AC at 37 °C up to 120 min, and the time-dependent reduction of PFAS concentration was monitored. In thermodynamic tests, PFAS solutions in SBJ were incubated at increasing concentrations with AC for 24 h at 37 °C and the concentrations at equilibrium evaluated. Results were finally fitted with available models in order to characterize the PFAS interaction with AC. All PFAS showed more than 80% sorption on activated charcoal from simulated bile juice within 120 min. This suggests rapid and nearly complete removal. Modeling analysis indicated that the pseudo-first-order kinetic model best described short-chain PFAS, while PFOS and PFOA fitted better with the Elovich model. Thermodynamic analysis showed a general fitting with the Freundlich model, presumptive of a heterogeneous binding model. PFOS binding was concentration-dependent and was better described by the Sips model. These data are suggestive of a potential noninvasive intervention strategy to increase fecal PFAS excretion through the dietary use of AC, in order to mitigate health issues associated with PFAS exposure.
Performing assays on large numbers of samples requires their analysis in distinct batches, which commonly affects the measurements made in a systematic way. Analytical approaches can correct for such batch effects, however for this to be possible the batch should not be confounded with either the independent variable or any covariates relevant to the analysis. Thus, how samples are distributed across batches influences subsequent analytic conclusions. We present SampleAllocateR, a tool that uses optimizsation methods from machine learning to optimally allocate a preselected set of samples to experimental batches in a way that statistically balances specified covariates between batches. This will result in better statistical estimates of the effect of not only the technical batch effects but also the other specified covariates upon the results of the experiment. SampleAllocateR accepts both continuous and categorical covariates, supports blocking of related samples (such as those from the same subject), and is tolerant of missing metadata. SampleAllocateR is freely available as an open source R package at https://github.com/CardiacProteomics/SampleAllocateR.
Emergency Department (ED) visits for ophthalmic conditions are common, yet a significant proportion of cases are non-emergent, contributing to ED overcrowding. This study examines the demographics and clinical characteristics of ophthalmic ED visits at Hadassah Medical Center in Jerusalem, Israel. A retrospective study was conducted on 1,406 patients who presented to the ophthalmic ED between January and June 2018. Data collected from electronic medical records included demographics, chief complaints, diagnoses (classified using ICD-9), and follow-up recommendations. Statistical analyses were performed to assess associations between patient characteristics and clinical outcomes. The study cohort had a mean age of 37.1 ± 23.1 years, with 56.6% male patients. The most common age groups were 15-34 years (35%) and ≥50 years (32%). Anterior segment disorders were the most frequent diagnosis (42.4%), while 15.6% of patients had no ocular pathology. Males had a significantly higher prevalence of ocular trauma (22.1% vs. 12% in females, p<0.001). Patients aged ≥50 years were more likely to present with visual disturbances (43.6%) and required follow-up care more frequently than younger groups. Overall, 83.6% of patients were referred for follow-up ophthalmic care. A substantial proportion of ophthalmic ED visits were for non-emergency conditions, highlighting the need for better triage strategies and expanded community-based ophthalmic services. Although urgency versus non-urgent visits were uncategorized, the proportion of cases without ocular pathology and those referred for follow-up visits was measured as proxy indicators. Increasing public awareness and improving primary eye care accessibility may reduce ED overcrowding and optimize resource utilization. Future studies should explore long-term trends and the impact of healthcare interventions on ophthalmic emergency care.
Disorders of gut-brain interaction (DGBI) are highly prevalent worldwide. Although the epidemiology of DGBIs in Europe has been previously investigated, data comparing disease prevalence across European regions in relation to sociodemographic and lifestyle factors are lacking. Therefore, this study aimed to assess the prevalence, regional distribution, and associated factors of DGBI in Southern Europe, and to compare findings with other European regions. Data were drawn from the Rome Foundation Global Epidemiology Study (RFGES). A representative sample of 20,420 European adults completed a comprehensive internet-based questionnaire assessing DGBI presence, psychological distress, somatic symptoms, dietary habits, and healthcare utilization. Comparative analyses were conducted between Southern European countries and the rest of the continent (Northern, Western, and Eastern European countries). Multivariate logistic regression identified independent associated factors. The prevalence of adults with at least one DGBI was significantly higher in Southern Europe than in the rest of Europe (44.0% [42.4-45.5] vs. 39.0% [38.3-39.8]; p < 0.001). Irritable bowel syndrome and functional dyspepsia were more prevalent in Southern Europe than in the rest of Europe. Similar trends were found for functional constipation and functional diarrhea. Individuals with DGBI in Southern Europe showed higher psychological distress but lower somatic symptom burden and lower work productivity and activity impairment. In multivariable models, residence in Southern Europe, female sex, younger age, higher psychological distress, greater somatic symptom burden, higher educational attainment, urban residence and more frequent healthcare utilization were independently associated with DGBI. Southern European populations exhibit a higher prevalence of DGBI compared with other European regions. Individuals with DGBI in Southern Europe showed higher rates of psychological distress, whereas those in the rest of Europe showed higher somatic symptom burden, greater work productivity and activity impairment. DGBI rates in Europe appear to be driven by a multifactorial interplay of demographic and psychosocial factors.
