Search Results (3,141)

Apnea of prematurity (AOP) remains a critical challenge in neonatal care, with caffeine citrate serving as the cornerstone of pharmacological intervention. However, the current standardized dosing schedule fails to account for significant inter-individual variability in caffeine pharmacokinetics and clinical response. This narrative review explores the transformative potential of integrating wearable sensor technologies and multi-modal data analytics into a closed-loop framework for personalized caffeine therapy. Based on a synthesis of current monitoring literature, we propose a theoretical, comprehensive monitoring system utilizing the area under the respiratory curve (rAUC) as a continuous proxy metric, alongside waveform amplitude analysis aligned with pediatric polysomnography standards. By incorporating emerging metrics such as respiratory rate variability (RRV) and hypoxic burden, the framework enables the objective quantification of respiratory stability. Furthermore, the integration of established neonatal intensive care unit (NICU) parameters for bradycardia and oxygen saturation detection provides a critical cross-validation layer to minimize artifact-induced false alarms. This conceptual model bridges the gap between advanced signal processing and clinical oversight, offering a scalable pathway toward precision dosing. By shifting from reactive to predictive neonatology, sensor-driven optimization can enhance therapeutic efficacy, reduce alarm fatigue, and ultimately improve developmental outcomes for preterm infants. Full article

Ecological degradation is accelerating worldwide, yet the losses of species, ecosystems, and landscapes often remain socially and culturally unmourned. This article explores how contemplative ecology may offer a pathway for engaging with ecological grief. Drawing on the case study of Lab Landschapspijn Veluwe in the Netherlands, it examines how contemplative practices—such as contemplative dialogue and contemplative walking—can help participants attune to ecological loss in degraded landscapes. Using heuristic inquiry and interpretative phenomenological analysis, the study investigates how participants perceive and articulate tangible ecological losses and their emotional, moral, and spiritual dimensions. The findings show that contemplative practices can function as forms of contemplative witnessing, making ecological loss more perceptible, grievable, emotionally acknowledged, and relationally processed. Contemplative practices may foster an open-ended engagement with ecological loss; an orientation that allows grief, wonder, uncertainty, and care to coexist without demanding immediate resolution. Therefore, contemplative ecology may cultivate the emotional, existential and relational capacities required to remain engaged with ecological crisis. Full article

Background/Objectives: Patient experience is increasingly recognised as a key dimension of healthcare quality, yet most tools fail to capture its temporal and processual nature, limiting its contribution to system improvement. This study aimed to demonstrate how a biographical approach to patient experience can generate actionable insights for improving care pathways. Specifically, we sought to: (i) identify and characterise distinct types of prehospital care pathways among patients hospitalised for COVID-19; (ii) identify patient-perceived significant events and safety issues; and (iii) generate structured variables to inform a subsequent quantitative phase. Methods: We conducted semi-structured biographical interviews with 31 patients hospitalised for COVID-19 in two French university hospitals. Data were collected using a life-events calendar (LEC), enabling day-by-day reconstruction of symptoms, healthcare contacts, and decision-making processes. Thematic analysis was performed with multidisciplinary triangulation. The qualitative phase identified three pathway types and the key mechanisms underlying each; these patterns were subsequently confirmed in a separate quantitative follow-up study (n = 312) using state sequence analysis. Results: Three distinct pathway types emerged: short (≤3 days), intermediate (4–9 days), and long (≥10 days). Delayed pathways were associated with repeated false-negative tests, underestimation of severity, and silent hypoxaemia. Across all pathways, patient experience suggested critical system-level failures, including diagnostic delays and inadequate escalation of care. Notably, in many cases, hospitalisation was triggered by a relative rather than a healthcare professional. These findings highlight the role of patient and social context as key components of care pathways. Conclusions: When captured longitudinally, patient experience may provide actionable insights into healthcare system functioning, suggesting structural mismatches between clinical trajectories and care responses. The life-events calendar method offers a replicable framework for transforming patient experience data into clinically and organisationally relevant knowledge. Integrating such approaches into healthcare evaluation could enhance patient safety, improve care coordination, and support more responsive care systems beyond COVID-19. Full article

