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Analysing the temporalities of collective action via the morphogenetic régulation:the case of the Notre-Dame-des-Landes movement
No full textThis article argues that social movement studies need a trans-immanent approach to better understand the persistence of collective action over time. Existing literature, based on immanent accounts of substance, fails to explain why social movements persevere. Immanence, by reducing substance to observable attributes, overlooks the complex causality at play in social phenomena. A trans-immanent perspective, as demonstrated through the morphogenetic régulation (MR) framework, offers a deeper insight into how social movements evolve. The case of the Notre-Dame-des-Landes (NDDL) movement in France highlights the utility of this approach. By applying MR to the NDDL movement, this study shows how the framework captures the interaction between the movement's internal dynamics and external factors shaped by political economic conditions. MR provides the tools to analyze the environment of social movements from a political economy viewpoint, helping researchers uncover the hidden causes of collective action.</p
Developing an integrated evaluation indicator system for non-communicable disease management in China’s primary care:a modified Delphi-analytic hierarchy process study based on the structure-process-outcome framework
No full textBackground: The aging population and increasing prevalence of chronic conditions have led to higher healthcare costs and greater resource utilization globally, exerting considerable pressure on healthcare system sustainability. Integrating services in primary healthcare can improve access and effectiveness for chronic disease management. However, China’s primary healthcare institutions have not achieved full integration of essential clinical services and public health services, hindering the continuity of care and chronic disease management. Guided by the Structure- Process- Outcome framework, this study aimed to develop core indicators to evaluate the capacity of integrated noncommunicable disease services within China’s public healthcare system. Methods: A modified Delphi method was employed with 22 experts over two rounds between January and May 2025. The panel reached a consensus on key indicators for integrating clinical and preventive services in primary healthcare institutions. The Analytic Hierarchy Process was employed to determine the weight values of the indicators. Results: A total of 78 indicators were identified, comprising 34 structural, 15 process, and 29 outcome indicators, with weight values of 0.2807, 0.2708, and 0.4485, respectively. The authority coefficient (Cr) was 0.7795. The coordination of experts’ opinions, measured by the Kendall coordination coefficient W, ranged from 0.219 to 0.246 (P < 0.01). Additionally, the consistency ratio (CR) values for each level were < 0.1. Conclusions: This study established a core set of indicators to evaluate the integration of clinical care and preventive services within China’s primary healthcare institutions. These indicators reflect the global health priorities of people-centered and inter-sectorally coordinated care. They support policy implementation and offer valuable insights for other countries seeking to develop or strengthen integrated primary healthcare systems in response to the growing chronic disease burden.</p
The E-AHPBA-ESSO-Innsbruck consensus recommendations on peri- and postoperative management following liver resection
No full textBACKGROUND: Liver surgery carries a high risk of complications due to the complex interplay of patient-related factors, disease characteristics, and liver function. Expertise is essential for healthcare professionals managing hepatobiliary patients. This European consensus provides evidence-based guidance on selected aspects of peri- and postoperative care. METHODS: A modified Delphi process was used to achieve consensus, with a 70% agreement threshold. The expert panel comprised hepatobiliary surgeons, anaesthetists, hepatologists, a specialist nurse, and a physiotherapist. A systematic literature search was conducted in PubMed/MEDLINE, Embase, Web of Science, and Cochrane databases. Six topics were addressed: thromboprophylaxis; perioperative antibiotics; prehabilitation/nutrition/mobilization; bile leak including bilioenteric anastomosis leaks; post-hepatectomy haemorrhage; and post-hepatectomy liver failure (PHLF). Evidence appraisal and statement development followed Scottish Intercollegiate Guidelines Network methodology. A patient representative reviewed the guideline. RESULTS: Searching the literature yielded 204 included publications from an initial 6514. Thirty-two statements were formulated with a median evidence level of 2. Evidence strength varied by topic with noticeably lower evidence levels in complex surgery settings and less prevalent conditions. In some topics, study heterogeneity and specific inclusion criteria resulted in conditional recommendations, despite high-level evidence. Notably, the weakest evidence was found for perioperative thromboprophylaxis and PHLF management. Strong recommendations were formulated for prehabilitation, early postoperative mobilization, and avoidance of routine drain use. Several evidence gaps warranting multicentre studies were identified. CONCLUSION: Optimizing peri- and postoperative care after liver resection remains challenging. Standardizing key practices and addressing evidence gaps through collaborative research are vital to improve outcomes.</p
