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Cardiac rehabilitation in patients with coronary heart disease-provision, attendance, and outcomes: results from the INTERASPIRE survey from fourteen countries across six WHO regions
No full textBackground: INTERASPIRE was an observational study of patients with coronary heart disease (CHD) from 88 hospitals in 14 countries across all six WHO regions. The objective was to describe the proportions of patients referred to and attending cardiac rehabilitation (CR) programmes and to compare lifestyle and risk factor target achievement according to participation in a CR programme.
Methods: Patients 18–80 years of age, with a first or recurrent coronary hospitalisation (acute coronary syndrome and/or revascularisation procedure) were identified and invited to an interview and examination, between six months and two years after the index hospitalisation.
Results: Overall, 4,548 (21.1% female) patients were interviewed a median of 1.05 (interquartile range 0.76–1.45) years after hospitalization. Of those patients, 34.4% reported having been advised to participate in a CR programme, though the percentage varied widely by country, from 4.0% in Kenya to 69.6% in Poland. Among patients advised to participate in CR, 57.1% participated in ≥50% of all sessions, 15.4% participated in <50% of the sessions, and 27.4% did not participate at all. Only 19.6% of all patients recruited to the study attended ≥50% of sessions. Content of programmes reported by patients also varied enormously between countries. Low education level, elective PCI, or unstable angina as recruiting events were associated with lower attendance rates. Attendance at ≥50% of all CR sessions was associated with a lower prevalence of persistent smoking and physical inactivity, better control of blood pressure and LDL-cholesterol, and a higher use of cardioprotective medications.
Conclusions: INTERASPIRE provides a standardised international picture of CR provision and attendance in patients with CHD. Despite CR being a Class 1 recommendation in all international guidelines, only one third of CHD patients reported being advised to attend any form of CR and just one in five patients attended 50% of the sessions, with striking heterogeneity between regions and countries. National cardiology societies should advocate to their governments for urgent investment in standardised CR services
The path to equitable respiratory syncytial virus prevention for infants: challenges and opportunities for global implementation
No full textThe approval for a respiratory syncytial virus (RSV) maternal vaccination programme by Gavi, The Vaccine Alliance, marks substantial progress toward equitable access, with important work still to come. Several countries, most of which are high-income, have introduced RSV immunisation either using a vaccine containing the RSV fusion protein in its prefusion conformation, which is given to pregnant people in late pregnancy, or by using a long-acting monoclonal antibody (mAb) administered directly to infants. Post-implementation real-world effectiveness data show a major impact in reducing medically attended RSV-lower respiratory tract illness and hospitalisation using either strategy. Although RSV poses a substantial burden to infants and vulnerable children worldwide, 97% of associated mortality occurs in low-income and middle-income countries. However, few of these countries have authorised and introduced RSV preventive strategies. This Review outlines the challenges and opportunities for expanding access to RSV prevention for infants in resource-restricted settings guided by WHO's Immunization Agenda 2030 and the UN's Leave No One Behind framework for non-discriminatory sustainable development. We discuss burden, vaccine and mAb development, health economics and impact modelling, policy, implementation and programmatic considerations, surveillance, and awareness as key RSV domains. This Review summarises recent advances in research and highlights the urgent steps needed to ensure equitable access to RSV prevention for all infants worldwide
Spatial transcriptomic analysis reveals significant differences in tumor microenvironment in HPV-dependent and HPV-independent vulval squamous cell carcinoma
No full textObjective
Vulvar squamous cell carcinoma (VSCC) can be either HPV-dependent (HPVd) or HPV-independent (HPVi). HPVd VSCC typically occurs in younger women, has a more favorable prognosis, and develops from high-grade squamous intraepithelial lesions (HSIL). HPVi VSCC predominantly affects older women and arises within areas of chronic inflammation, particularly lichen sclerosis (LS). We utilized sequencing-based spatial transcriptomics to explore gene expression in a cohort of patients with HPVi and HPVd VSCC.
Methods
We analysed gene expression in distinct areas (SCC, inflammation, LS, HSIL) from four early-stage VSCC cases (two HPVi, two HPVd) using the 10× Genomics Visium spatial transcriptomics platform. Cell-specific type expression was inferred using CIBERSORTx.