Rapid population ageing in China urgently demands improved attention to elderly friendly community green space design. Despite national efforts toward community renovation and urban regeneration, existing projects often overlook the systematic optimisation of green spaces explicitly tailored to elderly residents, leading to environments that inadequately support their physical, psychological, and social needs. Given that home-based care remains the predominant preference for elderly populations in China, creating optimised community green spaces is essential to facilitate healthy ageing-in-place effectively. This study systematically investigates the discrepancies between elders’ observed usage patterns and their stated landscape design preferences in two residential communities in Suzhou, China. By integrating year-round observational data with subjective interviews, the research identifies critical mismatches between elderly individuals’ actual behaviours and expressed preferences, highlighting significant deficiencies in current landscape designs. Comparative analyses reveal that prioritising microclimate comfort, accessible pathways, and targeted seating arrangements significantly enhances elderly usage frequency and satisfaction. Ultimately, this study provides practical, policy-aligned recommendations for designing climate-adaptive, elderly centric community green spaces, effectively contributing to sustainable urban renewal and the Healthy China 2030 initiative. Full article

The Five Domains Model has become one of the most widely adopted frameworks in animal welfare science and practice. The Model is now applied in a range of ways; among the most prominent are (1) as a framework for systematic and structured welfare assessment and (2) as an organising structure for planning and communicating appropriate (i.e., welfare-focused) care provisions, education, and standards. This paper focuses on these two applications and proposes a corresponding update to the affiliated Five Provisions and Welfare Aims. Specifically, we revise: (1) Provision 4 from “Appropriate Behaviour” to “Appropriate Choices” to reflect the 2020 update of the Model incorporating human–animal interactions and the 2023 operationalisation of agency in Domain 4; (2) Provision 2 from “Good Environment” to “Good Living Space” to resolve ambiguity with Domain 4’s “Interactions with the Environment”; and (3) Provision 5 from “Positive Mental Experiences” to “Integrated Care,” which captures consistent delivery of the first four provisions over time and across all those who interact with the animal. This update also pairs Provision 5 with a welfare aim that specifies the integrated mental state the animal should experience as a result. This change makes the distinction between care (provisions) and welfare (aims) consistent throughout the framework. It also makes explicit the integrative role of Provision 5, which parallels Domain 5’s role in the Model. We then describe the reasoning process that distinguishes welfare assessment from welfare-focused care provision. Welfare assessment uses the domain structure as a reasoning pathway, with the assessor using indicators and their impacts in Domains 1 to 4 to infer named mental (affective) experiences in Domain 5. Planning and communicating appropriate (i.e., welfare-focused) care uses the same structure to organise information about what is provided to animals, without executing the inferential step to Domain 5. Drawing on examples from organisations that use the Model for different purposes, we show that both applications are legitimate but produce different outputs. The Five Provisions framework, with its dual structure of provisions paired with welfare aims, serves the care planning and communication function more effectively than does the Model’s domain structure alone. Recognising these different uses also helps to locate where recent critiques of the Model apply and where they do not. Finally, we propose that the provisions and welfare aims framework can supplement “needs” language in legislation and policy to better reflect the distinction between animal care and animal welfare. Full article

Usnic acid (UA), a prominent lichen secondary metabolite, exhibits a unique dual therapeutic profile in dermatology, though its clinical translation is limited by systemic hepatotoxicity and poor solubility. This review comprehensively evaluates the topical efficacy, molecular mechanisms, and advanced formulation strategies of UA enantiomers and UA-rich extracts. A literature search across PubMed, Scopus, and Google Scholar identified 36 original publications focusing on anti-melanoma activity, photoprotection, and tissue regeneration. In vitro studies demonstrate that UA induces apoptosis in resistant melanoma cell lines (A375, HTB-140) via extrinsic/intrinsic pathways, with (−)-UA effectively overcoming doxorubicin resistance. Conversely, in non-cancerous models, low concentrations of UA accelerate wound and burn healing by upregulating vascular endothelial growth factor (VEGF), stimulating fibroblast proliferation, and optimizing extracellular matrix remodeling while preventing hypertrophic scarring. To mitigate skin sensitization and systemic risks, advanced drug delivery systems—including liposomes, nanoemulsions, chitosan nanogels, and electrospun scaffolds—have been developed, significantly enhancing skin permeability and localized dermal retention. Ultimately, the development of bio-functionalized smart dressings and targeted nano-formulations represents the most viable path toward unlocking the full clinical potential of UA in modern dermatological and oncological care. Full article

