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Is formal physical therapy necessary after reverse total shoulder arthroplasty? A single-blinded, randomized controlled trial
No full textBackground: Formal, supervised physical therapy (SPT) is a mainstay in the postoperative rehabilitation protocol after reverse shoulder arthroplasty. However, recent studies have called into question its superiority over alternative approaches. The purpose of this study was to compare, in a randomized controlled trial, the effectiveness of an unsupervised home therapy (UHT) program to SPT on patient-reported outcomes for patients undergoing reverse shoulder arthroplasty.
Methods: In this prospective, single-center study, 59 patients aged 60-85 undergoing primary reverse shoulder arthroplasty were randomly assigned to either SPT (n = 30) or UHT (n = 29) groups. The UHT group followed a detailed physical therapy manual provided before discharge. Exclusion criteria included a history of ipsilateral shoulder infection, autoimmune or neuromuscular disease, and a need for postdischarge rehabilitation facility care. The primary outcome measure was the American Shoulder and Elbow Surgeons score at 1 year postoperatively. Secondary outcomes included Simple Shoulder Test, Constant score, visual analog scale, patient satisfaction, and range of motion at 3 months and 1 year postoperatively. An independent examiner blinded to group assignment evaluated these outcomes.
Results: Results showed no significant difference in American Shoulder and Elbow Surgeons scores between the SPT group (mean 77.6) and UHT group (mean 81.1) at 1 year postoperatively (P = .501). Despite limited in-person follow-up rates, range of motion measurements showed no significant differences between groups at either 3 months (41 patients) or 1 year (25 patients) postoperatively. Both groups demonstrated comparable results in Constant scores, visual analog scores, and patient satisfaction measures. Neither group required any reoperations during the study period.
Conclusion: This study suggests that self-directed home therapy following reverse shoulder arthroplasty may be a viable alternative to formal SPT. Although the findings were limited by reduced in-person follow-up rates, which may have underpowered certain comparisons, the results consistently showed no significant differences between the two approaches across multiple outcome measures. These findings have important implications for patients who face barriers to accessing formal physical therapy due to circumstances, cost, or comorbidities, suggesting that a well-structured home exercise program may provide comparable outcomes. Future research with larger sample sizes and higher follow-up rates would be valuable to confirm these findings
Multilevel Interventions Demonstrate Mixed Effectiveness for Improving Blood Pressure Outcomes: A Rapid Review
No full textObjective: What types of multilevel interventions exist to improve blood pressure among community-dwelling adults aged 18+ in the United States? What is the treatment efficacy?
Data source: Peer-reviewed articles from Cochrane Library, EMBASE, PsycINFO, and PubMed. The search strategy was pre-registered on Open Science Framework.
Study inclusion and exclusion criteria: Inclusion criteria were community-dwelling adults in the United States aged 18 or older; interventions involving at least two levels; at least one blood pressure outcome measured; and published in a peer-reviewed journal.
Data extraction: Intervention activities, blood pressure outcomes, and moderation/subgroup analyses, when available, were extracted.
Data synthesis: Qualitative synthesis and summary statistics.
Results: Ninety-five papers covering 89 RCTs were included. Multilevel interventions involving the individual and healthcare team (without health policies = 49 studies; with health policies = 15 studies) tended to show the most consistent saltatory effects on blood pressure (systolic: 46% of studies showed statistical improvement; diastolic: 47% of studies showed statistical improvement). Interventions involving families or communities outside of healthcare settings were promising but were less frequently reported (19% of studies).
