Prevalence of breast cancer (BC) increases with age, but the external validity of data obtained from pivotal trials of medicinal products remains a concern due to the underrepresentation of frail and older adults. Cyclin-dependent kinase inhibitors (CDKi), palbociclib, abemaciclib, and ribociclib are considered an essential part of the standard-of-care in the management of advanced/metastatic breast cancer. We investigated age, comorbidities, and survival in a nationwide real-world cohort of CDKi users. Data from the Finnish Cancer Registry, reimbursed dispensed prescriptions, Electronic Prescription Database, Care Register for Health Care (CRHC), and Causes of Death Register were combined and analysed. Altogether 1921 women with BC initiated CDKi treatment in 2018-2022. The median age at initiation was 66.9 years, with 43.2% of the study cohort being < 65 years of age, 36.1% 65-74 years, 19.0% 75-84 years, and 1.7% 85 years or older. The prevalence of age or frailty-related comorbidities in individuals ≥ 65 years was low, highest for cardiovascular diseases, 32.3%, and diabetes, 16.9%. The median survival was 25.3 months, with longer median survival times in younger age groups (27.7 months in < 65 year-olds, 25.1 months in aged 65-74, 21.4 months in aged 75-84 years, and 15.4 months in 85 years or older). Real-world CDKi users are older than women included in the pivotal trials, and the survival differences between age groups imply challenges in the generalisability of data from pivotal trials. The real-world CDKi user population is characterised by a low prevalence of major comorbidities. This study reports the real‐world patient characteristics, age‐specific survival and concomitant illnesses of users of cyclin‐dependent‐kinase inhibitor drugs (CDKi), the currently recommended standard treatment of incurable breast cancer. In routine clinical practice, users of CDKis are older than those included in the pivotal clinical trials where these drugs have initially been studied. The oldest age groups have an inferior survival compared to younger patients. CDKi users have few other major age‐related diseases or conditions. The results of this study may imply challenges in the generalisability of results from previous breast cancer studies in older women.
In light of US Food and Drug Administration (FDA) warnings about adverse effects of statin therapy, some of which resemble menopausal complaints, this study compared menopause-related manifestations [Menopause Rating Scale (MRS), cognitive, and musculoskeletal symptoms] between users and non-users of statins among postmenopausal women. This multinational, cross-sectional sub-analysis of the REDLINC XII study included 1,184 postmenopausal women from nine Latin American countries. Menopausal symptoms were assessed with the MRS, cognitive function with the Montreal Cognitive Assessment (MoCA), and sarcopenia risk with the SARC-F questionnaire. Multivariable logistic regression models evaluated associations between statin therapy and outcomes (menopausal symptoms, cognition, and sarcopenia risk) after adjustment for sociodemographic, lifestyle, and clinical factors. Of the 1,184 women, 307 (25.9%) used statins. Compared with non-users, statin users had a higher prevalence of severe menopausal symptoms (47.2% vs. 30.6%), more intense musculoskeletal symptoms (53.1% vs. 33.9%), and higher sarcopenia risk (28.7% vs. 16.5%; all P=0.0001). In multivariable logistic regression analyses, statin therapy was not associated with mild cognitive impairment defined by the MoCA global score, although exploratory analyses suggested poorer performance in delayed recall memory and visuospatial function among users. Statin therapy remained independently associated with severe menopausal symptoms [odds ratio (OR): 1.56; 95% CI: 1.17-2.10] and sarcopenia risk (OR: 1.65; 95% CI: 1.19-2.29). In postmenopausal women, statin therapy was not associated with mild cognitive impairment; however, statin use was linked to poorer delayed recall memory and visuospatial function and a higher burden of menopausal symptoms and sarcopenia risk. Statin-related cognitive and somatic effects may overlap with menopausal symptomatology and contribute to symptom burden during midlife.
Density functional theory (DFT) has emerged as the most significant methodology in computational chemistry. However, the ever-growing number of density functional approximations (DFAs) has been a source of confusion to both users and developers. Particularly confusing is the extended "family" of DFAs based on B97, where many approaches have similar names but often differ in their underlying functional form. This review aims to be a succinct compendium of the family of B97-based DFAs and addresses both general and specialised audiences. 57 B97-based DFAs are comprehensively reviewed with a particular focus on the functional form and dispersion-corrected variants. Ambiguously named methods and common aliases are clarified. The general performance of B97-based methods in large-scale benchmarking studies on ground and excited state problems is summarised with the conclusion that B97M-V, ωB97M-V, and ωB97X-V (including other dispersion-corrected forms of these functionals) as well as ωB97M(2) are some of the currently most accurate DFT methods. It is our hope that this review clarifies the current state of the B97 family which is of relevance for DFT users and developers alike, particularly as development for this DFA family is ongoing.