Results
28,183 Visium spots were detected; each contained an estimated 20–50 cells. Reads per spot ranged from 9903 to 68,527. More genes were upregulated in HPVd (N = 601) than HPVi (N = 72) with distinct differences in Keratin and Collagen genes between etiologies. Gene expression was strikingly similar between SCC and adjacent inflammatory areas, regardless of etiology. IL-17 signaling was upregulated in HPVd samples. Surprisingly, CIBERSORTx inferred significantly more CD45+ cells in HPVi tissues than HPVd, especially CD4+ resting memory and follicular helper T cells in SCC areas. Immune cells moved from resting states in the pre-invasive tissues to activated states in the SCC and peri-tumoral inflammatory areas.
Conclusions
This study represents the first application of spatial transcriptomics in VSCC, with significantly more immune cells identified in HPVi SCC than in HPVd SCC. These data will act as a baseline for future studies
Narrowband detection via charge collection narrowing organic photodetector enabled by low band gap random terpolymer for biometric sensing
No full textAchieving spectrally selective organic photodetectors (OPDs) without using broadband-absorbing semiconductors with input filtering has been a strenuous challenge. Charge collection narrowing (CCN) is a promising strategy to obtain spectrally selective near-infrared (NIR) OPD by adopting a thick bulk heterojunction (BHJ) as active layers. In this work, a random terpolymer comprised from a diketopyrrolopyrrole (DPP), thiophene (T) and benzothiadiazole (BT), ranDPP-2TBT, was prepared and used as a donor material in combination with the low band gap non-fullerene acceptor (NFA) IEICO-4F. OPDs with a low dark current density (6.88 × 10-9 A cm-2) and a 68 nm full-width-at-half-maximum (FWHM) narrowband response (R = 0.13 A W-1 at 916 nm) in the NIR were achieved. Finally, an application of the OPD as a biometric heart-rate sensor via photoplethysmography (PPG) for real-time monitoring is demonstrated
Searches for additional Higgs bosons and for vector leptoquarks in ττ final states in proton-proton collisions at s = 13 TeV
No full textThree searches are presented for signatures of physics beyond the standard model (SM) in τ τ final states in proton-proton collisions at the LHC, using a data sample
collected with the CMS detector at √s = 13 TeV, corresponding to an integrated luminosity of 138 fb−1. Upper limits at 95% confidence level (CL) are set on the products of the branching fraction for the decay into τ leptons and the cross sections for the production of
a new boson φ, in addition to the H(125) boson, via gluon fusion (ggφ) or in association with b quarks, ranging from O(10 pb) for a mass of 60 GeV to 0.3 fb for a mass of 3.5 TeV each. The data reveal two excesses for ggφ production with local p-values equivalent to about three standard deviations at mφ = 0.1 and 1.2 TeV. In a search for t-channel exchange of a vector leptoquark U1, 95% CL upper limits are set on the dimensionless U1 leptoquark coupling to quarks and τ leptons ranging from 1 for a mass of 1 TeV to 6 for a
mass of 5 TeV, depending on the scenario. In the interpretations of the M 125 h and M 125 h,EFT
minimal supersymmetric SM benchmark scenarios, additional Higgs bosons with masses below 350 GeV are excluded at 95% CL
Dilated cardiomyopathy in the young: a patient-scientist informed review of unmet needs
No full textDilated Cardiomyopathy (DCM) is a leading cause of heart failure and the most common indication for a heart transplant. Guidelines are regularly based on studies of adults and applied to the young. Children and adolescents diagnosed with DCM face different lifestyle challenges from individuals diagnosed in adulthood that include medical trauma and are influenced by maturity levels and confidence with advocacy to adults.
Using a UK patient-scientist’s perspective (ERJ), we reviewed the age-specific challenges faced by the young with DCM, evaluated current guidelines and evidence, and identified areas requiring further recommendations and research. We highlight the importance of i) the transition clinic from paediatric to adult services, ii) repeated signposting to mental health services, iii) standardised guidance on physical activity, iv) caution surrounding alcohol and smoking, v) the dangers of illegal drugs, and vi) reproductive options and health.