Response to Zheng et al., “Enhanced metastatic risk stratification for cutaneous squamous cell carcinoma by combining clinical guidelines with the Erasmus MC model”
No full textCommunity challenge towards consensus on characterization of biological tissue:C<sup>4</sup>Bio's first findings
No full textThis study investigates methodological variability across various expert laboratories worldwide, with regards to characterizing the mechanical properties of biological tissues. Two testing rounds were conducted on the specific use case of uniaxial tensile testing of porcine aorta. In the first round, 24 labs were invited to apply their established methods to assess inter-laboratory variability. This revealed significant methodological diversity and associated variability in the stress–stretch results, underscoring the necessity for a standardized approach. In the second round, a consensus protocol was collaboratively developed and adopted by 19 labs in an attempt to minimize variability. This involved standardized sample preparation and uniformity in testing protocol, including the use of a common cutting and thickness measurement tool. Despite protocol harmonization, significant variability persisted across labs, which could not be solely attributed to inherent biological differences in tissue samples. These results illustrate the challenges in unifying testing methods across different research settings, underlining the necessity for further refinement of testing practices. Enhancing consistency in biomechanical experiments is pivotal when comparing results across studies, as well as when using the resulting material properties for in silico simulations in medical research.</p
Clinical and Cost-Effectiveness of Blended Cognitive Behavioral Therapy or Psychodynamic Therapy Versus Face-to-Face Psychotherapy for Depression (BLENDED Study):Protocol for a Pragmatic, Multicenter, Assessor-Blinded Randomized Controlled Noninferiority Trial
No full textBACKGROUND: Depression is a highly prevalent disorder. Yet, there is still a considerable treatment gap because of capacity issues across clinical services, which create barriers to access to effective psychological therapies. In addition, many individuals with depression do not seek treatment, and waiting lists for psychotherapy are typically very long. Blended psychotherapy, which combines online components and in-person sessions, may help bridge the treatment gap as a cost-effective intervention that complements other types of treatment for depression, as it may reduce therapist time and potentially lower the threshold for people to seek treatment for their depression.OBJECTIVE: This study aims to investigate the clinical effectiveness and cost-effectiveness of blended psychodynamic therapy (PDT) and cognitive behavioral therapy (CBT) for depression compared with face-to-face (FTF) PDT and CBT.METHODS: A pragmatic, single-blind, multisite, noninferiority trial will randomize adult patients referred to mental health care centers in Flanders, Belgium, and diagnosed with major depressive disorder (MDD; n=504), to FTF or blended PDT and CBT. The primary outcome is to investigate whether blended therapy for depression (ie, blended PDT and CBT) is noninferior from baseline to 6-month follow-up after treatment termination compared with FTF PDT and CBT in terms of severity of depression assessed with the Beck Depression Inventory-II (BDI-II) based on intention-to-treat analyses. Secondary outcomes include severity of depression as measured with the BDI-II at 1 and 2 years after treatment termination; recovery from depression as assessed with the Structured Clinical Interview for DSM-5 disorders - Clinical Trials Version (SCID-5-CT) and the Patient Health Questionnaire-9 (PHQ-9) at treatment termination and at 6-month, 1-year, and 2-year follow-up; and quality of life as measured with the EuroQoL 5-Dimension 5-Level (EQ-5D-5L) at treatment termination and at 6-month, 1-year, and 2-year follow-up. The feasibility of implementing blended care will be investigated, and health economic analyses will address the cost-effectiveness of blended care versus FTF psychotherapy. Exploratory analyses will focus on possible predictors of treatment outcome and mechanisms