Artificial intelligence (AI) is reshaping the field of diagnostic radiology; however, its applications in interventional radiology and pediatric interventional radiology (PIR) remain limited despite clear clinical needs and the rich multimodal data environment characteristic of pediatric procedural care. In this narrative review, I summarize the current state of AI technologies relevant to PIR and outline future perspectives for their clinical integration. Peer-reviewed literature and position statements identified through MEDLINE/PubMed, Embase, Scopus, and major society publications up to the first quarter of 2026 are synthesized, focusing on AI applications across the PIR care pathway, including dose-sparing image acquisition and reconstruction, automated image interpretation and computer-aided diagnosis, data-driven procedural planning and navigation, and post-procedural risk prediction and monitoring. After briefly introducing core machine learning and deep learning concepts, pediatric-specific challenges are discussed, including radiation sensitivity, growth-related anatomical variability, regulatory constraints, and the scarcity of large, annotated datasets, as well as existing and emerging applications along the PIR care pathway: AI-assisted dose reduction and image reconstruction, automated image interpretation, segmentation, and computer-aided diagnosis; data-driven procedural planning, including three-dimensional modelling, augmented reality, AI-enabled/AI-adjacent robotics, and AI-directed procedural navigation; and post-procedural risk prediction and outcome monitoring. Finally, emerging paradigms, including explainable AI, federated learning, and multimodal integration, are highlighted, and research priorities, collaborative frameworks, and governance principles required to ensure safe, equitable, and effective AI deployment in PIR are outlined. In doing so, this review delineates the current evidence gaps and priority directions for clinically meaningful AI adoption in PIR. Although AI has the potential to improve patient care, it has not yet been specifically designed, validated, or deployed in children. Existing work demonstrates feasibility across the PIR workflow, but most tools remain weakly linked to pediatric clinical endpoints. Full article

Background/Objectives: Adult patients supported with extracorporeal membrane oxygenation (ECMO) frequently require invasive diagnostic, therapeutic, surgical, or bedside procedures during ongoing extracorporeal support. These procedures are clinically challenging because ECMO-related anticoagulation, platelet dysfunction, acquired coagulopathy, and circuit-related coagulation activation may increase both bleeding and thrombotic risks. This systematic review evaluated the safety of invasive procedures performed during adult ECMO support, excluding tracheostomy/tracheotomy because this procedure has recently been addressed in a dedicated systematic review. Methods: A systematic search of PubMed/MEDLINE and Scopus was performed. The final bibliographic data collection was completed in April 2026. Studies were eligible if they included adult ECMO or extracorporeal life support patients undergoing invasive procedures during ongoing ECMO support, or with ECMO used as procedural support, and reported at least one procedure-specific safety outcome. Primary outcomes were procedure-related complications, bleeding, major bleeding, and transfusion requirements. Secondary outcomes included thrombotic and circuit-related complications, oxygenator exchange, reintervention, reoperation, procedural failure, ECMO duration, intensive care unit and hospital length of stay, and mortality. Results: The final qualitative synthesis included 46 studies, comprising 26 studies from PubMed/MEDLINE and 20 additional unique studies from Scopus. Included procedures were grouped into six domains: airway, bronchoscopic, and tracheobronchial procedures; thoracic surgery and lung resections; abdominal surgery, gastrointestinal endoscopy, and decompressive laparotomy; lung transplantation and perioperative extracorporeal life support; cardiovascular, vascular, pulmonary embolism-related, and mechanical circulatory support-related procedures; and mixed non-cardiac surgery. Airway and bronchoscopic procedures generally showed high procedural success in selected cohorts, although registry-level tracheal procedure data reported hemorrhagic complications in 26.0% and surgical-site bleeding in 13.0%. Emergency thoracic and abdominal procedures carried the highest bleeding, transfusion, reintervention, and mortality burden. Lung transplantation studies showed that ECMO can be integrated into perioperative pathways, but hemothorax, transfusion, thromboembolism, and anticoagulation strategy remained central safety issues. Conclusions: Invasive procedures during adult ECMO are feasible in selected patients and experienced centers, but procedural safety varies markedly by procedure type, urgency, baseline disease severity, and anticoagulation strategy. A procedure-centered, multidisciplinary approach with individualized anticoagulation management and careful planning is essential. Full article

