Conectar
by Navdeep Kaur, Marcus V. Merfa, Alexandra K. Kahn, Rodrigo P. P. Almeida, Leonardo De La Fuente
Xylella fastidiosa (Xf) is an insect-transmitted, xylem-limited bacterial plant pathogen that infects hundreds of plant species. This pathogen causes bacterial leaf scorch in southern highbush blueberry (Vaccinium corymbosum interspecific hybrids) in the southeastern United States, a disease that has not yet been reported elsewhere. Previously, a comparative genomic analysis of Xf and ancestral host species identified evolutionary events of gene gain and loss related to host range specificity. Here, by using a similar workflow, we identified two loci that are significantly found in blueberry-infecting strains. Locus_1088 included a hypothetical protein and a small part of the N-terminus of an orphan RelE toxin, while Locus_2741 was annotated as a hypothetical protein. Using a protocol based on natural competence, mutants were generated in three Xf subsp. multiplex strains from blueberry. Less biofilm, more planktonic growth, and increased twitching motility as compared to its wild-type (WT) were observed for the strain LA-Y3C_1088 mutant. In blueberry virulence assays, the LA-Y3C_1088 mutant caused significantly more severe symptoms than LA-Y3C_WT, whereas no significant differences were observed for other mutated strains. Interestingly the mutation of Locus_1088 additionally disrupted a toxin (part of a toxin-antitoxin system) that is likely responsible for the phenotypic changes observed. However, because the two independent mutants were not generated, we could not determine whether the phenotype resulted from disruption of hypothetical protein or the toxin. Additionally, since the coffee-isolated but never tested in blueberry Xf subsp. fastidiosa strain CFBP8073 was found to encode the two blueberry-associated loci studied here, its virulence was assessed in blueberry. This strain caused severe symptoms comparable to the control strain AlmaEm3 from blueberry. Due to the complexity of understanding host specificity in Xf, any advance in identifying genetic markers for host specificity in this devastating pathogen could greatly improve management of Xf worldwide.by Meirong Shan, Qian Guo, Ruofei Li, Ni Li, Yanhua Fu, Huanyu Qi, Ge Zhang, Qian Wang, Xingli Xu, Jinchuan Lai
Hypertension is one of the main causes of cardiovascular diseases worldwide, affecting over one billion people. Although aliskiren offers a valuable option for inhibiting the renin-angiotensin system, its safety profile in the real world remains insufficiently explored, especially for rare or under-recognized adverse events (AEs), which have not been fully clarified. Therefore, leveraging large-scale post-marketing surveillance data is crucial for identifying rare AEs and guiding safer clinical practice. This study aims to elucidate pharmacovigilance signals associated with aliskiren (an antihypertensive drug) by systematically analyzing the characteristics of adverse events (AEs) from the U.S. Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) database and WHO-VigiAccess database, which provides a reliable scientific basis for clinical practice and regulatory decision-making. We conducted a retrospective quantitative analysis of aliskiren-related AE reports from the aforementioned two databases, employing the Proportional Reporting Ratio (PRR), Reporting Odds Ratio (ROR), Bayesian Confidence Propagation Neural Network (BCPNN), and Multi-item Gamma Poisson Shrinker (MGPS) algorithms for signal detection. The results indicate that there were 5,596 and 5,549 aliskiren-related reports in the FAERS and WHO-VigiAccess databases, respectively. The median duration of these AEs during the observation period was 62 days, with an interquartile range (IQR) of 7–282 days. In both databases, signals for aliskiren were distributed across 28 System Organ Classes (SOCs), among which investigations, cardiac disorders, renal and urinary disorders, vascular disorders, and metabolism and nutrition disorders exhibited significant signals based on specific criteria applied across the four algorithms. A total of 607 preferred terms (PTs) with significant disproportionality signals were detected using the four algorithms, including potential AEs not previously well-documented, such as palpitations, myalgia, proteinuria, muscular weakness, pulmonary edema, and pollakiuria. This study not only confirms the known adverse reactions of aliskiren but also uncovers new potential risks, highlighting the importance of strengthening drug safety monitoring to enhance therapeutic efficacy and reduce the risk of adverse reactions. It provides valuable safety insights for physicians considering the use of aliskiren in the management of primary hypertension.by Verner N. Orish, Renosten E. Tetteh, David Adzah, Chinecherem A. Ndiokwelu, Emmanuel A. Allotey, Evans A. Yeboah, Sylvester Y. Lokpo, Kenneth Ablordey, Duneeh R. Vikpebah, Ekene K. Nwaefuna, Precious K. Kwadzokpui, Noble D. Dika, Elom Y. Dzefi, Kokou H. Amegan-Aho, Aninagyei Enoch, Senyo Tagboto
BackgroundToxoplasma gondii (T. gondii) is a successful protozoan parasite infecting up to a third of the human population. It has varied transmission routes including ingestion of food and water contaminated by cat feces containing oocysts of the parasite and ingestion of bradyzoites in poorly cooked meat. Blood transfusion is another possible route of transmission especially among people with medical conditions requiring blood transfusion, such as those with sickle cell disease (SCD). This study aimed at finding out the prevalence of T. gondii infection and the association of blood transfusion among patients with SCD.
