Search Results (761)

Increasing ethnic diversity raises potential inequalities within screening programmes. In the UK, newborns are screened for CF by initially measuring IRT. Dried blood spot IRT levels above a set cut-off require follow-up testing to establish a screening result. Variation exists in IRT levels between different ethnicities and therefore impacts the number of potentially false positive results obtained from ethnic groups. Over a 4-year period, IRT data was collected, and the 99.5th centile was calculated for different ethnic groups. Significant differences were noticed between ethnic groups, and the CF outcome data over a 10-year period were then analysed to establish the effect this had on positive predictive values. The largest difference in IRT 99.5th centile values was seen between the White British and Black African groups. Positive predictive values for Black African and Indian ethnic groups were much lower than the other groups. Rather than try to incorporate ethnicity into the UK CF screening algorithm, we suggest making CF clinicians aware of the differences between different ethnic groups to inform counselling families who receive screen-positive results. Full article

Traditional cardiovascular assessment has historically focused on the isolated evaluation of either atrial or ventricular structure and function. However, the left atrioventricular coupling index (LACI) represents a paradigm shift by moving beyond single-chamber metrics to quantify the dynamic interaction between the left atrium and left ventricle. Defined as the ratio of left atrial end-diastolic volume to left ventricular end-diastolic volume, LACI integrates structural and functional aspects of cardiac performance. This comprehensive review examines the physiological basis of how the left atrium and ventricle operate as an integrated hemodynamic unit. We detail current measurement methodologies, including two- and three-dimensional echocardiography, cardiac computed tomography, and cardiac magnetic resonance imaging, which serves as the reference standard. Furthermore, the review explores the pathophysiological mechanisms driving atrioventricular uncoupling, specifically mechanical dysfunction, electromechanical desynchrony, and hemodynamic alterations. Extensive clinical evidence demonstrates LACI’s robust independent prognostic value across diverse cardiovascular conditions, such as heart failure, myocardial infarction, cardiomyopathies, and atrial fibrillation. Observational data suggest that LACI provides a promising prognostic value beyond established risk assessment tools by combining the assessment of both chambers’ interdependence. Finally, we outline future directions for clinical translation, highlighting the necessity for standardized measurement protocols, the integration of artificial intelligence, and the potential of LACI as a target for personalized therapeutic strategies. Full article

Voluntary placement agreements are a less understood avenue through which children and families receive child welfare services. This article describes a qualitative exploratory study of participants who oversee and engage with children and families utilizing voluntary placement services in two states (n = 12). Thematic analysis of interviews revealed voluntary placements are used as a strategy for strengths-based engagement with families, including creative problem-solving, to help obtain resources for youth with emotional and behavioral health needs. Participants also described challenges managing ambiguity regarding the use of voluntary placements and acknowledged limitations and varied outcomes of voluntary placement. Youth in voluntary placements are often overlooked in broader child welfare and foster care practice and policy discussions. Stronger accountability and guidance on voluntary placements are needed to ensure children and families are provided adequate supports to reduce the need for out-of-home placements when possible. Full article

Objective: The aim was to evaluate the diagnostic accuracy and temporal reproducibility of multimodal large language models (LLMs) in the image-based diagnosis of oral mucosal lesions. Materials and Methods: The study included 100 anonymized clinical photographs of oral mucosal conditions obtained from the archive of the Department of Oral Medicine, School of Dental Medicine, University of Zagreb. Images were categorized into four subgroups: physiological variations, benign mucosal lesions, oral potentially malignant disorders, and oral cancer (25 images each). Three multimodal LLMs (ChatGPT-5.1 Plus, Gemini 3 Pro, and Perplexity Pro) analyzed each image using an identical prompt and were required to provide a single most probable diagnosis based solely on visual features. To evaluate temporal reproducibility, the entire evaluation was repeated in three independent testing cycles conducted at one-month intervals. Diagnostic accuracy was compared using chi-square tests, while intra-model agreement across cycles was assessed using Fleiss’ kappa. Results: Gemini demonstrated the highest diagnostic accuracy, reaching 78% correct responses in cycles 2 and 3, significantly outperforming ChatGPT (55–57%) and Perplexity (28–31%) (p < 0.00001). Subgroup analyses showed similar trends, with Gemini achieving the highest accuracy across most lesion categories. Intra-model agreement across cycles was moderate for ChatGPT (κ = 0.525), fair for Gemini (κ = 0.338) and Perplexity (κ = 0.409). Gemini also showed the highest proportion of responses that remained correct across all three cycles (51%). Conclusions: Multimodal LLMs demonstrate promising diagnostic capabilities in the image-based assessment of oral mucosal lesions; however, variability in reproducibility highlights the need for cautious clinical implementation and further validation. Full article