Background/Objectives: Foot and ankle presentations during Hajj occur in a dense mass-gathering environment where prolonged walking, heat exposure, crowding, variable footwear, and limited self-care can interact with chronic disease and wound vulnerability. Previous Hajj studies have described foot injuries and diabetes-related complications, but less is known about whether simple high-risk foot documentation flags identify presentation records with higher care-pathway intensity. The primary objective was to estimate the presentation-level burden of core high-risk foot profiles among pilgrims presenting with foot and ankle conditions during Hajj 2025. Secondary objectives were to evaluate associations with a surgery-coded care-intensity indicator, hospital referral, and component heterogeneity. Methods: This observational presentation-level analysis included 3957 foot and ankle presentation records. The unit of analysis was the presentation/case record, not a unique individual pilgrim. A core high-risk foot profile was defined as diabetes, neuropathy, diabetic foot ulcer, foot ulcer, complications of open wound, or osteomyelitis. The primary outcome was a surgery-coded care-intensity indicator, defined solely from treatment documentation containing “Surgery” and interpreted as a care-pathway proxy rather than confirmed operating-room surgery. Logistic regression estimated crude and adjusted odds ratios (ORs); exploratory risk-category analyses assessed heterogeneity within the composite profile. Results: Core high-risk foot profiles were identified in 1793/3957 presentations (45.3%). The primary outcome occurred in 239/1793 high-risk presentations (13.3%) and 201/2164 non-high-risk presentations (9.3%), an absolute difference of 4.0 percentage points. The crude OR was 1.50 (95% CI 1.23–1.83; p < 0.001). The association persisted in the primary adjusted model (adjusted OR 1.47; 95% CI 1.20–1.79; p < 0.001) and in the extended clinical sensitivity model (adjusted OR 1.47; 95% CI 1.20–1.80; p < 0.001). Care pathways and secondary outcomes are summarized was also more frequent in high-risk presentations (12.2% vs. 9.8%; crude OR 1.28; 95% CI 1.05–1.57; p = 0.017). Exploratory category analysis showed that chronic-risk-only presentations had a primary outcome rate similar to non-high-risk presentations (9.0% vs. 9.3%), whereas ulcer/wound/deep-infection presentations had a higher rate (17.3%; crude OR 2.04; 95% CI 1.63–2.55; p < 0.001). Model discrimination was modest (C-statistics 0.55–0.64). Conclusions: Core high-risk foot flags were common among Hajj foot and ankle presentation records and were associated with surgery-coded care-intensity and referral documentation. However, the composite was clinically heterogeneous, the outcome was not a validated surgery endpoint, and the models were not prediction tools. These findings support cautious use of high-risk foot flags as operational prompts for assessment and pathway planning rather than as standalone clinical risk estimates. Full article

Purpose: To provide an evidence-calibrated, time-bound clinical framework for using 38% silver diamine fluoride (SDF) as interim stabilization for severe early childhood caries (SECC) in young children, addressing gaps in existing guidelines regarding treatment duration, exit criteria, equity, and system accountability. Methods: This framework was developed from the American Academy of Pediatric Dentistry (AAPD) guidance (2017–2025), the 2024 Cochrane review, real-world utilization studies, and a narrative review proposing a preservation-to-precision heuristic. Recommendations are expressed using GRADE terminology. Results: The framework includes ten recommendations, a systems drift principle, explicit time thresholds (<6 months, 6–12 months, >12 months), a 12-month reassessment mandate, equity guardrails, a bridge vs. destination consent model, and a future research agenda. A clinical vignette contrasts appropriate short-term bridging with prolonged temporization due to access barriers. Conclusions: SDF is conditionally recommended for caries arrest in primary teeth. In children with SECC, SDF should be used within a documented, time-bound preservation-to-precision pathway. SDF should not become an open-ended substitute for definitive restorative care. Explicit equity implementation prevents the framework from penalizing underserved children. Full article