Appearance anxiety for social media users (AASMU) is emotional distress linked to social media use (SMU), negatively affecting mental and physical health. However, little is known about the dynamic relationship between AASMU and SMU, and effective interventions. Study 1 used Ecological Momentary Assessment (EMA) with 206 participants completing daily surveys for 20 days. Dynamic structural equation modeling (DSEM) revealed that AASMU tended to persist from 1 day to the next (β = 1.45) and that higher levels of AASMU and SMU often occurred together on the same day (β = 2.57). A higher level of self-compassion (SC) or a healthier lifestyle moderated this relationship, providing resilience against SMU's negative effects (β = -0.40 or -0.41). Study 2 utilized an ecological momentary intervention (EMI) with 200 participants, where the intervention group read SC statements daily. Results showed a significant reduction in both the mean level (β = -0.05) and intra-individual variability of AASMU in the intervention group (β = -0.11), suggesting SC-based EMI is an effective approach to reducing AASMU.
This study investigates the relationship between speech perception and production, focusing on consonant error patterns in children using cochlear implants (CIs), children with normal hearing (NH), and NH children listening to vocoder simulations (NHV). The goals were to determine how perception and production errors align within and across groups, to identify feature- and consonant-specific error patterns, and to assess the relative contributions of developmental constraints, signal degradation, and auditory experience. The study included three groups: 20 children with CIs, ages 5 to 9 years, implanted before the age of three; and two hearing-age-matched control groups of 20 children each, ages 4 to 8 years, presented with natural speech (NH) or listening to nine-channel tone vocoder simulations (NHV). To evaluate their speech perception and production abilities, participants were assessed using a modified version of the California Consonant Test. Relationships between perception and production: Moderate correlations were observed between perception and production across all groups, with slightly weaker correlations in the NHV group, supporting the interconnected nature of these processes. Error rates across groups: No statistically significant differences were observed in mean error rates between the CI and NH groups. However, the NHV group exhibited significantly poorer perception abilities, with higher error rates compared with both the NH and CI groups. NHV listeners also showed significantly higher error rates in perception than in production. This diminished perception in the NHV group likely reflects limited adaptation to the vocoder's degraded auditory signal. Error patterns across consonant features: All groups made fewer errors for stop consonants compared with fricatives in perception and production. In addition, all groups demonstrated fewer errors with voiceless consonants compared with voiced ones in perception and production, with some variability across groups. These results indicate that consonant features such as manner and voicing systematically influence performance. Individual consonant errors: The study revealed discrepancies between perception and production errors for individual consonants. Fricatives (e.g., /v/, /θ/, /z/) were associated with the highest error rates across groups. CI children frequently substituted [d] for /ɡ/, a rare pattern among NH children. Their most common production error was substituting [f] for /θ/, while NH children often confused /θ/ and /f/ or substituted [f] for /v/. These findings indicate that CI children's errors are more variable and sometimes atypical compared with NH peers, whereas NHV errors were broader and less systematic. The study's results emphasize that while overall error rates are similar between CI and NH groups, the error patterns for individual consonants can differ considerably. This indicates that interventions for children with CIs should focus on the specific error patterns observed. The poorer performance of the NHV group in perception underscores the limitations of vocoder simulations and suggests they may not fully capture the complexities of CI use. Clinical practices should incorporate these insights to develop more effective techniques tailored to the specific needs of children with CIs. Further research is needed to deepen our understanding of the interplay between perception and production errors in CI users to refine clinical protocols accordingly.
For people in rural and remote areas, government-funded travel subsidy schemes provide vital financial assistance and equitable access to specialist healthcare in city centres. However, few studies have examined users' experiences of these schemes. Adults travelling for healthcare in Queensland, Australia, completed an online survey capturing their most recent experience applying for the Patient Travel Subsidy Scheme (PTSS). Participants' responses were analysed using descriptive statistics and thematic analysis. From 69 respondents (aged 29-80 years, 60% female, 88% most recent application for cancer-related care), 57% agreed information about the scheme was easy to access, although only 39% found the initial registration process easy. Most indicated that local hospital staff and PTSS officers were knowledgeable and helpful (65%-70%). Less agreed that staff were available to assist (48%) or that processes were well-coordinated across hospitals (42%). Of those who sought reimbursement for travel costs (75%), almost two-thirds (63%) were out-of-pocket post-reimbursement (mean = AU$725; range = AU$20-10 000). Delayed reimbursement was relatively common (60%) and contributed to financial hardship (36%). For some (13%), challenges accessing the scheme impacted treatment decisions. User feedback included improved visibility of online application and reimbursement status, and fast-tracking of high-risk, urgent and ongoing cases. While information about the scheme and interactions with frontline staff were viewed positively by most, several system-level challenges remain. SO WHAT?: Substantial out-of-pocket costs and reimbursement delays contribute to financial hardship and can affect treatment decisions. Increased subsidy reflecting actual travel costs, timely reimbursement, fast-tracking, and greater application assistance and coordination would improve user experiences.