Conclusions: There was mixed evidence that multilevel interventions targeting cardiovascular health improved blood pressure among U.S.-based adults. Future research should continue evaluating interventions that improve the individual as well as the environments in which individuals work and play, especially those levels outside of traditional healthcare settings
Harnessing Microbiome, Bacterial Extracellular Vesicle, and Artificial Intelligence for Polycystic Ovary Syndrome Diagnosis and Management
No full textPolycystic ovary syndrome (PCOS) affects 6-19% of reproductive-age women worldwide, yet diagnosis remains challenging due to heterogeneous presentations and symptoms overlapping with other endocrine disorders. Recent studies have shown that gut dysbiosis plays a significant role in PCOS pathophysiology, with bacterial extracellular vesicles (BEVs) functioning as critical mediators of the gut-ovary axis. BEVs carry distinct cargos in PCOS patients-including specific miRNAs and inflammatory proteins-and show promise for both diagnostic and therapeutic applications. Artificial intelligence (AI) is emerging as a promising significant tool in PCOS research due to improved diagnostic accuracy and the capability to analyze complex datasets combining microbiome, BEV, and clinical parameters. These integrated approaches have the potential to better address PCOS multifactorial nature, enabling improved phenotypic classification and personalized treatment strategies. This review examines recent advances in the last 25 years in microbiome, BEV, and AI applications in PCOS research using PubMed, Web of Science, and Scopus databases. We explore the diagnostic potential of the AI-driven analysis of microbiome and BEV profiles, and address ethical considerations including data privacy and algorithmic bias. As these technologies continue to evolve, they hold increasing potential for the improvement of PCOS diagnosis and management, including the development of safer, more precise, and effective interventions
The Effects of Age on the Human Tear Film Assessed with a Novel Imaging Device
No full textPurpose: We aimed to analyze the effects of age on human tear film (TF) using a novel nanometer resolution TF imaging device (Tear Film Imager, TFI, AdOM, Israel). Methods: 44 healthy adult subjects (≥18 years of age) without ocular or systemic diseases or prior eye treatments with ages spanning seven decades were enrolled in this prospective cross-sectional study. Subjects underwent a comprehensive ophthalmic examination and completed the Ocular Surface Disease Index questionnaire (OSDI). All study participants underwent TF imaging using the TFI, including assessment of muco-aqueous layer thickness (MALT), lipid-layer thickness (LLT), inter-blink interval, and lipid map uniformity. Associations between TFI parameters and age were tested using linear regression (accounting for multiple eyes). Results: A total of 80 eyes (44 subjects) were imaged: 19 eyes from 10 subjects in the 3rd decade of life (aged 20-29); 10 eyes from 5 subjects in the 4th decade of life (aged 30-39); 5 eyes from 3 subjects in the 5th decade of life (40-49); 12 eyes from 7 subjects in the 6th decade of life (50-59), 19 eyes from 11 subjects in the 7th decade of life (60-69); 11 eyes from 6 subjects in the 8th decade of life (70-79); and 4 eyes from 2 subjects in the 9th decade of life (80-89). With increasing age, MALT significantly decreased (p = 0.024), and LLT significantly increased (p = 0.001). No statistically significant linear age effects were found for the other TFI parameters (p > 0.05) or the OSDI scores of study participants of different ages (p = 0.786). Conclusions: Quantitative TF biomarkers varied significantly with advancing age in healthy individuals, highlighting the importance of accounting for age in TF assessments
Millennialism and the Coming Tyranid Invasion: The Doomsday Beliefs of the Genestealer Cults
No full textReligious themes and the fanaticism that they bring are some of the most important to the universe of Warhammer 40K. While the Imperium of Man is steadfastly dedicated to the worship of the God Emperor, the Genestealer Cults thrive in the cracks of this mainstream religion, as a group of disorientated commoners. One defining element of the Genestealers is their belief in the “Day of Ascension,” a prophesied event, where, according to their beliefs, their planet and themselves will be transformed into a utopia with the arrival of the “Star Children.” This belief in a coming doomsday event is a hallmark of popular depictions of new Religious Movements, with a long history in western mysticism, and modern cult activity. This presentation will examine the millennialism beliefs of the Genestealer Cults, comparing them to Norman Cohn’s millennialist work and real world examples of New Religious Movements
A systematic review of the effectiveness and cost-effectiveness of implementing antimicrobial stewardship program at tertiary care facilities in India
No full textObjectives: This systematic review was performed to assess the effectiveness and cost-effectiveness of antimicrobial stewardship programs (ASPs) in Indian tertiary care facilities.