of change. Sensitivity analyses will address the potential impact of the COVID-19 pandemic on therapeutic outcomes. Finally, a qualitative substudy aims to address patients' and therapists' subjective experience of blended psychotherapy.RESULTS: The study was funded in July 2018, and the first patient was included in April 2019. As of September 2025, we have enrolled 463 patients. The first data lock (primary outcome) will take place in October 2025, and the results of the primary outcome are expected in February 2026. The second data lock is expected in March 2027, and the results of the 2-year follow-up are expected in September 2027.CONCLUSIONS: This trial promises to inform decisions concerning the implementation of blended versus FTF therapy for individuals with depression in routine clinical care.</p
Hospital variation in surgical outcomes for gastric cancer:the impact of case-mix and treatment across a global cohort
No full textBackground: There is substantial global variation in demographics, disease burden, and treatment for gastric cancer patients. Benchmarking is an instrument to assess such variation and enables to investigate to which extent case-mix and treatments explain differences in outcomes. We aimed to evaluate hospital-level variation in surgical outcomes following gastrectomy for gastric cancer before and after adjusting for case-mix and treatment-related factors. Methods: Data were retrieved from the GastroBenchmark and GASTRODATA databases, including consecutive gastric cancer resections performed between 2017 and 2021 from 43 centers. Patients who underwent a (sub)total gastrectomy for adenocarcinoma were identified. Outcomes included 30-day mortality, severe complications (Clavien-Dindo grade ≥ 3a), > 15 lymph nodes retrieved, negative resection margin (R0), prolonged hospitalization (> 14 days), readmissions (< 30 days), reoperations, and escalation of care. We assessed absolute inter-hospital variation for outcomes, and estimated outcomes using mixed-effect logistic regression models with a random intercept. We estimated crude, case-mix adjusted, and case-mix and treatment adjusted hospital effects. The conditional and marginal pseudo-R 2 were used to quantify the variance in outcome explained by case-mix and treatment-related factors. Results: A total of 7818 patients from 41 hospitals were included, with contributions ranging from 12 to 2554 patients per hospital (IQR: 49–146). Observed 30-day mortality and severe complications ranged from 0 to 9.7% (IQR: 3.2%) and 5.3 to 31% (IQR: 7.7%), respectively. Larger variation between hospitals was observed for retrieval of > 15 lymph nodes (IQR: 12.3%), prolonged hospitalization (IQR: 14.4%) and readmissions (IQR 11.3%). This variation was reduced in the crude model, while adjusting for case-mix and treatment-related factors did not significantly reduce variation for any outcome. Case-mix factors had a limited contribution to the explained variance, except for 30-day mortality (33.9%) and negative resection margins (31.7%). Adding treatment-related factors increased the explained variance for 30-day mortality by 40.8%, but had low impact (< 10%) on the variance in most surgical outcomes. Conclusions: Case-mix and treatment factors are not the primary drivers of variation in surgical outcomes following gastrectomy. Case-mix adjustment can improve the validity of global comparisons for 30-day mortality, but does not seem essential for comparing other investigated outcomes.</p
Cost-Effectiveness of Hydroxyurea for Treatment of Children With Sickle Cell Anemia in Ghana
No full textObjectives: Most African children born with sickle cell disease (SCD) will die before their fifth birthday. Hydroxyurea has proven therapeutic benefits for SCD yet remains inaccessible to many children in low- and middle-income countries. To inform policy on coverage and reimbursement, this study evaluates the cost-effectiveness of hydroxyurea for pediatric SCD in Ghana, compared with the standard of care.Methods: We developed a Markov model of SCD progression, incorporating costs and effects from a Ghanaian payer perspective, over a 17-year time horizon. Outcomes were life-years gained and disability-adjusted life-years averted. Cost-effectiveness was determined using the World Health Organization willingness-to-pay threshold of 1 times the per-capita gross domestic product and an alternative country-specific threshold based on health opportunity cost (1440.34 per disability-adjusted life-year averted and $1823.89 per life-year gained. The intervention was potentially cost-effective using the World Health Organization threshold but not cost-effective using the alternative threshold. The 1-way sensitivity analysis highlighted the incremental cost-effectiveness ratio’s sensitivity to price changes, emphasizing the importance of price negotiations.Conclusions: Hydroxyurea can provide substantial health benefits for Ghanaian children with SCD. The results provide a strong argument for the incorporation of hydroxyurea into the Ghana national health insurance benefits package. Future research should address the disparity in threshold outcomes and the need for country-specific data on the long-term effects and broader economic impact of hydroxyurea in Ghana