The efficacy of romosozumab (ROMO) in treating glucocorticoid-induced osteoporosis remains unclear. This randomized clinical trial demonstrated that in patients initiating glucocorticoid therapy, a treatment regimen of 12 months of ROMO followed by 24 months of denosumab (DMAb) was effective compared to either 36 months of DMAb or bisphosphonate monotherapy. The efficacy of romosozumab (ROMO), an antibody against sclerostin-an inhibitor of Wnt signaling-in the treatment of glucocorticoid-induced osteoporosis remains uncertain, particularly regarding the sequential use of ROMO and denosumab (DMAb). This study aimed to compare the long-term efficacy of 12 months of ROMO followed by 24 months of DMAb (ROMO-DMAb) to 36 months of DMAb or bisphosphonates (BP) alone. Patients with rheumatic diseases who had not previously received osteoporosis drugs and were newly treated with prednisolone ≥ 15 mg/day were randomly assigned to receive ROMO (ROMO-DMAb group), DMAb, or risedronate. Over a 36-month period, we measured bone mineral density (BMD) at the lumbar spine, femoral neck, and total hip every 6 months. Thirty-nine patients (median [interquartile ranges] age 72.0 [67.3 - 78.8] years; 69.2% women; prednisolone dose 20.0 [15.0 - 50.0] mg/day) were enrolled. The median percent change in lumbar spine BMD from baseline at 36 months was greatest in the ROMO-DMAb group (ROMO-DMAb; 11.3 [6.8 - 13.8] %, DMAb; 9.4 [4.7 - 13.5] %, BP; 2.1 [-1.3 - 6.8] %). The changes in the femoral neck and total hip were similar between the ROMO-DMAb and DMAb groups, and the increases were much smaller than that in the lumbar spine. Serum levels of total type I procollagen-N-propeptide and tartrate-resistant acid phosphatase-5b decreased in all groups from month 3. Sequential treatment with ROMO followed by DMAb increased lumbar spine BMD more than DMAb or BP alone up to 36 months, demonstrating the efficacy of this treatment strategy.
Differences in typical-use contraceptive failure rates between long-acting reversible contraception (LARC; such as intrauterine devices [IUDs] and implants) and shorter-acting methods (depot medroxyprogesterone acetate [DMPA], pills, rings, and male condoms) are often the focus of contraceptive counseling, but assessments of contraceptive counseling have not focused on contraceptive effectiveness over time. To assess 3-year continuation and typical-use contraceptive failure rates for 7 reversible contraceptive methods provided with access barriers removed. The HER Salt Lake Contraceptive Initiative was a 3-year prospective longitudinal cohort study (September 2015 to March 2017, with follow-up data collected through June 2020). Participants (new contraceptive users 18-45 years who indicated they wanted to avoid pregnancy for at least 1 year) enrolled at 4 family planning clinics in Salt Lake County, Utah, and received person-centered contraception counseling and same-day access to the reversible contraceptive method of their choice. Data were analyzed from June 2024 to February 2026. The exposure was contraceptive method selected at baseline (copper IUD, DMPA, implant hormonal IUD, condoms, pill, or ring). The outcome was experiencing a contraceptive failure, defined as an unintended pregnancy (self-reported or identified through electronic medical record) experienced while using a contraceptive method in the previous 4 weeks. Method-specific continuation and failure rates were calculated using a life table analysis. Among 4275 contraceptive users (1759 [41%] aged 20-24 years), 96 pregnancies resulting from contraceptive failures of methods initiated at baseline were identified. Of all participants, 529 (11%) selected a copper IUD, 558 (13%) selected DMPA, 823 selected an implant (19%), 1025 (24%) selected a hormonal IUD, 52 (<1%) selected condoms, 1065 (25%) selected pills, and 223 (5%) selected the ring. Cumulative continuation at 3 years included 741 hormonal IUD users (72%), 455 implant users (55%), 321 copper IUD users (61%), 186 DMPA users (33%), 75 ring users (34%), 376 pill users (35%), and 8 male condom (15%). Three-year contraceptive failure rates per 100 person-years were 0.7 (95% CI, 0.4-1.1) for hormonal IUD users, 0.8 (95% CI, 0.5-1.3) for implant users, 1.1 (95% CI, 0.6-1.8) for copper IUD users, 1.1 (95% CI, 0.6-2.1) for DMPA users, 1.4 (95% CI, 0.6-3.2) for ring users, 1.6 (95% CI, 1.1-2.3) for pill users, and 2.6 (95% CI, 0.5-10.0) for male condom users. In this cohort study of individuals initiating a contraceptive method following person-centered contraceptive counseling and removal of access barriers, low 3-year contraceptive failure rates were observed for all methods, and shorter-acting methods had lower failure rates than previously reported typical use rates. These findings suggest that removing access barriers to preferred contraceptive methods may support access to clinician-dependent LARC methods, like IUDs and implants, and improve the contraceptive effectiveness of user-controlled, shorter-acting methods.