MethodThis study was a cross-sectional study involving SCD patients attending the SCD clinic at the Ho Teaching Hospital in the Volta Region of Ghana. Questionnaire administration was employed to obtain sociodemographic information, cat ownership, consumption of poorly cooked meat, as well as blood transfusion history. A blood sample was collected and anti-T. gondii IgG and IgM were detected using Rapid Diagnostic Test (RDT), while Enzyme-linked Immunosorbent Assay (ELISA) was used as the gold standard and reference. Seropositivity was defined as either positive for IgG, IgM or both. Data was analyzed using SPSS version 23, with frequency distribution done for the sociodemographic variables and the prevalence of RDT and ELISA anti-T. gondii IgG and IgM. Pearson Chi-square analysis was performed to find any significant association between diagnosis of T. gondii infection with sociodemographic variables and blood transfusion. Logistic regression analysis was performed to investigate the odds of seropositivity (ELISA) with sociodemographic variables and blood transfusion.
ResultsA total of 156 SCD patients participated in this study of which 124 (79.5%) and 32(20.5%) were HbSS and HbSC respectively. Among the study participants, 105 (67.3%) had a history of blood transfusion. A total of 60 (38.5%) and 83 (53.2%) patients were positive for RDT and ELISA respectively. No significant association was seen between T. gondii diagnosis and cat ownership (RDT,20[37.7%], p = 0.891; ELISA, 27[50.9%], p = 0.673) and consumption of poorly cooked meat (RDT,37[41.6%],p = 0.370;ELISA,53[59.6%], p = 0.211). However there was a significant association between T. gondii diagnosis and age, with seropositive results predominantly seen among older patients (≥20 years) (RDT, 38[52.1%], p = 0.002; ELISA 49 [67.1%, p = 0.002]. Blood transfusion had a significant association with T.gondii diagnosis (RDT, p = 0.003; ELISA, p = 0.001). A total of 66 (62.9%) of SCD patients who had history of blood transfusion tested positive for ELISA and they had 3 times the odds of testing positive for ELISA (adjusted OR 3.14[95% CI 1.50–6.58]; p = 0.002).
ConclusionThe prevalence of T. gondii infection was higher by ELISA (53.0%) than by rapid diagnostic testing (RDT) (38.5%), and sickle cell disease patients with a transfusion history had higher odds of seropositivity. These findings highlight the need to strengthen transfusion safety protocols and consider screening strategies for T. gondii among high-risk populations such as patients with sickle cell disease. Also, there is the need for longitudinal research to help elucidate the true contribution of blood transfusion transmission of T. gondii since a cross-sectional study, causality could not be established.
To explore the views of healthcare practitioners in Britain regarding the role of midwives and nurses in the delivery of medical and surgical abortion.
An observational study of the Shaping Abortion for Change study healthcare practitioner survey (2021–2022).
Relationships between healthcare practitioner type, participant characteristics, knowledge of and attitudes towards abortion, and views about nurses' and midwives' role in abortion care were examined using Pearson's Chi-squared tests of association and multivariable logistic regression.