Cholangiocarcinoma (CCA) is an aggressive and molecularly heterogeneous malignancy characterized by a profoundly immunosuppressive tumor microenvironment (TME) and historically limited therapeutic options. Recent advances have redefined the treatment paradigm, with phase III trials establishing chemoimmunotherapy as a standard of care and multi-omic profiling elucidating the interplay between tumor genomics, stromal architecture, and immune regulation. Despite these gains, durable clinical benefit remains confined to a minority of patients, reflecting convergent mechanisms of primary and acquired resistance—including immune exclusion, myeloid-dominant suppression, and genotype-driven “cold” tumor states. In this review, we synthesize emerging insights into the immune landscape of CCA, integrating data from single-cell, spatial, and translational studies to define the cellular and molecular circuits governing immune evasion. Beyond canonical biomarkers such as mismatch repair and microsatellite status, we highlight how spatial organization of immunity—in particular, tertiary lymphoid structures, dynamic myeloid and stromal interactions, and pathway-level features—shape immunotherapy responsiveness. We also examine how tumor-intrinsic alterations, including IDH1 mutation, FGFR2 fusions, KRAS activation, and MTAP loss, define distinct immunologic phenotypes with direct implications for immunotherapeutic response and biomarker-driven patient selection. We evaluate the expanding clinical trial landscape of immunotherapy in CCA and more broadly in BTC, including adoptive cell therapies and cancer vaccines. Together, these advances position CCA as a paradigm of how tumor genotype and microenvironment co-evolve to define immunotherapy sensitivity and resistance. Full article

Background/Objectives: Western Canadian and U.S. communities outside urban centres remain underserved by primary, specialist, emergency, mental health, and chronic-disease services. These access problems reflect distance, weather, workforce shortages, specialist maldistribution, primary care attachment gaps, broadband limitations, and the governance realities of Indigenous and Tribal communities. This scoping review with narrative synthesis examined how telehealth and virtual-care models affect rural access in western Canada and the western/frontier United States. Methods: Searches were completed on 21 May 2026 in PubMed/MEDLINE, Embase, CINAHL, Scopus, the Cochrane Library, and PubMed Central. Supplementary searches included Google Scholar, publisher platforms, reference-list checking, and official Canadian and U.S. health-system sources. Peer-reviewed evidence published from 1 January 2016 to 21 May 2026 was eligible when it addressed rural, remote, frontier, Indigenous, underserved, western, or northern healthcare settings and reported access, implementation, safety, continuity, equity, or service-use outcomes. Results: The search identified 112 records; 27 duplicates were removed, 85 records were screened, 37 full texts were assessed, and 28 peer-reviewed records were included. Seven official sources were retained separately. Evidence was mainly observational, qualitative, mixed-methods, implementation-focused, or review-level. Moderate confidence supported telehealth for travel reduction and specialist input, especially through eConsultation, provider-to-provider consultation, telementoring, and real-time emergency support. Confidence was low to moderate for hybrid primary care and telemental health, and low for durable reductions in emergency department use. Conclusions: Telehealth may be most appropriately implemented as a hybrid, locally anchored, culturally safe access model, not as a stand-alone substitute for rural primary care, specialist capacity, or emergency services. Implementation should include broadband support, local physical assessment capacity, documentation, continuity, patient education, and clear escalation pathways. Full article

