143174 research outputs found
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Knowledge and awareness of HPV vaccination uptake and recommendations in gulf cooperation council countries 2009–2025: a systematic review
No full textCervical cancer, largely caused by persistent infection with human papillomavirus (HPV), remains a preventable disease through timely vaccination. However, in the Gulf Cooperation Council (GCC) countries, the uptake of the HPV vaccine has been inconsistent, and public knowledge remains limited. This systematic review aims to synthesise available evidence on HPV vaccine awareness, uptake, barriers, enablers, and recommendations in the GCC region.
Methods: A systematic search of peer-reviewed literature was conducted across major databases to identify studies published till March 2025. Eligible studies included cross-sectional, quasi-experimental, and descriptive studies reporting on HPV-related knowledge, attitudes, vaccine uptake, barriers, enablers, and recommendations in the six GCC countries. Data were extracted and synthesised thematically. The screening process followed PRISMA guidelines, and 52 studies were included in the final analysis.
Results: The study included 52 articles. While awareness of cervical cancer was moderate to high in several studies, knowledge of HPV infection and the HPV vaccine was generally low. Actual vaccine uptake rates were poor across all countries, with most reporting rates below 10%, except for Abu Dhabi, which reported the highest uptake (>95%) through its school-based programme. Key barriers included lack of knowledge, safety concerns, cultural and religious beliefs, cost, and the absence of national immunisation programmes. Enablers included personal willingness, trust in healthcare providers, prior health education, and availability of free vaccination. The studies recommended urgent policy change across GCC countries to incorporate the HPV vaccine into national vaccination programmes.
Conclusion: Despite the established link between HPV and cervical cancer, vaccine uptake remains low across the GCC due to persistent knowledge gaps, sociocultural barriers, and systemic limitations. This review highlights the urgent need for coordinated public health strategies that prioritise education, equitable access, and national policy integration
Hierarchical adaptive formation tracking control with uncertain time-varying exosystem
No full textThis paper investigates the formation tracking problem with uncertain time-varying exosystem over a general directed graph. The exosystem describes both the moving target and the disturbances affecting each agent. The dynamics of each agent is described by a parametric strict-feedback form subject to orbit constraints. The so-called congelation of variables method is employed in a hierarchical design to yield an adaptive formation estimator and an adaptive tracking controller. An adaptive coupling gain is integrated into the estimator design, which utilizes the local estimated states and is independent of the communication graph. Boundedness and convergence properties of the resulting adaptive systems are proven. Two simulation results are provided to show the effectiveness of the proposed estimator-controller scheme
Adaptive mesh h(p)-refinement of a discontinuous Bubnov-Galerkin isogeometric analysis spatial discretisation of the first-order form of the neutron transport equation with goal-based error measures and diffusion acceleration
No full textThis paper presents the first application of self-adaptive mesh h(p)-refinement (AMR), with goal-based error measures (DWR), to a discontinuous Bubnov-Galerkin (DBG) NURBS-based isogeometric analysis (IGA) spatial discretisation of the first-order form of the neutron transport equation with partially-consistent diffusion synthetic acceleration (DSA) schemes. A modified (symmetric) interior penalty (MIP) scheme is proposed for the spatial discretisation of the diffusion acceleration equation. The penalty parameters are calculated to be sufficiently large, without being arbitrarily so, for general element types; and where they become negligibly small for increasingly thick cells, a minimum penalisation is borrowed, from Wang and Ragusa [1], from a consistent diffusion-conforming form of the acceleration equation. The MIP-DBG-IGA discretisation yields linear systems that are symmetric positive definite; and so, the diffusion acceleration equation can be solved efficiently by the preconditioned conjugate gradient method. Importantly, the proposed MIP-DBG-IGA DSA schemes are stable and compatible over the increasingly irregular spatial meshes of complex, rational geometries generated at each iteration of the proposed DWR-AMR-h(p) algorithm, which employs duality arguments to minimise the error in some prescribed quantity of interest
Triple cardiovascular disease detection with an artificial intelligence-enabled stethoscope (TRICORDER) in the UK: a cluster-randomised controlled implementation trial
No full textBackground
Early detection of cardiovascular disease is a global public health priority. Artificial intelligence (AI)-enabled stethoscopes offer robust performance characteristics in point-of-care detection of heart failure, atrial fibrillation, and valvular heart disease (VHD). We conducted a pragmatic, cluster-randomised controlled implementation trial to determine the real-world effect and implementation challenges of AI-stethoscopes.