Amongst 763 participants including doctors, nurses, midwives and pharmacists, 71.6% supported specialist nurses in sexual and reproductive health and abortion clinics and hospitals, expanding their roles to include prescribing abortion medications and surgical abortion methods. Support was lower for midwives (35.8%) and primary care nurses (32.5%). There was considerable support for all nursing and midwifery groups to be involved in adjacent tasks of abortion care. Differences in support by healthcare practitioner type persisted after adjustment for exposure variables.
There is strong support for specialist nurses to expand their role in abortion care. This change could be implemented following clarification of the legal position. Some healthcare practitioner groups are more reluctant to support broader involvement of nurses and midwives in abortion provision.
Expanding specialist nurses' role in abortion care could increase service capacity and improve patient access and experience. Understanding and addressing the concerns of healthcare practitioners opposing this change is critical for successful implementation and patient safety.
This study addresses the potential for nurse and midwife role expansion in abortion care. The findings highlight broad support for specialist nurses whilst identifying barriers to wider role expansion. The research informs policy discussions on workforce optimisation and access to abortion services across Britain.
This study adheres to the STROBE guidelines for reporting observational studies.
In the SACHA study, patient and public involvement was included at all stages to inform study design, recruitment, data collection and analysis.
Hidradenitis suppurativa is a chronic inflammatory skin disorder causing painful nodules, abscesses and scarring, with the anogenital region presenting particular functional and reconstructive challenges. Although biologic therapy is commonly used in moderate to severe disease, its limitations highlight the role of surgery in advanced cases. This single-centre retrospective case series included five male patients with Hurley stage III perineal, anorectal, genital or gluteal disease treated surgically between 2021 and 2023 following failure of biologic therapy. Management consisted of two-stage radical excision, negative-pressure wound therapy and reconstruction with meshed split-thickness skin grafts. All patients achieved more than 90% graft take and complete wound healing. No recurrence occurred during a median follow-up of 19.2 months. One patient developed a keloid scar at the donor site, and one experienced delayed healing. Functional and aesthetic results were satisfactory in all cases. Two-stage surgical excision with split-thickness skin graft reconstruction was associated with sustained wound healing and favourable functional outcomes in selected patients with severe anogenital hidradenitis suppurativa refractory to biologic therapy.
Infections are a major cause of morbidity and mortality among individuals with haematological cancers, but the duration of elevated risk in long-term survivors remains uncertain. Although previous attempts to summarise the existing literature on this topic would have been hampered by the sheer volume of studies on cancer and all-cause infections, emerging artificial intelligence tools now offer the ability to streamline the screening process, allowing for broader and more comprehensive reviews.
This protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols guidelines. Eligible studies will include original observational data reporting long-term (≥1 year follow-up from diagnosis) infection-related outcomes in haematological cancer survivors compared with a general or cancer-free population. Screening will be supported by ASReview, an artificial intelligence-based tool for abstract prioritisation. An internal validation step will be conducted by comparing artificial intelligence-assisted screening results with manual review performed by two independent researchers on a subset of abstracts. The primary outcomes of infection incidence and infection mortality will be summarised by type of infection, type of haematological cancer and time since cancer diagnosis. Information on anti-cancer treatments received will also be described. Data synthesis will be mostly narrative due to the broad scope of the review, though meta-analyses will be performed in cases where studies are sufficiently homogenous. Risk of bias will be assessed using the Newcastle-Ottawa Scale.
Ethical approval is not applicable to this study. The results of the review will be disseminated to clinical audiences and submitted to a peer-reviewed journal.
CRD420251047091.
Loneliness significantly affects the physical and mental health of older adults, particularly those in long-term care settings. Despite the high prevalence of loneliness, comprehensive reviews on psychosocial interventions targeting loneliness in these populations are scarce.
To evaluate the effects of psychosocial interventions in reducing loneliness among long-term care residents.
A systematic review and meta-analysis.
We conducted a comprehensive search across five databases—CINAHL, EMBASE, PubMed/Medline, PsychINFO and The Cochrane Library—from inception to 14 February 2025. The inclusion criteria encompassed randomised controlled trials, quasi-experimental studies and pilot studies published in English that assessed psychosocial interventions for loneliness amongst long-term care residents. The Effective Public Health Practice Project framework was utilised for the quality assessment.
