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When is a prologue (not) a prologue? The second prologue in Cornelis van Ghistele's Van Eneas en Dido
No full textThis study starts to address the limited scholarship on identifying prologues and epilogues in dramatic texts. While many frame texts are easily recognisable, there are instances where classification is ambiguous. Using Cornelis van Ghistele’s Aeneas and Dido as a test case, the article explores criteria for determining the function of frame texts. The play, staged in Antwerp in 1552 (or 1551), includes two frame texts marked as ‘prologue’ in the manuscript, although the editor decided one of them was in fact the epilogue. Examining the manuscript evidence, including labels and structural elements, as well as the content of the frame texts, the analysis concludes that the second frame text is the prologue to the second play of Cornelis van Ghistele’s Aeneas and Dido and not an epilogue
A Scoping Review on Generative AI Prompting to Optimize the Workflow of Healthcare Professionals in Sub-Saharan Africa
No full textGenerative artificial intelligence (AI) applications have enhanced democratization of information to the extent that industry professionals can automate routine tasks, gain insights from complex data and execute tasks more efficiently through generation of text, image, and audio content. Although these applications augment human capabilities, there are concerns about veracity of AI prompting, which results in hallucinations that could have dire consequences on clinical workflow of healthcare professionals. The impact of prompting patterns on optimization of clinical workflows at points-of-care remains nascent with limited evidence especially in healthcare sectors of sub-Saharan Africa. This review explores existing literature on how generative AI prompt engineering optimizes clinical workflow of healthcare professionals by adopting Arksey and O’Malley five-stage scoping review framework to analyze peer-reviewed publications. A comprehensive search strategy was conducted in scholarly databases, including PubMed, IEEE Xplore, and Google Scholar between 2019 and 2025. The study highlights AI prompt engineering strategies, how prompting affects clinical and administrative activities, and how limitations of generative AI prompting could be addressed. Evidence of generative AI prompt engineering are limited in SSA while the Global North and China are the most dominant regions in the discourse. Consultations, clinical decision support, record summaries and documentation, research and prescription recommendations are leading activities in which AI prompting is perceived as most significant. To conclude, this study provides insights for health managers, healthcare professionals, data scientists, ethicists, health IT experts, human-computer interaction practitioners, and researchers on standardizing integration of generative AI use at points-of-care
A citation index bridging Hirsch's h and Egghe's g
Get PDFWe propose a citation index (``nu'') and show that it lies between the classical -index and -index. This idea is then generalized to a monotone parametric family (), whereby and , while the limiting value is expressed in terms of the maximum citation
Building a Brazilian Cultural Analysis Network in Europe and Beyond: Reflections on a Ten-year Milestone and Future Plans for REBRAC
No full textChildhood outcomes in children with Hirschsprung disease: a population-based data linkage study in England
Get PDFObjective Hirschsprung disease (HSCR) is a rare congenital intestinal condition that, despite corrective surgery, can lead to recurrent hospitalisations and reduced quality of life throughout childhood. There is limited population-level evidence on the causes of these admissions or associated educational needs.
Design/methods Using linked health and education data from the Education and Child Health Insights from Linked Data database, we created a cohort of all children born in England between 2002 and 2020. We compared admission rates, mortality, surgical procedures and causes of admission for children with and without HSCR at ages 0–4, 5–9 and 10–14 years. We also assessed the prevalence of recorded Special Educational Needs and Disability (SEND) by Year 1 of primary school (age 6).
Results Among 11 261 227 children, 3227 (0.03%) had HSCR. By age 4, 95.0% of children with HSCR had been readmitted, compared with 40.2% without. Common admission reasons included constipation, gastroenteritis, intestinal infection, abdominal pain and nausea or vomiting. 81.4% of children with HSCR had two or more surgical procedures between ages 0 and 4, compared with 2.9% in children without HSCR. Mortality by age 4 was 3.2% for HSCR versus 0.5% for non-HSCR children. By age 6, 44.0% of children with HSCR had recorded SEND compared with 17.9% of those without.