Fetal therapy has evolved into a rapidly advancing field with the potential to alter the natural history of many severe congenital and genetic disorders before irreversible injury occurs. Progress in prenatal imaging, molecular diagnostics, and fetal intervention techniques now enables the earlier identification of disease and, in select settings, targeted prenatal treatment. This review synthesizes the current landscape of fetal therapies, spanning established surgical interventions for structural anomalies and emerging biologic and molecular approaches, including enzyme replacement therapy, stem cell-based strategies, gene therapy, and gene editing. The intrauterine environment provides a distinct therapeutic context, with developmental plasticity, immune immaturity, enhanced tissue accessibility, and relatively permissive central nervous system exposure that together define a time-sensitive window for intervention. Preclinical studies and early clinical experience across both structural anomalies and genetic disorders, including lysosomal storage disorders, osteogenesis imperfecta, and spinal muscular atrophy, support the premise that prenatal treatment can preserve organ development and improve pediatric outcomes. However, translation remains constrained by procedural risks, uncertainty regarding long-term safety and durability, ethical and regulatory complexities, and challenges with equitable access, alongside the need for robust comparative evidence versus early postnatal therapy. As the field advances, multidisciplinary collaboration, rigorous trial design with meaningful developmental endpoints, and ethically grounded implementation frameworks will be essential to guide responsible clinical adoption and maximize benefit for children and families. Full article

This article explores Daniel Kahneman’s concept of system thinking from his book Thinking Fast and Slow (2013) in the context of contemporary spiritual and theological reflection. The question studied here is: What does the intentional use of emotions, dreams and intuition described by Daniel Kahneman as System 1 thinking look like in contemporary spiritual and theological reflection? According to Kanheman, System 1 thinking includes emotions, dreams and intuition. The method for answering the research question is hermeneutical. This means gathering texts that fit Kahneman’s description of System 1 thinking and integrating these concepts into some form of spiritual and theological reflection. Hermeneutical research is text-based. Fifty-three (53) texts were found in a search of various databases. These texts are analyzed noting the impact of System 1 thinking on spiritual and theological reflection. Findings include the following: First, there is a rise in the number of texts using System 1 thinking in spiritual and theological reflection. Second, disciplines outside of theology are practicing spiritual reflection as part of their spiritual care. Third, these non-theological disciplines are also using System 1 thinking in their spiritual reflections. Fourth, there is an awareness and utilization of diverse cultures and faith experiences in spiritual reflection. Fifth, these texts indicate the growth of the demographic of people who are spiritual but not religious and a connection to dreams, emotions and intuition in spiritual and theological reflection. Sixth, there is also a developing overlap between spiritual and theological reflection. Cautions and gaps in the textual analysis are noted as well as future applications. Full article