Twitter's "EDTWT" community constitutes a prominent online space for eating disorder (ED) discourse, yet large-scale computational characterization remains limited. To characterize EDTWT behavioral patterns, emotional dynamics, thematic structure, and develop automated content classification methods through computational analysis of a three-year dataset. We analyzed 48,341 tweets from 18,587 users (January 2022-February 2025). Analyses included engagement patterns, temporal dynamics, clinical keyword prevalence, multi-method sentiment analysis (TextBlob, VADER, clinical affect lexicons), topic modeling (LDA, NMF), and ensemble-based multi-label classification. User engagement followed a highly skewed distribution in which a small number of highly active users generated the majority of content (62.1% of users posted only once, while the top 10% produced 48.9% of all content), suggesting that a concentrated subset of users may warrant particular clinical attention. Temporal patterns showed a 7.5-fold difference in posting volume between Friday night peaks and Tuesday morning troughs, with consistent nocturnal peaks between 21:00 and 23:00. Clinical keywords appeared in 26.6% of tweets (body image 14.4%, restrictive eating 6.7%, recovery 4.3%). Sentiment was slightly positive (M=0.060, SD=0.282) with moderate subjectivity (M=0.298). Topic modeling revealed ten themes including calorie tracking (13.2%), Spanish (9.7%) and Polish (8.2%) subcommunities, and recovery discourse (9.4%). An ensemble of automated classifiers trained to categorize eating disorder content achieved strong performance (macro F1=0.753, κ=0.703, where higher values indicate better classification accuracy), outperforming a biomedical-domain language model by 21.4% on the least frequently occurring content categories. EDTWT exhibits complex heterogeneity with coexisting pro-ED content, recovery discourse, and culturally-specific subcommunities. The concentration of activity among a small number of highly active users enables efficient identification of individuals who may be at elevated risk and in need of targeted support. Automated classification enables scalable content monitoring for digital mental health surveillance and evidence-based platform moderation. This study examined three years of Twitter posts from the eating disorder community known as EDTWT. We analyzed nearly 50,000 tweets from over 18,000 users to understand how people use this online space. We found that a small group of very active users creates most of the content, while many people only post once. Posting activity peaks on Friday nights and late evenings, times when people may feel particularly vulnerable. About one-quarter of tweets mentioned eating disorder symptoms like body image concerns or restrictive eating, though recovery-related content was also present. The community includes people from different countries, with notable Spanish and Polish-speaking groups. Surprisingly, many posts expressed positive emotions, often related to achieving weight loss goals rather than overall wellbeing. We developed computer tools that can automatically identify different types of eating disorder content, which could help social media platforms and mental health professionals monitor these communities more effectively. Our findings suggest that online eating disorder communities are complex spaces where harmful content exists alongside recovery support, requiring thoughtful approaches to both protect vulnerable individuals and preserve helpful peer connections.