In this update, we review a framework for identifying and mitigating information bias in electronic health records and administrative claims data, highlighting practical recommendations for study design, variable definition, and statistical analysis. We also discuss a perspective on emerging privacy-preserving technologies - synthetic data and federated networks - that enable secure cross-border data access while maintaining patient privacy.
Prominent metalwork remains a common source of postoperative discomfort following fixation of olecranon fractures and often leads to elective implant removal despite successful union. This study aimed to assess the incidence and pattern of symptomatic hardware prominence among different fixation methods involving tension band wiring (TBW), plate fixation, and suture constructs in a tertiary trauma center. A retrospective review was conducted of adult patients who underwent operative fixation for olecranon fractures at the Queen Elizabeth Hospital, Birmingham, between January 2021 and July 2025. Patients with a minimum follow-up of 12 weeks were included. Both open and closed fractures were analyzed. Fixation methods included TBW, plate fixation using pre-contoured or hook plates, and high-strength fiber-suture constructs. The primary outcome was the reoperation rate, along with other fixation-related complications. Data were analyzed using Fisher's exact test, with p<0.05 considered statistically significant. Of the 95 patients, 62 met the inclusion criteria (30 males, 32 females; mean age 57 years). The mean follow-up was 46 weeks (range, 3-42 months). TBW was used in 11 cases, plate fixation in 46, and suture fixation in five. A total of 22 patients experienced complications, of which 15 were due to prominent metalwork. Other complications requiring surgery included nonunion (1), synostosis (1), muscle hernia (1), and revision of radial head replacement (1). Three patients with loss of reduction did not undergo further surgery due to subsequent functional improvement. Sixteen patients had open fractures, with no postoperative infections noted. Of the 15 patients with prominent metalwork, 11 underwent implant removal (three in the TBW group and eight in the plating group). There was a difference in the incidence of removal of symptomatic metalwork between TBW (3/11, 27%) and plating (8/46, 17%), although the overall rate of symptomatic metalwork was similar in both groups (27% vs. 26%, respectively). While both TBW and plate fixation provide stable fixation and reliable union, prominent metalwork remains a frequent postoperative issue and the primary reason for secondary surgery. Careful implant selection, meticulous soft‑tissue handling, and patient counseling are essential to minimize postoperative discomfort and optimize outcomes.
Insecticide-treated nets (ITNs) represent a key tool in reducing human vector contact for malaria control. However, increasing insecticide resistance of malaria vectors threatens the effectiveness of pyrethroid-only nets in reducing malaria risk. Next-generation nets, such as those with dual-active ingredients, have been recommended for use in areas with high malaria burden and confirmed pyrethroid resistance. Here, we assessed the impact of the distribution of Interceptor® G2 (IG2) ITNs on malaria cases in the Western North Region of Ghana distributed in 2021. We analysed monthly numbers of confirmed malaria cases reported by health facilities in the Western North Region from 2018 to 2023. To control for possible confounding effects of climate, monthly mean values of modelled vector habitat suitability and temperature suitability were included. Bayesian Poisson regression time series models were developed to assess the immediate and sustained impact of IG2 ITNs on malaria case trends measured as odds ratio (OR) with their corresponding credible intervals (CrI). Malaria cases reduced by 30% (OR, 0.696; CrI, 0.623-0.778) immediately after the distribution of IG2 ITNs in the Western North Region. This effect was sustained at 6 months up to 30 months post-intervention, where cases reduced by 26% (OR, 0.739; CrI, 0.653-0.837) and 40% (OR, 0.594; CrI, 0.492-0.718), respectively. The intervention was also strongly associated with reductions in malaria cases in seven of the nine districts in the region, after controlling for climatic factors. This study demonstrates the effectiveness of dual-active Interceptor® G2 ITNs in the Western North Region, an area with confirmed pyrethroid resistance. The findings support the scale-up of next-generation nets by National Malaria Programs and highlight the need for further research to explore the utility of these nets in other high-burden malaria areas with region-specific insecticide resistance profiles.