De Haan and Dahm have recently proposed a “Middle Way” to reconcile the long-standing conflict between Corruptionists and Survivalists in the ancient Thomistic debate over the personhood of the separated soul. While the Middle Way avoids some difficulties with the traditional positions, it relies on the unstable notion of an “incomplete person.” Building on the Middle Way’s insights, this paper proposes a “Mixed View.” Based on “Single-Part-Composition”, “Composition as Non-Identity”, “the Criterion of the Numerical Identity of Substances”, and the three criteria of personhood analyzed by De Haan and Dahm, I argue that the separated soul solely composes a substance that is numerically identical to the pre-mortem substance. This post-mortem substance satisfies the criteria for personhood but no longer under the species of human being, and the soul itself is not a person. The Mixed View preserves personal continuity without attributing personhood (complete or incomplete) to the soul, while also retaining the metaphysical seriousness of death as a substantial change, the abhorrence of death and the necessity of Resurrection. Full article

Transcatheter aortic valve implantation (TAVI) has become the predominant treatment strategy for severe aortic stenosis across all surgical risk categories. The coexistence of coronary artery disease (CAD) in 40–75% of TAVI candidates has traditionally mandated pre-procedural invasive coronary angiography (ICA). However, computed tomography coronary angiography (CTCA), which is already integral to TAVI planning for annular sizing and access route evaluation, offers the potential to assess coronary anatomy simultaneously. Accumulating evidence demonstrates that CTCA possesses excellent sensitivity (90–97%) and high negative predictive value (94–99%) for excluding significant proximal CAD, potentially serving as a reliable gatekeeper to avoid unnecessary ICA in a substantial proportion of patients. This approach is particularly attractive given the questionable benefit of routine pre-emptive coronary revascularization in stable TAVI candidates, as demonstrated by the ACTIVATION and NOTION-3 trials. This review synthesizes the current evidence on the diagnostic performance of CTCA, clinical outcomes with CT-guided strategies, technical considerations and limitations, and the evolving paradigm of coronary assessment in the contemporary TAVI era. We propose a practical algorithm integrating CTCA as a first-line screening tool, reserving ICA for patients with suspected significant proximal disease, thereby optimizing resource utilization while maintaining patient safety. Full article

Many debates in Christian theology and philosophy, especially debates having to do with the Trinity (like the debate over the filioque) and with divine action (like the debate over whether there is a distinction between God’s essence and God’s energies), have made use of the idea of divine processions. But with rare exceptions, theologians have said little about how the terms used for divine processions are the same terms used for liturgical, military, and state processions and marches. Rather, in general, theologians have treated these terms in a purely technical metaphysical sense. I contend that progress will be made on solving these debates if we attend to the image of actual processions that is conveyed by words originally used for divine processions (including Latin words like ‘processio’ and ‘procedere’ and Greek words like ‘proodos’ and ‘ekporeusis’). After describing the relevant debates, I outline a method for recovering the experiences and images conveyed by those procession words; this perceptual and aesthetic method draws upon the work of a range of phenomenologists and phenomenologically-inspired thinkers. I then use this method to draw out the content of procession words, and to show that procession as such is a pure perfection, a property of being, a privileged manifestation of persons, and a divine attribute. Finally, I show how this more holistic approach to divine processions allows for a defense of the Western Christian doctrine of the filioque, without losing essential Eastern Christian insights about the procession of the Holy Spirit, and a defense of the Eastern doctrine of the essence–energies distinction, without losing crucial Western insights about divine simplicity. While it is of course beyond the scope of a single paper to solve such complex debates, this paper lays a foundation for future synthesis between Eastern and Western views. Full article