Conclusion Children with HSCR experience substantially higher hospital readmission rates, more surgeries and greater mortality up to age 14 than their peers. They are also more likely to require educational support, independent of comorbidities such as Down syndrome. Improvements in surgical and long-term care, including novel or complementary approaches, alongside enhanced educational and psychosocial support, are needed to improve outcomes and quality of life across childhood and adolescence
Target trial emulation to incorporate real-world data in the estimation of the clinical and cost-effectiveness of biologic treatment
Get PDFIntroduction
In the health technology assessment (HTA) of biologic treatments for rheumatoid arthritis (RA), there is limited randomized evidence on treatment effectiveness after first-line treatment failure. We demonstrate how real-world data (RWD) could fill this evidence gap.
Methods
Target trial emulation (TTE) minimizes biases in the causal analysis of RWD by prespecifying a protocol for a hypothetical randomized clinical trial (RCT) that would estimate the effect of interest. The application of TTE for HTA was illustrated using RWD from the British Society for Rheumatology Biologics Register for Rheumatoid Arthritis to estimate the effectiveness of rituximab versus nonbiologic therapy (NBT) after first-line biologic failure, in terms of European Alliance of Associations for Rheumatology response achievement. The effectiveness estimates from RWD were combined with RCT estimates in a meta-analysis. The pooled estimates were entered into an economic model to estimate the incremental cost-effectiveness ratio (ICER) comparing biologic versus NBT strategies.
Results
Based on RWD, rituximab was associated with higher probabilities of achieving a moderate or good response (0.215 v. 0.174) and a good response (0.090 v. 0.066) as compared with NBT. These probabilities were lower than those estimated from RCT data (moderate or good 0.650; good 0.150). The economic model estimated less time on treatment and lower costs associated with biologics when based on RWD compared with RCT data (mean £63,500 v. £70,000). This resulted in a higher ICER based on RWD compared with RCT data (mean £46,800 v. £34,700 per quality-adjusted life-year gained).
Conclusions
RWD can provide supplemental evidence on treatment effectiveness where randomized evidence is limited. This can make a meaningful difference to cost-effectiveness estimates. Our results are not intended to inform current RA management
Synergistic Cu-Sb oxide electrocatalyst synthesized by sol-gel method for high-efficiency nitrate reduction to ammonia with suppressed hydrogen evolution
Get PDFAntimony is one of the hydrogen evolution poison and copper is one of the well-known catalysts for the nitrate reduction to ammonia (NRA). Therefore, to synthesize an efficient electrode that can have the highest selectivity for the reduction of nitrate to ammonia and is accompanied by the lowest hydrogen evolution, in this study, a combination of different Cu to Sb ratios was prepared on a Ti substrate using the sol-gel method in the form of crystalline oxides (CuSbyOₓ/Ti) to achieve the best catalytic activity and ammonia yield. A 2:1 ratio of Sb to Cu synthesized and calcined at 600 °C had the best catalytic properties. CuSbyOₓ/Ti electrocatalysts were evaluated for NRA in an alkaline medium. The CuSb2Ox electrocatalyst had the highest activity with the lowest cathodic Tafel constant of 78 mV dec− 1. EIS results also showed that CuSb2Ox has the lowest charge transfer resistance (Rtotal=3.75 Ω cm2). The measurements revealed that the CuSb2Ox electrocatalyst performed superlative, with an NH3 yield of 7280 µg h− 1 cm− 2 and an F.E. of 89% at a potential of -0.7 V vs. RHE. The high NH3 yield of this oxide electrocatalyst, compared to other oxide compounds, highlights the synergistic effect of Cu and Sb
Epidemiologic features of depression and anxiety among homeless adults with healthcare access problems in London, UK: descriptive cross-sectional analysis
Get PDFBackground
In England, 354 000 people were homeless on a given night in 2024. It has long been recognised that the physical and mental health of people who are homeless is poorer than for those who are stably housed. There are few peer-reviewed studies to inform health- and social care around depression or anxiety for people who are homeless in this setting.
Aims
To measure the symptoms of depression and anxiety among adults who are homeless and who have difficulty accessing healthcare, and to describe the distribution of symptoms across sociodemographic, health-related characteristics and indicators of social vulnerability.
Method
We surveyed 311 adults between August and December 2021. We measured anxiety and depression symptoms using the four-item Patient Health Questionnaire (PHQ-4) score. We compared median PHQ-4 scores across strata of sociodemographic, social vulnerability and health-related characteristics, and tested for associations with the Kruskal–Wallis test.