Prognostic value of liver stiffness measurement vs. biochemical response in primary biliary cholangitis
No full textBackground & Aims:Both liver stiffness measurement (LSM) and biochemical response have prognostic significance in patients with primary biliary cholangitis (PBC). However, the frequency and clinical relevance of discordant biochemical and LSM changes remain unclear. We aim to determine the performance of the most recent or current LSM (LSMc) in predicting first hepatic decompensation (HD) in the setting of discordant biochemical and LSM responses.Methods:In this international, multicenter study, we included patients with at least two reliable LSM performed at least 6 months apart. Patients with prior HD, liver transplantation or hepatocellular carcinoma were excluded. Biochemical response was based on the Paris-II criteria. LSM response was defined as stable or any reduction in LSM. The primary outcome was the occurrence of the first HD. Secondary outcomes were liver transplantation and liver-related death. The influence of LSM on HD was estimated using Cox regression analysis. Results:A total of 1,793 patients with PBC were analyzed. Over a median follow-up of 22 (IQR 12-39) months, 3.3% developed HD. Up to 55% of patients with PBC exhibited discordance between LSM and biochemical response. Among patients with LSM response, achieving Paris-II criteria was associated with a lower risk of HD (hazard ratio [HR] 0.25, 95% CI 0.06-0.97, p < 0.044). Among patients with biochemical response, LSM response did not influence the risk of developing HD (HR 0.64, 95% CI 0.21-1.96, p = 0.429). The LSMc >10 kPa strongly predicted HD (HR 14.5, 95% CI 6.9-30.6, p < 0.001), irrespective of biochemical response and prior LSM trajectories.Conclusions:Discordance between LSM and biochemical response is frequent. Most recent or current LSM is the strongest predictor of first liver-related events in patients with PBC, irrespective of prior biochemical response or LSM trajectory.Impact and implications:Both liver stiffness measurement (LSM) and biochemical response have prognostic significance in patients with primary biliary cholangitis. However, the clinical relevance and how discordant biochemical and LSM changes should be best interpreted remain unclear. In this large international multicenter study, we demonstrated that once the current LSM is known, prior LSM trajectories and biochemical changes did not improve the prediction of liver-related events in patients with primary biliary cholangitis. Our finding addresses a common clinical dilemma in risk-stratifying PBC patients with discordant biochemical and LSM responses. Importantly, the use of the latest LSM value for risk prediction significantly simplifies the use of LSM in clinical decision-making for PBC patients with multiple LSM readings.<p/
Does assisted reproductive technology influence the complexity and associated malformations in esophageal atresia?
No full textPurpose: Assisted reproductive technology (ART) has been associated with increased risks of congenital anomalies and preterm birth. However, its role in influencing the complexity of specific malformations, such as esophageal atresia (EA), remains unclear. This study aimed to assess whether ART impacts the phenotypic complexity of EA, including associated anomalies and VACTERL (vertebral, anal, cardiac, tracheoesophageal, renal, and limb anomalies) association. Methods: Data from 374 EA patients enrolled in the European Pediatric Surgeons’ Association (EUPSA) Esophageal Atresia Registry were analyzed. Patients were grouped based on mode of conception (28 ART and 346 natural conception) and compared for demographics, gestational age, birth weight, associated malformations, VACTERL association, and genetic disorders. Results: Gestational age and birth weight were comparable between groups (36.5 ± 3.3 vs. 36.4 ± 3.3 weeks, p = 0.42; 2412.3 ± 761.6 g vs. 2601.3 ± 744.3 g, p = 0.24). Maternal age was significantly higher in the ART group. The prevalence of cardiac, gastrointestinal, renal, musculoskeletal, and vertebral anomalies did not differ significantly. All cardiac anomalies in ART patients were minor. VACTERL association rates (25.0% vs. 18.5%, p = 0.398) and genetic disorder prevalence (7.1% vs. 4.9%, p = 0.605) were comparable. Conclusions:ART does not appear to increase the complexity of EA in terms of associated malformations, VACTERL spectrum disorders, or genetic abnormalities. Further studies with larger cohorts and detailed ART subtype data are warranted to confirm these findings.</p