A total of 19 studies with 1646 participants were included. Results indicated that psychosocial interventions significantly reduced loneliness in long-term care residents. The interventions were categorised into lifestyle and leisure activities, psychological interventions, social support interventions and animal/robot-assisted interventions. Subgroup analyses revealed significant effects for lifestyle and leisure activities, group-based interventions, face-to-face delivery and interventions that less than 8 weeks.
Psychosocial interventions demonstrated a large effect size in reducing loneliness amongst long-term care residents. Interventions that incorporated lifestyle and leisure activities with a physical activity component, delivered face-to-face in group settings and lasted for less than 8 weeks may be particularly effective.
This review provides updated evidence that psychosocial interventions could improve loneliness amongst residents in long-term care settings. Consequently, it offers solid information to inform policy changes and intervention strategies.
The researching results were reported in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis checklist.
This study is a systematic review with meta-analysis, and such details do not apply to our work.
Trial Registration: This protocol was registered in the PROSPERO database (ID: CRD42024534009)
Death preparedness is an important prerequisite for improving the quality of life and the quality of death in advanced cancer patients. However, research on the level of death preparedness in patients is insufficient, and there is little understanding of the current status and influencing factors of death preparedness in advanced cancer patients.
This study aims to assess the current status of death preparedness and its influencing factors in advanced cancer patients.
Based on the PRECEDE-PROCEED model, a structured survey questionnaire was designed to collect data on personal factors (such as gender, age and residence area), interpersonal factors (such as social support, caregiver readiness and healthcare worker readiness) and social factors (such as care resources, policy support and information supply). Through multiple linear regression and BP neural network analysis, the study explores the impact and significance of these influencing factors on death preparedness in advanced cancer patients.
A total of 930 valid questionnaires were collected in this study. The death preparedness score in advanced cancer patients was 72.18 ± 22.82, indicating a moderate level, with the highest score being the ‘reflexive care’ dimension and the lowest score being the ‘hospice programme’ dimension. Multivariate analysis revealed that meaning in life and social support were the most significant predictors of death preparedness in advanced cancer patients. In addition, personal factors such as dignity, household income and coping style, also played an important role. Interpersonal factors like social support, as well as social factors such as care resources and policy support, also had an impact on patients' death preparedness to some extent.
Death preparedness in advanced cancer patients is generally at a moderate level, and death preparedness is influenced by a combination of personal factors, interpersonal factors and social factors.
This study is based on the PRECEDE-PROCEED model to comprehensively explore the influencing factors of death preparedness in advanced cancer patients. It provides theoretical support for improving life services for advanced cancer patients. It offers valuable practical experience and insights for societal attention and reform in end-of-life care.
No Patient or Public Contributions were included in this paper.
To consolidate the best evidence on digital therapeutic interventions for self-management in patients with hip fragility fractures, providing a foundational guide for clinicians in developing digital therapy-based self-management plans.
Integrative review.
A comprehensive electronic search was conducted across multiple databases, including UpToDate, BMJ Best Practice, Joanna Briggs Institute, Health and Clinical Excellence, Cochrane Library, Embase, PubMed, Cumulative Index to Nursing and Allied Health Literature, Web of Science and Chinese databases like China National Knowledge Infrastructure and SinoMed. This study retrieved papers published from the establishment of the database to September 2023.
Studies were selected based on inclusion criteria, such as relevance to hip fragility fractures and self-management through digital therapies. Quality assessments were conducted independently by two reviewers using established tools for each type of study, ensuring the inclusion of high-quality evidence.
Fifteen studies were included: 4 guidelines, 5 expert consensus documents, 5 systematic reviews and 1 evidence summary. From these, 26 best practices were identified across 4 domains: digital design, self-management influencing factors, intervention plans and intervention content.
This integrative review provides a comprehensive, evidence-based summary of digital therapeutic interventions for self-management in patients with hip fragility fractures. The findings offer healthcare professionals a scientific basis for integrating digital therapy into clinical practice, highlighting its potential to enhance patient self-management.
This review underscores the value of digital therapies in empowering patients to take an active role in their rehabilitation, potentially improving adherence to self-management strategies and long-term outcomes.