Sexually transmitted infections (STI) testing is less frequently accessed in rural and regional Australian communities due to many barriers, including limited access to specialised services and stigma. To address this, we sought to pilot the implementation of STI test kit dispensing vending machines and assess their acceptability and use. We conducted a 12-month pilot, placing two free STI test kit vending machines in 4-month intervals across seven rural and regional towns/cities. We worked with each community to determine ideal placement locations and marketing strategies. We assessed utilisation rates, return rates, positive diagnosis rates and user satisfaction. The vending machines dispensed 176 STI test kits over a period of 836 days in situ across seven towns/cities. Users ranged from 17 years to 70 years of age-those over 30 years had a greater odds of travelling over 25 km to access a test compared with younger users (OR 0.53, 95%CI 0.28 to 1.01). A large number (43.9%) of users reported having never completed an STI test before. 32 users returned samples for analysis with 12.5% receiving a positive result. Of the users who rated the vending machine process, 94.0% (79/84) rated it as 'easy' or 'very easy' to use and 95.6% (86/90) rated the process as 'fast' or 'very fast'. Our pilot suggests that STI test kit vending machines are an acceptable testing option for a wide range of users in rural and regional communities. Further research is necessary to understand how to improve return rates in order to improve sustainability.
Pressure injuries (PIs) are a common complication in people with reduced mobility or sensation and can be burdensome for individuals with PIs and their caregivers. Valuable insights and real-world challenges faced by individuals living with PIs can be captured through candid accounts posted on social media. Social media listening (SML) is a tool that can enhance the understanding of those with lived experience by offering firsthand accounts that are irreproducible from controlled studies. This study aims to capture the candid experiences of individuals with PIs and caregivers through social media. A noninterventional qualitative descriptive analysis was conducted using SML. Social media posts made on X (formerly Twitter), Reddit, and YouTube between January and December 2022 were compiled using SML tools X Pro (formerly TweetDeck) and Awario, and using Boolean search terms. Posts were manually screened for relevance, and duplicates were removed. Relevant posts were hand-coded by two independent reviewers. Inductive content analysis was used to analyze the posts. The search yielded 666 relevant posts from 498 unique social media users. Most posts were made in the United States (170/666, 25.5%), the United Kingdom (150/666, 22.5%), and Canada (62/666, 9.3%). Social media users provided detailed descriptions of the PIs, including the setting in which the PI occurred, the cause of the PI, and how the PI was managed. The majority of PIs (197/666, 29.6%) were reported to have occurred in the hospital setting due to a perceived lack of care from care providers, and local wound care was often cited (99/666, 14.9%) as a PI management strategy. Three key themes were developed regarding living with or caring for someone with a PI: (1) challenges experienced when living with or caring for a PI, (2) needs related to PI prevention and management, and (3) emotions experienced when living with or caring for a PI. Social media users frequently discussed challenges associated with living with a PI, including negative personal impacts and poor perceived treatment quality. Users also described a critical need for health care, education, and social support. Finally, users often expressed anger and/or sadness related to living with or caring for a PI. SML captured candid insights into the experiences, challenges, and needs of individuals living with PIs and their caregivers globally that may not be gleaned from controlled studies. Individuals with lived experience and their caregivers often struggled with negative personal impacts regarding their physical health and daily functioning related to PIs, further highlighting the urgent need to address barriers to appropriate PI care. Clinicians and policymakers should consider practices and policies that optimize the delivery of person-centered PI care in order to overcome challenges and needs identified in this study.
Co-design methods, which create innovation tailored to the end-user needs and setting, are increasingly used to improve research uptake and impact. Peer review and methodologists have emphasised the need for early, meaningful, and continuous involvement of stakeholders, and the transparent and detailed reporting of co-design methods. The implementation of both complex interventions (such as an integrated care pathway), and technology, into healthcare is difficult and has high failure rates. Designing, implementing, and adapting interventions to ensure they work in the local context requires in-depth understanding of multiple end-users' needs, processes, and contexts. Achieving this requires early, meaningful, and continuous engagement between multiple end-users. This study aimed to contribute to co-design research by reporting the: 1) process used to develop and test Participatory Rapid Appraisal and Focus Groups methods to co-design integrated care. 2) details of how the method was applied in the GERONTE project. 3) core steps involved in this co-design method (to facilitate use and/ or adaptation of the method). The study aimed to develop, test, and evaluate a co-design method that: I. enabled early, continuous, and meaningful engagement of multiple end-users in different locations and across different design iterations. II. enabled timely feedback and checking between the end-users and design team. III. optimised end-users participation by being flexible in the time, duration, and method of data collection and feedback. The Participatory Rapid Appraisal and Focus Group to co-design integrated care method was developed in four stages. The first stage involved defining the project's co-design needs and reviewing the co-design literature to identify how to meet these. GERONTE aimed to co-design, evaluate, and prepare for EU-wide deployment, an integrated technology-supported care pathway for older adults with cancer and other morbidities. Focus Groups and Participatory Rapid Appraisal, in combination, were chosen as an empirically-based and practical approach. Focus Groups (FG) provided a participatory-based way to collect data in order to identify and agree multiple stakeholders' needs and collective priorities. Participatory Rapid Appraisal (PRA) provided a timely way; to gain participant feedback on the data collected; and, to ensure accuracy in the data sent to the pathway and technology design teams. The second stage involved applying the method in the GERONTE Project (using meetings between the project team, technologists, and older adults to develop a co-design protocol for the project). The third stage involved the use, refinement, evaluation, and reporting of the co-design method. The fourth stage, evaluation of the method, is ongoing. This study resulted in the development of a structured approach to using Participatory Rapid Appraisal and Focus Groups in combination to co-design technology-supported integrated care. This method is proposed as an evidenced-based, practical, user-friendly way to co-design (or adapt an existing design) an integrated technology-supported care pathway. This co-design method involves three cycles of design. Each cycle involves multidisciplinary FG to collect semi-structured data followed by rapid analysis and feedback of the FG data to the participants to design or refine the intervention.