Further research is needed to address the many uncertainties in these areas with respect to young age, particularly for physical activity, and such guidance would be welcomed by the young with DCM who must come to terms with being different and more limited amongst healthy peers
Exploring the use of the WAST-short domestic abuse screening tool in primary care: a cross-sectional study in Northwest London
No full textBackground: Domestic abuse (DA) is often overlooked in general practice, despite primary care’s pivotal role. While screening
improves early detection, it is not standard in primary care. This cross-sectional study aimed to assess the potential integration
of a brief DA screening tool into primary care and explore the association between abuse histories and WAST-Short scores,
controlling for demographics in Northwest London. Methods: An e-Survey with 29 items, translated into 18 languages, was
sent to eligible NHS patients (aged 18 years and older) identified by general practices between 3 March and 7 October 2022
via SMS. It included questions about DA experiences, with the WAST-Short screening questionnaire used to assess tension in
relationships and difficulty resolving arguments. Regression analysis examined the relationship between WAST-Short scores
and abuse history. Results: Seventeen general practices participated, with 6,967 patients clicking the survey link and 4,253
(61%) completing it. Nearly half reported DA experiences, while 6.1% declined disclosure. After adjusting for age, gender, and
ethnicity, the multivariable logistic regression model revealed that individuals who disclosed a history of abuse or preferred not
to had significantly higher odds of experiencing tension in relationships and difficulty resolving arguments compared to those
with no history of abuse. Conclusion: This study underscores the potential of DA screening in primary care, particularly for
those hesitant to disclose abuse. The WAST-Short tool offers a non-intrusive means of early identification. However, successful
implementation requires adequate training and resources for primary care practitioners
A design framework for microintervention software technology in digital health: critical interpretive synthesis
No full textBackground:
Although many digital health interventions have been studied in human-computer interaction, long-term engagement remains a challenge. Microinterventions that leverage small but meaningful steps toward health outcomes have been proposed as a method for providing flexible and engaging, yet short and focused, interventions. One way to mitigate the potentially limiting scope of each microintervention is through narratives combining multiple different microinterventions over time to facilitate greater effects and engagement. As an emerging field of research, significant focus has thus far been placed on the creation and testing of individual microinterventions with little consideration for the consolidated experience, that is, the narrative over time. A more concise terminology and framework could make it easier to design, evaluate, and compare systems for microinterventions, facilitate collaboration in the field, and foster communication across required disciplines.
Objective:
This paper aims to provide a framework for the creation of microintervention systems and the narratives served by these through their microinterventions.
Methods:
To synthesize a framework, we carried out a critical interpretive synthesis involving reciprocal translational analysis, refutational synthesis, and lines-of-argument synthesis, based on a systematic review of microintervention literature following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines across the Association for Computing Machinery Digital Library, PubMed, Scopus, and Web of Science. To assess the resulting framework, we applied it retroactively back onto the literature.
Results:
Based on a review including 35 studies, of which 80% (n=28) were published after 2020, we present and rationalize the Design for Microintervention Software Technology (D-MIST) framework, which can be used to better classify, design, and evaluate microinterventions. D-MIST defines a microintervention system on three levels: (1) the narrative, (2) the microintervention, and (3) the event. The narrative is the consolidated experience of engaging with multiple microinterventions over time, supporting a narrative goal, for example, a clinical goal. A microintervention is a highly focused intervention consisting of self-contained events aiming to facilitate small but meaningful steps toward the narrative goal. The event attempts a positive momentary change through a resource, for example, an exercise. Events may, for example, be designed for single use, present variations to facilitate engagement, or present order-dependent sequential resources. We additionally discuss supporting constructs, such as decision rules, conceptual models, and the system’s interaction model, that is, how the system interacts with the user through its design and other actors to create a consolidated narrative.
Conclusions:
The resulting D-MIST framework, based on current state-of-the-art literature, describes the components of microintervention systems and how these contribute to a consolidated experience. Based hereon, we suggest opportunities for personalization of microintervention systems, discuss design guidelines, and the roles of actors in creating health narratives aiming to obtain better distal health outcomes.
J Med Internet Res 2025;27:e7265
End-to-end integrative segmentation and radiomics prognostic models improve risk stratification of high-grade serous ovarian cancer: a retrospective multi-cohort study
No full textBackground
Valid stratification factors for patients with epithelial ovarian cancer (EOC) are still lacking and
individualisation of care remains an unmet need. Radiomics from routine Contrast Enhanced
Computed Tomography (CE-CT) is an emerging, highly promising approach towards more
accurate prognostic models for the better preoperative stratification of the subset of patients with
high-grade-serous histology (HGSOC). However, requirements of fine manual segmentation
limit its use. To enable its broader implementation, we developed an end-to-end model that
automates segmentation processes and prognostic evaluation algorithms in HGSOC.