Methylphenidate is sometimes used to address residual symptoms of major depressive disorder (MDD), but concerns about psychiatric destabilization and limited long-term evidence have constrained its use. We examined the psychiatric safety of methylphenidate in adults with MDD in a large, real-world cohort. Using the TriNetX Global Collaborative Network, we identified adults with MDD who initiated methylphenidate and matched them 1:1 with controls who did not receive methylphenidate. Patients with attention-deficit/hyperactivity disorder, bipolar disorder, mania, or recent psychiatric destabilization were excluded. The primary outcome was a composite of all-cause hospitalization or emergency room visits; secondary outcomes included hospitalization, emergency visits, suicidal behavior, manic episodes, and recurrence of MDD. Hazard ratios (HRs) were estimated with Cox proportional hazards models after propensity score matching. Of 425,190 eligible patients, 3,211 matched pairs were included (mean age, 55.8 years; 58% female). Over 1 year, the composite outcome occurred less frequently in the methylphenidate group than in controls (574 vs. 694; HR, 0.85; 95% CI, 0.76-0.95). No significant differences were observed for hospitalization, emergency visits, suicidal behavior, manic episodes, or MDD recurrence. Results were consistent across subgroups defined by sex, age, and antidepressant class. In adults with MDD, methylphenidate use was associated with a lower risk of hospitalization or emergency visits and was not linked to increased risk of suicidality, mania, or recurrence. These findings support the psychiatric safety of methylphenidate as an adjunctive treatment for selected patients, though longer follow-up is needed.
Background Risk prediction in emergency laparotomy supports peri-operative decision-making, counselling and resource allocation in acutely unwell surgical patients. In the United Kingdom (UK) practice, the National Emergency Laparotomy Audit (NELA) score is widely used because it is specific to emergency laparotomy, whereas the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) calculator incorporates broader comorbidity and functional status variables. Direct comparisons between these tools in UK emergency laparotomy cohorts remain limited. The primary objective of this study was to compare the discriminatory performance of pre-operative NELA, post-operative NELA and ACS-NSQIP for predicting 30-day mortality after emergency laparotomy. Secondary objectives were to compare overall prediction accuracy using the Brier score and to describe threshold-based test characteristics. Methods We performed a retrospective observational two-centre cohort study at two district general hospitals. Adult patients undergoing emergency laparotomy between November 2023 and October 2024 were identified from electronic records. Mortality risk was calculated using ACS-NSQIP, pre-operative NELA and post-operative NELA. Pre-operative NELA was derived from variables available at the time of operative decision-making, whereas post-operative NELA incorporated intra-operative variables. The primary outcome was 30-day post-operative mortality. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC) and Brier score. DeLong's test was used to compare AUCs. Results A total of 138 patients were included; 30-day mortality was 11.6% (16/138). Post-operative NELA had the highest AUC at 0.878 (95% CI: 0.762-0.943), followed by pre-operative NELA at 0.863 (95% CI: 0.762-0.943) and ACS-NSQIP at 0.826 (95% CI: 0.765-0.942). Brier scores were 0.077, 0.078 and 0.094, respectively. Although post-operative NELA showed numerically higher discrimination and lower overall prediction error, differences between models were not statistically significant, including comparison with ACS-NSQIP (DeLong's test; p = 0.616). At a descriptive 10% mortality threshold, post-operative NELA had higher sensitivity than ACS-NSQIP but slightly lower specificity. Conclusion In this two-centre retrospective cohort, all three models demonstrated good performance for predicting 30-day mortality after emergency laparotomy. Post-operative NELA performed numerically best, but differences between models were statistically non-significant and should be interpreted cautiously given the small sample size and limited number of mortality events. These findings are exploratory and support further evaluation in larger multicentre cohorts.