Augmented reality (AR) display characteristics have the potential to either enhance or impair users' spatial abilities and performance. While previous work included studies of spatial performance with various display factors, evidence for objective performance differences is limited due to compensatory behaviors employed by users and overall behavioral differences. In general, it is challenging to document the effects of display factors on task performance as they depend on users' task behaviors, which in turn depend on users' reliance and trust in the technology, which are also affected by the display factors. In this paper, we present two within-subjects experiments (each N=20) in which we aim to elucidate some of the interrelations between two AR display factors (field of view and visual contrast) with objective task performance and subjective assessments of reliance and trust, while controlling for different behaviors. Participants performed a ${360}^{\circ }$ search-and-selection task in a unique hybrid setup, in which we simulated a controlled task environment by having participants stand inside an immersive CAVE-like space while at the same time wearing a head-worn display that overlaid AR tags over the simulated environment. Specifically, we evaluated three fields of view (${43}^{\circ }$, ${93}^{\circ }$, and ${143}^{\circ }$) and three visual contrasts (0.05, 0.25, and 0.5). We controlled for four different behaviors: AR-Only (only relying on AR), AR-First (prioritizing AR over real world), Real-First (prioritizing real world over AR), and Real-Only (only relying on real world). By controlling for these behaviors, we were able to show objective and subjective benefits of larger fields of view and visual contrast. We illustrate how the controlled behaviors relate to users' subjective reliance and trust in an AR system, and why it is important for researchers and practitioners to understand these subjective and behavioral aspects.
Transfemoral prosthesis users experience heightened fall risk following a trip or stumble when using their conventional, passive prostheses. In a laboratory setting, 54% of all stumble perturbations resulted in a fall for transfemoral prosthesis users using passive prostheses, while able-bodied controls never fell across 190 similar perturbations at a faster walking speed. Shortcomings in the mechanics and control of passive prostheses may contribute to this disparity, including inadequate stance support, poor swing assistance, and the lack of access to certain able-bodied stumble recovery strategies that require positive power at the knee. In this work, a powered knee prosthesis was used to provide bimodal stumble recovery behaviors, modeled after able-bodied stumble reflexes, while also providing robust stance support and swing assistance. Three transfemoral prosthesis users underwent a series of treadmill-based obstacle perturbations on both the powered prosthesis and their prescribed, passive prosthesis to compare the stumble recovery outcomes between the two classes of prosthesis. Results from this preliminary study indicate that the powered prosthesis eliminated knee buckling, improved trunk control, improved base of support adjustment, and reduced hip circumduction. While improvements were consistent across stumble conditions and metrics for two of the three participants, improvements were less consistent with the third participant. Overall, the results suggest that powered stumble recovery-specific behaviors in prosthetic knee prostheses may have promise to improve stumble recovery outcomes for transfemoral prosthesis users.
[Purpose] To investigate the users' perceptions of powered wheelchairs (PWCs) provided by the rental service of equipment for long-term care covered by public aid in Japan and to identify factors influencing the feasibility of their widespread use. [Participants and Methods] This qualitative study was conducted using semistructured interviews with five Japanese individuals who used PWCs rented from the rental service of equipment for long-term care covered by public aid to investigate their usage and perceptions of PWCs. The interview data were organized using the KJ method. [Results] The users chose wheelchairs of their own volition based on their values, developed attachments to their PWCs, and used them as effective tools to lead independent lives. Participants positively evaluated the value of PWCs and accepted their advantages and disadvantages. However, they felt that using PWCs in their daily lives was difficult. [Conclusion] PWCs can be efficiently distributed among wheelchair users who wish to live independently and participate in society. The specific and complex driving maneuvers, safety considerations for operating PWCs in real-life situations, and the low public awareness of PWCs are factors influencing their widespread use.