No patient or public contribution was used for this study.
In China, government-funded free treatment programmes have substantially expanded access to mental healthcare for patients with severe mental illnesses (SMIs). However, the effectiveness and patient satisfaction associated with these programmes can vary significantly. Understanding the factors underlying these variations is crucial for optimising patient adherence and rehabilitation outcomes.
To identify factors influencing SMI patients' satisfaction with a government-funded free treatment programme in District S, Nanjing, China, and propose targeted measures to enhance the programme's effectiveness and improve patient outcomes.
A cross-sectional study.
This study was conducted in 23 community healthcare centres in District S, Nanjing, China, from January to July 2022. A total of 924 SMI patients enrolled in the programme were selected using a two-stage random sampling method. Data on patients' individual characteristics, health behaviours and satisfaction with the programme were collected by a self-developed structured questionnaire. Guided by Andersen's Behavioural Model, hierarchical logistic regression analysis was employed to determine factors associated with patient satisfaction.
Among the 924 valid responses, 51.3% of patients with SMIs reported low satisfaction with the programme. Factors associated with patient satisfaction included individual predisposing, enabling, need and health behaviour variables. Specifically, patients who were employed, had schizophrenia, experienced adverse drug reactions, feared program exposure of their condition and received treatment in hospital were more likely to report lower satisfaction.
This study revealed that satisfaction among SMI patients with the programme remains low, with patient satisfaction primarily determined by individual need and health behaviour factors. Policymakers and stakeholders should implement targeted measures to address these factors and improve patient satisfaction.
The findings offer new insights and scientific bases for policymakers seeking to improve the programme and practical recommendations for stakeholders to develop effective solutions.
STROBE guidelines.
No patient or public contribution.
Cough, a prevalent and debilitating symptom of lung cancer, remains poorly managed. Accumulating evidence on non-pharmacological interventions for lung cancer cough necessitates systematic evaluation to assess their efficacy.
To synthesise evidence on non-pharmacological interventions for managing cough in lung cancer patients.
A systematic review and meta-analysis following the Preferred Reporting Items for Systematic reviews and Meta-Analyses reporting guideline.
Nine databases were searched from inception to December 2024 to identify randomised controlled trials. Study quality was appraised using the Revised Cochrane Risk-of-Bias Tool for Randomised Trials. Meta-analyses were performed for quantitative synthesis, with sources of heterogeneity examined using meta-regression and subgroup analyses.
Thirty-eight studies representing 2995 lung cancer patients were identified. These studies investigated acupuncture therapy, moxibustion, pulmonary rehabilitation, self-management intervention, physical exercises, psychoeducation support, mindfulness, and multicomponent interventions. Non-pharmacological interventions showed positive effects on cough severity and cough-related quality of life. Additional benefits were observed for expectoration, dyspnea, and general quality of life. Pulmonary rehabilitation showed a greater effect on cough severity than other non-pharmacological interventions.
Non-pharmacological interventions are promising in improving cough, expectoration, dyspnea, and general quality of life among lung cancer patients. Pulmonary rehabilitation showed the most promising effect. Future research should adopt objective cough measures in addition to self-reported measures.
Non-pharmacological interventions demonstrated potential effects in relieving cough and additional benefits in improving expectoration, dyspnea, and general quality of life among lung cancer patients. Healthcare professionals may adopt pulmonary rehabilitation for cough and related symptoms in lung cancer patients.
As the first meta-analysis addressing non-pharmacological interventions for lung cancer cough, this study provides evidence supporting their clinical efficacy for improving cough and associated symptoms among patients with lung cancer.
No patient or Public contribution.
PROSPERO CRD42024588729.