Results
The median PHQ-4 score was 7 out of 12, with 38% having scores warranting clinical attention. While PHQ-4 scores were consistently high across a range of socioeconomic, social vulnerability and health-related characteristics, they were positively associated with young age; food insecurity; recent and historic abuse; joint, bone or muscle problems; and marijuana use. The most common barrier to accessing healthcare related to transportation (60%).
Conclusions
People who are homeless and have difficulty accessing healthcare have high levels of depression and anxiety symptoms. Our findings support further coordination between health- and social care sectors
Understanding the difference in symptoms and outcomes between glioblastoma patients diagnosed based on histological or molecular criteria: a retrospective cohort analysis from the Histo-Mol GBM collaborative
Get PDFPURPOSE: Since the 2021 World Health Organisation (WHO) classification, glioblastoma could be diagnosed based on classical histological features (hGBM) or molecular criteria (mGBM). However, prior studies included patients who required reclassification as a mGBM, potentially biasing survival analyses. The Histo-Mol GBM collaborative performed an international multicentre retrospective real-world cohort study of glioblastoma patients diagnosed according to WHO CNS 5.
METHODS: We identified consecutive patients diagnosed in 2021 with IDH wildtype glioblastoma according to WHO CNS 5. Clinicopathological, treatment, and survival data were collected and compared between mGBM and hGBM.
RESULTS: 1828 patients diagnosed with glioblastoma were included. 75 mGBM patients (8.4% of tested patients) were identified, with no difference in age (median 61 vs 64, p = 0.057), gender (p = 0.937), or proportion with performance status 0–1 (82.7% vs 68.3%, p = 0.052) compared to hGBM. mGBM patients had an extended interval from MRI to surgery (median 23 vs 14 days, p < 0.001) and more frequently underwent biopsy (69.3% vs 30.3%, p < 0.001), but equivalent proportions received oncological treatment (80.0% vs 78.7%, p = 0.784). Overall survival (OS) from surgery was not different (p = 0.063). However, OS from initial MRI, stratified by surgical extent, demonstrated improved OS for mGBM patients (hazard ratio (HR) 0.56, 95% confidence interval (CI): 0.43–0.73). Propensity score matching identified improved survival following resection (HR 0.48, 95% CI: 0.24–0.95; median OS: 26.0 versus 14.0 months, p = 0.031) but not biopsy (HR 1.10, 95% CI: 0.71–1.72).
CONCLUSION: In this large real-world cohort, mGBMs had longer OS than hGBMs following resection with implications for prognostication and clinical decision making.
SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s11060-025-05364-8
Second victim syndrome in surgeons: systematic review and meta-analysis of the impact of adverse events on surgeons
Get PDFBackground
Second victim syndrome (SVS) is characterized by negative psychological and psychosomatic effects on a healthcare provider after an adverse care event. The aim of this systematic review and meta-analysis was to characterize the symptoms of SVS experienced by surgeons and factors affecting their impact, as well as understand common coping strategies that surgeons employ to deal with them.
Methods
A systematic review of five electronic databases was conducted without restrictions on publication date or language in January 2025. Second victim syndrome, surgeon, and adverse event and their synonyms were used as search terms. Records were screened, quality assessed, and data extracted by two independent researchers. Both qualitative and quantitative studies were included and narratively synthesized. A meta-analysis was performed using a random effects model to calculate the overall prevalence rates of symptoms and coping methods.
Results
A total of 36 papers were included in the analysis from 6629 retrieved records. Anxiety (56.3% (95% c.i. 45.8% to 66.3%)), guilt (53.8% (95% c.i. 41.3% to 65.8%)), sadness (48.3% (95% c.i. 34.6% to 62.3%)), and sleep disturbance (50.5% (95% c.i. 38.4% to 62.5%)) were the most commonly reported symptoms. Talking to either colleagues (72.5% (95% c.i. 65.6% to 78.4%)) or family/friends (52.0% (95% c.i. 40.6% to 63.2%)) were the most commonly employed coping strategies. The sex and level of experience of the surgeon and the severity of the event were identified as potential predictors of deleterious impact.
Conclusion
SVS significantly impacts surgeons’ global well-being, leading to burnout and attrition. Effective interventions require a multifaceted approach, including peer support, resilience training, and institutional changes that normalize emotional responses, encourage disclosure, and address barriers to seeking help. Targeted support for at-risk groups may also be necessary
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