Dental diseases have long been taught and treated as separate entities: cariology, operative dentistry, endodontics, and periodontology, each working within its own boundaries. However, increasing biological and clinical evidence suggests that this classified view does not fully reflect how disease progresses in the mouth. Instead, dental disease should be understood as a continuum within the interconnected tooth–pulp–periodontium complex. This review provides current evidence showing how dental caries can serve as the starting point of a process that can progress through pulpitis and apical periodontitis and eventually affect surrounding periodontal tissues. Caries is now widely known as a biofilm-driven and host-influenced condition shaped by ecological imbalance rather than specific pathogens alone. As lesions penetrate deeper into dentin, the structure becomes more permeable, permitting diffusion of microbial metabolites and signaling molecules toward the pulp. This initiates a multifaceted inflammatory reaction within the pulp tissue. At this stage, pulpitis becomes a critical turning point, where the outcome depends on microbial load, lesion activity, host response, and quality of clinical intervention. If the disease is not well controlled, it may lead to pulp necrosis, allowing infection to spread beyond the root canal and initiate periapical inflammation. Through anatomical pathways such as apical foramina and lateral canals, these processes can extend further, sometimes resembling or overlapping with periodontal disease. This overlap creates diagnostic challenges, as conventional tests may not always distinguish between conditions. A structured, pathway-based diagnostic approach is therefore essential. From a treatment perspective, this continuum model highlights early intervention, minimally invasive care, preservation of pulp vitality when possible, and maintenance of a strong coronal seal. Ultimately, stronger integration across dental disciplines can improve diagnosis, guide treatment decisions, support long-term tooth preservation, and promote unified dental education. This article presents a narrative review supported by a structured literature search and proposes a clinically actionable framework that extends established endodontic–periodontal concepts upstream to include caries initiation and restorative modulation. Full article

Background/Aims: The increasing complexity of disasters requires effective integration of nurses into Civil Defense (CD) systems. Despite their crucial role, the competencies needed to operate within these multi-agency frameworks remain fragmented and insufficiently defined. The main aim of the study was to map nursing competencies for disaster response within the CD context, identifying essential skills, contextual variations, and barriers to application. Methods: A scoping review was conducted following the JBI methodology and reported according to PRISMA-ScR guidelines. Major databases (PubMed, CINAHL, Scopus, Embase) were searched without time limits, resulting in the inclusion of 27 studies published between 2011 and 2025. Results: 12 core competency domains were identified. Clinical care was the most cited competency (70% of studies), followed by communication (63%), leadership (60%), triage (48%), and psychosocial support (48%). The lack of specific training emerged as the primary individual barrier (44%), while the absence of standardized curricula was the leading systemic obstacle (41%). Competency requirements varied significantly based on the hazard type and organizational setting. Conclusions: Disaster nursing is emerging as an essential specialized field in response to the increasing frequency of climate-related events and global conflicts. There is an urgent need to move beyond purely clinical training to integrate “organizational literacy” and psychological resilience, harmonizing educational pathways with national CD policies and competency-based disaster preparedness programs. Full article

Artificial intelligence (AI) is now applied across oncology, including imaging, pathology, therapy selection, toxicity assessment, and survival modeling, and large language models (LLMs) have been adopted particularly quickly. Reported physician use of AI roughly doubled between 2023 and 2026. The frameworks used to evaluate these tools have not advanced at the same rate. Many are available, but each was designed for a single stage of the AI lifecycle, and none directly answers the question most relevant to a treating clinician: whether a given tool is appropriate for the individual patient under care. We reviewed the frameworks in current use, including TRIPOD+AI, PROBAST+AI, CLAIM, SPIRIT-AI, CONSORT-AI, DECIDE-AI, MINIMAR, and CREMLS, together with the oncology-specific ESMO EBAI and the newer LLM-specific guidance (TRIPOD-LLM, MI-CLEAR-LLM, CHART, and ESMO ELCAP). Each addresses part of the evaluation problem, but none is sufficient on its own for oncology, where the standard of care changes rapidly, assays drift, biomarker-defined subgroups are small, and a model validated in one period may perform poorly in the next. LLMs introduce additional challenges, including sensitivity to prompting, undisclosed vendor updates, behavioral drift, and hallucination rates approaching 50% on clinical quality-assurance tasks. The predictive-model frameworks were not designed to capture these failure modes. The central argument of this review is that the frameworks the field requires already exist; what is missing is their mandatory adoption. We propose that journals and regulators move from recommending these frameworks to requiring their use, and we outline a cancer-aware evaluation pathway together with the specific responsibilities of authors, reviewers, journals, and regulators in implementing it. Full article