Negative-pressure wound therapy (NPWT) is widely used in clinical practise to enhance wound healing; however, its biological effects on intact skin remain poorly understood. Given the expanding applications of NPWT, understanding its impact beyond open wounds is increasingly important. This study aimed to evaluate the biological responses of intact skin to negative-pressure, specifically focusing on epithelial-mesenchymal transition (EMT). The effects of negative-pressure loading were assessed using an in vitro model of non-diabetic human keratinocytes and an in vivo model of intact diabetic mouse skin. Human keratinocytes exposed to negative-pressure exhibited increased expression of thrombospondin-1 (THBS1), transforming growth factor-beta 1 (TGF-β1), plasminogen activator inhibitor-1 (PAI-1), and hypoxia-inducible factor 1-alpha (HIF-1α), alongside decreased epithelial markers and increased mesenchymal markers. These EMT-related changes were mitigated by inhibiting the THBS1-TGF-β1 interaction. Similarly, in diabetic mice, intermittent negative-pressure loading applied to intact dorsal skin significantly increased THBS1 and TGF-β1 levels, resulting in epidermal and dermal thickening, and promoted hypoxic, prothrombotic and angiogenic responses, as evidenced by increased HIF-1α, PAI-1, fibrinogen and vascular endothelial growth factor expression. These findings suggest that negative-pressure loading can induce EMT-like responses and tissue remodelling in intact skin primarily via mechanisms involving the THBS1-TGF-β1 signalling axis. This study expands the understanding of the biological influence of NPWT beyond traditional wound treatment applications, potentially informing future therapeutic considerations and safety guidelines.
The feature cover image is based on the article Intent to treat analysis of the Primary and Secondary Outcomes for the XXX intact fish skin graft for deep diabetic foot wounds trial by John Lantis et al., https://doi.org/10.1111/iwj.70847.
The feature cover image is based on the article Intent to treat analysis of the Primary and Secondary Outcomes for the XXX intact fish skin graft for deep diabetic foot wounds trial by John Lantis et al., https://doi.org/10.1111/iwj.70847.
Negative pressure wound therapy (NPWT) is widely used to facilitate healing by improving local perfusion, reducing edema and controlling exudate. The porous foam dressing is central to NPWT effectiveness, however, its performance in viscous, particle-rich exudates remains challenging. Standard industry tests often rely on protein-free aqueous solutions, which overlook the complex rheology and particulate load of real wounds. This study reports a bench evaluation of a multilayer foam prototype compared with three commercial dressings under NPWT, using a simulated viscous exudate with suspended particles. We recorded 60-min drainage curves and quantified effluent turbidity as a simple, interpretable proxy for particulate transport, summarised as percentage of input turbidity recovered. The mass-based endpoint (percent solid matter recovered) showed the same ranking as turbidity. At −75 mmHg, the prototype recovered 31.6% of input turbidity, exceeding commercial foams (≤ 9.7%). At −125 mmHg, particulate recovery decreased across all dressings (≤ 9.1%). A matrix-only control indicated that commercial effluents, particularly at −75 mmHg, clustered near background level, whereas the prototype evacuated substantially more particulate while maintaining robust fluid drainage. These findings suggest that moderate negative pressure and multilayer architecture can help preserve channel patency and reduce clogging in complex exudates. We highlight the need for test methodologies that incorporate viscosity and particulate content, and for practical guidance that links dressing architecture and pressure settings to exudate characteristics. Prospective validation, including larger-sample confirmation, particle-size distributions and ultimately clinical endpoints, is warranted.
Hand osteoarthritis (OA) is a prevalent and debilitating joint disorder that impairs daily functioning and quality of life. Current treatments are often inadequate in managing the symptoms and progression of the disease. The cytokine interleukin (IL)-17 has been implicated in the inflammatory processes associated with OA, making it a potential target for therapeutic intervention. This trial aims to evaluate the efficacy of vunakizumab, an IL-17A inhibitor, in reducing pain and improving functional outcomes in patients with erosive hand OA.
This multicentre, randomised, placebo-controlled, double-blind trial will enrol 150 participants aged 30–80 years with symptomatic erosive hand OA. Participants will be randomised in a 1:1 ratio to receive either vunakizumab 120 mg or placebo subcutaneously every 4 weeks for 24 weeks, with a loading dose injection period during the first 4 weeks. The primary outcome is the change in hand pain assessed by the Visual Analogue Scale at 28 weeks. Secondary outcomes include changes in physical function measured by the Functional Index for Hand Osteoarthritis, the Quick Disabilities of the Arm, Shoulder and Hand questionnaire and the Health Assessment Questionnaire, as well as changes in grip strength and radiographic and MRI evaluations of the hands.