Background: Artificial intelligence (AI) is expected to play an increasingly important role in medicine and dentistry. While its diagnostic potential has been tested in various medical fields, limited research exists on its applications within oral medicine diagnoses using clinical images. Objective: This pilot study aimed to evaluate the diagnostic accuracy of ChatGPT, Gemini, and Copilot in identifying benign, potentially malignant, and malignant oral lesions. Methods: A cross-sectional study was conducted using clinical images from three categories: benign oromucosal conditions, oral potentially malignant disorders, and malignant oral lesions. Results: ChatGPT evaluated all images and consistently outperformed Copilot—and in some cases Gemini—across multiple diagnostic questions, with statistically significant advantages particularly in the cancer subgroup. Copilot showed the weakest performance, with high rates of missing evaluations and significantly lower proportions of correct responses in several analyses. Across both full-dataset and adjusted analyses, ChatGPT demonstrated the highest diagnostic performance overall. Diagnostic accuracy metrics for malignancy suspicion was similar for ChatGPT and Gemini. Several limitations such as sample size, lack of reproducibility testing and inability of some AI models to process images must be taken into account when interpreting the results. Conclusions: AI tools show promise but cannot yet replace clinical expertise. Further research and development are needed to improve the accuracy and applicability of AI diagnostic tools. Full article

Background/Objectives: Older adults frequently present with emergency ventral hernias, a situation that carries significant physiological risks and often requires challenging clinical decisions. Despite the prevalence of these cases, there is a lack of robust evidence to inform emergency care in this demographic, as most existing research centres on short-term mortality rates and operative variables. Key aspects such as the impact of frailty and the course of recovery following surgery are insufficiently addressed in the literature. This study aimed to describe management strategies, frailty burden and postoperative outcomes in older adults presenting with emergency ventral hernias. Methods: This study retrospectively examined patients aged 65 and older who were admitted to a UK tertiary centre with emergency ventral hernias from February 2016 to July 2024. Data, including patient demographics, comorbid conditions, frailty status (as measured by the Clinical Frailty Scale), management approach, healthcare resource use, and clinical outcomes, were analysed descriptively. Additionally, a structured literature review was conducted in accordance with PRISMA guidelines to identify research on emergency ventral hernia treatment outcomes in adults aged 60 years and older. Results: A total of 67 patients met the inclusion criteria for the cohort. High rates of frailty and multiple coexisting health conditions were observed. While surgical intervention was the predominant management strategy, a subset of patients received conservative or palliative care. Greater degrees of frailty correlated with longer hospital stays and an increased need for critical care, even though six-month mortality remained comparatively low. Traditional risk assessment tools tended to overpredict mortality risk and failed to reflect the true postoperative burden or the recovery process. The systematic review yielded 7 studies, most of which documented mortality and complication rates, but few addressed frailty or provided detailed postoperative recovery data. Conclusions: The management of emergency ventral hernias in older adults is highly variable, with a significant postoperative impact that extends beyond mortality statistics. Assessing frailty appears to provide additional information that may support clinical decision-making and help anticipate recovery after surgery. Integrating frailty evaluation into emergency hernia care could enhance multidisciplinary collaboration and help ensure that treatment plans are better tailored to patient vulnerability and individual care goals. Full article

Background: Precise staging of prostate cancer is vital for treatment planning and prognosis. While [⁶⁸Ga]Ga-PSMA-11 PET-CT has demonstrated high diagnostic accuracy in detecting metastatic disease, the interpretation of indeterminate or potentially benign PSMA-avid bone lesions remains a clinical challenge in routine practice. Methods: We conducted a retrospective single-centre study involving 214 patients who underwent [⁶⁸Ga]Ga-PSMA-11 PET-CT between January 2021 and January 2024. Patients with prior known bone metastases or alternative PSMA radiotracers were excluded. Only those with follow-up imaging were included for diagnostic accuracy analysis. Follow-up modalities included PSMA PET-CT, CT, MRI, and bone scintigraphy. Final classification (metastatic or benign) was based on radiological and clinical assessment. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) were calculated using follow-up imaging as the reference standard. Lesions classified as indeterminate were analysed separately and excluded from diagnostic performance calculations. Results: Of the 214 included patients, 142 had follow-up imaging. Among 80 patients with bone lesions initially reported as metastatic, 74 (92.5%) were confirmed. Among 28 patients initially reported as having benign bone lesions, 26 (92.9%) remained benign on follow-up. Thirty-four patients with indeterminate lesions were reviewed; four were ultimately metastatic. Excluding indeterminate cases, sensitivity, specificity, PPV, and NPV were 97.4%, 86.7%, 94.9%, and 92.9%, respectively. Diagnostic discordance was primarily associated with benign uptake in the ribs, iliac bones, pubic rami and degenerative changes. Conclusions: [⁶⁸Ga]Ga-PSMA-11 PET-CT shows excellent sensitivity and positive predictive value for detecting metastatic bone disease in prostate cancer. However, benign lesions may also exhibit uptake, emphasising the importance of integrating imaging results with PSA levels, Gleason scores, and TNM staging. Prospective studies are needed to validate these findings and assess their impact on long-term outcomes. Full article