Methods
UK primary care practices were cluster randomised 1:1 to intervention (training and implementation in use of AI-stethoscopes in routine care) or control (routine care). Given the nature of the intervention, masking of participants (practices, clinicians, and patients) was not feasible. During cardiac examinations, the AI stethoscope recorded 15 s of single-lead electrocardiogram and phonocardiogram signals for input to three AI algorithms that returned binary predictions for the presence or absence of reduced left ventricular ejection fraction (≤40%), atrial fibrillation, and VHD (all with regulatory approval). The primary endpoint was incidence of any newly coded diagnosis of heart failure (all subtypes), expressed per 1000 patient-years (incidence rate ratio [IRR]), derived from a UK National Health Service Secure Data Environment. A coprimary endpoint stratified detection of heart failure by place of diagnosis (community-based vs via hospital admission). Secondary endpoints included atrial fibrillation and VHD detection rates, performance characteristics of the AI-stethoscope, use rates, and clinician-reported implementation barriers and enablers.
Findings
Between Oct 30, 2023, and May 22, 2024, 205 practices were randomly assigned (96 to the intervention arm [701 933 registered patients] and 109 to the control arm [851 242 registered patients]). Intervention practices recorded 12 725 patient examinations with the AI-stethoscope, across 972 clinical users. Intention-to-treat analysis found heart failure detection did not differ between groups (IRR 0·94 [95% CI 0·86–1·02]); with no difference in community-based or hospital-based diagnoses (p>0·05).
Interpretation
Implementation of an AI stethoscope in routine primary care did not significantly increase detection of heart failure or increase community-based diagnosis after 12 months of implementation. AI stethoscope use was independently associated with significantly higher detection rates of heart failure, as well as atrial fibrillation and VHD. This randomised controlled implementation trial establishes a pragmatic design with randomisation that generates real-world data essential for understanding and overcoming the barriers to implementation of innovation in health care.
Funding
National Institute for Health and Care Research, British Heart Foundation, and Imperial Health Charity
Migration of stent grafts following an endovascular aneurysm repair, a reappraisal of current definitions: an analysis of prevalence, prognosis, and review of surveillance strategies
No full textThe introduction of endovascular aneurysm repair (EVAR) has transformed the treatment of abdominal aortic aneurysms, yet stent graft migration remains a complication driven by intrinsic aortic changes. A lack of standardisation complicates reporting; a systematic review identified 18 definitions, with only "≥10mm or intervention" showing robust historical validity.
This study assessed migration rates across two tertiary vascular centres using a standardised protocol. Migration prevalence varied by definition: 20.7% (≥5mm), 11.3% (≥10mm), and 14.7% (≥10mm or intervention). Migration ≥10mm was associated with a significantly higher risk of proximal seal failure compared to migration at 5-9.9mm (27% vs 5%, p=0.001). The average time to migration was 63.6 months, confirming it as a long-term complication.
Crucially, "early migration" (≥5mm within 18 months) was identified as a powerful predictor of eventual ≥10mm migration (OR 139.3, CI 39.15-495.6, p<0.001). This provides a practical, accessible screening tool for identifying high-risk patients.
Additionally, freehand electromagnetic 3D ultrasound successfully reconstructed a phantom aorta to measure EndoAnchor positions. This demonstrates a foundation for future non-invasive, radiation-free post-operative surveillance despite current challenges with EndoAnchor visualisation.Open Acces
Decoherence from universal tomographic measurements
No full textThe decoherence phenomenon arising from an environmental monitoring of the state of a quantum system, as opposed to monitoring of a preferred observable, is worked out in detail using two equivalent formulations, namely, repeated applications of universal tomographic measurements using positive operator-valued measures, and its continuous time unravelling from the Lindblad equation. The effect of decoherence is analysed by studying the evolution of Stratonovich-Weyl quasiprobability distributions on the state-space of the system. It is shown that decoherence makes an arbitrary-given quasiprobability distribution manifestly positive, thus modelling the emergence of classicality in some sense. The decoherence timescale, the minimum time that quasiprobability distributions of every initial state of the system become nonnegative, is shown to decrease in Hilbert-space dimension, and hence larger quantum systems decohere faster
Corrigendum: Age-related vestibular loss: Current understanding and future research directions
No full textManagement of people with asthma in primary care by smoking status: a cohort study
No full textBackground
Previous studies suggest that cigarette smokers with chronic respiratory disease may be managed differently. However, evidence is limited on whether smoking status impacts asthma management.