Written informed consent will be obtained from all participants. The study was approved by the Ethics Committee of Shanghai Sixth People’s Hospital (2024–217) and will adhere to the Declaration of Helsinki. Research results will be published in peer-reviewed journals.
ChiCTR2500101031; https://www.chictr.org.cn/showproj.html?proj=264789.
Accessible, person-centred, non-pharmacologic modalities are needed to address chronic pain and health-related quality of life (HRQoL) among individuals with sickle cell disease (SCD). Building off prior single-site pilot studies of music therapy (MT) in SCD, the purpose of this study is to (1) examine the data collection processes and intervention implementation overall and across two sites and (2) evaluate the implementation of the MT and health education interventions using quantitative and qualitative data.
This three-arm, two-site, feasibility randomised controlled trial will include 90 individuals ≥14 years who have SCD, chronic pain and access to a mobile device who are not currently engaged in mind-body pain management interventions under the supervision of a healthcare professional. Participants will be randomised to six sessions over 8 weeks of either: (1) in-person MT, (2) hybrid (one in-person, five virtual) MT or (3) hybrid health education. Patient-reported outcome measures of HRQoL and self-efficacy will be assessed at baseline, post-intervention and 6 weeks post-intervention. 24 participants (eight per arm) and 20 stakeholders (eg, haematologists, music therapists, nurses) will be invited to complete semi-structured interviews to further examine intervention acceptability, perceived benefits and implementation. Sessions will be monitored for fidelity, and participants lacking access to home internet or videoconferencing technology will be provided tablets to engage in virtual sessions. Feasibility will be determined by rates of data completion, recruitment, retention, session attendance and home practice.
This study was approved by the University Hospitals Cleveland Medical Center Institutional Review Board (STUDY20231055). The dissemination plan includes presenting findings at national and international scientific conferences and publishing in peer-reviewed journals. All activities will be conducted in collaboration with SCD community stakeholders.
Approximately 20%–40% of older adults face loneliness. The effectiveness of artificial agents used to treat loneliness in this population is contentious in current studies. We aim to investigate the efficacy of this treatment for loneliness and other well-being outcomes in the elderly and identify factors that moderate its effects.
A systematic review and meta-analysis of randomised controlled trials and non-randomised studies of interventions with control groups involving artificial agents to alleviate loneliness in older populations; data sourced from PubMed, CENTRAL, EMBASE, CINAHL (EBSCO) and PsycINFO (EBSCO). Two reviewers will independently assess the literature, with a third reviewer consulted to resolve disagreements. Study characteristics will be narratively summarised. A meta-analysis will assess treatment effects on loneliness and other outcomes. Meta-regression and subgroup analysis will be conducted based on artificial agent type, treatment strategy and participants’ settings; and comparisons performed via a random-effects model, using Cochrane Review Manager V.5.4.1 and STATA V.16.0 for quantitative synthesis. Study quality will be assessed using appropriate risk-of-bias assessment tools. Cochran’s Q test and I2 statistics will assess heterogeneity. Publication bias will be identified using Egger’s test and a funnel plot.
Since this systematic review is carried out based on published scientific databases, it is exempt from ethics approval. The findings of this review will be disseminated in a related peer-review journal.
CRD42023428127.
An alarmingly low number of children meet public health guidelines for physical activity and dietary behaviours and, therefore, are at increased risk of developing lifestyle-related diseases. This paper describes the protocol of the B-Challenged project, which aims to co-create systemic actions to promote active outdoor play and healthy dietary behaviours before, during or after their outdoor play together with children themselves.
In five European countries, child-centred Participatory Action Research (PAR)—combined with systems dynamics methods—was conducted with 15–20 child co-researchers (aged 9–12 years) and 15–20 adult actors (eg, youth workers, local policy makers). In the first phase, the main drivers of children’s active outdoor play and related dietary behaviours were mapped by (1) analysing existing cohort data, and (2) conducting child-centred PAR. In the second phase, systemic actions targeting the local physical and social environments will be co-created and implemented by child co-researchers and adult actors to promote children’s active outdoor play and related healthy dietary behaviours. A mixed-methods design will be used to evaluate (1) if actions positively contributed to systems change and 6- to 12-year-olds’ outdoor play and related dietary behaviours (140 children per country); (2) the process of conducting multi-actor, child-centred PAR and implementing the co-created actions and (3) if the child-centred PAR positively contributed to child co-researchers’ feelings of empowerment.