Biopsies are only performed in less than 1% of all consultations dedicated to paediatric genital dermatology. The objectives of this paper are to review and clarify the histopathological features of the conditions most often biopsied: first, lichen sclerosus, which has a peak incidence in childhood and progresses over years; secondly, pigmented lesions, including atypical genital naevi and common naevi in the context of lichen sclerosus, both histologically differential diagnoses of melanoma, which probably does not present in childhood. And finally, Crohn’s disease, which is a cause of vulval oedema or genital ulceration. Full article

PET scans have long been used in oncology imaging to provide molecular and metabolic information about diseases. The use of artificial intelligence (AI) in PET scans in oncology theranostics has the potential to optimise PET modality and overcome the constraints that PET scans have, such as semi-quantitative metrics, reader subjectivity, and variability across scanners/institutions. Advances in AI and radiomics are overcoming those limitations by deep learning lesion detection, enhancing image reconstruction, and improving noise resolution, which allows ultra-low dose acquisitions, while physics-informed models integrate with PET systems to strengthen interpretability and quantitative accuracy. There are also predictive AI frameworks that link PET imaging biomarkers to therapy response and outcomes, create individualised care and are even able to simulate treatment response and help with treatment planning. However, challenges do exist. Most AI PET studies are retrospective, single-centre, and underpowered (small sample), with limited external validation and inconsistent standardisation (in acquisition, segmentation, and extraction), leading to poor reproducibility and higher performance estimates. Furthermore, ethical considerations, including data protection and transparency, need to be considered before implementation. Federated learning, physics-informed frameworks, and adherence to standardised protocols offer steps towards regulated AI systems. In summary, PET is evolving from an imaging modality to a platform with the integration of deep learning, radiomics and reconstruction capable of predicting treatment response and guiding treatment. With rigorous prospective validation, cross-institutional collaboration, and regulatory standardisation, AI in PET would create an advancement in nuclear medicine imaging in oncology. Full article

Background: e-Lung (Brainomix) is an artificial intelligence (AI)-driven software that is based on multi-class convolutional neural network (CNN) techniques. The aim of this research was to demonstrate the feasibility of e-Lung to evaluate progression in lung volume reduction in patients with interstitial lung disease (ILD) undergoing lung transplant assessments. Methods: This was a single-center retrospective cohort study of consecutive patients with ILD who received lung transplants between June 2021 and November 2024. Patients who underwent serial prospective conventional evaluations using lung function testing (LFT) and conventional radiological assessments as well as retrospective lung volume measurements using e-Lung were included in this study. Results: An analysis of 20 consecutive patients who met strict inclusion criteria and underwent an additional e-Lung assessment revealed that both the serial physiological actual total lung capacity (aTLC) measurements and e-Lung-derived lung volume measurements were able to provide recipient lung size estimations and detect serial declines in lung volume. A poorer DLCO (2.61 ± 0.77 vs. 3.87 ± 1.59 mmol/min/kPa, p = 0.044) at the time of wait-listing was associated with a significant lung volume reduction. Conclusions: e-Lung may serve as an additional upscale tool for the rapid and objective quantitative evaluation of the actual lung volume and the detection of the extent of parenchymal shrinking in patients with advanced ILD awaiting lung transplantation. Full article