Methods: Searches were performed in PubMed, Scopus, Cochrane Library, Google Scholar, Epistemonikos, and ScienceDirect up to July 2024. Data on antimicrobial consumption, resistance patterns, patient outcomes, and economic evaluations were extracted using standardized form. This review included 29 studies from various Indian states, and, due to heterogeneity in study type, narrative synthesis was performed.
Results: ASP interventions-such as guideline implementation, antibiotic prescription audits with feedback, and clinician education-were associated with significant reductions in overall antibiotic use (up to 32% reduction in neonatal intensive care units) and improvements in resistance patterns (decrease in methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus rates). Patient-related outcomes, including reduced length of hospital stay and lower rates of health care-associated infections, were observed, although changes in mortality were variable. Economic analyses demonstrated substantial cost savings and favorable cost-effectiveness profiles.
Conclusions: ASPs in Indian tertiary care settings are clinically effective and economically viable, reducing antimicrobial misuse, curbing resistance, and improving patient outcomes, while lowering health care costs. Further research using standardized metrics and extending to other health care levels is needed to optimize and sustain ASP benefits
Neurologic and Psychological Outcomes 2 Years After Multisystem Inflammatory Syndrome in Children
No full textImportance: Neurologic and psychological sequelae are observed 1 year after hospitalization for multisystem inflammatory syndrome in children (MIS-C), but whether these concerns persist is not known.
Objective: To examine the trajectory of neurologic, psychological, and quality-of-life sequelae up to 2 years after MIS-C.
Design, setting, and participants: This longitudinal cohort study assessed children diagnosed with MIS-C from August 1, 2020, to August 31, 2021, and matched sibling and community controls, when available. The study was conducted 6 to 12 months and 18 to 24 months after discharge from a US or Canadian hospital. Data analysis was performed from May 2024 to January 2025.
Exposure: Hospitalization for MIS-C.
Main outcomes and measures: A central study site remotely administered a structured interview, surveys, neuropsychological assessment, and neurologic examination. Group differences were assessed using generalized estimating equations, accounting for matching. Variables extracted from hospital records included intensive care unit admission and echocardiographic left ventricular ejection fraction (LVEF).
Results: Overall, 95 participants were included in the study; 93 of 108 participants (86%) returned from the year 1 study and 2 participants were added in year 2 (median [IQR] age, 12.6 [11.0-15.7] years; 38 [40%] female and 57 [60%] male). Fifty-nine patients with MIS-C (mean [SD] age, 13.2 [4.0] years; 39 [66%] male) and 36 controls (mean [SD] age, 13.5 [3.5] years; 18 [50%] male) enrolled. In year 2, the MIS-C group was similar to controls on all outcome measures, except they had more somatization symptoms (Behavior Assessment Scale for Children, Third Edition mean [SD] somatization score, 52.1 [13.0] vs 46.5 [8.5]; mean difference, 5.2; 95% CI, 1.3-9.1). Within the MIS-C group, scores generally improved between initial and follow-up evaluations, a finding that was not observed in controls. Eight of 13 children with MIS-C (62%) who had abnormal neurologic examination findings in year 1 had normal examination findings by year 2. Among patients with MIS-C, measures of higher illness severity during hospitalization were associated with worse executive function in year 2 (National Institutes of Health [NIH] List Sort Working Memory Test score, -7.3 points per intensive care unit admission vs not [95% CI, -14.3 to -0.3 points] and -5.8 points per LVEF category change [95% CI, -9.1 to -2.6 points]; verbal fluency switching score, -0.8 points per LVEF category change [95% CI, -1.5 to -0.1 points]).
Conclusions and relevance: In this longitudinal, matched cohort study of children with MIS-C and controls followed up sequentially up to 2 years after hospital discharge, children with MIS-C had more somatic symptoms than control children. Overall, however, patients with MIS-C had improved neurologic and psychological outcomes between the testing intervals, performing similarly to controls on most measures by year 2 follow-up. These findings suggest that these concerns may improve over time
The state of global palliative care research: a bibliometric study
No full textBackground: Palliative care research (PCR) plays a critical role in improving the quality of life for patients with serious illness, yet its global distribution and focus areas remain uneven. Understanding the trends and impact of PCR over the past decade can inform future research priorities and policy development.