Methods
We retrospectively collected and segmented 607 CE-CT scans across Europe and United States.
The development cohort comprised of patients from Hammersmith Hospital (HH) (n=211),
which was split with a ratio of 7:3 for training and validation. Data from The Cancer Imagine Archive (TCIA) (United States, n=73) and Kliniken Essen-Mitte (KEM) (Germany, n=323) were
used as test sets. We developed an automated segmentation model for primary ovarian cancer
lesions in CE-CT scans with U-Net based architectures. Radiomics data were computed from the
CE-CT scans. For overall survival (OS) prediction, combinations of 13 feature reduction
methods and 12 machine learning algorithms were developed on the radiomics data and
compared with convolutional neural network models trained on CE-CT scans. In addition, we
compared our model with a published radiomics model for HGSOC prognosis, the radiomics
prognostic vector. In the HH and TCIA cohorts, additional histological diagnosis,
transcriptomics, proteomics, and copy number alterations were collected; and correlations with
the best performing OS model were identified. Predicated probabilities of the best performing
OS model were dichotomised using k-means clustering to define high and low risk groups.
Findings
Using the combination of segmentation and radiomics as an end-to-end framework, the
prognostic model improved risk stratification of HGSOC over CA-125, residual disease, FIGO
staging and the previously reported radiomics prognostic vector. Calculated from predicted and
manual segmentations, our automated segmentation model achieves dice scores of 0.90, 0.88,
0.80 for the HH validation, TCIA test and KEM test sets, respectively. The top performing
radiomics model of OS achieved a Concordance index (C-index) of 0.66 ± 0.06 (HH validation)
0.72 ± 0.05 (TCIA), and 0.60 ± 0.01 (KEM). In a multivariable model of this radiomics model
with age, residual disease, and stage, the C-index values were 0.71 ± 0.06, 0.73 ± 0.06, 0.73 ±
0.03 for the HH validation, TCIA and KEM datasets, respectively. High risk groups were
associated with poor prognosis (OS) the Hazard Ratios (CI) were 4.81 (1.61-14.35), 6.34 (2.08-
19.34), and 1.71 (1.10 - 2.65) after adjusting for stage, age, performance status and residual
disease. We show that these risk groups are associated with and invasive phenotype involving
soluble N-ethylmaleimide sensitive fusion protein attachment receptor (SNARE) interactions in
vesicular transport and activation of Mitogen-Activated Protein Kinase (MAPK) pathways
Using a single penetrating interfascicular electrode to improve spatial selectivity of an extraneural polymeric cuff array
No full textBackground: Damage to the peripheral nervous system severely disrupts motor control, sensory perception, and organ function, often resulting in long-term disability. To restore such impairments, peripheral nerve interfaces (PNIs) aim to achieve precise stimulation selectivity, yet current approaches face several limitations. Most PNIs rely on metal-based electrodes, which introduce a mechanical mismatch with soft neural tissue and are limited by low charge-injection capacity. The device design of these PNIs also suffers from a fundamental trade-off: highly invasive approaches enable high selectivity but provoke strong foreign-body responses, while less invasive designs minimize tissue damage but fail to provide sufficient selectivity. Although current-steering strategies have been explored to enhance selectivity, their performance remains inadequate for clinical application. Significant advances in PNIs are required to safely achieve higher selectivity.
Methods: In this work, a novel array consisting of a single penetrating interfascicular electrode (SPIF) added to an extraneural cuff (EC) array, termed SPIFEC, was developed using laser-based fabrication and polymeric materials. Electrochemical properties were characterized, and ex vivo experiments using whole rat sciatic nerve were conducted to assess fascicular selectivity. The implantation was assessed through computed tomography (CT) imaging.
Results: The SPIFEC design includes seven extraneural electrodes and one double-sided interfascicular penetrating electrode. Electrochemical analysis revealed the polymeric electrodes had low impedance, high charge storage capacity and high charge-injection limit, when compared to previous reports on traditional metallic devices. Ex vivo studies demonstrated that the device achieved high fascicular selectivity, particularly in nerves with well-defined fascicles, outperforming a comparable non-penetrating cuff. CT imaging confirmed the interfascicular positioning of the penetrating electrode.
Conclusion: These results demonstrate the potential of this novel SPIFEC array in enhancing spatial selectivity for peripheral nerve applications. Further studies, including chronic in vivo testing, are required to fully evaluate long-term performance and clinical potential in neuroprosthetic systems