Allergic rhinitis (AR) in adolescents can negatively affect daily functioning, sleep, and school performance. This observational, non-randomized prospective cohort study compared the real-world effectiveness of intranasal corticosteroids (INCS) and second-generation oral antihistamines (OAH) on disease-specific quality of life and school attendance. This observational, non-randomized prospective cohort study included 80 adolescents aged 12-18 years with moderate-to-severe allergic rhinitis who were followed for one school term. Participants received either INCS monotherapy or OAH monotherapy according to routine clinical practice; treatment allocation was not randomized. Specific drug selection within each treatment class was determined by the treating clinician and was not fully standardized, reflecting real-world treatment heterogeneity. Primary outcomes were changes in Pediatric Rhinoconjunctivitis Quality of Life Questionnaire (PRQLQ) scores and school absenteeism. Secondary outcomes included classroom productivity, sleep quality (Pittsburgh Sleep Quality Index), daytime sleepiness (Epworth Sleepiness Scale), adherence, and adverse events. Between-group comparisons and multivariable analyses were performed. Both treatments were associated with improvement, but the magnitude of improvement was greater in the INCS group. Mean PRQLQ scores decreased by -1.0±0.4 in the INCS group and -0.6±0.5 in the OAH group; the between-group difference in mean change was -0.4 (95% confidence interval [CI], -0.7 to -0.1; p = 0.01). Clinically meaningful QoL improvement (≥0.5 reduction) occurred in 65.0% of INCS users versus 37.5% of OAH users (p = 0.02). Median school absenteeism decreased in the INCS group (change, -2 days) but not in the OAH group (change, 0 days; between-group p = 0.03). INCS users also reported greater improvements in classroom productivity and sleep quality, and fewer participants had ESS scores ≥10 at follow-up (3% vs 18%). In this real-world adolescent cohort, INCS use was associated with greater short-term improvement in quality-of-life and school-attendance outcomes than OAH use. However, because the study was observational and non-randomized, and because treatment heterogeneity existed within both treatment groups, these findings should be interpreted as associations rather than definitive causal effects.
Electronic cigarette (e-cig) use (vaping) has been associated with dysregulation of genes and molecular pathways in epithelial tissues. However, the relative contributions of dose and product characteristics to vaping-associated transcriptomic alterations have not been systematically evaluated. We performed RNA-sequencing of oral epithelial cells from e-cig users (vapers), cigarette smokers, and non-users. Differential gene expression was assessed using covariate-adjusted limma-voom modeling with false discovery rate control. We evaluated the extent to which exposure-specific dose metrics (including cumulative e-liquid, cumulative e-nicotine, years vaped, and plasma cotinine for vaping, and pack-years and plasma cotinine for smoking) explained transcriptional changes. Among vapers, we additionally examined whether device generation and flavor type contributed to variation in gene expression. Both vaping and smoking were associated with transcriptomic dysregulation relative to non-users, with partial overlap in differentially expressed genes (DEGs). Functional enrichment analyses revealed disruption of shared cancer- and signaling pathways, including RHO GTPase Cycle, as well as perturbation of pathways specific to vapers or smokers. Among vapers, 27.6% of DEGs showed concordant behavior across all dose metrics, indicating heterogeneous dose-response patterns for the remaining DEGs. Device generation and flavor type explained additional, largely non-overlapping components of gene expression variability. A much higher proportion of smoking-associated DEGs (54.1%) was consistently affected across dose metrics, reflecting more unified dose-dependent responses. These findings suggest that vaping-associated transcriptional dysregulation reflects combined influences of dose and product characteristics, highlighting structural differences in molecular perturbations between vaping and smoking. Incorporating multidimensional exposure metrics and product features into regulatory evaluation may better capture the biological complexity of e-cig exposure, thus informing clinical, public health practice, and regulatory decisions.