Methods: We conducted a bibliometric analysis of publications indexed in the Web of Science related to PCR between 2013 and 2022. Articles were identified using a comprehensive filter based on title keywords and specialist journals, and were further classified by research domain, disease area and study type.
Results: The volume of PCR publications has grown over the past decade, increasing from 0.29% of all biomedical research outputs in 2013-14 to 0.62% in 2021-22. Countries with the highest levels of PCR output-primarily European and Anglophone nations-also ranked highly on the Economist Intelligence Unit's Quality of Death Index. Using eight different bibliometric indicators, we assessed the impact of countries' PCR outputs; while rankings varied by metric, European countries such as the Netherlands, Belgium, the United Kingdom and Ireland consistently performed strongly. Cancer emerged as the dominant disease focus, although many studies also addressed co-morbid conditions including COVID-19 in recent years. A significant proportion of PCR also examined the impact of illness on patients' families and caregivers.
Conclusion: The findings highlight cancer as a major area of focus and need within PCR. However, research outputs remain disproportionately concentrated in high-income countries, revealing a persistent gap in low- and middle-income settings.
Recommendations: To address the growing global burden of cancer and serious illness, palliative care should be integrated as a core component of national cancer control plans. This integration must be supported by a targeted research agenda that emphasises implementation and scaling of palliative care models, particularly in low- and middle-income countries. Policymakers and research funders should prioritise holistic, patient-centred approaches and ensure that impact measurement reflects meaningful outcomes for patients and families
Culinary Medicine Interventions Among Racial and Ethnic Minority and Underrepresented Populations: A Systematic Review
No full textIntroduction: Racial and ethnic minority populations experience a higher rate of diet-related disparities compared to the general population. Culinary medicine interventions have the potential to help improve health equity among disadvantaged groups. We examined behavioral, anthropometric, and laboratory outcomes of culinary medicine interventions among racial and ethnic minority and underrepresented populations. Methods: All articles on the PubMed database were searched to identify eligible studies with no date limitation. Articles that included a culinary medicine intervention for racial and ethnic minority and underrepresented populations were eligible for inclusion. Results: A total of 25 articles were included. There were 4186 participants with 3268 adult, 857 child, and 2452 female participants. Participants predominantly identified as Black (25.0%), South Asian (21.6%), and Hispanic (33.5%). Studies varied in design, setting, length, and outcomes (e.g., behavior, clinical). Overall, outcomes varied in significance and effect size. Risk of bias was high among studies. Discussion: Culinary medicine interventions appear to be successfully integrated across various settings and among diverse populations with variable effect on behavioral changes and anthropometric measurement changes. Conclusion: Culinary medicine interventions show promise for improving diet-related health equity; however, greater rigor and controlled study designs are needed
DiCE: differential centrality-ensemble analysis based on gene expression profiles and protein–protein interaction network
No full textUncovering key genes that drive diseases and cancers is crucial for advancing understanding and developing targeted therapies. Traditional differential expression analysis often relies on arbitrary cutoffs, missing critical genes with subtle expression changes. Some methods incorporate protein-protein interactions (PPIs) but depend on prior disease knowledge. To address these challenges, we developed DiCE (Differential Centrality-Ensemble analysis), a novel approach that combines differential expression with network centrality analysis, independent of prior disease annotations. DiCE identifies candidate genes, refines them with an information gain filter, and reconstructs a condition-specific weighted PPI network. Using centrality measures, DiCE ranks genes based on expression shifts and network influence. Validated on prostate cancer datasets, DiCE identified genes overrepresented in key pathways and cancer fitness genes, significantly correlating with disease-free survival (DFS), despite DFS not being used in selection. DiCE offers a comprehensive, unbiased approach to identifying disease-associated genes, advancing biomarker discovery and therapeutic development