Ethics approval for the mapping phase was obtained and approval for implementation and evaluation will be obtained from the five local research institutions. Participating children, one of their parents/caregivers and adult actors had given informed consent before participating in the project. Throughout the project, child-friendly methods, materials and language will be applied, and ethical challenges and potential solutions will be discussed. Project results will be disseminated locally and internationally through various channels and activities among the scientific community, professionals—for example, in health and policy making, children and other citizens.
Traditional encounter-based analyses overlook downstream costs and complications that follow emergency department (ED) care. To enable more comprehensive evaluations, we developed standardised episode of care definitions for five common, high-cost conditions: chest pain, congestive heart failure (CHF), pneumonia, chronic obstructive pulmonary disease (COPD) and suicidality.
A two-round modified Delphi panel study was conducted following a literature review and evidence synthesis. Using structured surveys with anonymous feedback, panellists rated candidate criteria. To be retained in the final episode definitions, criteria were required to meet a predefined validity threshold without panellist disagreement. Data were analysed descriptively, and meeting deliberations were recorded and reviewed thematically.
Virtual, supported by an online survey platform.
A multidisciplinary panel of 11 experts in emergency medicine and relevant clinical specialties with 9 members participating in each round.
Criteria to determine inclusion, exclusion (including pre-trigger, post-trigger and event exclusion) and risk-adjustment standards for constructing ED-based episodes of care.
Candidate criteria were presented to the panel by condition: 30 for chest pain, 54 for CHF, 30 for COPD, 79 for pneumonia and 375 for suicidality. Following deliberations and re-rating, the number of valid criteria was reduced, primarily in the episode exclusion category. Thematic analysis highlighted trade-offs between episode exclusion criteria and the use of risk adjustment to account for heterogeneity.
Operational definitions for ED-based episodes of care for five conditions were established. These may support healthcare administrators, policymakers and researchers in evaluating variation in ED care delivery and its downstream cost and outcomes.
by Ting Zhao, Yulin Wang, Fu-an Lin
BackgroundSystemic sclerosis–associated interstitial lung disease (SSc-ILD) is a major clinical challenge with no effective treatments. It is also the leading cause of death in patients with systemic sclerosis. Thus, understanding its underlying molecular mechanisms, particularly those related to macrophage-related gene functions, is critical to address this urgent medical need.
MethodsIn this study, single-cell and transcriptomic data retrieved from a public database were analyzed to investigate the underlying molecular mechanisms of SSc-ILD. A series of comprehensive analyses was conducted, including cell–cell communication analysis, pseudotime trajectory analysis, and high-dimensional weighted gene co-expression network analysis, to identify pertinent genes linked to macrophage modules. Candidate genes were determined by intersecting differentially expressed genes (DEGs) with macrophage module genes. Subsequently, key genes were identified through protein–protein interaction (PPI) network analysis and gene expression validation. Various analytical procedures were used to evaluate the function of the key genes in the regulatory roles of SSc-ILD, including enrichment analysis, immune infiltration analysis, drug prediction, and molecular docking.
ResultsOf the 1515 DEGs and 400 macrophage module genes intersected, 50 candidate genes were identified. In particular, ARG2, ELF3, and NKX2–1 emerged as key genes through subsequent PPI network analyses and gene expression evaluations. Enrichment analyses revealed a notable co-enrichment of the lysosomal pathway with these key genes. Moreover, immune infiltration analysis revealed a strong negative correlation between NKX2–1 and monocytes, whereas ELF3 and ARG2 exhibited a positive association with activated dendritic cells. The molecular docking results showed that the binding energies of ARG2-SKA-111/cyclophosphamide and ELF3–voruciclib/cyclophosphamide were less than − 5 kcal/mol.
ConclusionThe findings of this study highlight the key roles of ARG2, ELF3, and NKX2−1 in macrophage-related mechanisms of SSc-ILD, providing insights into potential therapeutic targets. Further research is necessary to explore their functional implications in disease progression and treatment.
FreshRSS 