New psychoactive substances (NPS) represent a growing public health challenge in Europe. Their rapid emergence, chemical diversity and unpredictable toxicity complicate prevention, clinical management and regulatory responses. This study provides an updated overview of NPS-related harms in France using national addictovigilance data. Data were extracted from three complementary surveillance systems: (i) the NotS program of spontaneous reports of NPS-related adverse events (2009-24), (ii) the OPPIDUM survey conducted among users attending addiction care centers (2016-24), and (iii) the DRAMES registry of toxicologically confirmed drug-related deaths (2012-23). Substances were classified by chemical family and clinical effects were coded using MedDRA terminology. In addition to descriptive analyses, regression models were used to assess temporal trends. A total of 3468 NotS involving at least one NPS were recorded, increasing from 5 cases in 2009 to 726 in 2024. Synthetic cathinones and synthetic cannabinoids accounted for nearly 90% of notifications. Trend analyses confirmed a significant increase in NPS notifications and reported use over time. In OPPIDUM, the proportion of NPS users increased from 0.3% in 2016 to 1.7% in 2024. In DRAMES, 136 NPS-related deaths were identified between 2012 and 2023, with no significant overall increase in mortality during the study period. Synthetic cathinones and synthetic cannabinoids dominate the French NPS landscape. The integration of multiple addictovigilance data sources provides a robust framework for early signal detection and supports public health decision-making.
Usability of hospital information systems (HIS) is critical for workflow efficiency, user satisfaction, and safe clinical practice. Comparative evaluations of legacy desktop-based HIS and newer web-based platforms remain limited, particularly during the real-world digital transition. This study aimed to compare the usability of the legacy Iranian Hospital Information System (IHIS) and the newly implemented web-based Sepid system in the Inpatient Admission and Radiology modules of a teaching hospital in Mashhad, Iran. This convergent parallel mixed-methods study was conducted from July to September 2025 at Qaem Educational and Research Hospital. In the qualitative phase, eight expert evaluators conducted heuristic evaluations based on Nielsen's ten usability heuristics. In the quantitative phase, 34 end-users with routine experience using both systems completed the System Usability Scale (SUS). Qualitative findings were thematically consolidated, and quantitative data were analyzed using descriptive statistics and paired comparative tests. Heuristic evaluation showed that Sepid's main usability problems were related to system performance, external database integration, and error messaging, whereas IHIS demonstrated more fundamental interface-related limitations, including visual clutter, weak flexibility, and lack of undo/redo functionality. Quantitatively, Sepid achieved a higher mean SUS score than IHIS (66.25 vs. 51.99). For Sepid, 4 users (11.8%) rated usability as unacceptable, 17 (50.0%) as marginal, and 13 (38.2%) as acceptable. For IHIS, the corresponding values were 12 (35.3%), 19 (55.9%), and 3 (8.8%), respectively. The between-system difference in SUS scores was statistically significant (p < 0.001). Although Sepid outperformed IHIS, both systems remained within the marginal usability range. The findings indicate that HIS improvement should prioritize user-centered interface redesign, stronger error prevention, better interoperability with external databases, and continuous user training. These results may guide developers, hospital managers, and policymakers in improving HIS design and implementation during the digital transition.
Hormonal contraceptives are widely used by women of reproductive age, yet concerns persist regarding their potential effects on mental health. Although mood-related side effects are frequently reported, their prevalence, clinical significance, and variation across formulations remain unclear. This scoping review examined associations between hormonal contraception and psychiatric outcomes, focusing on depressive symptoms, anxiety, and other mental health disorders. A comprehensive search of four major databases identified peer-reviewed studies published between 2014 and 2024. Forty-six studies met inclusion criteria, encompassing observational cohorts, cross-sectional surveys, and clinical trials. Study quality was assessed using the Joanna Briggs Institute checklist. Random-effects meta-analysis and subgroup analyses were conducted by hormonal class and psychiatric outcome. Pooled analyses indicated a small but statistically significant association between hormonal contraceptive use (particularly progestin-only methods) and increased depressive symptoms (RR = 1.24, 95% CI 1.08-1.42; I² = 97.7%). For suicidality, cohort studies reported estimates ranging from HR = 1.97 in younger users to OR = 1.57 with long-term progestin-only use, although the pooled estimate across four studies was imprecise (RR = 1.20, 95% CI 0.65-2.21; I² = 98%). Evidence for anxiety and other psychiatric outcomes was inconsistent; four anxiety-focused studies yielded a non-significant pooled effect (RR = 1.08, 95% CI 0.83-1.40; τ² = 0.13). Methodological heterogeneity, particularly in outcome measurement and control for confounding, was a frequent limitation. These findings suggest that hormonal contraception may contribute to adverse psychiatric outcomes in a subset of users. Integrating mental health screening into contraceptive counseling and conducting well-designed prospective studies with standardized psychiatric measures are essential for guiding safer, more tailored contraceptive prescribing practices.