Methods
Data from the UK Clinical Practice Research Datalink (CPRD) Aurum were used to define a cohort of adults (aged over 18) diagnosed with asthma between January 1, 2010, and March 31, 2021. Start of follow-up was defined at first recorded asthma diagnosis. End of follow-up was March 31, 2021, or earlier if patients died or left the general practice. The exposure was the most recently recorded cigarette smoking status prior to asthma diagnosis, categorised as never, ex, or current smokers. Two outcome measures were used to assess asthma management: i) a record of at least one inhaled corticosteroid (ICS) prescription in the first year of follow-up and ii) asthma annual review visits over the follow-up period. Logistic and negative binomial regression models were applied, respectively, adjusting for potential confounders. An interaction with sex was tested to account for differences in asthma management in males and females.
Results
Among 241,624 adults with asthma (59.6% female, mean age 50.8), current smokers were less likely to receive ICS than never smokers (OR 0.94, 95% CI 0.91–0.96), while ex-smokers were more likely (OR 1.09, 95% CI 1.07–1.11). A sex interaction showed males were less likely to receive ICS than females among never smokers. Current smokers also had lower annual review rates (IRR 0.83, 95% CI 0.82–0.84), whereas ex-smokers had rates similar to never smokers (IRR 0.99, 95% CI 0.98–1.00). Males had lower review rates than females among never smokers only.
Conclusion
Cigarette smoking status influences asthma management. Findings highlight the importance of considering smoking status in planning and tailoring asthma care
Residual lung abnormality following COVID-19 hospitalisation is characterised by biomarkers of epithelial injury
No full textSome survivors of acute COVID-19 infection have long-term symptoms that could suggest ongoing lung impairment. Searches performed in MEDLINE and Embase for SARS-COV-2 studies with radiological lung follow-up estimated that 50% of participants had inflammatory patterns and 29% had fibrotic patterns at a median of 3 months post infection. Analysis of the UK nationwide Post-hospitalisation COVID-19 Study at 5-months follow-up suggested that up to 11% of people discharged from hospital following COVID-19 infection were at-risk of radiological residual lung abnormalities, such as ground glass opacity and reticulation. In people with pulmonary fibrosis, these radiological patterns are often consistent with persistent epithelial lung injury. Biomarker studies have identified associations with COVID-19 severity, however there are few studies that explore the relationship between biomarkers of epithelial injury and parenchymal lung abnormalities post-hospitalisation
Systemic inflammation and its associations in acute moderate-severe Traumatic Brain Injury: a cross-sectional study
No full textTraumatic Brain Injury (TBI) triggers an acute systemic inflammatory response, which may impact outcomes. This response may interact with pre-existing factors linked to inflammation, such as age, to influence outcomes. Previous studies have typically measured few cytokines, but high-dimensional proteomic approaches can sensitively detect a broad range of inflammatory markers, to better characterise post-TBI inflammation.
We analysed plasma from BIO-AX-TBI study participants (n = 37 acute moderate–severe TBI (Mayo Criteria), n = 22 acute non-TBI trauma (NTT), n = 28 non-injured controls (CON)) using the Alamar NULISA™ panel (>200 inflammatory markers). The NTT group enabled differentiation of TBI-specific versus general injury-related responses. Inflammatory markers were correlated with plasma NFL, GFAP, total tau, UCH-L1 (Simoa®), S100B (Millipore), and subacute (10 days–6 weeks) 3T MRI measures of lesion volume and white matter injury.
Differential expression analysis identified four markers elevated specifically in TBI (VSNL1, IL1RN/IL-1Ra, GFAP, IKBKG), while other derangements reflected non-specific injury responses. Higher VSNL1 correlated with greater lesion volume (rs = 0.53) and higher IL1RN/IL-1Ra with greater white matter injury (rs = −0.66, both FDR-adjusted p < 0.05). IL33, part of the non-specific injury response was higher in participants with good (GOS-E 5–8) versus poor (GOS-E 1–4) outcomes (W = 47, FDR-adjusted p = 0.0024). Using an Elastic Net model trained on healthy controls, we show that “inflammation age” exceeded chronological age in TBI, particularly in younger participants.
In summary, acute post-TBI inflammation includes both TBI-specific and non-specific components, linked to structural brain injury and functional outcome. Age modulates the inflammatory response. VSNL1, IL1RN/IL-1Ra, and IL33 are potential mediators of post-TBI pathophysiology